The current national strategy and its associated action plans envisage further expansion of the national treatment system by adopting a more holistic concept of dependence treatment, which covers both licit and illicit substances. Over the past years, counselling and specialised care networks have been developed, which has enabled drug users to start treatment at an earlier stage in their drug career.
Specialised drug treatment infrastructure in Luxembourg relies on government support and control and is provided through specialised outpatient treatment facilities, lowthreshold agencies, hospital-based drug treatment units and a therapeutic community. Treatment units are available in prisons. Treatment is decentralised and is most commonly provided by state-accredited NGOs. Most of these specialised agencies have signed an agreement (i.e. convention) with the Ministry of Health that guarantees their annual funding. While outpatient treatment is provided free of charge, inpatient treatment is covered by health insurance. The overall management of these agencies is ensured by a ‘coordination platform’, which includes three members of the institution and at least one representative from the competent ministry. All major decisions must be approved by the coordination platform. All institutions work in close collaboration and could be viewed as an interdependent therapeutic chain. A number of collaboration agreements between agencies were signed in 2008 and 2009 to ensure throughcare and rational use of available resources. With the exception of detoxification departments, all treatment units or agencies accept any drug-using patient, irrespective of the type of substances that are involved. Detoxification treatment is provided by five different hospitals, in their psychiatric units. The programme provided by the residential therapeutic community is divided into three progressive phases and the duration varies from three months up to one year. The programme offers special treatment opportunities to pregnant females, drug-using couples and mothers with children. An outpatient centre and a non-specialist residential centre admit young problem drug users. A dedicated psychosocial and medical care programme is operational in national prisons (Programme Tox).
Trends in percentage of clients entering specialised drug treatment, by primary drug in Luxembourg
NB Year of data 2015.
Opioid substitution treatment in Luxembourg: share of clients receiving methadone or buprenorphine and trends in overall number
NB Year of data 2015.
Office-based medical doctors play an important role in the delivery of opioid substitution treatment (OST), but OST is also provided by specialised agencies. The pharmaceutical types of OST registered in Luxembourg include methadone, buprenorphine, morphine-based medications and heroin (within the framework of a pilot project). The costs of OST is partly covered by individuals’ health insurance, while the state covers pharmaceutical costs and pharmacy fees.
The majority of clients entering treatment in Luxembourg during 2015 were treated in outpatient settings, but prisoners also accounted for a large proportion of clients. While opioids, mainly heroin, are the primary substance used among all treatment clients, the proportion of clients entering treatment as a result of opioid use has decreased since 2010
The number of patients receiving OST by prescription from independent and licensed practitioners has remained stable in recent years. The majority of clients receive methadone maintenance treatment and the others receive buprenorphine-based treatment