Statistical Bulletin 2014: Health and social responses — an overview of the methods and definitions used
Between 2004 and 2012, the 27 EU Member States and Norway reported data on needle and syringe availability through specialised needle and syringe programmes (NSPs), using a standardised format (standard table on syringe availability, ST10). The information was compiled in previous Statistical bulletins and the current edition (2013).
The data-reporting tool comprises information on the availability of different types of needle and syringe programmes (NSPs) in the country, including prison-, pharmacy- and non pharmacy-based programmes and on the number of syringes provided at these programmes. It includes data on the number of syringe provision sites, defined as individual locations or physically distinct outlets, managed by specialist drugs or medical agencies where sterile syringes are made available for free, against payment, or in exchange against used ones. Their geographical spread according to NUTS - Tertiary Administrative Units of the European Community – based on the European classification of territorial units for statistics defined in the Regulation (EC) No 1059/2003 of 26 May 2003, was collected through a specific survey which was piloted for the first time in 2010 and was again conducted in 2011 to gather more detailed information about NSPS availability at NUTS 3 level.
The legal framework of needle and syringe programmes can be found in the EMCDDA European Legal Database on Drugs (ELDD), an online database on European drugs-related legislation for the Member States and Norway.
While data on the number and types of syringe provision points that exist in the countries can provide important background information on syringe availability, it is essential to interpret the number of specialised syringe programme points and of the syringes provided in their respective national context, in particular with regard to the estimated prevalence level of drug injecting, as well as the density of the national pharmacy network and finally also pharmacists attitudes towards syringe sales to drug users, which may all have an important impact the overall availability of syringes to injecting drug users in the countries.
Data on substitution treatment provision and availability in the EU was mainly collected through a standard table on access to treatment (ST 24) filled out by national focal points in between 2004 and 2012 and by a structured questionnaire on treatment programmes (SQ 27) which was implemented in 2005, 2008 and 2011 (both data collection tools can be found on the EMCDDA health and social responses website). Data for 2002 and earlier years were collected through national reports and were published in Table 1 in the 1998 Annual report and Table 3 in the 2003 Annual report.
Table HSR10 provides an estimate of the total number of clients in treatment in 2011 which was calculated to be at least 1.2 million people. The estimation is based on the number of clients reported by countries through different tools available within the EMCDDA data collection on treatment. For each country three sets of data are presented: the total number of clients in substitution treatment, the total number of all clients entering treatment registered through the TDI – Treatment Demand Indicator, and the estimate of the total number of treatment clients. The latter figure can include clients entering treatment, clients in continuous treatment during the reporting year and clients in treatment reported from providers not covered by the TDI and is submitted to the EMCDDA through the standard table on access to treatment (ST 24). However, not every country is able to provide an overall estimate of the total number of people in drug treatment. In that case, either the total number of clients in opioid substitution treatment (indicated with an (i) in the table) or the total number of clients entering treatment (TDI) (indicated as (iii) in the table) have been used to estimate the total number of clients in treatment for Europe.
When reporting on numbers of clients in substitution treatment, cases of detoxification treatment, as well as substitution treatment in prison have, as far as possible, been excluded to avoid double-counting.
The current lack of harmonisation in case-reporting does not allow any comparisons between countries and the EMCDDA is working on achieving better reporting standards to improve its information on treatment coverage.
The establishment of a national monitoring system and/or a national register of individuals receiving opioid substitution treatment are means to prevent double-prescription and diversion of the prescribed substances in many countries. While specialised treatment agencies are more likely to be covered by such registries as well as clients receiving methadone, under-reporting of clients treated by private medical doctors and with other substitution medicines, is rather likely.
However, the establishment of registration systems over the last few years in further countries is likely to have led to improvements in the quality of data on substitution treatment and as a result, a clearer European picture of this type of service provision can be drawn.
Concerning the estimated rate of problem opioid users receiving substitution treatment, it should furthermore be borne in mind that wide confidence intervals in the estimates of problem opioid use mean that comparisons between countries can only be made with caution.
Data on the specific responses implemented by countries to prevent infectious diseases and reduce drug-related deaths, both in the community and in prison, have been collected through dedicated surveys carried out in 2008 and 2011. The data collection tool used in these surveys, structured questionnaire 23, can be found on the EMCDDA health and social responses website.