Table HSR-2. Legal framework and practice of substitution treatment initiation and continuation

Country		Methadone treatment				Buprenorphine treatment
		Treatment centres	Specialized medical doctors	Any medical doctor		Treatment centres	Specialized medical doctors	Any medical doctor		Law/guidelines
Belgium (Flemish community)		++	+	+		++	+	#		Royal Decree on substitution treatments of 19 March 2004
Belgium (French community)		++		++		++		++		Royal Decree on substitution treatments of 19 March 2004
Bulgaria	(2)	++								Decree No24 of 31 October 2000
Czech Republic		++				++		++		Act on Prevention of Harms Caused by Tobacco, Alcohol and Other Psychoactive Substances, No. 379/2005
Denmark		++	++			++	+			Paragraph 142 of the Act on Health (Sundhedsloven. Lov nr. 546 af 24. juni 2005), paragraph 41 of the Act on Authorisation of Health Personnel and on Health Professional Practice (Lov nr. 451 af 22. maj 2006 om autorisation af sundhedspersoner og om sundhedsfaglig virksomhed
Germany		++	++	+		++	++	+		Narcotic Drugs Prescription Ordinance, Section 5 (2)
Estonia		++				++				Regulation No. 73 of the Minister of Social Affairs of 18 May 2005. Conditions and Procedure for Handling of Narcotic Drugs and Psychotropic Substances for Medical and Research Purposes (RTL 2005, 57, 807)
Ireland		++	++			++				Misuse of Drugs (Supervision of Prescription and Supply of Methadone Regulations) 1998
Greece		++				++				Law 2955/2002; Ministerial Decree 19546/2003
Spain	(1)	++								Royal Decree 75/1990, amended by Royal Decree 5/1996
France		++	#	#		+	+	++		General health laws on medicines (L.5111-1 CSP ‘definition of a medicinal product’): French Medicines Agency or Drug regulation agency (AFSSAPS). L.3411-1 & L.3411-5 and D.3411-1 to D.3411-9 CSP on ‘care system for drug users
Italy		++		+		+		+		Presidential Decree 309/90, art. 43
Cyprus	(3)					++				Regulation 160/79
Latvia		++				++	#			Regulation No.429 of 24.09.2002 and amendments No. 640 of 09.08.2008
Lithuania		++				++				Order No 702 of Ministry of Health (Žin., 1998, 13-326)
Luxembourg		+	++			+	++			Grand-ducal Decree on substitution treatment programmes 30 January 2002
Hungary	(2)	++								Methodological Guidelines of the Professional College of Psychiatry on Methadone Treatment (2002)
Malta		++				++	+
Netherlands		++	+	+		++	+	+		Opium Act and Opium Act decree, April 1997
Austria		++	++			++	++			Narcotic Substances Act (Suchtmittelgesetz), 1 January 1998
Poland	(2)	++								Regulation of the Minister of Health and Social Security of 6th September 1999 on substitution treatment, further amended by the Regulation of 13 May 2004. The newest act of law is a Regulation of the Ministry of Health on substitution treatment of the 19th October 2007.
Portugal		++	+			++	+	+		Decree-Law 183/2001, Art 44.1; Decree-Law 15/93, Art 15.1-3
Romania		++		+						Governmental decision no. 1324/2004 published in the Official Gazette no. 865/22.09.2004
Slovenia		++	+			++	+			Prevention of the Use of Illicit Drugs and Dealing with Consumers of Illicit Drugs Act (1999)
Slovakia		++				++				“Professional Guideline on standards for diagnostics and therapy in drug addiction area” in Ministry of Health gazette (2003 , unit 12-15, No. 45); “Methodical Instruction on providing methadone maintaining therapy for opiate addicted patients with persistent development of disease” in Ministry of Health gazette (2004, unit 21-27, No. 31)
Finland		++				++				Decree 33/2008
Sweden		++				++				Medical Products Agency's Code of Statutes LVFS 2004:15
United Kingdom		++	++	++		++	+	+		Misuse of Drugs Act 1971, Section 7.3(a)
Croatia		++	++	++		++	++	++
Turkey	(4)
Norway		++	##			++	##			Regulation 24 April 1998 no. 455, art 2-1 (3) d

Notes:

 : indicates data not available 

 "'#" indicates a provider who is only allowed to continue substitution treatment once this has been initiated elesewhere (e.g. treatment centres). 

 "'+" indicates a provider who is allowed to initiate and continue substitution treatment. 

 "##" indicates a provider who is not only legally entitled, but also predominantly involved in the provision of subsitution treatment, continuation only. 

 "++" indicates a provider who is not only legally entitled, but also predominantly involved in the provision of subsitution treatment, initiation and continuation. 

 "Specialized medical doctors'"refers to specifically trained or accredited office-based medical doctors. 

 (1) In Spain, high dosage buprenorphine is not commercially available. 

 (2) High dosage buprenorphine treatment is not available in Poland, Hungary and Bulgaria. 

 (3) In Cyprus there is no legal framework specifically for OST, but a framework is being prepared. However, under Regulation 160/79 issued under the Narcotic and Psychotropic Substances Law of 1977, (reg.6), a doctor is allowed to prescribe certain substances which are mentioned in the appendix to the Regulation, and which include substances used for OST programmes. 

 (4) In Turkey, an opioid substitution treatment strategy is currently being developed (Turkey Health Transformation System, 2008-2009). 

 See also 'General notes for interpreting data' on the Explanatory notes and help page. 

Sources:

 Structured Questionnaire on 'treatment programmes' (SQ27P1), submitted by NFPs in 2005 and 2008. 

 Answers from the legal correspondents of the European Legal Database on Drugs (ELDD) to a EMCDDA survey on the legal framework of substitution treatment (2006). See also ELDD topic overview. 

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