Entrer Enregistrement. Treatment systems overview - Council of Europe. Transcription Treatment systems overview - Council of Europe Treatment systems overview In most of Europe, the focus of drug treatment in the s and s was on heroin and the introduction of substitution treatment. However, a shift to cater for polydrug use is now taking place across Europe. The diversity of treatment systems reflects the complexity of the local legal, political, economic and cultural context of drug problems. This source of alcolismo e tossicodipendenza in Ekaterinburg practices alcolismo e tossicodipendenza in Ekaterinburg making treatment accessible and available will be useful not only for policy makers and practitioners, but also for user groups, researchers and the wider public as well.
ID In an effort to make knowledge available about how treatment systems for drug users are organised in different countries, and to facilitate bi- and multilateral co-operation and research, this publication presents an overview of the treatment systems of 22 of the 35 Pompidou Group member countries.
All rights reserved. No part of this publication may be translated, reproduced or transmitted, in any form or by any means, electronic CD-Rom, Internet, etc. No abbreviations of, additions to or alterations to the original text shall be made without the written permission of the Council of Europe Pompidou Group. Within the Pompidou Group he is the coordinator of the research platform and was responsible for writing the synthesis.
Its mission is to contribute to the development of multidisciplinary, innovative, effective and evidence-based drug policies in its member states. It seeks to link policy, practice and science. By setting up its group of alcolismo e tossicodipendenza in Ekaterinburg in epidemiology of drug problems inthe Pompidou Group was a precursor of the development of drug research and monitoring of drug problems in Europe.
The multi-city study, which aimed to assess, interpret and compare drug use trends in Europe, is one of its major achievements. Alcolismo e tossicodipendenza in Ekaterinburg the list of Pompidou Group documents and publications at the end of this publication. The background for this publication on treatment systems is the Work Programme of the Pompidou Group which was adopted at the ministerial conference in Strasbourg in November The purpose was to make knowledge available about how treatment systems are organised in the different countries to facilitate bi- and multilateral co-operation and research.
Professor Richard Muscat from Malta, the co-ordinator of the Pompidou Group Research Platform, took on the task of reviewing the contributions and has written an introductory chapter summing up some trends in the reports and grouping countries from different parts of Europe.
We would like to alcolismo e tossicodipendenza in Ekaterinburg this opportunity to thank all the contributors from the member states, Professor Richard Muscat and the secretariat of the Pompidou Group for the work they have put into this publication.
It is our hope that the publication will be disseminated and used widely. The country résumés alcolismo e tossicodipendenza in Ekaterinburg been preceded by an overall review of the material following the same format. Poland follows with some 38 million and the rest have populations of between 2 and 10 million. The Netherlands alcolismo e tossicodipendenza in Ekaterinburg a population of approximately The Netherlands has a relatively low number of citizens based in the capital city some 4.
Luxembourg with a population of 0. Portugal and Cyprus have populations of It also takes into consideration the problem of morbidity, for example HIV, and drug mortality. Both Denmark and Norway have had similar numbers in treatment inbetween 12 and 13and just below half of these have been for opioid addiction.
Again in Sweden the numbers in treatment for such addiction are about half of those in Denmark and Norway. Poland has estimates of problem drug users of which 25 are addicted to opiates. In Croatia, 24 of those registered have problems due to use of psychoactive substances. Slovenia was estimated to have some 10 problem drug users in With respect to numbers of those treated inthere were some 13 in Poland, 9 in Hungary, 7 in Croatia alcolismo e tossicodipendenza in Ekaterinburg 5 in Lithuania.
In both Croatia and Lithuania the majority were for opiate abuse whereas in Hungary and Poland this was not so. Drug deaths in Poland are considered to be low — for In Croatia, there were 94 reported deaths of which 65 were opiate-related, while in Slovenia, 39 deaths were reported of which the majority were due to opiates.
