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 opioid substitution treatment (OST).
Municipalities organise treatment services based on their own needs. Specialised services are mainly provided through outpatient care, short-term inpatient care, long-term rehabilitation care and support service units, as well as 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 is mainly funded by the public budget of the communities; it is either free of charge or 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 psychological 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, buprenorphine and buprenorphine-naloxone combinations are used in OST treatment.
In Finland, according to the 2016 census of substance treatment facilities, the majority of clients received treatment in outpatient settings. Most clients in inpatient care received non-hospital-based residential drug treatment through social sector institutions.
In 2016, clients whose primary problem drug was an opioid (mainly injected buprenorphine) constituted the largest group, accounting for approximately half of all treatment clients in Finland. However, the number of primary opioid clients entering drug treatment decreased by 40 % between 2009 and 2016. 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 substances remain common.
Around 3 320 people received OST in Finland in 2015; the majority received buprenorphine-naloxone combinations.