Access to opioid substitution treatment in Europe

AuthorEuropean Monitoring Centre for Drugs and Drug Addiction (EU body or agency)
TECHNICAL REPORT | Balancing access to opioid substitution treatment with preventing diversion of medications
including the impact of past drug epidemics, drug policies, geographical availability, health
service funding, health insurance reimbursement schemes and legal prescribing frameworks
(Vranken et al., 2014; Hedrich and Pirona, 2017).
1.3. Methods
For this report, a non-systematic review of the international literature was carried out. Primary
analyses, including not previously published analyses, used national epidemiological data
submitted by the Reitox national focal points to the EMCDDA. The main national datasets used
in this report were the treatment demand, health and social responses, overdose deaths,
seizures of drugs and problem drug use datasets published annually in the EMCDDA’s
Statistical Bulletin. Previously published data were also used, namely from the EMCDDA’s
European Drug Report, EMCDDA-Europol EU Drug Markets Report and Statistical Bulletin.
Data sources are referenced in the report where necessary. Further national information on the
history, availability, accessibility and affordability of OST, as well as on the misuse and diversion
of OST medications at the national level, was collected through a dedicated survey among
national focal points from Czechia, Germany, Ireland, France, Austria, Poland and Finland.
2. Access to opioid substitution treatment in Europe
Access to OST can be understood as a general concept that includes a set of more s pecific
dimensions describing the fit between the patient and the system providing OST. These
dimensions include availability and accessibility, but also the affordability and acceptability of
OST (see the Glossary). In a country, these dimensions are affected by moderating factors,
each of which can have an impact on one or more of the dimensions. For example, legal
frameworks or national regulations will determine which OST medications can be prescribed for
the treatment of opioid dependence and which medical professionals are allowed to prescribe
them. Limitations in one or more of these dimensions will have an impact on the overall level of
access to OST in a country (or region or city) (Figure 1).
Figure 1. System dimensions and their moderating factors affecting access to opioid substitution

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