Medically assisted treatment

Methadone is by far the most used substitution substance. Buprenorphine, the most used substitution substance in France for years, is also prescribed by private doctors in Portugal and Luxembourg. Sweden is preparing restrictions on the prescription of buprenorphine, and in Finland illicit misuse of buprenorphine has caused demand for treatment, with a few deaths reported related to misuse of buprenorphine and depressants. Currently, buprenorphine is used to a much lesser extent than methadone in Belgium, Denmark, Germany, Greece, Spain, Austria and the United Kingdom.

Information on the number of persons receiving substitution treatment has been available for some years (Farrell et al., 1996, 2000) and it is now possible to follow development in this area. Table 3 compares information on substitution treatment as reported in 1997/1998 with the latest information from Member States. Table 3 shows that there has been a substantial increase in the overall availability of medically assisted treatment. The aggregate increase at EU level is about 34 % in approximately five years.

Table 3: Development of substitution treatment in the 15 EU Member States and Norway

 

Estimated number of persons in substitution treatment reported (1)

Change ( %)

1997/1998

2001/2002

Belgium

6 617

7 000

5.8

Denmark

4 298

4 937

14.9

Germany (2)

45 300

49 300

8.8

Greece

400

1 060

165.0

Spain

51 000

78 806

54.5

France

53 281

85 757

61.0

Ireland

2 859

5 865

105.1

Italy

77 537

86 778

11.9

Luxembourg (3)

931

1 007

8.2

Netherlands

13 500

13 500

0

Austria

2 966

5 364

80.8

Portugal

2 324

12 863

453.5

Finland

200

400

100.0

Sweden

600

621

3.5

UK (4)

28 776

35 500

23.4

Norway

204

1 853

808.3

Total

290 793

390 611

36.2

(1) For some countries numbers refer to clients, for other countries they refer to estimated slots.

(2) In the case of Germany figures also include patients receiving dihydrocodeine, which was estimated to be around 8 800 patients in 1998 and 3 700 patients in 2000.

(3) 186 and 156 clients were registered in the state-run methadone project in1998 and 2001 respectively, whereas 745 and 849 received substitution treatment through general practitioners.

(4) England and Wales only.

Sources: EMCDDA annual report 1998 (with data from 1997 or earlier national reports) and national reports 2001 and 2002.

Co-prescription of heroin

The Netherlands has already conducted a trial with medical co-prescription of heroin and presented its findings in February 2002 (Central Committee on the Treatment of Heroin Addicts, 2002). Clients admitted to the trial received both methadone and heroin. The evaluation showed that the clients in the experimental group experienced considerable health benefits compared with the control group, which received methadone treatment only.

Between March 2002 and February 2003 the German cities of Bonn, Cologne, Frankfurt, Hamburg, Hannover, Karlsruhe and Munich launched a heroin-assisted treatment programme in the framework of a scientific randomised controlled trial. A total of 1 120 clients were admitted to the heroin trial, which will be closely monitored and evaluated by the Centre for Interdisciplinary Addiction Research, Hamburg (Zentrum für Interdisziplinäre Suchtforschung), for two study periods each of 12 months.

In Spain, the autonomous regions of Cataluña and Andalucia are preparing trials of co-prescription of heroin. In Barcelona (Cataluña) the total cohort of the study will be 180 male clients aged 18–45. The heroin prescribed will be for oral administration.

In Luxembourg, a decree of 30 January 2002 allows for a trial of heroin prescription to be conducted in the framework of a pilot project managed by the Directorate of Health.

In the United Kingdom, heroin is prescribed through general practitioners to an estimated 500 clients.