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 dependency service units (Ser.Ds) and social-rehabilitative facilities (mainly residential or semi-residential). Ser.Ds provide mainly outpatient treatment and are part of the national health system. Integrated treatment is provided within the Ser.Ds, 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 and paid for by the Ser.Ds.
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.
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 Ser.Ds remains rare.
Out of approximately 157 282 clients who were treated for drug dependence in Italy in 2016, 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 decreased since 2014. Among those entering treatment for the first time, the increase in the numbers of opioid users that had been observed since 2014 seems to have reversed in 2016.
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. The latest data indicate that 62 868 people received OST in Italy in 2016.
Data quality issues should be considered when interpreting the data. A major change in the treatment reporting system occurred in 2011/2012, while the recent OST data are underestimates and, therefore, not comparable with previous years.