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Drug treatment overview for Italy

Map of Italy

1. National context

In Italy, the coordination of drug-related treatment is carried out at the regional level by 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. To ensure the quality of treatment, the regions are given responsibility for the adoption of treatment guidelines; however, in a significant proportion of the regions such tools have not yet been adopted. 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: in 2013 there were 645 public drug addiction service units (SerTs) and 959 social-rehabilitative facilities (mainly residential or semi-residential). SerTs mainly carry out outpatient treatment, and are part of the national health system. Within the SerT, integrated treatment is provided and reintegration programmes are also implemented. The majority of social-rehabilitative facilities are private and non-profit organisations. They carry out inpatient treatment, but also semi-residential and outpatient treatment. Referral to social-rehabilitative facilities is made by the SerTs, which in most cases authorise the local national health service unit to pay the fees for treatment. Most services are located in the northern regions of Italy, which have the highest number of problem drug users and the greatest urban densities. Interventions carried out in both the public and the private services include psychosocial support, psychotherapy and social service interventions, and also detoxification in residential settings and vocational training in semi-residential settings. Detoxification is also carried out in general hospitals. However, the number of high-risk drug users in hospital settings is believed to be low. Treatment programmes usually do not distinguish between different types of substances used by their clients. Programmes are in place in most of Italy that focus on cocaine users, children and adolescents who use psychoactive substances, and those with dual diagnosis, while programmes for ethnic minorities are available in a third of all regions.

The Presidential Decree 309/90, Article 43 stipulates that opioid substitution treatment (OST) 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 specialised treatment centres is rare. The most widely used substitution substance in Italy is methadone (introduced in 1975), although the use of buprenorphine has been increasing since its introduction in 1999. In 2013 there were 94 376 clients in OST, of whom 69 933 were on methadone and 13 873 on buprenorphine.

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2. Treatment registries and monitoring systems

There is a monitoring system for all types of drug related treatment delivered by public and private drug services which is compatible with the Treatment Demand Indicator (TDI), although only public data is provided through the TDI.

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3. Treatment demand

Table 1: Number of clients entering treatment in Italy by year
Clients in treatment 2010 2011 2012 2013
Number of all clients entering treatment 56146 57577 54620 57956
Number of all clients entering treatment with known primary drug 39836 42341 30193 33065
% of which for opioid use 48.5 55.3 55 54.7
% of which for cocaine use 28.7 24.3 24 25.8
% of which for cannabis use 20.1 18.8 17 17.4
% of which for stimulants use (other than cocaine) 0.4 0.4 0 0.4
Number of new clients entering treatment 35597 33679 26745 25834
Number of new clients entering treatment with known primary drug 24993 22899 13962 12845
% of which for opioid use 39.5 42.4 39 37.2
% of which for cocaine use 32.5 30.3 30 31.4
% of which for cannabis use 24.7 25.2 26 28.0
% of which for stimulants use (other than cocaine) 0.3 0.6 0 0.6
Notes:
The variation across time, in particular with regard to the absolute numbers of clients in treatment, should be interpreted with caution as coverage data may have changed over time. For further information on coverage details please refer to the relevant EMCDDA Statistical Bulletin.
For an explanation of terms used, see the definitions of terms.
Sources:

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

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4. Treatment provision

Table 2: Opioid substitution treatment provision in Italy
Opioid substitution treatment 2010 2011 2012 2013
Number of clients in opioid substitution treatment 103564 109987 98460 94376
of which with methadone 85047 93119 82017 69933
of which with buprenorphine 17005 16868 15065 13873
Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HSR section).
‘N. Av.’ stands for ‘No information available’.
For an explanation of terms used, see the definitions of terms.
Sources:
Standard Table 24 (ST24) on 'Treatment availability' submitted in 2014.
Table 3: Year of official introduction of opioid substitution treatment substances in Italy
Applied substances in opioid substitution treatment Officially introduced in
Methadone (MMT) 1975
Buprenorphine (HDBT) 1999
Heroin assisted treatment,including as trials N.App.
Slow-release morphine N. Av.
Buprenorphine/naloxone combination 2007
Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HSR 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 Italy
Legal framework of opioid substitution treatment Methadone Buprenorphine
Do office-based medical doctors have the right to initiate the prescription of substitution treatment? Yes Yes
Do specialised medical doctors have the right to initiate the prescription of substitution treatment? N.App. N.App.
Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HSR 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.

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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

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Page last updated: Friday, 22 May 2015