Health and social responses — an overview of the methods and definitions used

In 2004, 2006 and 2008, the 27 EU Member States and Norway reported data on needle and syringe availability through specialised needle and syringe programmes (NSPs), using a standardised format (standard table on syringe availability, ST10), while in 2009 data was reported through the national reports. The information was compiled in previous Statistical bulletins and the current edition (2010).

In the chapter on responses to health correlates of drug use in the national report on the drug situation, Member States provide further data and information about measures taken to prevent infectious diseases, including on needle and syringe programmes. Data are now available for the years 2003 to 2008, allowing a better insight into the recent evolution of this type of service in the reporting countries.

The data-reporting tool comprises information on the availability of different types of needle and syringe programmes (NSPs) in the country, including pharmacy and non pharmacy-based programmes, their geographical spread, and on the number of syringes provided at these programmes. It includes data on the number of syringe provision points, defined as individual locations or physically distinct outlets, managed by specialist drugs or medical agencies where sterile syringes are made available for free, against payment, or in exchange against used ones.

While data on the number and types of syringe provision points that exist in the countries can provide important background information on syringe availability, it is essential to interpret the number of specialised syringe programme points and of the syringes provided in their respective national context, in particular with regard to the estimated prevalence level of drug injecting, as well as the density of the national pharmacy network and finally also pharmacists attitudes towards syringe sales to drug users, which may all have an important impact the overall availability of syringes to injecting drug users in the countries. In the year 2010, reporting of the number of syringe programme points per Tertiary Administrative Units of the European Community (NUTS-III) is being piloted and results will be made available in the 2011 Statistical bulletin.

Information about the legal framework of syringe exchange was collected through a standardised format (structured questionnaire 27 on treatment availability) in 2008, which complemented a previous survey of the EMCDDA legal correspondents (available in the legal database online).

Data on substitution treatment provision and availability in the EU was mainly collected through a standard table on access to treatment (ST 24) filled out by national focal points in 2004, 2006 and 2008 and by a structured questionnaire on treatment programmes (SQ 27) which was implemented in 2005 and 2008 (both data collection tools can be found on the EMCDDA drug treatment website). Data for 2002 and earlier years were collected through national reports and were published in Table 1 in the 1998 Annual report and Table 3 in 2003 Annual report. Data about the most recent reporting year (2008) were reported only through the 2009 national reports and the standardised data collection table will be used again in 2010.

When reporting on numbers of clients in substitution treatment, cases of detoxification treatment, as well as substitution treatment in prison have, as far as possible, been excluded to avoid double-counting.

The current lack of harmonisation in case-reporting does not allow any comparisons between countries and the EMCDDA is working on achieving better reporting standards to improve its information on treatment coverage.

The establishment of a national monitoring system and/or a national register of individuals receiving opioid substitution treatment is a means to prevent double-prescription and diversion of the prescribed substances in many countries. While specialised treatment agencies are more likely to be covered by such registries as well as clients receiving methadone, under-reporting in such registries of clients treated by private medical doctors and with other substitution medicines, is rather likely.

However, the establishment of registration systems over the last few years in further countries is likely to have led to improvements in the quality of data on substitution treatment and as a result, a clearer European picture of this type of service provision can be drawn. The list of national register of individuals receiving opioid substitution treatment for each country can be found in the online EMCDDA drug treatment overviews of the availability of drug-related treatment in Member States, Norway, Croatia and Turkey.

Concerning the estimated rate of problem opioid users receiving substitution treatment, it should furthermore be borne in mind that wide confidence intervals in the estimates of problem opioid use mean that comparisons between countries can only be made with caution.