Topics
1. National context
All UK drug strategies give priority to the provision of better access to effective treatment, particularly for vulnerable or excluded groups, and to encourage client retention. Delivery of drug treatment is through local multi-agency partnerships, representing health, criminal justice agencies and social care services. In recent years, increased attention is given to measuring health and social outcomes associated with treatment.
In most parts of the United Kingdom, particularly in England, there is a four-tier system of treatment providing a conceptual framework for treatment provision. Tier 1 refers to generic interventions such as information and advice, screening and referral to more specialist services. Tier 2 refers to open-access interventions, such as drop-in services providing advice, information and some harm reduction services such as syringe exchange. Tier 3 services are specialist community services and include prescribing services, structured day programmes and structured psychosocial interventions, such as counselling and therapy and community-based detoxification. Tier 4 services are inpatient services, including detoxification and residential rehabilitation. The majority of structured treatment is delivered at Tier 3, predominantly through community-based specialist drug treatment services.
Recovery and social reintegration are key elements of drug strategies in the United Kingdom. In England and Wales, the Drug Interventions Programme targeting drug users in the criminal justice system offers a range of treatment and social reintegration responses through Criminal Justice Intervention Teams, based in the community and in the prison system.
Substitution treatment remains the main treatment in the United Kingdom for opiate users mostly offered through specialist outpatient drug services, commonly in shared care with arrangements with general practitioners. Oral methadone is the drug of choice for substitution treatment, but buprenorphine has also been available since 1999. Furthermore, in England prescribed injectable methadone and heroin are also available although this is rare.
Section 7.3(a) of the Misuse of Drugs Act 1971 allows for prescription and administering of controlled drugs by medical practitioners and Section 10.2(g)–(i) allows for the development of regulations on the control and monitoring of prescriptions of controlled drugs. The enabling legislation for substitution treatment is the Misuse of Drugs Regulations 2001 and treatment can be initiated and provided by medical doctors, specialised medical doctors and treatment centres. The latest available estimates on the total number of clients in substitution treatment were 487 in Northern Ireland in 2008/09, 22 224 received methadone treatment in Scotland in 2006 and 143 219 received a prescribing intervention in England in 2008/09.
2. Treatment registries and monitoring systems
There is no monitoring system which covers the whole of the UK. However, England uses the National Drug Treatment Monitoring System (NDTMS), which delivers data on the numbers of individuals in treatment as well as on treatment settings. However, it does not provide information on whether treatment is medically assisted or not. While Scotland does not have a treatment information system, monitoring and evaluation data from Northern Ireland are regularly available. A Welsh standardised data collection and reporting system has been developed to underpin a performance management framework for drug use treatment services.
3. Treatment demand
| Clients in treatment | 2007 | 2008 | 2009 |
|---|---|---|---|
| Number of all clients entering treatment | 128208 | 132003 | 139390 |
| % of which for opioid use | 63.7 | 61.9 | 61.2 |
| % of which for cocaine use | 12.7 | 13.9 | 14.5 |
| % of which for cannabis use | 15.6 | 16.4 | 17.1 |
| % of which for stimulants use (other than cocaine) | 4.6 | 4.2 | 3.5 |
| Number of new clients entering treatment | 47165 | 46601 | 45048 |
| % of which for opioid use | 47.7 | 42.5 | 41.0 |
| % of which for cocaine use | 17.4 | 19.6 | 21.8 |
| % of which for cannabis use | 25.1 | 27.2 | 28.0 |
| % of which for stimulants use (other than cocaine) | 5.9 | 5.6 | 4.4 |
| 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 2008 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 | Extensive |
| Psychosocial in-patient interventions | Extensive |
| 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 | 154561 | 143706 | N. Av. |
| of which with methadone | 134232 | N. Av. | N. Av. |
| of which with buprenorphine | N. Av. | 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 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. | |||
| Applied substances in opioid substitution treatment | Officially introduced in |
|---|---|
| Methadone (MMT) | 1968 |
| Buprenorphine (HDBT) | 1999 |
| Heroin assisted treatment,including as trials | 1920s |
| Slow-release morphine | N. Av. |
| Buprenorphine/naloxone combination | 2006 |
| Notes: For a detailed European overview please see Table HSR-1 in the EMCDDA Statistical Bulletin 2011. ‘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 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. | |
| 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 office-based 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 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. | ||
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 The United Kingdom
- Country overview for The United Kingdom
- 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
Treatment research centre
- Alcohol Concern (EN)
- Alcohol, Drugs and Addiction Research Group, School of Psychology, University of Birmingham (EN)
- Association of Therapeutic Communities (EN)
- Centre for Addiction Research and Education Scotland (CARES) (EN)
- Department for International Development (EN)
- Economic and Social Research Council (EN)
- Henry Smith's Charities (EN)
- Institute of Psychiatry, King's College London (EN)
- Joseph Rowntree Foundation (EN)
- Kings fund (EN)
- Medical Research Council (EN)
- Mental Health Foundation (EN)
- National Addictions Centre (Kings College / Maudsley Institute of Psychiatry, London) (EN)
- National Drug Evidence Centre, (University of Manchester), Epidemiology & Health Sciences (EN)
- National Institute for health and Clinical Excellence (NICE) (EN)
- National Programme on Substance Abuse Deaths, International Centre for Drug Policy, St George's Hospital Medical School (EN)
- NCCDP National Collaborating Centre for Drug Prevention (EN)
- Nuffield Foundation (EN)
- Scottish Addiction Studies (EN)
- Scottish Executive Health Department
- SSA Society for the Study of Addictions (EN)
- St. James's House (EN)
- Wellcome Trust (EN)
