Treatment and rehabilitation

Last year, several countries in the EU introduced legislative changes to facilitate the treatment and rehabilitation of addicts. In Luxembourg, a national decree established the legal framework for drug substitution treatment at the national level, with a licensing system for doctors, admission criteria for patients and a committee for surveillance of the programme. In Greece, a pilot scheme authorising buprenorphine substitution was implemented in the public general hospital in Rhodes. In Finland, opiate addicts are entitled to receive detoxification and substitution treatment, complemented by maintenance treatment, and as a result there has been an increase in the number of units assessing the need for and providing pharmaceutical treatment of drug addicts. And in Germany, since the ninth Book of the German Social Security Code came into effect in July last year, addicts have benefited from improved rights and legislation that defines more clearly how and when health insurance schemes should pay for detoxification and pension insurance schemes should pay for rehabilitation.

In April 2002 the Danish Parliament decided to abolish legal provisions which, although they had never been implemented, had previously allowed county authorities to retain drug addicts in treatment. And in June last year, a ministerial decree in Italy, in line with the national drugs plan and aiming to improve abstinence-focused treatment, gave private treatment services the authority to certify drug dependency. As a result, drug-treatment centres were able to admit residents directly from anywhere in the country and, with the authority of a certificate of dependence, require a drug user’s local SerT (drug addiction service) to pay for the treatment provided. However, following an amendment to the Italian Constitution, transferring competence for health and social care from the central to regional administrations, the Constitutional Court determined that the decree was unconstitutional as it concerned a matter that was the responsibility of the regions. In Norway, the State assumed ownership and operational responsibility for hospitals in 2002, and responsibility for low-threshold health services and medically assisted rehabilitation of drug abusers resides with the Ministry of Health. County responsibility for specialist health services for drug abusers should be transferred to the State in 2004, and the Ministry of Social Affairs has proposed that county responsibility for specialist social services and care of drug abusers should be transferred to the municipalities as of 2004. This aims to provide drug abusers with a more comprehensive and coherent system of care and treatment measures.

In Austria, there is a problem providing the health-related measures required by Article 11 of the Narcotic Substances Act. Officially, effort should focus on the elimination of (organised) drug trafficking, but despite this a large proportion of offences concern cannabis use, for which district health authorities usually, under Article 11, prescribe health-related measures. As a result, drug-treatment centres do not have sufficient resources to meet demand and are unable to fulfil their responsibilities.