The Norwegian state has an overarching responsibility for the provision of specialised health services. The treatment-related objectives of the current national action plan emphasise a client-oriented approach, early interventions, diversification of services, reintegration, and expanding alternative measures to incarceration. The Ministry of Health and Care Services is responsible for the overall implementation of those objectives. In addition, the drugs policy reform of 2004 stipulates that four regional health authorities in Norway are responsible for the specialist treatment of drug and alcohol users, while the municipalities bear overall responsibility for providing general and mental healthcare services, outreach outpatient services/community teams, services for next of kin, low-threshold services, assessment and referral to treatment and follow-up during and after treatment in the specialist health services or in prison. Treatment is financed mainly by public funds. In addition, the Ministry of Labour and Social Inclusion and the Ministry of Health and Care Services have funds at their disposal for the development of special high-priority work in the areas of epidemiology, research, prevention and treatment.
Drug treatment in Norway encompasses a range of services including assessment, detoxification, stabilisation, short- and long-term residential treatments and medication-assisted treatment, such as opioid substitution treatment (OST). The majority of treatment services available to drug users, whether outpatient or inpatient, treat drug dependence in general and are not specifically designed for users of illicit drugs. Most services are delivered through specialised treatment units, while general practitioners are mainly involved in the prescribing of OST medication.
In Norway, OST has been available through a nationwide programme since 1998. Its provision is integrated into health trusts and the specialist care services under the auspices of the regional health authorities. The health trusts either organise the provision of OST through units that have separate management and a dedicated team, or integrate OST as part of an interdisciplinary specialist treatment team that does not have separate management. In general, OST provision follows a basic model of a tripartite collaboration comprising social security offices, general practitioners and the specialist health services. The specialist health services are given authority to assess the need for OST, whereas general practitioners can operate only within strict, shared arrangements with specialised drug treatment centres.
In 2016, a total of 17 925 clients were treated in Norway, the majority of whom were treated in outpatient settings.
The largest group had opioid dependence or problem use as their primary diagnosis, followed by those who received treatment because of cannabis dependence or problem use and those who received treatment because of polydrug use.
The proportion of clients treated with methadone has been declining in recent years, as methadone is no longer recommended as the first-choice option. In 2016, 7 554 clients received OST. Approximately 6 out of 10 clients were treated with buprenorphine-based medications, while the remaining clients were treated with methadone, and slow-release morphine was prescribed to a small proportion of clients. The long-term analysis indicates some reduction in new OST admissions since 2011. Overall, very few people are now waiting to initiate OST, and it is assumed that the system is approaching saturation in terms of numbers of current opioid users seeking treatment.