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Module 1

Module 1. General introduction to substitution treatment. What is opiate dependence?. Opiate consumption versus addiction Dependence is a complex condition: Metabolic, biological, psychosocial aspects Chronic relapsing Varying prevalence across countries.

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Module 1

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  1. Module 1 General introduction to substitution treatment

  2. What is opiate dependence? • Opiate consumption versus addiction • Dependence is a complex condition: • Metabolic, biological, psychosocial aspects • Chronic relapsing • Varying prevalence across countries

  3. Neurobiology of opiate dependence • Craving is a symptom of a deficiency in the function of the natural opiate-like substances in the brain • The brain adapts to repeated exposure of narcotic drugs and becomes pharmacologically dependent • For some people, this adaptation becomes fixed • From this perspective, substitution treatment is a replacement therapy when taken in adequate doses compensating for the impairment in function of the natural opiate receptor system

  4. Is there a cure for opiate dependence? • Different forms of treatment: residential, drug-free, outpatient, psychosocial, medically assisted • Substitution treatment has proven to be the most effective form of treatment for the majority of people with an opiate dependence

  5. Germany Netherlands Austria Denmark Finland France Ireland Spain Norway Italy Luxembourg Portugal UK 200 - 300 (0.2 – 0.3%) 400 - 600 (0.4 – 0.6%) 600 - 900 (0.6- 0.9%) Prevalence of problem drug use in the EU per 100.000 population, aged 16-65 (EMCDDA, 2002)

  6. HIV prevalence amongst IDU in the EU (EMCDDA, 2002) * (local data between brackets) Austria 0 – 4.9 Belgium 0.5 (5.9)* Denmark (0 – 3.4) Finland (0 – 7.9) France 15.9 – 19.3 Greece 0.0 – 2.2 Ireland 3.5 – 8.7 Italy 15.8 (2.3 – 32.8) Luxemburg 3.6 The Netherlands (0.5 – 25.9) Portugal (9.2 - 48) Spain 33.5 Sweden 2.6 UK: England and Wales 0.3 – 2.9 UK: Scotland 0.6

  7. Substitution treatment • Use of safe medication: Agonist • Acts in a similar way as opiates • Longer half-life • Alleviates withdrawal symptoms • Long-term treatment • Maintenance versus detoxification

  8. Substitution treatment Acts in similar way as opiates Stimulates opiate reception Alleviates craving for opiates Does not produce a rush Can produce physical dependence Methadone, LAAM, morphine, heroin Blocking or aversion treatment Blocks the action of opiates Blocks opiate reception Does not produce a rush Does not produce physical dependence Naltrexone, naloxone (emergency OD) Agonist Antagonist

  9. Heroin use and methadone dose

  10. The aims of substitution treatment • To reduce risk behaviour • Injecting • use of illegal drug use • To improve physical and social well-being • Improve participation in medical care • Give health education • Deal with social problems • To reduce criminal activity

  11. Methadone • Synthetic opiate • Introduced in the sixties in the USA • Half a million people worldwide • In Europe, 90% of opiate substitution treatment with methadone

  12. Increase in the numbers of drug users (times 100) receiving methadone in the 15 EU member states (1993-2000) Source: EMCDDA 2000

  13. Other opiate substitution medication • Buprenorphine • LAAM • Diamorphine • Slow-release morphine

  14. History of substitution treatment in the EU EMCDDA 2002

  15. Extent of treatment

  16. Types of treatmentWHO (1990) • Short-term detoxification: decreasing doses over one month or less • Long-term detoxification: decreasing doses over more than one month • Short-term maintenance: stable prescribing over six months or less • Long-term maintenance: stable prescribing over more than six months

  17. The balance between methadone maintenance and detoxification treatment in EU in 2000 Source:EMCDDA 2000 (estimates)

  18. Types of programme • Low threshold programmes • Easy to enter • Harm reduction oriented • Primary goal improve quality of life and alleviate withdrawal symptoms • Offer a wide range of treatment options • High threshold programmes • Selective intake criteria • Abstinence oriented • No flexible treatment options • Compulsory counselling and psychotherapy • Urine controls and inflexible discharge policy

  19. General practitioner’s: Austria, Belgium, France (buprenorphine), Germany, Ireland, Luxembourg, UK, Denmark Specialised centres: Denmark, France (methadone), Italy, the Netherlands, Portugal, Spain Specialised centres, limited number: Finland, Greece, Sweden, Norway Organisation of substitution treatment(EMCCDA, 2002)

  20. Conclusion • Opiate dependence is a complex and often chronic condition • It is prevalent across Europe • Substitution treatment valuable form of treatment • Various forms and types of treatment programmes (detoxification-maintenance), medications, etc across the EU.

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