The current national strategy and its associated action plans envisage further expansion of the national treatment system by adopting a more holistic concept of dependence treatment, which covers both licit and illicit substances. In recent years, counselling and specialised care networks have been developed, which have enabled drug users to start treatment at an earlier stage.
Specialised drug treatment infrastructure in Luxembourg relies on government support and oversight and is provided through specialised outpatient treatment facilities, low-threshold agencies, hospital-based drug treatment units and a therapeutic community. Treatment units are available in prisons. Treatment is decentralised and is most commonly provided by state-accredited non-governmental organisations. Most of these specialised agencies have signed an agreement (i.e. convention) with the Ministry of Health that guarantees their annual funding. Outpatient treatment is provided free of charge, whereas inpatient treatment is covered by health insurance.
The overall management of these agencies is ensured by a ‘coordination platform’, which includes three members of the institution and at least one representative from the competent ministry. All major decisions must be approved by the coordination platform. All institutions work in close collaboration and could be viewed as an interdependent therapeutic chain. Detoxification treatment is provided by five hospitals within psychiatric units. The programme provided by the residential therapeutic community is divided into three progressive phases and the duration varies from 3 months up to 1 year. The programme offers special treatment opportunities to pregnant women, drug-using couples and mothers with children. An outpatient centre and a non-specialist residential centre admit young problem drug users. A dedicated therapeutic psychosocial and medical care programme is operational in national prisons (Programme Tox).
Office-based medical doctors play an important role in the delivery of opioid substitution treatment (OST), but OST is also provided by specialised agencies. The pharmaceutical types of OST registered in Luxembourg include methadone, buprenorphine, morphine-based medications and heroin (within the framework of a pilot project). The costs of OST are partly covered by individuals’ health insurance, while the state covers pharmaceutical costs and pharmacy fees.
The majority of clients entering treatment in Luxembourg during 2017 were treated in outpatient settings, but prisoners also accounted for a large proportion of clients. While opioids, mainly heroin, are the primary substance used among all treatment clients, the proportion of clients entering treatment as a result of opioids use has decreased since 2010.
The number of patients receiving OST has remained stable in recent years. The majority of clients receive methadone maintenance treatment.