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Drug treatment overview for the United Kingdom

Map of The United Kingdom

1. National context

All United Kingdom drug strategies give priority to the provision of better access to effective and comprehensive treatment, particularly for vulnerable or excluded groups, and to encouraging client retention, recovery and reintegration. Delivery of drug treatment is through local multi-agency partnerships representing health, criminal justice agencies and social care services. Increased attention has been given in recent years to measuring the health and social outcomes associated with treatment. In England, for example, the government’s main indicator for measuring the treatment systems’ performance is the treatment outcome measure — the number leaving treatment free from their drug(s) of dependency and not re-presenting to treatment for six months.

Drug treatment in the United Kingdom encompasses a range of available treatments and services including community (and primary care) based prescribing, community one-to-one and group based psychosocial interventions to support recovery, inpatient treatment, day programmes, and quasi- and full residential drug treatment and rehabilitation supports. Prescribing (mainly of methadone) is provided for stabilisation, detoxification, maintenance and relapse prevention. Local areas across the United Kingdom are expected to provide a wide range of services, including information and advice, screening, care planning, psychosocial interventions, community prescribing, inpatient drug treatment and residential rehabilitation. In addition, drug misusers should be offered aftercare and relapse-prevention programmes, HBV vaccinations, testing for HBV, HCV and HIV, and access to hepatitis and HIV treatment. In England, guidance by an expert group on recovery-orientated treatment was published in 2012. Alongside the development of a suite of recovery resources, this provided a new national framework for best practice for practitioners and effectively updated and replaced the Models of care document and the previous four-tiered treatment framework in England. In addition, a manual for practitioners and a diagnostic tool for partnerships were published to support effective recovery-focused intervention and to optimise treatment. A guidance document on recovery-oriented integrated systems of care was also published by the Welsh Government in 2013. In 2014, a number of care quality standards have been published in Scotland, England and Northern Ireland. The Drug Interventions Programme in England and Wales targeted drug users in the criminal justice system, offering them a range of treatment and social reintegration responses through criminal justice intervention teams based in the community and in the prison system. From April 2013 this programme was no longer centrally funded and local areas must decide which mechanism to use to route offenders into treatment. The Drug Rehabilitation Requirement in England and Wales is a court mandated community sentence with a drug treatment condition attached. In Scotland, Drug Treatment and Testing Orders serve the same purpose.

Opioid substitution treatment (OST) remains the most common treatment in the United Kingdom for opiate users, and is mostly offered through specialist outpatient drug services, commonly in shared care arrangements with general practitioners. Oral methadone is the most commonly prescribed drug for substitution treatment but buprenorphine has also been available since 1999. Furthermore, in England, prescribed injectable methadone and diamorphine 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 general practitioners, specialised medical doctors and treatment centres. The latest available estimates on the total number of clients in opioid substitution treatment are: 607 in Northern Ireland in 2010/11; 22 224 received methadone treatment in Scotland in 2006/07; 147 640 received a prescribed intervention in England in 2012/13; and 2 042 in Wales in 2012/13.

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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. 

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3. Treatment demand

Table 1: Number of clients entering treatment in The United Kingdom by year
Clients in treatment 2010 2011 2012 2013
Number of all clients entering treatment 119652 N.Av. 113814 101753
Number of all clients entering treatment with known primary drug 114904   109525 99186
% of which for opioid use 59.3   56 50.3
% of which for cocaine use 12.3   13 12.9
% of which for cannabis use 20.3   22 26.8
% of which for stimulants use (other than cocaine) 3.2   3 4.8
Number of new clients entering treatment 47566 N.Av. 43110 35229
Number of all clients entering treatment with known primary drug 44984   40691 34524
% of which for opioid use 40.0   33 19.7
% of which for cocaine use 16.0   17 17.1
% of which for cannabis use 32.4   37 48.6
% of which for stimulants use (other than cocaine) 3.9   3 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 (ST34).
EMCDDA Statistical Bulletin 2015.

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4. Treatment provision

Table 2: Opioid substitution treatment provision in The United Kingdom
Opioid substitution treatment 2010 2011 2012 2013
Number of clients in opioid substitution treatment 177993 N.Av. 171082 172513
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 The United Kingdom
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 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 The United Kingdom
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 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 centre

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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