EMCDDA Home
  • EN
Search

Drug treatment overview for Belgium

Map of Belgium

1. National context

The national drug strategy document, the Federal Drug Policy Note of 2001, specifies that the treatment offer should be based on a multidisciplinary approach adapted to the complex bio-psychosocial problem of addiction. This approach was further emphasised in the 2010 Communal Declaration and elaborated in the Joint Statement of the Inter-ministerial Conference on Drugs held in 2010. In Belgium different levels of decision-making provide funding for treatment, including the regional and federal governments. A range of services for drug use treatment and/or healthcare is available in a large part of the country, except in the German community where there are no specialist treatment centres for drug users.

The primary care network encompasses GPs, general welfare centres, domiciliary help services, youth advice centres and public centres for social welfare, which provide outpatient treatment. Specialist outpatient care is provided by nine medical and social care centres and a number of day-care centres. In general, these centres provide low-threshold help, including a wide range of psychosocial, psychological and healthcare services, and opioid substitution treatment. Inpatient treatment consisting of detoxification, stabilisation and motivation, and social reintegration is offered at crisis intervention centres, which provide the care based on case-management principles, at specialist hospital units or in long-term residential treatment services. There are also specialist outpatient units at some mental health centres. Most aftercare and re-integration programmes are delivered in outpatient and inpatient structures. For example, there are halfway houses in therapeutic communities, day treatment in drug centres and employment rehabilitation programmes. Action has recently been taken to improve treatment for clients with a dual diagnosis or polydrug use and for children and young people, especially for cannabis use, while a pilot project exploring a community reinforcement approach combined with a voucher treatment method has shown promising results for the treatment of cocaine users. A new treatment programme for young cannabis users has also been piloted.

Consensus guidelines for opioids substitution treatment (OST) have existed in Belgium since 1994. Nevertheless, treatment with substitution substances (such as methadone and buprenorphine) was still a crime until 2002. In 2002 the law on the legal recognition of opioid substitution treatment was adopted, and in 2004 a Royal Decree on OST that mentions methadone and buprenorphine as substitution substances was adopted. In the Flemish region, most OST programmes (for which both methadone and buprenorphine are used) are provided by low-threshold, ambulatory and outpatient drug services. However, in smaller towns and rural areas methadone or buprenorphine may also be prescribed by GPs under the supervision of drug services. In the French community a broad range of agencies such as low-threshold facilities, GPs, outpatient specialised units and mental health facilities, and pharmacies offer access to both methadone and buprenorphine, though GPs still play the most important role in prescribing the treatment. According to the latest available estimates (2013) a total of 17 482 clients were on OST in Belgium, 15 112 of which were on methadone and 2 370 on buprenorphine. Between 2011–13 an open-label randomised controlled trial was carried out comparing heroin-assisted treatment and methadone maintenance treatment. The study concluded that the use of heroin-assisted treatment should remain a second-line treatment in patients who have resistance to methadone and recommendations were provided for setting up a heroin-assisted treatment programme.

top of page

 

2. Treatment registries and monitoring systems

The treatment demand indicator (TDI) registration was officially approved by the Inter-ministerial Conference on Public Health in 2006. In 2008 the first treatment demand data were reported. In 2010 a new TDI registration protocol (based on TDI 2.0) was adopted and has been operational since 2011.

top of page

3. Treatment demand

Table 1: Number of clients entering treatment in Belgium by year
Clients in treatment 2010 2011 2012 2013
Number of all clients entering treatment 8505 5946 6749 9192
Number of all clients entering treatment with known primary drug 7958 5906 6749 9192
% of which for opioid use  34.0 36.8 35 30.6
% of which for cocaine use  13.5 12.9 15 15.6
% of which for cannabis use  34.1 31.0 31 33.5
% of which for stimulants use (other than cocaine)  12.4 10.4 9 11.3
Number of new clients entering treatment 3332 2246 1696 3220
Number of new clients entering treatment with known primary drug 3261 2236 1696 3220
% of which for opioid use 19.4 18.0 17 12.9
% of which for cocaine use 13.8 13.6 16 15.2
% of which for cannabis use 48.1 48.2 49 54.2
% of which for stimulants use (other than cocaine) 13.6 12.2 7 10.3
Notes:
Data do not cover Brussels Capital Region.
‘N. Av.’ stands for ‘No information available’.
For an explanation of terms used, see the definitions of terms.
Sources:

Reitox national reports 2014 and TDI tables.
EMCDDA Statistical Bulletin 2015.

top of page

4. Treatment provision

Table 2: Opioid substitution treatment provision in Belgium
Opioid substitution treatment 2010 2011 2012 2013
Number of clients in opioid substitution treatment 17622 17701 17351 17482
of which with methadone  15395 15510 15132 15112
of which with buprenorphine  2227 2191 2219 2370
Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HRS section).
‘N. Av.’ stands for ‘No information available’.
For an explanation of terms used, see the definitions of terms.
Sources:
Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2014.
Table 3: Year of official introduction of opioid substitution treatment substances in Belgium
Applied substances in opioid substitution treatment Officially introduced in
Methadone (MMT) 1994
Buprenorphine (HDBT) 2003
Heroin assisted treatment 2011
Slow-release morphine N.App.
Buprenorphine/naloxone combination N.App.

Notes:

For a detailed European overview please see EMCDDA Statistical Bulletin 2015 (HRS section).
‘N. App.’ stands for ‘Not applicable’.
For an explanation of terms used, see the definitions of terms.
Sources:
Reitox national reports.

Table 4: Legal framework of opioid substitution treatment in Belgium
Legal framework of opioid substitution treatment Methadone Buprenorphine
Do office-based medical doctors have the right to initiate the prescription of substitution treatment?    
Do specialised medical doctors have the right to initiate the prescription of substitution treatment?    
Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HRS section) .
For an explanation of terms used, see the definitions of terms.
'Specialised medical doctors' refers to specifically trained or accredited office-based medical doctors.
Sources:
Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2014.

top of page

5. References and links

Related EMCDDA resources

 

External links

Please note that the EMCDDA is not responsible for the content of external sites.

Treatment inventories

Treatment research centres

top of page

About the EMCDDA

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the reference point on drugs and drug addiction information in Europe. Inaugurated in Lisbon in 1995, it is one of the EU's decentralised agencies. Read more >>

Contact us

EMCDDA
Praça Europa 1, Cais do Sodré
1249-289 Lisbon
Portugal
Tel. (351) 211 21 02 00
Fax (351) 218 13 17 11

More contact options >>

Page last updated: Friday, 22 May 2015