Opioid agonist treatment – the current situation in Europe (European Drug Report 2023)
Last update: 16 June 2023
Evolving need for multidisciplinary supports to treat ageing opioid clients
An estimated 1.6 million people received treatment for problems related to the use of illicit drugs in the European Union in 2021 (1.9 million, including Norway and Türkiye). Opioid users represent the largest group undergoing specialised drug treatment and consume the greatest share of available treatment resources, mainly in the form of opioid agonist treatment, typically combined with psychosocial interventions. The available evidence supports this approach, with positive outcomes found with respect to treatment retention, illicit opioid use, reported risk behaviour, drug-related harms and mortality.
There are important differences between countries, however, in the settings and form in which treatment is provided and the extent to which the availability of opioid agonist treatment is sufficient to meet the needs of those requiring this form of care. In some countries, the provision of opioid agonist treatment is still clearly insufficient. The relative importance of outpatient and inpatient provision within national treatment systems also varies greatly between countries. Approximately a quarter of drug treatment in Europe is provided in inpatient settings, mainly hospital-based residential centres (e.g. psychiatric hospitals), but this can also include therapeutic communities and specialised residential treatment centres in some countries prisons. Overall, however, opioid agonist treatment is more commonly provided in outpatient settings. These can include specialist drug treatment centres, low-threshold agencies and primary healthcare and general mental healthcare centres, which can include general practitioners’ surgeries.
Trends in the total numbers receiving opioid agonist treatment indicate that provision did not drop significantly during the pandemic, although service delivery models may have been adapted during this period. Examples of this include a greater use of telemedicine and less restrictive approaches to providing take-home doses. There is also some information to suggest that access to care for new clients seeking opioid agonist treatment may have been disrupted temporarily during the pandemic period.
The data available on the characteristics of those receiving opioid agonist treatment underline the long-term nature of opioid problems. The data also indicate that Europe’s cohort of those who have had problems with heroin is ageing. This is illustrated by the fact that over 60 % (60 500) of clients in opioid agonist treatment are now aged 40 or older, while less than 10 % are under 30 years old. This has important implications for service delivery, with services having to address a more complex set of healthcare needs in a population that is becoming ever more vulnerable. An important consideration here is the need to ensure the existence of effective referral pathways to more generic services offering treatment for other conditions associated with the ageing process. This is becoming increasingly necessary in order to support older opioid treatment clients needing geriatric care, arising from the long-term impact of illicit drug use, but also tobacco and alcohol use, on their physical health. The treatment of this often highly marginalised group also needs to respond to a complex and often long-established set of problems related to mental health issues, social isolation, employment and housing.
Key data and trends
Number of people in treatment
- A comparison with current estimates of the number of high-risk opioid users in Europe would suggest that, overall, agonist treatment was received by about half of the number of high-risk opioid users in the European Union in 2021, an estimated 511 000 (524 000 including Norway and Türkiye). However, there are differences between countries. In those countries where data from 2011 or 2012 are available for comparison, there was generally an increase in coverage. Levels of provision, however, remain low and inadequate in some countries.
- Trends from countries that consistently reported data on clients receiving opioid agonist treatment between 2010 and 2021 show an overall stable trend of treatment levels during this period, with little fluctuation in the number of clients receiving this treatment.
Coverage is defined as the share of high-risk opioid users receiving the intervention. Data are displayed as point estimates and uncertainty intervals.
- At the onset of the COVID-19 pandemic, EU Member States sought to ensure continued access to opioid agonist treatment for people engaged in high-risk drug use. Comparing treatment data between 2019 and 2021 indicates that the number of clients remained stable, with only Croatia, Cyprus and Slovakia reporting a decrease greater than 10 % of their opioid agonist treatment population during this period.
- Some countries have continued to expand treatment coverage, with 10 countries reporting an increase in the number of people receiving agonist treatment between 2015 and 2021, including Romania (40 %), Poland (37 %) and Sweden (23 %).
Pathways to treatment
- Client pathways through drug treatment are often characterised by the use of different services, multiple entries and varying lengths of stay. Self-referral continues to be the most common route into specialised drug treatment for opioid clients. This form of referral, which also includes referral by family members or friends, accounted for more than half (55 %) of those with primary opioid problems entering specialised drug treatment in Europe in 2021. About one fifth (23 %) of clients were referred by health, education and social services, including other drug treatment centres, while 17 % were referred by the criminal justice system.
Opioid agonist medications
- The provision of more than one opioid agonist treatment medication in 2021 is reported by 24 countries (see the figure Number of European countries implementing opioid agonist treatment, up to 2022, below). Methadone is the most commonly prescribed, received by more than half (56 %) of opioid agonist treatment clients across Europe. Another 35 % are treated with medications based on buprenorphine, which is the principal medication reported to be used in 8 countries. Other substances, such as slow-release morphine or diacetylmorphine (heroin), are more rarely prescribed, being received by almost 10 % of opioid agonist clients in Europe, with 5 countries reporting some provision of heroin-assisted treatment, if pilot projects are included.
Trends in the number of opioid agonist clients are based on 25 countries. Only countries with data for at least 10 of the 12 years are included in the trends graph. Missing values are interpolated from adjacent years. Data for age distribution are based on 15 countries. Data for gender are based on 14 countries. Data for treatment duration are based on 7 countries.
Implementation at any level, including pilot projects, is included.
Alternative treatment options
- Although less common than opioid agonist treatment, alternative treatment options for opioid users are available in all European countries. In the 11 countries for which data are available, between 5 % and 47 % of all opioid users in treatment receive interventions not classified as opioid agonist treatment, such as medically assisted detoxification and outpatient or inpatient abstinence-oriented interventions.
Source data
The data used to generate infographics and charts on this page may be found below.
About this page
Recommended citation: European Monitoring Centre for Drugs and Drug Addiction (2023), European Drug Report 2023: Trends and Developments, https://www.emcdda.europa.eu/publications/european-drug-report/2023_en
Identifiers:
HTML: TD-AT-23-001-EN-Q
ISBN: 978-92-9497-865-3
DOI: 10.2810/161905