Shifting Focus in Substitution Treatment in the Nordic Countries

Abstract

The article compares the development of substitution treatment in Denmark, Finland, Norway and Sweden. The focus is on the official guidelines: under what conditions, for whom and by whom should substitution treatment be organised? For many years, substitution treatment was fiercely opposed in Finland, Norway and Sweden, all of which had a restrictive drug policy and relied on social work rather than medicine. The debate cut through the professions and was at times the main political issue. Methadone treatment started in Denmark and Sweden in the 1960s, and while Finland and Norway did not give the go-ahead until the latter part of the 1990s, they have today expanded their substitution treatment considerably. In all four countries, substitution treatment has become an accepted and established part of treatment responses to abuse problems. The guidelines have become less strict even if the regimes in practice include various kinds of control measures. The thresholds of substitution treatment have remained the lowest in Denmark where this treatment mode is more geared toward harm reduction than in the other countries.

Methadone-Related Overdose Deaths in a Liberal Opioid Maintenance Treatment Programme

“…Furthermore, strong drug user organizations promoted drug users' dislike of buprenorphine and of being switched from methadone to buprenorphine [10] . Overall, the progress of the OMT delivery strategy in Denmark has resulted in a minimum of supervised intake, prescription of methadone doses outside recommended limits (60-120 mg), and a high number of take-home doses (a 'liberal' treatment approach) [10,12,13] .…”

Driving under the influence (DUI) among patients in opioid maintenance treatment (OMT): a registry-based national cohort study

“…OMT was integrated into the general health and social security system, and patients applied to regional OMT centres via their general practitioner or social service centres [34]. During the initial years of OMT in Norway, which also applies to the observation period of this study, the OMT guidelines were restrictive and had a relatively high threshold.…”

Shifts in Opioid Substitution Treatment Policy in Denmark from 2000–2011

“…The general treatment philosophy initially developed by Dole et al (1966) involved prescription medication, especially methadone, as well as various forms of psychosocial treatment interventions (Dahl, 2005;Houborg, 2006). Although this general treatment philosophy has been implemented in many countries, especially in the Western world, its precise configuration has varied in different countries because of different historical, structural, and political circumstances (Bourgois, 2000;Fraser & Valentine, 2008;Gomart, 2002;Hallgrimsson, 1980;Skretting & Rosenquist, 2010). This article examines how substitution treatment policy has developed in Denmark from 2000 to 2011.…”

“…In effect, a dual treatment system was developed in which little or no cooperation existed between the two sectors. The drug user treatment field overall can, therefore, be characterized by its lack of a coherent service for clients with drug use-related problems (Bjerge, 2009;Skretting & Rosenquist, 2010).…”