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Drug treatment overview for Luxembourg

Map of Luxembourg

1. National context

Specialised drug treatment infrastructure in Luxembourg relies on governmental support and control. Treatment is decentralised and is most commonly provided by state-accredited NGOs. Most of these specialised agencies have signed an agreement with the Ministry of Health that guarantees their annual funding. NGOs involved in drug treatment fall under the obligations of the so-called ASFT law (8/09/98) and the subsequent Grand-ducal Decree of 10 December 1998, both of which regulate the relationship (duties and rights) between the state on one side, and NGOs or organisations providing psycho-medical-social and therapeutic care on the other side.

The overall management of these agencies is ensured by a ‘coordination platform’ that includes three members of the institution, and at least one representative from the competent ministry. All major decisions must be approved by the coordination platform. All institutions work in close collaboration and could be viewed as an interdependent therapeutic chain, and a number of collaboration agreements between agencies were signed in 2008 and 2009 to ensure thorough care and rational use of available resources. With the exception of detoxification departments, all treatment units or agencies accept any drug-using patient, irrespective of the type of substances that are involved. Detoxification treatment is provided by five different hospitals via their respective psychiatric units and is funded by health insurance.

There are six specialist outpatient treatment facilities, one residential therapeutic community and one specialist psycho-medical inpatient transition unit. While outpatient treatment is provided free of charge, inpatient treatment is covered by health insurance. The programme within the residential therapeutic community is divided into three progressive phases, and the duration varies from three months up to one year. The programme offers special treatment opportunities to pregnant women, drug-using couples and mothers with children. A non-specialist residential centre admitting young problem drug users opened in 2007 in the north of Luxembourg. A dedicated psychosocial and medical care programme is operational in the national prison (Programme Tox).

Opioid substitution treatment (OST) is mainly delivered through office-based medical doctors. In addition, a multidisciplinary OST programme is provided by the Jugend-an Drogenhëllef Foundation, which mainly provides liquid oral methadone. In 2002 the Grand-ducal Decree on substitution programmes of 30 January 2002 was approved; this regulates OST in general by means of substitution treatment licences granted to specialist medical doctors and specialist agencies. The referred legal framework lists medicines for substitution, including methadone, buprenorphine, morphine-based medications and heroin within the framework of a pilot project, as well as substitution treatment modalities. With regard to the cost of treatment, medical interventions and counselling are covered by health insurance, while the state covers pharmaceutical costs and pharmacy fees. In 2013 there were 1 254 clients in OST, with 95 % of the clients receiving methadone maintenance treatment and the rest buprenorphine-based treatment.

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2. Treatment registries and monitoring systems

There is a comprehensive register and monitoring system for all clients in addiction treatment and persons in contact with law enforcement authorities for drug use offences (RELIS). This relies on a multi-sectorial data network including specialised in- and outpatient treatment centres, counselling centres, some general hospitals as well as law enforcement agencies and national prisons.

The decree of 30 January 2002 replaced the former ‘Methadone Commission’ by the ‘Surveillance commission on substitution treatment’ mandated to control all aspects of substitution treatment at national level. Established in 2002, it is composed of delegates from involved NGOs, the Directorate of Health, the AST, two pharmacists and two general practitioners affiliated to the programme, and is in charge of admissions, releases and exclusions of substitution treatment demanders or patients.

This Commission, the national drug coordinator and the specialised treatment centres involved are about to establish a central substitution register to be operational in the beginning of 2007.

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3. Treatment demand

Table 1: Number of clients entering treatment in Luxembourg by year
Clients in treatment 2010 2011 2012 2013
Number of all clients entering treatment 230 224 277 N.Av.
Number of all clients entering treatment with known primary drug 230 224 277  
% of which for opioid use 80.0 67.4 59  
% of which for cocaine use 10.4 18.3 13  
% of which for cannabis use 7.8 12.9 26  
% of which for stimulants use (other than cocaine) 0.4 0.4 1  
Number of new clients entering treatment 12 18 N.Av. N.Av.
Number of new clients entering treatment with known primary drug N.Av. N.Av.    
% of which for opioid use        
% of which for cocaine use        
% of which for cannabis use        
% of which for stimulants use (other than cocaine)        
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.
Data on "new clients" were not reported as the figures were too small.
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 Luxembourg
Opioid substitution treatment 2010 2011 2012 2013
Number of clients in opioid substitution treatment 1248 1228 1226 N.Av.
of which with methadone N. Av. 1167 1165  
of which with buprenorphine N. Av. 61 61  
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 Luxembourg
Applied substances in opioid substitution treatment Officially introduced in
Methadone (MMT) 1989
Buprenorphine (HDBT) 2002
Heroin assisted treatment,including as trials N.App.
Slow-release morphine 2006
Buprenorphine/naloxone combination N.Av.

Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HSR section).
‘N. App.’ stands for ‘Not applicable’.
‘N. Av.’ stands for ‘No information available’.
For an explanation of terms used, see the definitions of terms.
Sources:
Reitox national reports.

Table 4: Legal framework of opioid substitution treatment in Luxembourg
Legal framework of opioid substitution treatment Methadone Buprenorphine
Do office-based medical doctors have the right to initiate the prescription of substitution treatment? N.App. N.App.
Do specialised medical doctors have the right to initiate the prescription of substitution treatment? Yes Yes
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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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 >>

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Page last updated: Friday, 22 May 2015