Substitution treatment for opioid use problems
Substitution treatment, typically combined with psychosocial interventions, is the most common treatment for opioid dependence. The available evidence supports this approach, with positive outcomes found in respect to treatment retention, illicit opioid use, reported risk behaviour, drug-related harms and mortality.
An estimated 630 000 opioid users received substitution treatment in the European Union in 2015 (650 000 including Norway and Turkey). The trend shows an increase in clients up to a peak in 2010, followed by a 6 % decline to 2015. Between 2010 and 2015, decreases were observed in 12 countries, with the largest (decreases of more than 25 %) reported by Spain, Hungary, the Netherlands and Portugal. This decline may be explained by factors related to demand or provision, including a falling population of ageing, chronic opioid users or shifts in treatment goals in some countries. Other countries have continued to expand provision, as they seek to improve treatment coverage, with 12 countries reporting increases between 2010 and 2015, including Latvia (157 %), Finland (67 %) and Greece (61 %).
These two tendencies are confirmed in the most recent data (2014–15), with 12 countries reporting increases in the overall number of clients in substitution treatment and 9 reporting decreases.
A comparison with current estimates of the number of high-risk opioid users in Europe would suggest that half receive substitution treatment, but there are differences between countries. However, these findings must be interpreted cautiously for methodological reasons.
Coverage of opioid substitution treatment (percentage of estimated high-risk opioid users receiving the intervention)
Data displayed as point estimates and uncertainty intervals.
Methadone is the most commonly prescribed opioid substitution drug, received by around two thirds (63 %) of substitution clients. A further 35 % of clients are treated with buprenorphine-based medications, which is the principal substitution drug in 8 countries. Other substances, such as slow-release morphine or diacetylmorphine (heroin), are more rarely prescribed, being received by an estimated 2 % of substitution clients in Europe.
Methadone is the most commonly prescribed opioid substitution drug
Principal opioid substitution drug prescribed
Although less common than substitution treatment, alternative treatment options for opioid users are available in all European countries. In the 9 countries for which data are available, between 1 % and 26 % of all opioid users in treatment receive interventions not involving opioid substitution.
Percentage of high-risk opioid users receiving drug treatment (estimate)