Finland Country Drug Report 2017

Treatment

The treatment system

In Finland, drug treatment is provided in a broader context of substance use treatment. The provision of substance use treatment is the responsibility of the regions and municipalities and is regulated by the Act on Welfare for Substance Abusers, the Social Welfare Act, the Mental Health Act and a Decree governing detoxification and OST.

Municipalities organise treatment services based on their own needs. Specialised services are mainly provided by outpatient care, short-term inpatient care, long- term rehabilitation care and support service units, and peer support activities. Services are provided either by municipalities or by private service providers, working on either a profit or a non-profit basis. The majority of specialised treatment is provided by the social services. Nevertheless, increasing numbers of people receive drug and other substance use treatment within the healthcare services. This is particularly the case for the provision of OST, which has increasingly been transferred to health centres or pharmacies.

Drug treatment in Finland: settings and number treated

NB Year of data 2014.

Trends in percentage of clients entering specialised drug treatment, by primary drug in Finland
 

NBYear of data 2015.

Opioid substitution treatment in Finland: proportions of clients in OST by medication and trends of the total number of clients

NBYear of data 2014.

Drug treatment is mainly funded by the public budget of the communities; it is either free of charge or a subject to a small customer fee. Inpatient treatment usually requires a payment guarantee from the social welfare office of the client’s home municipality.

Outpatient services also include specialised outpatient services for young people and outpatient services for high-risk drug users. These provide an assessment of mental and somatic status, counselling, individual, family or group therapy, referrals, detoxifications or OST. Short-term inpatient care refers to inpatient detoxification treatment. Long-term rehabilitation includes residential psychosocial treatment for problem drug users, residential services for young people and psychiatric services for problem drug users. As a result of budget restrictions, residential long-term rehabilitation is increasingly being replaced by housing services providing outpatient drug treatment. In addition, income-related activities and living and employment assistance are provided to facilitate treatment and recovery. Specialised medical care for individuals with drug dependencies is also provided in emergency clinics and mental health services. It should be noted that the available treatment is often focused on the needs of opioid users, while long-term treatment options for amphetamine users remain limited.

OST is typically initiated in specialised inpatient units, after which clients are transferred to social outpatient services or health centres. General practitioners and pharmacies are increasingly involved in the provision of these services. Methadone was introduced in Finland in 1974 and buprenorphine became available in 1997. The

buprenorphine-naloxone combination was introduced in 2004, making Finland the first country in Europe to make available this substitution medication.

Treatment provision

In Finland, according to the 2015 census of substance treatment facilities, out of a total of approximately 23 600 clients, the majority received treatment in outpatient settings. Most clients in inpatient care received non- hospital-based residential drug treatment through social sector institutions.

In 2015, clients whose primary problem drug was an opioid (mainly buprenorphine injecting) constituted the large group, accounting for approximately half of all treatment clients in Finland. However, the number of primary opioid clients entering drug treatment has decreased by two thirds between 2009 and 2015.The available data indicate some differences in the profiles of clients served in different care settings. Buprenorphine is the most common primary problem drug among clients in inpatient settings, but the least common among clients entering treatment in primary healthcare and other outpatient settings. In these settings, clients seeking treatment as a result of primary use of sedatives, benzodiazepines or multiple substance use remain common.

Approximately 3 000 people were estimated to be receiving OST in Finland in 2014; the majority received buprenorphine-based medication.


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