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Drug treatment overview for Sweden

Map of Sweden

1. National context

In Sweden, drug treatment is organised by the social services in local communities (specialised outpatient clinics), hospitals (providing detoxification) or therapeutic communities. The National Board of Institutional Care provides compulsory treatment (up to a maximum of six months) in special cases. Drug treatment is also offered for those in prisons and on probation.

Funding for substance treatment, including treatment delivered by non-governmental organisations (NGOs), is provided by the public budget of the municipalities, which are 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 submitted by the NGOs. About 60 % of all inpatient services are provided by private and non-governmental organisations.In Sweden, there are treatment facilities specifically for drug users, but as a rule of thumb drug use treatment takes place alongside treatment for alcohol and/or other addictions. The county councils are responsible for the provision of detoxification, opioid substitution treatment and treatment of psychiatric co-morbidities, while municipalities have overall responsibility for long-term rehabilitation through social services in so-called ‘homes for care and living’ or ‘family homes’. Many of those ‘homes’ are privately operated. Social reintegration interventions seem to be limited in availability and coverage. Psychosocial and medical treatment and psychosocial support services are provided in inpatient settings. Cognitive behavioural therapy, methods of aggression replacement treatment and relapse and motivational interviewing are applied in compulsory treatment.

The Medical Products Agency’s Code Statutes LVFS 2004:15 stipulate that only treatment centres can initiate, and should be predominantly involved in, opioid substitution treatment (OST). Methadone (introduced in 1967) and buprenorphine (introduced in 1999) are the only officially recognised pharmaceutical substances for OST. According to the most recent study from 2013 there are about 110 OST units in Sweden. OST with methadone has always been subject to strict regulation. Since the new guidelines for OST came into force in January 2005, provision of medically assisted treatment has increased. At the same time, some centres have introduced ‘zero tolerance’ against lateral drug use, which leads to low retention rates in the treatment. In cases of lateral drug use, the clients are frequently referred to another type of treatment. A number of clinical trials have been conducted in Sweden to increase the retention rates in medically assisted treatment through the administration of structured psychosocial interventions.

The latest available data indicate that in 2013 a total of 3 700 clients were in opioid substitution treatment in Sweden.

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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. 

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3. Treatment demand

Table 1: Number of clients entering treatment in Sweden by year
Clients in treatment 2010 2011 2012 2013
Number of all clients entering treatment 6231 N.Av. 1262 31377
Number of all clients entering treatment with known primary drug 6223   1237 30983
% of which for opioid use 24.8   20 25.3
% of which for cocaine use 1.5   1 0.8
% of which for cannabis use 24.9   16 12.6
% of which for stimulants use (other than cocaine) 28.1   19 7.7
Number of new clients entering treatment 1597 N.Av. N.Av. 10018
Number of new clients entering treatment with known primary drug 1549     9916
% of which for opioid use 16.5     14.7
% of which for cocaine use 1.7     1.4
% of which for cannabis use 45.1     24.7
% of which for stimulants use (other than cocaine) 19.9     6.5
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 Sweden
Opioid substitution treatment 2010 2011 2012 2013
Number of clients in opioid substitution treatment N. Av. N. Av. N.Av. 3700
of which with methadone N. Av. N. Av. N.Av. N.Av.
of which with buprenorphine N. Av. N. Av. N.Av. N.Av.
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 Sweden
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 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 Sweden
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 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

Treatment research centres

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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: Thursday, 28 May 2015