Topics
1. National context
All drug treatment infrastructures in Luxembourg, general hospitals excluded, rely on governmental support and control. Most specialised agencies have signed a convention with the Ministry of Health, which 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 regulating the relation (duties and rights) between the State on one side, and NGOs or organisations providing psycho-medico-social and therapeutic care on the other. The overall management of the agencies is ensured by a ‘coordination platform’ that includes three members of the concerned 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 substance(s) that are involved.
Detoxification treatment is provided by five different hospitals via their respective psychiatric units. There are a total of five specialised outpatient treatment centres, one residential therapeutic community and one specialised psycho-medical inpatient transition unit. The programme within the residential therapeutic community is divided into three progressive phases, and the duration varies from three months up to a year. A non-specialised residential centre admitting young problem drug users opened in 2007 in the north of the country. A dedicated psycho-social and medical care programme is operational in the national prison (CPL).
Substitution treatment is mainly delivered through office-based medical doctors. In addition, there is a structured substitution treatment programme of the ‘Jugend an- Drogenhëllef’ Foundation which mainly provides liquid oral methadone. Until the beginning of 2001, there was no legal framework regulating drug substitution treatment. In 2002, the Grand-ducal Decree on substitution programmes of 30 January 2002 was approved, which regulates drug substitution in general by means of substitution treatment licences granted to specialised medical doctors and specialised agencies. The new 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. In 2009, the total number of clients in substitution treatment was 1 212, with 95 % of the clients receiving methadone maintenance treatment and the rest, high-dosage buprenorphine treatment.
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.
3. Treatment demand
| Clients in treatment | 2007 | 2008 | 2009 |
|---|---|---|---|
| Number of all clients entering treatment | 376 | 327 | 350 |
| % of which for opioid use | 76.9 | 82.0 | 79.1 |
| % of which for cocaine use | 11.8 | 13.5 | 9.1 |
| % of which for cannabis use | 5.6 | 0.6 | 10.6 |
| % of which for stimulants use (other than cocaine) | 3.0 | 0.3 | 0.6 |
| Number of new clients entering treatment | 34 | 15 | 21 |
| % 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. ‘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 | Extensive |
| 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 | 1092 | 1050 | 1212 |
| of which with methadone | 1037 | N. Av. | N. Av. |
| of which with buprenorphine | 55 | N. Av. | N. Av. |
| 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) | 1989 |
| Buprenorphine (HDBT) | 2002 |
| Heroin assisted treatment,including as trials | N.App. |
| Slow-release morphine | 2006 |
| Buprenorphine/naloxone combination | N.App. |
| 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? | 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 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 Luxembourg
- Country overview for Luxembourg
- 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.
Treatment inventories
- Centre de Prévention des Toxicomanies (FR, DE)
- Réseau Luxembourgeois d'Information sur les Stupéfiants et les toxicomanies (EN)
- Fondation Jugend- an Drogenhëllef (FR)
- 12345 - Drug helpline for youngsters (FR, DE)
