A review of the legislation, regulation and delivery of methadone in 12 Member States of the European Union

European Commission Directorate-General For Employment Social Affairs And Inclusion

Description

Health policy

Sujets

• Health care system
• Narcotic
• Preventive medicine
• Member state of the European Union
• santé
• santé publique

Informations

• Publié par: EUROPEAN-COMMISSION-DIRECTORATE-GENERAL-FOR-EMPLOYMENT_SOCIAL-AFFAIRS-AND-INCLUS
• Nombre de lectures: 144
• Langue: English
• Poids de l'ouvrage: 23 Mo

Extrait

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Drug prevention
A review of the legislation,
regulation and delivery of
methadone in
12 Member States
of the European Union
Final report
The National Addiction Centre — London
Professor M. Farrell
1995
EUROPEAN
COMMISSION Cataloguing data can be found at the end of this publication.
Luxembourg: Office for Official Publications of the European Communities, 1996
ISBN 92-827-6094-4
© ECSC-EC-EAEC, Brussels · Luxembourg, 1996
Reproduction is authorized, except for commercial purposes, provided the source is acknowledged.
Printed in Belgium Acknowledgements
Special thanks to Ellie Hooper for secretarial support and to Samantha Howes for tech­
nical support. Thanks also to Kate Tidnam and Margaret Sheehan.
Particular thanks to Phillipe Roux and MD Véronique Wasbauer of DG V of the
Commission of the European Communities for supporting the execution of this project.
Thanks to all the national experts and service providers who have given much of their
time to provide information, support and advice. These include:
DENMARK: Peter Ege, Anne Sindballe, Ade Ojeniyi, Andreas Sorensen, Christian
Rasmussen.
GERMANY: Gerhard Buhringer, Jutta Kunzel, Manfred Mosch, Dr Austin, Dr Freibot,
Dr Knabbe, Michael Krausz, Peter Degkwitz.
GREECE: Anna Kokkevi, Dr Vasconcelos, Dr Narino Tralhao.
SPAIN: Maria J Bravo, L. de la Fuente Hoz, Antonio Rodriguez, Gregorio Martin,
Tomas Perez Marquez, Juan José Fernadez Miranda, Pedro A. Marina
Gonzalez, Maria del Carmen Veiras Vicente, Irma Carvajal, Montse Garcia
Folez, Marta Torrens, Claudio Castillo, Enric Serras, Gloria Mayral.
FRANCE: M. Jean-Francois, Philip Birier, Marc Auriacombe, Jean Tignol, Denis
Grabot, Didier Touzeau, Ann Coppel, Patrick Aberhard.
IRELAND: John O'Connor, Katherine Bailey, Brian Sweeney, Kathleen O'Higgins,
Gerard Bury, Arthur Dormán.
ITALY: Enrico Tempesta.
HOLLAND: Giel Van Brussell, Gerit Van Santen, A. W. Ouwhand, Dr Van Berkestijn,
Dr Sanderson, Dr Kuif, Wim Van den Brink.
UK: Alan MacFarlane, John Gerrard, John Merrill, Ron Alcorn, Hamid
Ghodse, Margaret Jackman, Anthony Thorley, Siobhan Riordan.
Neither the Commission of the European Communities nor any person acting in the
name of then is to be held responsible for the use made of the information
contained in this publication.
This project was supported by funding from the Commission of the European
Communities. >
7T
Further enquiries about this report should be directed to Dr Michael Farrell, Senior &·
Lecturer and Consultant Psychiatrist, National Addiction Centre, Institute of Psychiatry, 3
4, Windsor Walk, London SE5 8AF. Tel: [phone] Fax: [phone].
1 Aden owledgements
1 Executive summary
2 Introduction
3 Belgium
4 Denmark
5 France
6 Germany
7 Greece
8 Ireland
9 Italy
10 Luxembourg
11 The Netherlands
12 Portugal
Spain 13
United Kingdom 14
Results and conclusions 15
n
o
3
S
a Executive summary
Introduction
This report describes the development of drug problems and the evolution of policy,
legislation and services responding to thoses in 12 EU Member States. The
specific aim of this project was to provide a description of the organization and delivery
of methadone or other drug substitution services in the individual EU Member States.
The attitude to and the organization of drug substitution services and in particular of
methadone substitution services reflects national variation in attitude to and organization
of drug services probably more than any other single component of national drug services.
Method
A key national informant approach was used to provide information on policy, research
and service aspects. Between two and five services are described in each country with such
services. A semi-structured interview was conducted with national informants. A separate
semi-structured interview was conducted with individual service providers. National and
international data was aggregated to provide an overview of the trends in methadone ser­
vices in the European Union.
Results
In 12 chapters a detailed country-by-country report is provided which outlines the his­
torical, cultural, legislative, regulatory and financial framework of each country's substi­
tution services.
Each country now has a sizeable and comparable long-term opiate-addicted population
who make demands on criminal justice, health and social services.
One of the key features of the development of drug-related problems in Europe has been
the epidemic of HIV in 1980s among injecting drug users and their sexual partners. The
HIV problem has strongly shaped the development of drug policy and drug services with
a strong emphasis on harm reduction policies in many countries. There is striking vari­
ation in the HIV prevalence among injecting drug users within and between countries.
Methadone substitution services have a major role to play in HIV prevention and HIV
containment strategies. Methadone may be used for long- or for short-term interventions.
There is a striking variation between countries on the balance between long-and short-
term use. Longer-term use confers more benefit than short-term use.
There has been a dramatic growth in methadone maintenance services in Europe between
1988 and 1993 with a 2 to 5 fold increase in the total amount of methadone consumed
in different countries. The countries with the largest net increase, such as France and
Germany, started with a very low baseline and it would appear that the countries with sig­
nificant HIV problems have responded with the expansion of methadone programmes. Overall in Europe the growth of methadone consumption parallels the growth in inject­
ing drug use related AIDS cases.
Reasonable estimates of the size of the methadone service population are based on esti­
mates for longer term methadone places. The figures range from 40 to 80 places per
100 000 population, with provision in France and Germany at less than 10 places per
100 000, both France and Germany's treatment population have grown con­
siderably since 1993 and are still undergoing rapid expansion.
There has been limited success in linking substitute prescribing services with primary care
services but given the overall health needs of drug users many planning and policy mak­
ers appear to be prioritizing the need to link specialist drug services with primar