Recent trends in drug treatment in Europe

The Baltic and Nordic responses to the first Taliban poppy ban: Implications for Europe & synthetic opioids today

The 2000-2001 and the 2022-2023 Taliban opium bans were and could be two of the largest ever disruptions to a major illegal drug market. To help understand potential implications of the current ban for Europe, this paper analyzes how opioid markets in seven Baltic and Nordic countries responded to the earlier ban, using literature review, key informant interviews, and secondary data analysis. The seven nations' markets responded in diverse ways, including rebounding with the same drug (heroin in Norway), substitution to a more potent opioid (fentanyl replacing heroin in Estonia), and substitution to one with lower risk of overdose (buprenorphine replacing heroin in Finland). The responses were not instantaneous, but rather evolved, sometimes over several years. This variety suggests that it can be hard to predict how drug markets will respond to disruptions, but two extreme views can be challenged. It would be naive to imagine that drug markets will not adapt to shocks, but also unduly nihilistic to presume that they will always just bounce back with no lasting effects. Substitution to another way of meeting demand is possible, but that does not always negate fully the benefits of disrupting the original market. Nonetheless, there is historical precedent for a European country's opioid market switching to synthetic opioids when heroin supplies were disrupted. Given how much that switch has increased overdose rates in Canada and the United States, that is a serious concern for Europe at present. A period of reduced opioid supply may be a particularly propitious time to expand treatment services (as Norway did in the early 2000s).

Dual Substance Abusers Seeking Treatment: Demographic, Substance-Related, and Treatment Utilization Characteristics

High comorbidity exists between alcohol and drug-related disorders. However, little information is available on characteristics of clients abusing both alcohol and illicit drugs (so-called dual substance abusers). The proportion of dual substance abusers and their characteristics are examined in a sample of 1,626 clients seeking treatment in one of the 16 participating centers in the province of Antwerp (Belgium). More than a quarter of all clients were identified as dual substance abusers. Their characteristics correspond better to those of drug abusers than to those of alcohol abusers, but compared to the former, they are younger, more often male, use more types of illicit substances and more often use stimulating substances. Alcohol is often underestimated in substance use patterns. Thorough alcohol assessment, early intervention, and preventive actions are needed within the drug treatment system, and closer collaboration with the alcohol treatment system is absolutely essential.

Co-ordination and continuity of care in substance abuse treatment. An evaluation study in Belgium

Considering the complexity of drug dependence and the multiplicity of services for substance abusers, co-ordination and continuity of care are important prerequisites for the quality of substance abuse treatment. However, several shortcomings concerning co-operation, communication and co-ordination have been reported in most European countries. In this study, different aspects of co-ordination and continuity (e.g. first contact, intake, referral, follow-up) have been studied among all services (n = 27) that are addressed by substance abusers in a clear-cut region in Belgium. Structured interviews with key informants show a lack of systematic communication between services and a lack of follow-up of clients. A study of 57 client records in 12 of these 27 centers illustrates that relatively little information is registered concerning the course of the treatment process and that only 10% of all client files contain a treatment plan. Following the introduction of a formalized plan that was regarded as a precondition for systematizing and optimizing communication between services, key informants considered the implementation of a model of case management as an appropriate way of improving co-ordination and continuity of care in this region.