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Substitution Treatment - Infractions and Sanctions

Country Does the legal framework list potential infractions and sanctions specific to the ST programmes? What are they?
Czech Republic YES: The Standard of Substitution Treatment (Decree of Ministry of Health No. ZD07/2001) In specialized centres, a therapeutic contract between a patient and doctor is concluded. During the treatment, the patient is examined for a substitution substance and illegal drugs. Each infringement results in a revision of the contract, including possible termination of treatment in "serious cases".
Denmark YES: National Board of Health, Binding Guideline of June 8, 2007 concerning the prescription of addictive substances paragraph 7 It is stated that a decision to interrupt the treatment against the will of the patient has to be considered carefully, that it is a decision that needs to be made by a physician whether the treatment is useless or not, and that the treatment should be resumed when the patient is motivated and an agreement can be reached concerning the treatment plan.
Germany YES: Section 5(2) of the Narcotic Drugs Prescription Ordinance Infractions that will lead to the cessation of treatment: The patient fails to participate in necessary accompanying treatment and care, uses substances that endanger the purpose of substitution treatment, uses the substitute in a manner that is not foreseen,does not consult his/her doctor regularly.
Estonia NO. National Drug Treatment Guidelines but they are not endorsed legally. In specialized centres, a therapeutic contract between a patient and doctor is concluded. Should patient break the contract (s)he is excluded from the programme and can not return during up to six month (depending on the specific centre).
Greece NO. The therapeutic group defines the potentials infractions and sanctions (persistent use of heroin, refusal of urinalysis, violent conduct in the treatment centre, convictions for new drug law infractions).
Spain NO: It depends on the regulation by each centre depending on Autonomous Communities.
France NO. L.324-1 & L.315-2 CSS but no specific sanctions
Méthadone (no specific sanction : sanction applicable for narcotics) : L.3421-1 CSP : use (1) and 222.34 to 222.37 CPP : traffic (2)
Buprenorphine (no specific sanction : sanction applicable for toxic substances) : L.5432-1 CSP (traffic)
Therapeutic contract between a patient and his practioner and the Health Insurance practioner; suspension of partial reimbursement of the medicines cost.
(1) prison sentence of 1 year and a 3750 euros fine ; (2) a 7500000 euros fine and prison sentence of 10 year to life imprisonment
prison sentence of 2 years and a 3750 euros fine
Ireland NO. A treatment contract between the treatment centre and the client stipulates rights and duties.
Italy Presidential Decree 309/90, art. 43, paragraph 5 - art. 73, paragraph 1-bis, letter b) - art. 83 Sanctions will be applied to patients who cannot demonstrate possession of medicine (exhibiting a copy of the medical prescription or the therapeutic plan) and to doctors who prescribe narcotics for non-medicinal purposes.
Cyprus Not applicable
Lithuania Order No V-653 of Ministry of Health of the Lithuania as of August 6, 2007, on Approval of the procedure of substitution treatment designation and use for patients suffering from opiate addiction, substitution treatment, medicine prescription, authorization, store and accounting in health care institutions (Žin., 2007, 90-3587). Patient and healthcare institution make an agreement wherein rights and duties are defined. In cases where rights and duties are broken, ST programme may be suspended. ST programme may be suspended only by the decision of the medical examination commission.
Luxembourg YES: 2002 decree, Art 11 An accredited association or MD can exclude a participant in ST programme if the directives of the ST programme are not respected.
Hungary NO: There are no infractions and sanctions in the Methodological Guideline.
Netherlands NO: The national guideline does not list sanctions. Most addiction care centres have a policy of infractions and sanctions, but this may be counterproductive to the goals of treatment. Violent conduct however, is never accepted. An aggressive client may be referred to another treatment centre for a period of a week.
Austria YES: Article III Substitution Decree Abuse of the substitution substance, use of other illegal drugs, or sale of the substitution substance, as well as not participating in the programme or refusing urinalysis, are grounds for the physician in charge of treatment to decide whether to go on with or stop the treatment. When treatment is terminated, the health department and the Ministry of Health are to be informed. The sanctions applied depend on the criminal charges
Poland YES: § 2 pass. 3 of the Regulation of the Minister of Health of 6 September 1999 (with the amendments of 16 May 2001) The patient may be excluded from ST programme upon the decision of the head of addiction treatment programme if: 3 consecutive urinalysis indicate the use of other narcotic drugs or psychotropic substances; 5 urinalysis in last 6 months the use of other narcotic drugs or psychotropic substances; patient do not obey any other conditions of ST programme.
Portugal YES: Article 45 nº 4 and 5 of the Decree-Law 183/2001. 4 – Medication may be refused to users who fail to perform their duties as set out in the number 3 of the same article.
5 - Medication may be refused to users who are not in a state to take it safely, if they are manifestly sedated or inebriated with alcohol or who behave in an inappropriate or violent manner.
Slovenia NO, it is settled by doctrine, adopted by Health Council Every patient signs an informed consent including therapeutic agreement. The patient could be excluded from the treatment programme for aggressive behaviour. Usually the exclusion is not a punishment, so they are redirected to another treatment centre in the country.
Slovakia YES: The Instruction contains provisions about termination of methadone ST programme by a doctor (against a will of such patient) In a case of serious infraction of collaboration (observance of medical regime) e.g. violence against staff or other persons in center, if patient goes to imprisonment institution, or other infractions that are detected in health documentation.
Sweden YES: The National Board of Health and Welfare`s Code of Statutes SOSFS 2004:8 General laws apply but if a patient, despite special support measures, cannot be persuaded to participate in such a way that the goals of the treatment (no more drug use; improved health and social situation) may be obtained. The treatment will also be terminated if he or she: has not participated in the substitution program for more than a week; - repeatedly uses narcotic drugs/psychotropic substances; - uses alcohol in such a way that it creates a medical risk; - repeatedly manipulates urine tests; - has used violence or threats of violence on other patients or staff at the treatment centre, or; - has been convicted of a drug crime and the sentence has entered into force.
United Kingdom No, no legal framework
Norway YES: (circular I-35/2000). The Directorate for Health and Social Affairs is working on new guidelines. The patient shall be discharged from the program, unless it seems like an inappropriate reaction, in cases of : - trafficking in illegal drugs and/or addictive substances, or there is a well-founded suspicion of this; - use of violence, and/or threat of violence. Other circumstances which can lead to discharge are (because continuation of treatment in such cases could lead to inadequate treatment result): persistent alcohol and/or drug abuse alongside treatment; failure to appear at meetings or pick-up medication; refusal to cooperate according to agreements, regulations and/or the treatment plan; cheating/ refusing of urine analysis.

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Page last updated: Wednesday, 21 November 2007