Standards and quality of treatment

Setting up accreditation systems, establishing quality standards, developing guidelines, training staff and monitoring and evaluation are all examples of measures aiming at assuring a certain standard and quality level of treatment related to illegal drugs.

Accreditation or certification systems are reported from Germany, France, Luxembourg, Austria and Portugal and imply that an authorised independent external body monitors services to ensure that they meet pre-established specific requirements. In some countries, for example France and Luxembourg, treatment providers must be certified or accredited in order to receive funding for treatment. In other countries, national certification is possible but optional, although the opportunity to become certified according to international standards, such as ISO, is available throughout Europe.

Guidelines on treatment implementation in order to assure quality are reported from many Member States, such as Greece, Italy, the Netherlands, Austria and Finland. However, their extent of use and implementation as well as their nature vary. Guidelines can be non-binding advice that is widely available or semibinding principles that have to be adhered to for funding to be considered. At EU level, non-binding guidelines for the provision of methadone treatment have been developed and are available in German, English, French and Spanish (78).

Staff training is available in all Member States, although no Member State reports nationwide systematic training of treatment staff. The availability, diversity and level of training vary widely across the EU, as does the involvement of treatment-related authorities in setting up such activities.

Treatment evaluation and research

Evaluation of and research into drug treatment, which takes various forms, is reported from all countries. However, the vast majority of studies are small scale and conducted at institutional or local level. In the United Kingdom, a nationwide treatment outcome survey was conducted in England and Wales with results over five years. Italy’s VEdeTTE study, which involves almost 12 000 clients in 118 outpatient treatment centres (SerT), is still ongoing, and so far only initial results are available. The preliminary results show that the daily average dose of methadone was 40 mg and only 10 % of clients received 60 mg or more, the required dose according to the scientific literature. Annual treatment drop-out rates for drug-free treatment and for methadone-maintenance treatment were 52 % and 35 % respectively. It also appears that higher doses of methadone reduce the risk of drop-out. The study also confirmed that psychosocial intervention is effective. The Danish DANRIS study, which started in May 2000, aims to monitor treatment and its efficiency at roughly 40 inpatient treatment centres. At European level, the Treat 2000 project, partly financed by the fifth research framework programme, aims to analyse and compare healthcare systems and their efficiency in dealing with opioid addicts in six European regions.

(78) See guidelines at Euromethwork web site.