Topics
1. National context
In Italy, the coordination of drug-related treatment is carried out at regional level, and heads of the local drug departments or drug services coordinate drug-related treatment. The Regional Government establishes the treatment delivery services, manages 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 on a yearly basis to the regions by the Government.
The Italian drug treatment system includes two complementary sub-systems: SerTs and therapeutic communities. SerTs are public drug treatment units which 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 therapeutic communities are private and non-profit organisations. They carry out in-patient treatment, but also semi-residential and outpatient treatment. Referral to therapeutic communities is made by the SerTs, which in most cases authorise the local NHS unit to pay the fees for the treatment. The largest number of services is located in the northern regions of Italy, which have the largest number of problem drug users and highest 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 problem drug users in hospital settings is believed to be low. The Presidential Decree 309/90, Article 43 stipulates that substitution treatment can be initiated by general practitioners, specialised medical practitioners and treatment centres. However, the provision of opioid substitution treatment 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 2009, the total number of clients in substitution treatment was 107 892 (with a service coverage of 85 %) of whom 89 968 were on methadone and 16 708 on buprenorphine.
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.
3. Treatment demand
| Clients in treatment | 2007 | 2008 | 2009 |
|---|---|---|---|
| Number of all clients entering treatment | 51609 | 53990 | 54141 |
| % of which for opioid use | 62.4 | 56.6 | 55.4 |
| % of which for cocaine use | 23.3 | 28.2 | 27.6 |
| % of which for cannabis use | 12.8 | 12.2 | 14.3 |
| % of which for stimulants use (other than cocaine) | 0.4 | 0.2 | 0.3 |
| Number of new clients entering treatment | 35586 | 34334 | 33983 |
| % of which for opioid use | 56.8 | 50.9 | 43.7 |
| % of which for cocaine use | 25.9 | 28.8 | 32.7 |
| % of which for cannabis use | 15.6 | 16.4 | 19.7 |
| % of which for stimulants use (other than cocaine) | 0.4 | 0.3 | 0.3 |
| 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. Until 2004, under ‘all clients’ reported clients continuing in or entering treatment in reported year; since 2005 data conform to the TDI protocol. ‘N. Av.’ stands for ‘No information available’. For an explanation of terms used, see the definitions of terms. Sources: Reitox national reports 2009 and TDI tables (ST34) V. 1.0-2007, questions 13.1.1 and 13.1.2. EMCDDA Statistical Bulletin 2005, 2007 (Tables TDI 4 and 5) and 2011 (Tables TDI 2 and 5). | |||
4. Treatment provision
| Type of treatment | Availability |
|---|---|
| Psychosocial out-patient interventions | Full |
| Psychosocial in-patient interventions | Full |
| Detoxification | Full |
| Substitution/maintenance treatment | Full |
| Notes: For an explanation of terms used, see the definitions of terms. Based on question 3.1 " Please assess the current availability of the treatment interventions below in relation to the user needs, judging the degree to which treatment capacity matches the demand" of Structured Questionnaire SQ27P1 on 'Treatment programmes'. Rating Scale (level of availability):
Reitox national reports 2008, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | |
| Opioid substitution treatment | 2007 | 2008 | 2009 |
|---|---|---|---|
| Number of clients in opioid substitution treatment | 112896 | 97509 | 107892 |
| of which with methadone | 96453 | 83481 | 89968 |
| of which with buprenorphine | 17443 | 14027 | 16708 |
| Notes: For a detailed European overview please see Table HSR-3 in the EMCDDA Statistical Bulletin 2011. ‘N. Av.’ stands for ‘No information available’. For an explanation of terms used, see the definitions of terms. Sources: Reitox national reports 2009, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | |||
| 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 Table HSR-1 in the EMCDDA Statistical Bulletin 2011. ‘N. App.’ stands for ‘Not applicable’. For an explanation of terms used, see the definitions of terms. Sources: Reitox national reports 2009, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | |
| 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 Table HSR-2 in the EMCDDA Statistical Bulletin 2011. 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: Reitox national reports 2009, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | ||
Treatment availablity in Europe
The graphic below presents an overview of treatment provision by different types of service (psychosocial outpatient, substitution, psychosocial inpatient and detoxification) in different European countries and can be used for comparative purposes. Click on the thumbnail to view it.
Figure 1: Treatment availability in Europe, 2007
5. References and links
Related EMCDDA resources
- Health and social responses statistics
- Treatment demand statistics
- Annual report on the state of the drugs problem
- National reports for Italy
- Country overview for Italy
- Drug treatment responses page
- Best practice portal
- Treatment demand key indicator page
For a comprehensive overview on drug treatment systems, availability and utilisation in Europe, please consult the 2008 online report on ‘Quality of treatment services in Europe — drug treatment — situation and exchange of good practice’ published by the Directorate General for Health and Consumers.
External links
Please note that the EMCDDA is not responsible for the content of external sites.
- Main centres which carry out treatment and evaluation research are Regional offices, the local drug Departments and local health services
- Istituto Superiore di Sanità (IT, EN) - National Health Institute
- Consiglio Nazionale delle Ricerche (IT, EN) - National Research Council
- Ministero dell'Università e della Ricerca (IT)
Treatment inventories
