Price and purity of heroin

Box 10: Buprenorphine: treatment, misuse and prescription practices, in EMCDDA Annual report 2005: selected issues

In the past 10 years, buprenorphine has increasingly become available in Europe as an alternative to methadone for the treatment of opiate dependence. First developed as an analgesic, buprenorphine was suggested for use in the treatment of opiate dependency in the late 1970s. Buprenorphine’s introduction for opiate treatment in the EU-15 Member States and its expansion in these countries and into the new Member States is described.

Comparisons are made between buprenorphine and methadone in terms of efficacy and costs. The provision of buprenorphine treatment in Europe is described, and comparisons are made between Member States in which buprenorphine is the principal substance used in the treatment of opiate dependency and those where medically assisted treatment (MAT) is mainly carried out with methadone. Among the findings is that around 20 % of clients in MAT in the EU today receive buprenorphine, although most of these clients are in one country (France). Overall, buprenorphine has spread to many countries, but the actual number of clients is still limited in the majority of Member States.

Buprenorphine is looked at from the perspective of potential misuse. The first indications are that misuse of buprenorphine is prevalent in only a few countries, and is uncommon elsewhere. Some evidence is reported that relates misuse of buprenorphine to specific populations or age groups, or attempts to identify distinct groups of buprenorphine misusers. Although deaths due to buprenorphine misuse are very rare, some deaths are reported by scientific literature and by some European countries. Reports of deaths related to buprenorphine misuse are compared with those related to methadone misuse.

The selected issue draws conclusions about the relative merits of buprenorphine and methadone in the treatment of opiate dependency. Buprenorphine is identified as representing an opportunity to make MAT more widely available and more easily accessible.

This selected issue is available in print and on the internet in English only.

In Europe, heroin occurs in two forms: the commonly available brown heroin (its chemical base form) and the less common and more expensive white heroin (a salt form), which typically originates from South-East Asia. In 2003, in the EU the average street price of brown heroin was reported to vary between €27 per gram in Belgium and €144 per gram in Sweden, while the price of white heroin ranged from €25 (Slovakia) to €216 (Sweden) per gram (168). This price differential is likely to reflect the purity of the drug being sold.

In 2003, the average purity of brown heroin at street level in the EU varied from 6 % in Austria to 40 % in Malta. Data on purity of white heroin were reported by only a few countries (169); it ranged on average from 6 % in Finland to 70 % in Norway (170).

(168) See Table PPP-2 (part i) in the 2005 statistical bulletin.

(169) See Table PPP-6 (part i) in the 2005 statistical bulletin.

(170) Small sample number for Norway (n = 8).