Statistical Bulletin 2021 — methods and definitions for health and social responses

This page provides methods and definitions information for the Health and social responses statistics, which form part of the EMCDDA's Statistical Bulletin 2021.

Methods and definitions used

Between 2004 and 2018, the 27 EU Member States and Norway reported data on needle and syringe availability through specialised needle and syringe programmes (NSPs) were collected from , EU Member States and Norway using a standardised format (standard table on syringe availability, ST10, renamed to standard table on harm reduction in 2017). The information was compiled in previous Statistical bulletins and the current edition (2020).The data-reporting tool comprises information on the availability of different types of needle and syringe programmes (NSPs) in the country, including prison-, pharmacy- and non pharmacy-based programmes and on the number of syringes provided at these programmes. It includes data on the number of syringe provision sites, defined as individual locations or physically distinct outlets, managed by specialist drugs or medical agencies where sterile syringes are made available for free, against payment, or in exchange against used ones. Their geographical spread according to NUTS - Tertiary Administrative Units of the European Community – based on the European classification of territorial units for statistics defined in the Regulation (EC) No 1059/2003 of 26 May 2003, was collected through a specific survey since 2010.

While data on the number and types of syringe provision points that exist in the countries can provide important background information on syringe availability, it is essential to interpret the number of specialised syringe programme points and of the syringes provided in their respective national context, in particular with regard to the estimated prevalence level of drug injecting, as well as the density of the national pharmacy network and finally also pharmacists attitudes towards syringe sales to drug users, which may all have an important impact the overall availability of syringes to injecting drug users in the countries.

Data on substitution treatment provision and availability in the EU was mainly collected through a standard table on access to treatment (ST 24) filled out by national focal points between 2004 and 2018. Data for 2002 and earlier years were collected through national reports and were published in Table 1 in the 1998 Annual report and Table 3 in the 2003 Annual report.

Table HSR10 provides an estimate of the total number of clients in treatment in 2017 which was calculated to be at least 1.2 million people. The estimation is based on the number of clients reported by countries through different tools available within the EMCDDA data collection on treatment. For each country three sets of data are presented: the total number of clients in substitution treatment, the total number of all clients entering treatment registered through the TDI – Treatment Demand Indicator, and the estimate of the total number of treatment clients. The latter figure can include clients entering treatment, clients in continuous treatment during the reporting year and clients in treatment reported from providers not covered by the TDI and is submitted to the EMCDDA through the standard table on access to treatment (ST 24). However, not every country is able to provide an overall estimate of the total number of people in drug treatment. In that case, either the total number of clients in opioid substitution treatment (indicated with an (i) in the table) or the total number of clients entering treatment (TDI) (indicated as (iii) in the table) have been used to estimate the total number of clients in treatment for Europe.

When reporting on numbers of clients in substitution treatment, cases of detoxification treatment, as well as substitution treatment in prison have, as far as possible, been excluded to avoid double-counting.

The current lack of harmonisation in case-reporting does not allow any comparisons between countries and the EMCDDA is working on achieving better reporting standards to improve its information on treatment coverage.

The establishment of a national monitoring system and/or a national register of individuals receiving opioid substitution treatment are means to prevent double-prescription and diversion of the prescribed substances in many countries. While specialised treatment agencies are more likely to be covered by such registries as well as clients receiving methadone, under-reporting of clients treated by private medical doctors and with other substitution medicines, is rather likely.

However, the establishment of registration systems over the last few years in further countries is likely to have led to improvements in the quality of data on substitution treatment and as a result, a clearer European picture of this type of service provision can be drawn.