Topics
1. National context
In Sweden, social legislation determines that social services in the local community are responsible for the implementation of treatment of problem drug use. Treatment is mainly delivered by public institutions, followed by private and non-governmental organisations. Funding of substance treatment, including treatment delivered by NGOs, is provided by the public budget of the municipalities, which are also subsidised by state funds. In the case of NGOs, public funding is handled by the National Board of Health and Welfare and is based on applications from the NGOs.
Social services in the municipalities are responsible for the treatment of problem drug use, even if the cases require medical treatment. Thus, most treatment for problem drug use is organised outside hospitals by social services. There are treatment facilities specifically for problem drug users, but as a rule of thumb, treatment of problem drug use takes place alongside treatment of alcohol and/or other addictions. As regards social reintegration, there are reports of social reintegration interventions, although they seem to be modest in availability and coverage. This was confirmed by the National Board of Institutional Treatment that expressed the belief that there were shortcomings in aftercare, especially in housing.
The Medical Products Agency’s Code Statutes LVFS 2004:15 stipulate that only treatment centres can initiate, and should be predominantly involved in, substitution treatment. Methadone introduced in 1967 and buprenorphine introduced in 1999 are the only officially recognised pharmaceutical substances for substitution treatment. In Sweden, there are about 60 treatment units at hospitals used in substitution treatment. Substitution treatment with methadone has always been subject to strict regulations. Since the new guidelines for substitution treatment came into force in January 2005, provision of medically-assisted treatment has increased.
In 2007, a total of 3 115 clients were in substitution treatment, 1 496 of whom were on methadone and 1 619 on buprenorphine.
2. Treatment registries and monitoring systems
A general monitoring of the Swedish alcohol and drug treatment system is carried out by the National Board of Health and Welfare every second year, in the form of a survey to all the known treatment units - more than 700 - on a reference day. The response rate is about 80 %, and information is collected on the types of units that exist, services provided, treatment methods used and the number and categories of clients who are active in treatment.
3. Treatment demand
| Clients in treatment | 2007 | 2008 | 2009 |
|---|---|---|---|
| Number of all clients entering treatment | 6480 | 6017 | 6216 |
| % of which for opioid use | 25.7 | 23.5 | 26.5 |
| % of which for cocaine use | 2.7 | 9.0 | 2.3 |
| % of which for cannabis use | 16.1 | 17.3 | 21.0 |
| % of which for stimulants use (other than cocaine) | 34.7 | 31.7 | 27.9 |
| Number of new clients entering treatment | 1346 | 1256 | 1694 |
| % of which for opioid use | 21.6 | 19.0 | 20.1 |
| % of which for cocaine use | 3.3 | 2.8 | 3.4 |
| % of which for cannabis use | 28.1 | 34.0 | 37.9 |
| % of which for stimulants use (other than cocaine) | 28.6 | 24.8 | 18.6 |
| 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. The system is under development and every year new units are added to the information system. 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 2007 (Tables TDI 4 and 5), 2009 and 2011 (Tables TDI 2 and 5). | |||
4. Treatment provision
| Type of treatment | Availability |
|---|---|
| Psychosocial out-patient interventions | N. Av. |
| Psychosocial in-patient interventions | N. Av. |
| Detoxification | N. Av. |
| Substitution/maintenance treatment | N. Av. |
| Notes: ‘N. Av.’ stands for ‘No information available’. 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 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. | |
| Opioid substitution treatment | 2007 | 2008 | 2009 |
|---|---|---|---|
| Number of clients in opioid substitution treatment | 3115 | N. Av. | N. Av. |
| of which with methadone | 1496 | N. Av. | N. Av. |
| of which with buprenorphine | 1619 | 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) | 1967 |
| Buprenorphine (HDBT) | 1999 |
| Heroin assisted treatment,including as trials | N.App. |
| Slow-release morphine | N.App. |
| 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? | 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 Sweden
- Country overview for Sweden
- 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.
- Swedish Council for Information on Alcohol and other Drugs (SE, EN)
- Drogportalen (SE)
- Drugsmart (SE)
Treatment inventories
Treatment research centres
- Centre for Social Research on Alcohol and Drugs (SE, EN)
- University of Lund (SE, EN, CN)
- Malmö University (SE, EN)
- Akademiska sjukhuset (SE, EN)
- Beroendecentrum (SE)
