Methadone substitution and needle and syringe programmes

Overview of the data

The links above give access to the tables in the bulletin and the associated graphics in the section dealing with availability of substitution treatment as well as of needle and syringe programmes, as well as to a description of the methods and definitions used in compiling this data. A brief overview is provided below. See also the side navigation bar for links to all chapters.

Tables NSP-1 to NSP-6 give information on the provision of syringes through needle and syringe programmes (NSPs) and pharmacy sales in the EU Member countries, the candidate countries and Norway. Reported are the numbers of syringes distributed, exchanged and sold at different types of syringe provision points, including pharmacies, non-pharmacy-based services and vending machines. Data on the year of introduction of needle and syringe programmes complement the information.

References and sources used for the needle and syringe programme information provided in tables NSP-1 to NSP-6 are given in Table NSP-0.

Tables NSP-7 to NSP-9 give data on the number of clients receiving methadone treatment and on the overall amount of methadone consumed per country. Data on the year of introduction of methadone and buprenorphine treatment as well as of heroin-assisted treatment, including trials, are also provided.

Summary points

Needle and syringe provision

• Table NSP-1 provides an overview of the number of points where syringes have been available for distribution, exchange or sale in the countries, including at vending machines and community pharmacies. The table also gives the reported number of syringes provided to drug users at these services in 2003.

• Despite continuous increases over the past years in most countries, differences are still apparent in the coverage of needle and syringe programmes among Member States, which affect data comparability. Table NSP-2 provides information on the year in which needle and syringe exchange programmes were introduced in the countries, from when on they were publicly funded, and which types of needle and syringes programmes were available in 2003.

• Nearly all countries have needle and syringe programmes based at drugs agencies, although comparatively few countries base them at pharmacies. Table NSP-3 provides the numbers of non-pharmacy needle and syringe exchange programmes, including fixed and mobile points serviced by drugs agencies, outreach work and peer-distribution, as well as total number of syringes exchanged, distributed or sold at these points in 2002 and 2003. Data from vending machines are not included. The table includes local or regional information where national totals are not available.

• While nearly all countries have needle and syringe programmes based at drugs agencies, comparatively few countries make use of pharmacies as outlets for needle and syringe programmes. Table NSP-4 gives information on the number of community pharmacies involved in needle and syringe programmes and on the number of syringes exchanged or distributed to drug users at these pharmacies in 2002 and 2003. The table includes only those countries where information on pharmacy-based NSPs were available, and the table includes local or regional information where national totals were not available

• Table NSP-5 shows the reported numbers of syringe vending machines and total numbers of syringes distributed or sold in 2002 and 2003. The table includes only those countries where information on syringe provision via vending machines was available, again including local or regional information where national totals were not available.

• Data are particularly poor with regard to the number of syringes sold to drug users at community pharmacies and only a few countries are able to provide reliable data in this area. This is despite the fact that pharmacy syringe sale is legal in all countries except Sweden and it is therefore likely to be a main source of syringe provision for a many drug users. Table NSP-6 shows the reported number of pharmacy sales of syringes in 2002 and 2003. It includes only those countries where information was available and shows local or regional information where national totals were not available.

• The results presented in these tables reflect that data on the number of syringes provided are not available to the same extent from all types of syringe provision points in the Member States.

Availability of substitution treatment

• Table NSP-7 shows the number of clients reported to receive methadone treatment in the years 2003 and 2004 for the 24 EU Member States where such treatment is available (not in Cyprus). For the year 2003, data are reported separately for specialised methadone treatment units and non-specialised treatment institutions, showing that the majority of treatment takes place in specialised units. In 2004, further increases in methadone treatment provision can be noted for a number of countries, but in others there is an apparent stabilisation or a decline of the number of treated clients. The current lack of harmonisation in case-reporting prohibits any comparisons between countries and the EMCDDA is working on achieving better reporting standards to improve its information on treatment coverage.

• Table NSP-8 shows the year of introduction of methadone maintenance treatment, buprenorphine treatment and of heroin-assisted treatment (including as trial). Methadone was pioneered in Europe by Sweden, the Netherlands, the UK and Denmark in the late 1960 and beginning of 1970s, but only in the late 1980s an acceleration of the rate at which it became an official treatment modality in other European countries could be noted. Buprenorophine, which became available in the first European country in 1996 has been introduced more quickly and is now available in most EU countries. Heroin is an option in the treatment of opioid dependence in the UK since the 1920s but has more recently been studied in the Netherlands, Germany and Spain.

• Table NSP-9 presents data on the amount of methadone (in kg) consumed in the years 1995 to 2004 that countries reported to the International Narcotics Control Board. Besides the EU Member States, the candidate countries and Norway data for Switzerland and for the Unites States of America are included in the table. The global consumption of methadone worldwide, which is rising since the 1990s, is also provided. These statistical data have been extracted from technical reports published by the INCB in 2001 and 2005. While methadone is also a medication used for the treatment of pain, the sharp upward trend in its consumption – especially since the year 2000 – has reached a new record high of 21.4 tons in 2004. According to the analysis of the INCB, this trend is mainly attributable to its growing use in the treatment of opioid addiction.