Methadone treatment of drug abusers in Denmark in the light of altered Legislation

by C. Damm and C. Lundstedt

The Danish Parliament passed a bill, effective from January 1st, 1996, to ensure better treatment for drug users by directly observed therapy (DOT) and social support. This article examines the effects of this bill on the treatment for drug users in three selected areas: the county of Århus, the county of Funen and the city of Copenhagen.
 
Since the beginning of the nineteen seventies the use of methadone was solely abstinence-orientated on a short term basis, and guidelines were issued defining proper use of detoxification drugs. Those guidelines were very restrictive with regard to age, drug abuse career and motivation towards abstinence, but to some extent the implementation of the guidelines proved to be unsuccessful and an increasing number of general practitioners and other medical doctors took to prescribing methadone on a long term basis to their drug abusing patients more or less according to rules.
The Danish counties were and are responsible for the social treatment of drug abuse, and long term methadone treatment was introduced on a trial basis primarily in Copenhagen, and also in counties with larger cities, in the late nineteen seventies. By the end of the decade approximately 500 drug abusers were being treated with long term methadone prescription mostly in general practice, and the number rose to approximately 3000 in the mid ninetieen.

 

Side effects

This development had some undesired side effects. Since most drug abusers were treated with methadone by general practitioners, the medication was unsupervised by staff, there was no correlated social support, and injection, side abuse, drug related death and illegal sale were not unusual.

 

New bill

Acknowledging these negative factors, the Danish Parliament passed a new bill effective from January 1st 1996. The aim of the bill is to ensure better treatment by directly observed therapy (DOT) and social support, and the main contents of the bill are:
In order to examine the preliminary effects of the new bill, three selected counties, Funen, Århus and Copenhagen have been asked to give information about:

 

Differences

It appears that there are major differences between the three counties in their ways of coping with the new legislation. The county of Århus, which is the second largest county in Denmark, is very restrictive in licensing general practitioners to continue methadone treatment, and the number of patients are significantly reduced. The county is intent on drug-free treatment and methadone is almost solely used for detoxification purposes. The public health sector treatment system has not been expanded. The same tendency can be seen in the county of Funen, where methadone treatment by general practitioners is virtually non-existent, but the county has almost doubled its treatment capacity.
The City of Copenhagen differs from the other two selected counties by more than doubling the public health sector treatment capacity and by allowing more general practitioners to continue methadone treatment. The control measures in Copenhagen are more relaxed and clients in public health sector treatment are allowed unsupervised medication primarily in the weekend.

 

Patients negative, GP's divided

The patients' reactions to being referred to treatment in the public health sector mostly negative, while the general practitioners are divided in their opinions. The amount of seizures of illegal methadone and the number of drug-related deaths nationwide decreased marginally from 1995 to 1996. The number of seizures of illegal methadone dropped from 380 in 1995 to 318 in 1996. The number of drug-related deaths was 274 in 1995 and 266 in 1996. It is not possible to deduce a definite tendency from these figures, but it is remarkable that a decrease in the amount of seizures of illegal methadone and the number of drug-related deaths has occured for the first time in seven years.

 

Conclusions

There are great differences in the way the new legislation is handled in Copenhagen and the counties of Århus and Funen. The control measures are less harsh in Copenhagen, and a larger number of general practitioners is licensed to continue methadone treatment. The overall reaction of the patients to being referred to public health sector treatment is mostly negative, while the general practitioners reaction are divided. The public health sector treatment capacity has been greatly increased in Copenhagen and the county of Funen. Drug-related deaths and seizures of illegal methadone have decreased marginally. The new legislation has been implemented. It is too early to judge the long term effects of the new legislation. It is important that research is carried out in order to secure a true picture of the effects on the drug abusing population.

back to contents no. 15