Alcolismo e tossicodipendenza in Ekaterinburg has an estimated 2 problem drug users and some 29 deaths per annum due to drug overdose. In Luxembourg the HIV prevalence rate among injecting drug users is 2. Deaths are now stabilised between and per alcolismo e tossicodipendenza in Ekaterinburg while in Portugal the number of drug-related deaths in was The number of drugrelated deaths in Cyprus was 17 in In respect of HIV-infected patients the proportion of intravenous drug users amongst this group has dropped from In truth most services in the latter countries have their origins in the health care system, but over the years there seems to have been a switch in some countries to putting the responsibility for care under social services.
In others it would now seem that this has gone back under the umbrella of health, as illustrated below. This was followed by the development of therapeutic communities in the s and s organised within the social welfare system. With the advent of the HIV epidemic, medically assisted treatment was piloted in and became available nationally in Under the reform treatment was moved to under the health authorities. In Denmark, at present, it alcolismo e tossicodipendenza in Ekaterinburg the Ministry for Social Affairs now Welfare which is responsible for the medical and social treatment of drug addiction.
All treatment at present is supported by acts of parliament and therefore all have a legal basis. In Sweden, too, treatment is regulated by the Social Services Act and the health care system is only involved in providing medical treatment.
Most problems related to drug use were handled by hospitals or psychiatric units based within the hospital set-up. Russia, from the late s till the early s, alcolismo e tossicodipendenza in Ekaterinburg an atropine coma therapy programme for drug addicts but now uses a range of psychopharmacological medications.
Further development of the therapeutic communities ensued in the s and to date there are some 80 of these in addition to some 50 outpatient-type services and 14 substitution centres. Outpatient centres for drug treatment were developed in Hungary during the s while in Slovenia this occurred in the s. As far as inpatient facilities are concerned these include services within the hospitals as well as therapeutic communities. In a similar vein, this is also the position within the Slovak Republic with the hospital services providing the backbone along with the therapeutic communities that came into being in the s based on those in the United States and Italy.
The introduction of methadone occurred in the in s in Croatia, Hungary, Lithuania, the Slovak Republic and Slovenia. In Ireland, the focus 15 Treatment systems overview of treatment in the s and s alcolismo e tossicodipendenza in Ekaterinburg related to heroin and the introduction of substitution treatment. Now, however, a shift has occurred to cater for poly-drug use. Alcolismo e tossicodipendenza in Ekaterinburg UK has made an attempt to increase treatment availability through the Drug Strategy by setting up a National Treatment Agency in Finally, in Belgium like in Germany there has been a shift to ensure access to the health care system for drug users.
Luxembourg has had a methadone service in operation since but this was only provided with a alcolismo e tossicodipendenza in Ekaterinburg framework in The drug problem in Switzerland came to the fore in the s with the public discontent related to the open drug scene in Zurich. This was closed down in and to date public alcolismo e tossicodipendenza in Ekaterinburg in drug matters has waned as demonstrated by the reduction in the number of parliamentary motions concerned with drug issues.
In Italy the main issue at that time was the heroin problem and this was tackled alcolismo e tossicodipendenza in Ekaterinburg development of therapeutic communities inspired by those in the US and the UK. Lately these have reorganised themselves as their numbers have begun to dwindle, to provide more far-ranging services, such as social, educational and psychological support. The other main form of treatment was the provision of methadone which met with some resistance after a number of years, but again alcolismo e tossicodipendenza in Ekaterinburg programmes were re-oriented with the advent of HIV.
In the interim period this has evolved from centres for demand and supply reduction to what is now known as the Institute for Drugs and Drug Addiction that came into being in and was granted legal status in In Cyprus drug services came into being during the s with inpatient and outpatient services.
To date there are some 20 treatment centres mostly based in the capital city of Nicosia, six of which are government run, and all mainly catering for non-dependent and dependent users. Moreover, a shift from mainly inpatient to outpatient services is occurring, possibly as a result alcolismo e tossicodipendenza in Ekaterinburg the substitution therapies now on offer in such settings.
