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Therapeutic treatment

Treatment for drug addiction was seen as a means of reducing drug abuse as early as 1961 when the UN Single Convention on Narcotic Drugs was signed. However, therapeutic measures to treat drug addiction through maintenance and substitution substances such as methadone or similar antagonists are not expressly mentioned by any of the three UN Conventions.

Yet the fact that Article 30.2.b.i of the 1961 Single Convention permits the 'supply or dispensation of drugs to individuals' on prescription provided the necessary legitimacy for some practitioners to apply therapeutic measures such as substitution treatment for acute heroin addicts. These practices began in some European countries in the late 1960s and early 1970s. At international level, however, the legitimacy of substitution-treatment interventions does fall into a legal 'grey area' given that none of the UN Conventions expressly regulate the supply and use of narcotics to reduce drug abuse or other related problems.

The 1961 UN Single Convention calls on its signatories to take 'all practicable measures for the prevention of abuse of drugs and for the early identification, treatment, education, after-care, rehabilitation and social reintegration of the persons involved' (art. 38). However, the Convention does not specify what those measures should be, leaving this to the individual signatories to define. Indeed, drug-free treatment as such is only defined in Resolution II of the United Nations Conference for the Adoption of the 1961 Single Convention:

The Conference � declares that one of the most effective methods of treatment for addiction is treatment in a hospital institution having a drug free atmosphere.

This Resolution, however, while declaring drug-free treatment in a hospital environment 'one of the most effective methods of treatment for addiction' does not exclude recourse to other 'practicable measures' that the Parties may deem appropriate.

Substitution treatment
Substitution treatment in Europe developed during the 1970s and 1980s with rather ambiguous legitimacy. It is only recently that European countries have appeared to take a formal position concerning the effectiveness and necessity of substitution-treatment programmes to the extent that prescribing methadone or other opiate agonists has become accepted by practitioners and decision-makers, and often formalised by law.

Yet, although substitution treatment is generally recognised as an effective means of reducing risk behaviour and drug-related criminality and improving social and health well-being, major variations can be found in practice among the EU Member States. These include differences in the substances prescribed, the actors allowed to prescribe them and to control prescription, the purposes and modalities of execution, eligibility criteria, as well as great variations in the length of time a Member State has alllowed such treatment to be carried out.

As reported in the EMCDDA's November 2000 Insights publication, Reviewing current practice in drug-substitution treatment in Europe, for a long time the only legal option for treatment in Europe was detoxification. Methadone or other opiates could only be administrated to drug users when highly specific criteria were met or for pain therapy. In many countries during the 1970s and 1980s, the therapeutic ideal of permanent abstinence for all opiate users was considered the only valid premise for providing practical support and the only valid criterion for successful drug treatment. There was general opposition to substitution treatment, including from politicians, medical professionals and authorities, and methadone-maintenance treatment was even considered as medical malpractice.

Gradually, the effectiveness of maintenance therapy in other countries and increasing awareness of risk factors like HIV infection produced a change in the medical and political approach to maintenance treatment. In many countries during the 1980s, a new demand for alternative, harm-reduction measures led to a gradual acceptance of methadone-maintenance programmes to treat those severely addicted. These new programmes often started as treatment trials and pilot projects, outside any formal legal recognition, and often under opposition from some areas of public opinion, the medical profession and political society. It was the effectiveness of these pilot programmes in reducing HIV, drug-related risks and drug-related crime — as well as in improving the general health conditions of drug addicts — that opened the way for legislative changes legally formalising maintenance treatments with methadone or other opiate agonists.

To date, all EU Member States have legal provisions and/or guidelines for administering methadone or other opiate agonists to drug addicts. However, the organisation of substitution-treatment programmes, the availability of places on such programmes, resources and funding, as well as the substances prescribed, are still strongly associated with public opinion and political views.

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: Wednesday, 27 October 2004