Medically assisted treatment

Medically assisted treatment (MAT) includes both substitution treatment with agonists (methadone, buprenorphine, dihydrocodeine, heroin, slow-release morphine) and, although much less widely used, treatment with antagonists (for example, naltrexone).

Methadone is available in almost all Member States (see Table 3) and continues to be the most commonly prescribed substitution treatment in Europe. However, in recent years, treatment options have widened. Buprenorphine is now available in 18 of the 26 countries for which information is available. Treatment with other agonists, as well as treatment with antagonists (naltrexone, naloxone or clonidine), is less frequently used across the EU. A study on the introduction of controlled heroin prescriptions is currently under way in Belgium, and Austria has received an expert opinion on heroin-assisted treatment of chronic opiate addicts, based on the results of existing international programmes.

Table 3: Applied substances in medically assisted treatment in the EU (including trials)

The latest figures show that in 2003 there were more than 450 000 clients in substitution treatment in specialised units in the EU (Table 4), of whom more than 90 % were receiving methadone. In addition to these were clients receiving other kinds of substitution treatment (such as dihydrocodeine, slow-release morphine or heroin) and those who received substitution treatment in settings such as at their general practitioner. Unfortunately, reliable data on these aspects of substitution treatment are not currently available in many Member States and consequently it is not possible to determine aggregate figures for the EU as a whole.

Table 4: Estimates of clients in substitution treatment in the European Union in 2003

However, some countries do have reliable data or estimates on the number of clients receiving substitution treatment from general practitioners, thereby adding important information to the overall estimates of clients in substitution treatment in the EU. Clients receiving methadone treatment through their general practitioner in 2003 numbered 8 500 in France, 2 682 in Ireland, 851 in Luxembourg and 930 in the Netherlands. In addition, in the Czech Republic and France, 1 200 and 70 000 clients, respectively, were receiving buprenorphine treatment through their general practitioner. It is estimated that a total of 81 743 clients were substitution treatment at their general practitioner in these five countries. Bearing in mind that there are more than 450 000 clients in substitution treatment in specialised units, the total number of clients receiving substitution treatment has now passed the half-million mark at around 530 000. Again, as the information is incomplete, the figure of 530 000 represents a minimum estimate of the number of drug users in substitution treatment.

The level of availability of substitution treatment differs markedly between the EU-15 and the new Member States and candidate countries. Although they account for more than 20 % of the total population, the new Member States and candidate countries account for only 1.3 % of clients in substitution treatment (not including Turkey, where no data regarding substitution treatment are available). Of the new Member States, only two, the Czech Republic and Slovenia, provide estimates of the prevalence of problem drug use, and in both these countries substitution treatment is available for a smaller proportion of problem drug users (16 % and 26 % respectively) than is average for the EU-15 (35 %). Despite the lack of estimates of the prevalence of problem drug use in other new Member States and candidate countries, the level of substitution treatment is far behind that in the EU-15 Member States. Considering the high risk of spread of infectious diseases in some countries and the preventative role that MAT can play in limiting this (see, for instance, UNODC, 2002), the situation is a cause for concern.

Two distinct trends in MAT have emerged in recent years. The first is a continuation of the trend of increasing availability of substitution treatment, although the increase is becoming less pronounced. In addition, there has been a diversification in substances provided; for example, the number of countries reporting use of buprenorphine has risen to 14 in 2003, compared with six in 1999/2000.

A third, although less distinct, trend is that of increasing involvement of general practitioners in the provision of MAT. Involvement of general practitioners was reported in only three of the 15 Member States (Belgium, France, the United Kingdom) in 2000/2001 (Solberg et al., 2002) but is now found in 10 of the EU-15 Member States (Belgium, Germany, France, Ireland, Italy, Luxembourg, Netherlands, Austria, Sweden and the United Kingdom) as well as three of the new Member States (Czech Republic, Malta and Slovenia).