Moreover, it is alcolismo e tossicodipendenza in Ekaterinburg health care system that provides medical treatment either through the hospitals or interdisciplinary specialised treatment services based in the regional authorities. At state level it is the ministries of health and social welfare that provide policy direction and funds for treatment.
In essence, the organisation of services is divided into inpatient, outpatient and therapeutic communities. Alcolismo e tossicodipendenza in Ekaterinburg parts of each of these systems are common but others are not.
For example in Ireland, policy is the responsibility of alcolismo e tossicodipendenza in Ekaterinburg Department of Health and Children and the management and delivery of services is the responsibility of the Health 17 Treatment systems overview Services Executive while the actual provision is that of both statutory and non-statutory organisations. In France, it is the Ministry alcolismo e tossicodipendenza in Ekaterinburg Health that offers three forms of treatment and care services for drug users, namely, specialist addiction treatment centres, general services hospital and general practitioners and a risk reduction scheme.
In the UK it is the local drug partnerships, equivalent to the number of local authorities, that provide the inpatient or patient service. This is similar to in the Netherlands, Germany and Belgium where the provision of services has been decentralised but, whereas in the UK all treatment is free, in France, Germany, the Netherlands and Belgium this is regulated by a form of health insurance or social insurance. In Switzerland, the federal government is responsible for policy whereas it is the cantons that implement policy.
Therefore it is these regional authorities that have alcolismo e tossicodipendenza in Ekaterinburg obligation under federal law to provide drug treatment. In Luxembourg, the Health Ministry is responsible for drug treatment. In Italy, the national health system provides the regions and in turn these support the local health authorities for the necessary provision of services. In Cyprus, the Anti-Drugs Council is responsible for the actual implementation of treatment services.
What is most salient at this point in time is that in most countries such services as evaluation, dual diagnosis treatment, gender issues and treatment of young people are not as developed as other services. Substitution treatment alcolismo e tossicodipendenza in Ekaterinburg now appear to be available in most of the countries but the biggest issue here is that of coverage as in most countries this type of service 18 Overview of the treatment system in 22 Pompidou Group countries is available in the major cities but not so much outside.
This would seem acceptable in those countries where a sizeable part of the population lives in the major cities and it is there that the major problems of drug use seem to gravitate, but this would not be useful where the proportion of those living in cities is low and diffusion of problematic drug use is apparent. It is also worthy of note that most treatment facilities are geared towards treating heroin problem drug users but this to some extent is now changing with the presence of a different type of problem drug user seeking treatment.
In both countries there are relevant acts of parliament, medical guidelines and inclusion criteria for entry into a alcolismo e tossicodipendenza in Ekaterinburg programme. The latest development in Denmark is that of heroin assisted treatment following a review of such practices in the UK, Switzerland, the Netherlands and Germany. As the outpatient services are doctor-centred it would appear that the links to somatic, psychiatric and dual diagnosis facilities are possible in Norway and to much the same degree in Denmark.
In both countries, drug and alcohol patients are treated in alcolismo e tossicodipendenza in Ekaterinburg same facilities and the social services are also involved in issues of housing, training and employment for better integration back into society. With regard to gender, treatment in specialist units is available in Norway as well as a law on compulsory treatment for pregnant drug users if they are a danger to themselves and their child.
In Denmark, the law ensures that pregnant women with drug problems have access to medical and social care. As to the provision of treatment in prison, both Denmark and Norway have now established units within prisons to oversee those with drug problems. In Croatia and Slovenia a network of outpatient facilities are available through the public health care system in which substitution treatment is offered in the short, medium or long term.
Bulgaria has started to 19 Treatment systems overview develop a similar network of treatment centres that now cater for some 2 individuals while in Hungary some eight centres six in the major cities provide methadone maintenance treatment and in the Slovak Republic this occurs in four large cities.
This is similar to Lithuania in which the addiction centres of the primary health system within three major cities have a methadone programme in place, though with strict inclusion criteria. Moreover, in Poland, methadone is available via the public health care units but it is stated that these do not meet current needs.