Italy Country Drug Report 2017

Treatment

In Italy, the coordination of drug-related treatment is carried out at regional levels by the heads of the local drug departments or drug services. The regional government establishes the treatment delivery services, manages the accreditation of private community treatment centres and records the number of treatment centres. Both the public and private sectors provide treatment, and both are funded through the Regional Health Fund. Funds are allocated to the regions by the government on a yearly basis.

The Italian drug treatment system includes two complementary sub-systems consisting of public drug addiction service units (SerDs) and social-rehabilitative facilities (mainly residential or semi-residential). SerDs provide mainly outpatient treatment and are part of the national health system. Integrated treatment is provided within the SerDs, and reintegration programmes are also implemented. The majority of social-rehabilitative facilities are provided by private organisations. They provide inpatient treatment, but also semi-residential and outpatient treatment. Referral to social-rehabilitative facilities is made by the SerDs, which, in most cases, authorise the local national health service unit to pay the fees for treatment. Most services are located in the northern regions of Italy, which have the highest numbers of drug users and the greatest urban densities. Interventions carried out by both public and private services include psychosocial support; psychotherapy and social service interventions; detoxification in residential settings; and vocational training in semi-residential settings. Detoxification is also carried out in general hospitals. However, the number of high-risk drug users in residential settings is believed to be low.

Treatment programmes do not usually distinguish between the different types of substances that are used by their clients; however, some programmes focus on particular groups, such as cocaine users, children and adolescents who use psychoactive substances, those with dual diagnosis, or members of ethnic minorities. Opioid substitution treatment (OST) in Italy can be initiated by general practitioners, specialised medical practitioners and treatment centres, and should be implemented in combination with psychosocial and/or rehabilitative measures. However, the provision of OST outside SerDs remains rare.

Drug treatment in Italy: settings and number treated

NB Year of data 2015.

 

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

NB Year of data 2015.

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

NB Year of data 2015.

Treatment provision

Out of approximately 147 353 clients who were treated for drug dependence in Italy in 2015, one third entered treatment during that year, while the remainder were long-term clients. The majority of clients in treatment were treated for opioid dependency, many of whom received OST. Opioids, mainly heroin, were reported as the main substance used by the majority of clients entering treatment in Italy. The proportion of opioid clients entering treatment has remained relatively stable over the last five years. Among those entering treatment for the first time, the decrease in the numbers of opioid users that had been observed in earlier years seems to have stabilised.

Methadone, which was introduced in 1975, is the most widely used substitution substance, although the use of buprenorphine has been increasing since its introduction in 1999.

Data quality issues should be considered when interpreting this Italian data. A major change in the treatment reporting system occurred in 2011/2012; therefore, the data on treatment entries should be interpreted with caution, while the recent OST data are underestimates and, therefore, not comparable with previous years.


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