Opioid agonist treatment – the current situation in Europe (European Drug Report 2026)
People who use opioids represent nearly one third of the clients in specialist drug treatment. Opioid agonist treatment is the main form of treatment for opioid-related problems in these cases. On this page, you can find the latest analysis of the provision of opioid agonist treatment in Europe, including key data on coverage, the number of people in treatment, pathways to treatment and more.
This page is part of the European Drug Report 2026, the EUDA’s annual overview of the drug situation in Europe.
Last update: 9 June 2026
As Europe’s drug problem changes, improved access to opioid agonist treatment is needed
Opioid agonist treatment
Opioid agonist treatment is a well-established intervention for opioid dependence. It is recommended, in both community and prison settings, to prevent transmission of HIV and HCV and to help reduce injecting risk behaviour and injecting frequency. In addition, enrolment in opioid agonist treatment is strongly evidenced as a protective factor against opioid overdose and some other causes of death (see also Injecting drug use – the current situation in Europe and Drug-related infectious diseases – the current situation in Europe).
The long-term nature of opioid use disorders means that opioid agonist treatment accounts for a major share of the resources invested in drug treatment services in many countries. In 2024, an estimated 505 000 people in the European Union received some form of opioid agonist treatment for opioid-related problems. This represents nearly one third of the estimated 1.76 million people who received treatment for problems related to the use of illicit drugs during the same period.
European countries differ in the settings, forms and extent to which opioid agonist treatment is available. Opioid agonist treatment is primarily provided in outpatient settings. These can include specialist drug treatment centres, low-threshold agencies and primary healthcare centres, which can include general practitioners’ surgeries. More flexible outpatient treatment options are also available in some countries, as are new treatment modes, such as extended-release formulations of buprenorphine, which allow clients to have sustained opioid agonist treatment with a single monthly injection or a subcutaneous implant. Emerging evidence indicates that this modality may be effective in reducing opioid and polysubstance use, preventing diversion of opioid agonist medicines in prison settings, help alleviate pressure on prescribers by reducing the number of visits each client requires, and may also support the extension of coverage to rural or remote areas.
Coverage, availability and emerging threats
In terms of treatment availability, a mixed picture emerges across EU Member States, with some reporting increases in access to opioid agonist treatment and others reporting declines. However, limited availability of data continues to hinder rigorous analysis of provision and capacity at the EU level. Nonetheless, the available information shows that opioid agonist treatment provision remains insufficient and below the minimum levels recommended by the WHO in some EU Member States that report a high prevalence of high-risk opioid use (see Key data and trends). Some of these countries have observed the use of potent new synthetic opioids and high rates of drug overdoses (see Drug-induced deaths – the current situation in Europe). The EUDA carried out a threat assessment of the increased availability, use and harms of highly potent synthetic opioids in the Baltic region in 2025. It found that treatment access was hindered by stigma, administrative restrictions and poor adaptation of opioid agonist treatment to the needs of those who use synthetic opioids. The assessment identified the need to expand access and geographic coverage for opioid agonist treatment.
Polysubstance use and the availability of potent new synthetic opioids on local drug markets can increase the risks from opioid use. Recent syringe residue analysis data from the ESCAPE network reveal that, alongside heroin, a range of highly potent new synthetic opioids, including fentanyl, carfentanil, nitazenes and orphines are being injected in some cities. In countries and cities where these new synthetic opioids may be continuously available, more research is needed to determine if adaptations are needed to ensure that current levels of opioid agonist treatment provision remain optimal. There is also a need for further research, especially for randomised controlled trials, to establish the utility and effectiveness of new treatment modalities and pharmaceutical preparations.
Evolving service needs and challenges
Because opioid dependence is a long-term, relapsing condition, people often undergo multiple episodes of treatment and may require a combination of responses for care to be effective. In addition, many people with opioid dependence experience co-occurring mental and physical health issues and social problems, which creates further service needs and underscores the importance of integrated care delivery.
