In Italy, the coordination of drug-related treatment is carried out at regional level 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 also have large 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 130 000 clients who were treated for drug dependence in Italy in 2017, 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; however, the proportion of primary opioid clients entering treatment has decreased since 2014, in parallel with an increase in the proportion of clients entering treatment who report primary use of cocaine or cannabis. In addition to methodological changes in the reporting system, an increase in the number of cocaine treatment demands may be related to increases in: (i) drug availability as a result of a decrease in price, (ii) the number of hospital emergencies due to cocaine-related problems, and (iii) the availability and provision of cocaine treatment, including specific cocaine programmes.
Methadone, which was introduced in 1975, is the most widely used substitution drug, although the use of buprenorphine has been increasing since its introduction in 1999. The latest data indicate that close to 70 000 people received OST in Italy in 2017.
Caution is needed when interpreting these data. A major change in the treatment reporting system occurred in 2011/12, and the recent OST data are likely to be underestimates and, therefore, not directly comparable with previous years.