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Health and social responses

Information is provided on availability of substitution treatment and of different types of needle and syringe programmes (NSPs), including pharmacy-based programmes.

Methods and definitions: health service responses

In 2004 and 2006, 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), and the information was compiled in previous Statistical bulletins: 2005, 2006 and 2007.

In the chapter on responses to health correlates of drug use in the national report on the drug situation, Member States provide further data and information about measures taken to prevent infectious diseases, including on needle and syringe programmes . Data are now available for the years 2003 to 2007, allowing a better insight into the recent evolution of this type of service in the reporting countries.

The data-reporting tool comprises information on the availability of different types of needle and syringe programmes (NSPs) in the country, including pharmacy and non pharmacy-based programmes, their geographical spread, and on the number of syringes provided at these programmes. It includes data on the number of syringe provision points, 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.

A revised, updated version of the data collection tool was introduced in 2008. On a voluntary basis, data on numbers of NSP clients and contacts, and an estimate of the volume of syringe sales at pharmacies can in the future be submitted by NFPs.

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.

Information about the legal framework of syringe exchange was collected through a survey of EMCDDA legal correspondents and a summary is available in the legal database online.

Substitution treatment provision and availability

Data on substitution treatment provision and availability in the EU was mainly collected through a standard table on treatment availability (ST 24) filled out by national focal points in 2004 and 2006 and by a structured questionnaire on treatment programmes (SQ 27) which was implemented in 2005 (both data collection tools can be found on the EMCDDA drug treatment website. Collected data was compiled in previous Statistical bulletins: 2006 and 2007.

Revised and updated versions of the treatment data collection tools were introduced in 2008 and additional information on substitution treatment (e.g. number of clients according to different substitution substances, etc), but also other drug treatment information will be available in 2009.

Complementary sources of information used to compile the present tables on the availability of treatment, initiation, and client numbers have been the National reports, produced by the national focal points of the Reitox network. The latest (2007) versions will become available at the date of the launch of the Annual report 2008 in November 2008.

Information about the legal framework of substitution treatment was collected through a survey among the legal correspondents of the EMCDDA in 2006. The results are described in more detail in a topic overview, to be found at in the legal database.

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 doesn’t 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 is a 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 in such registries 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.