The long-term nature of opioid problems is underlined by the data available on the characteristics of those receiving opioid agonist treatment. The data also indicate that Europe’s cohort of people with heroin-related problems is ageing, with more than 70% of clients in opioid agonist treatment now aged 40 or older, while 5% are under 30 years old. A lag of 14 years exists between the average age of first use at 24 and first treatment episode at 38. This has service delivery and cost implications, with providers now addressing more complex healthcare needs in increasingly vulnerable and marginalised clients. There is a need to ensure the existence of effective referral pathways to generic services offering treatment for other conditions associated with the ageing process, including geriatric care, due to the long-term effects of illicit drug use, but also tobacco and alcohol use. Other complex problems among these clients include mental health issues, social isolation, employment and housing. The development of integrated, multidisciplinary and age-specialised care services for this group remains a key policy and provision consideration.
Another challenge for treatment provision is that, in some countries, younger people with opioid problems have limited access to opioid agonist treatment. Barriers to service access may include regulatory restrictions and stigma associated with the potentially long-term nature of treatment. This issue is particularly relevant in the context of polysubstance use and the presence of new synthetic opioids in Europe. There is also concern about the potential emergence of a more diverse group of people at risk of opioid dependence and related harms, driven by the increased availability of opioid-containing tablets on some local drug markets. For example, Denmark launched an inter-ministerial action plan, Youth Without Opioids, in 2024 to address increased opioid-containing tablet consumption among young people. The plan included measures across multiple policy areas, such as increased prevention initiatives, closer surveillance and strengthened customs control, further training for doctors in opioid agonist and withdrawal treatment, along with efforts to enhance access to treatment.
More information on health and social responses to opioid use, including among older people, can be found in the EUDA’s Health and social responses to drug problems: a European guide.
Key data and trends
Number of people in opioid agonist treatment
- Overall, opioid agonist treatment was received by about 60% of the estimated 855 000 high-risk opioid users in the European Union in 2024, an estimated 505 000 (517 000 including Norway and Türkiye) (Figure 12.1). Incomplete availability of data continues to limit our ability to estimate the number of high-risk opioid users and the proportion receiving opioid agonist treatment and to conduct trend analysis.
- The number of people receiving opioid agonist treatment increased in 10 EU Member States between 2019 and 2024, including in Finland (by 114%), Poland (42%), Denmark (18%) and Estonia (10%).
- Levels of provision remain low and inadequate in some countries estimated to have significant numbers of high-risk opioid users, such as Latvia and Lithuania (Figure 12.2), and are decreasing in Bulgaria and Romania.
Pathways to treatment
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Self-referral continues to be the most common route into specialist drug treatment for opioid clients. This form of referral, which also includes referral by family members or friends, accounted for about two thirds (65%) of those with primary opioid problems entering specialist drug treatment in Europe in 2024. Almost a quarter (24%) of clients were referred by health, education and social services, including other drug treatment centres, while 7% were referred by the criminal justice system.
Opioid agonist medications
- The provision of more than one opioid agonist treatment medication in 2024 is reported by 25 countries. Methadone is the most commonly prescribed medication, received by more than half (61%) of opioid agonist treatment clients across Europe. Another 36% are treated with medications based on buprenorphine, which is the principal medication reported to be used in 9 countries. Other substances, including slow-release morphine or diacetylmorphine (heroin), are more rarely prescribed, being together received by 3% of opioid agonist clients in Europe. Three countries reported clients receiving heroin-assisted treatment in 2024.
- Six countries report the use of newer buprenorphine preparations: a prolonged-release solution for injection and a subcutaneous implant.
Source data
The data used to generate infographics and charts on this page may be found below.
The complete set of source data for the European Drug Report 2026, including metadata and methodological notes, is available in our data catalogue.
A subset of this data, used to generate infographics, charts and similar elements on this page, may be found below.