Although the prevalence of opioid dependence among European adults is low and varies considerably between countries, it is associated with a disproportionate amount of drug-related harm that includes infectious diseases and other health problems, mortality, unemployment, crime, homelessness and social exclusion. Heroin use remains a major concern but in many European countries the use of synthetic opioids has also been growing and in a few countries now predominates.
- Opioid users are the largest group in specialised drug treatment in Europe. However, differences exist between countries. These differences reflect variations in prevalence but also in the orientation of the drug treatment systems.
- The most common treatment approach is opioid substitution treatment, usually provided in outpatient settings. Methadone (63 %) and buprenorphine (35 %) are the medicines most commonly used for OST in Europe. It is estimated that overall, around 50 % of people with opioid dependence receive some form of substitution treatment but coverage varies greatly between countries.
- All European countries provide some residential treatment but the level of provision varies greatly.
Summary of the available evidence
Implications for policy and practice
- The core intervention is OST in combination with psychosocial treatment. This is an effective way to reduce illicit opioid use, transmission of infectious disease, drug overdose and crime.
- Different medicines are available for substitution treatment. Therapeutic choices need to be based on individual needs, involve a dialogue with patients and be regularly reviewed.
- Abstinence-oriented psychosocial treatment in residential settings can benefit some opioid-dependent people if they remain in treatment. However, this form of treatment is relatively costly and the relapse-rate is often high, with an increased risk of fatal overdose. Appropriate client selection and management are important as is support in the event of relapse.
- Optimise service delivery: The quality of treatment delivery is important, in particular, adequate doses of opioid substitution medicines are essential and continuity of treatment is vital. Increasing access to OST should remain a public health priority in those countries where it falls below recommended levels.
- Where good coverage has been achieved and many of those in OST treatment have now been in care for many years there may be a need to increase the attention given to social reintegration, including employment. Also there may be a need to review what constitutes appropriate individual therapeutic goals for different individuals and to promote recovery where appropriate.
- Treatment services should be alert for the use of opioids other than heroin among treatment entrants and also polysubstance use, including alcohol and tobacco.
- Better information on unmet need for treatment is required in order to ensure appropriate levels of service availability.