Treatment demand data

Of the total treatment requests made, 60 % are known to be for opiate treatment, although in many cases the primary drug is not recorded – and over half (54%) of these opiate clients are known injectors, with 10 % being of unknown injecting status. Opiates are also reported to be the secondary drug for around 10 % of new clients (110).

In many countries, opiates (largely heroin) remain the principal drug for which clients seek treatment, but relevant differences are found between countries. Dividing the EU countries broadly into three groups depending on the extent to which the treatment population is characterised by those with heroin problems shows:

The prevalence of opiate clients who continue in treatment for many years is reported to be increasing, while the incidence of new opiate treatment demands is decreasing (Reitox national reports, 2004; Drug Misuse Research Division, 2004). For some countries, trends in heroin use among new clients in treatment can be tracked from 1996 to 2003, and these show in an overall decline in absolute numbers seeking treatment.

The relative contribution of opiate treatment to the size of the new-to-treatment population has decreased more markedly, owing to an increase in the number of reported clients with problems primarily related to other drugs. This, in turn, may be due to a switch from heroin to cocaine use by some opiate clients (Ouwehand et al., 2004), differentiation of the treatment system, which has become more accessible for other problematic drug users, or the reduced recruitment of new problem users (Dutch national report).

Differences in this trend in the last decade are found between countries, with a strong decrease in heroin clients in Denmark, Germany, the Netherlands, Slovakia and Finland and some increase in Bulgaria and the United Kingdom (112).

Data analysis on new clients attending outpatient treatment centres allows a more detailed description of the profile of opiate users. There are 2.8 men for every woman asking for new treatment for primary opiate use; however, gender ratios vary considerably by country, from 5:1 to 2:1, with the exceptions of Cyprus, where the male to female ratio is very high (11:1), and Sweden, where it is very low (0.9:1) and women outnumber men among opiate users (113).

Most opiate users are aged between 20 and 34 years, and in the age group 30–39 years more than half the clients seek treatment for opiate use. The reported trend is towards an ageing opiate clientele; for example, in the Netherlands around 40 % of new opiates clients are more than 40 years old. The exceptions are Romania and Slovenia, where a very young population (15–19 years) of opiate clients is found (114).

Most opiate clients report having used opiates for the first time when they were between 15 and 24 years old, with around 50 % of clients first using the drug before the age of 20 (115). Comparing the age at first use with the age at first treatment, the time lag between first use and first demand for treatment is generally between 5 and 10 years. An early age at onset of opiate use is often associated with a range of behavioural problems and social deprivation (United Kingdom national report).


Figure 14 New outpatient clients injecting opiates as a proportion of the total number of new opiates clients by country, 2003

Notes

Only countries where there are clients with opiates as primary drug and/or countries supplying data are reported.

Source: Reitox national reports (2004).

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In most countries, between 60 % and 90 % of opiate clients use the drug daily, whereas some clients have not used opiates in the last month or used them only occasionally; this is probably explained by clients stopping use of the drug before entering treatment (116).

Forty per cent of clients inject the drug and another 40 % smoke or inhale it. Differences in the method of use are reported between old and new Member States (117) (Figure 14), with the proportion of opiate injectors being higher than 60 % in the new Member States and lower than 60 % in the old Member States (with the exception of Finland, where the proportion of opiate injectors among clients is 78.4 %). The proportion of injectors among opiate clients is lowest in the Netherlands (8.3 %) (118).

Many new clients use opiates as well as another drug, often cannabis (47 %) or alcohol (24 %). However, marked differences are found between countries: in the Czech Republic and Slovakia, almost half the clients use opiates together with stimulants other than cocaine; in Greece and Malta, 18 % and 29 % of clients, respectively, use opiates, with cocaine as a secondary drug; in Finland, among opiate users (mainly users of buprenorphine) 37 % report the use of hypnotics and sedatives (mainly benzodiazepines) as secondary drugs (119).


(110) See Table TDI-24 in the 2005 statistical bulletin.

(111)  See Table TDI-5 (part ii) in the 2005 statistical bulletin.

(112) See Table TDI-3 (part i) in the 2005 statistical bulletin.

(113) See Table TDI-22 in the 2005 statistical bulletin.

(114) See Table TDI-10 (part iii) in the 2005 statistical bulletin.

(115) See Table TDI-11 (part ii) in the 2005 statistical bulletin.

(116) See Table TDI-18 (part i) in the 2005 statistical bulletin. Only Germany reports 70 % of new clients using opiates occasionally or not having used them in the last month.

(117) Only countries for which data were available.

(118) See Table TDI-17 (part I) in the 2005 statistical bulletin.

(119) See Table TDI-25 (part ii) in the 2005 statistical bulletin. See also the selected issue on buprenorphine. Each client may report the use of up to four secondary drugs.