Where can we obtain information on treated drug users from?
Following European standards Treatment Demand Indicator (TDI) data collection started in 2005 in Hungary. On the basis of legal obligation all treatment units – both health and social ones – have to fill in a so-called TDI datasheet every time a new client starts drug treatment in the facility. The datasheet, which includes questions on the treatment episode, on social-demographic characteristics and patterns of use of the client, has to be filled in at the 2nd or 3rd face-to-face meeting with the drug user. Data then has to be forwarded to the National Centre for Addiction quarterly. National Centre for Addiction with the assistance of the Hungarian National Focal Point compiles, cleans and processes data annually. Clients are recorded by an individual identification code that protects their anonymity but provides the possibility to follow the clients in the data (e.g. to control annual data for reoccurring cases). Data presented below cover clients starting drug treatment in the given year therefore valid conclusions can be drawn only with the reference to this population.
How many clients entered drug treatment in 2015?
In 2015 the 79 treatment units reporting to the TDI system reported on 4308 clients entering treatment due to drug use. 90.5% of all the clients (3900 out of the 4308 persons) started treatment at specialised outpatient units, low threshold service providers or at general/mental health care service providers. In the scope of outpatient treatment 2780 persons started treatment as an alternative to criminal procedure (QCT).
European comparative data
What is the proportion of clients starting treatment as an alternative to criminal procedure?
The majority of entering treatment in Hungary is linked to the legal possibility of treatment/preventive interventions that may be used as an alternative to criminal procedure. The total number of treatment entrants in a given year is affected by the changes in the legal conditions and availability of quasi-compulsory treatment (QCT), and also by the activity of law enforcement bodies.
In 2015 64.9% of all clients (2780 persons) entered treatment in the scope of QCT.
What are the most commonly reported primary substances?
The majority (56.2%) of those starting treatment due to drug problem – similarly to previous years – started a treatment programme because of cannabis use. 16.6% started treatment because of amphetamine type stimulants use, including ecstasy. 5.2% of the clients entered treatment because of the use of hallucinogens. . Opioid use was the reason for starting treatment to a less significant extent (3.6%). The proportion of cocaine and ecstasy users was around 2% each. 12.1% of treatment entrants indicated the use of ‘other’ non-categorisable substances as their primary substance.
The distribution according to primary drug also shows a different picture among those starting treatment as an alternative to criminal procedure (quasi-compulsory treatment, QCT) and those starting for other reasons. In the case of those in QCT the most marked difference is the extremely high proportion of cannabis users (69.7%). This was also the most characteristic primary drug among those starting treatment for other reasons, but among them the proportion was just 31.1%.
What changes could be observed among injecting drug users (IDUs) seeking treatment over the past years?
With some delay, but by 2013 the change could also be seen among those starting treatment, which had been observed earlier in the other data sources: namely the decline in the use of opioids – primarily heroin – and the increase in the use of designer stimulants among injecting drug users.
Before 2010 90% of injecting drug users were using heroin and/or amphetamine. Between 2009 and 2015 the proportion of those injecting primarily heroin decreased from 70% to around 32% while the proportion of those injecting other stimulants or other non-specified substances in total was greater than the proportion of those injecting heroin.
What characteristics can be observed among injecting drug users (IDUs) seeking treatment?
Among the users of new substances the proportion of the very young (under the age of 20) is higher than among the users of classical substances, and the treatment demand in the case of the use of new substances appears earlier. Those IDUs who reported having used primarily new psychoactive substances also reported using their substance on a daily basis or several times a week in a greater proportion. Among IDUs starting treatment, the highest proportion of those injecting every day or 2–6 days a week is among those injecting designer stimulants (73.9%) (other stimulants + other non categorisable substances) as compared to those injecting heroin (69.1%) and amphetamine (51.1%).
What trends can be observed among clients entering treatment?
Among both first-time treatment entrants and all clients cannabis use is the most typical problem linked to treatment demand, especially among those starting treatment as an alternative to criminal procedure (QCT). In general the majority of clients start treatment in order to avoid criminal procedure.
The other noticeable trend is the marked increase in ‘other substances’ from 2010 onwards considering the primary drug of treatment entrants. This phenomenon is obviously linked to the spreading of NPS. Among all treatment entrants, a decrease in treatment demands linked to opioids can be seen starting from 2009.
Treatment due to new psychoactive substance use may supposedly be reported under three categories in the TDI system (TDI v2.0). The category ‘other stimulants’ covers cathinones and other stimulants, ‘other hallucinogens’ covers synthetic cannabinoids, and ‘other drugs (not classified)’ may also be dominated by treatment demand for new psychoactive substance use. Even if taking methodological uncertainties into account it is noteworthy that these three categories altogether stand for about 40% of all treatment demand in 2015.
There is no significant difference in the trends by primary substance regarding all clients and clients entering treatment for the first time because of the dominance of QCT.
Facts and figures on substitution treatment
What kinds of opiate substitution treatment (OST) programmes are available in Hungary?
Methadone treatment was introduced in 1995 in Hungary. The product is financed by the National Health Insurance Fund since 2002. In 2007 the palette of OST programmes for opiate addicts was extended by buprenorphine/naloxone treatment. Since 2008 the preparation is also financed by the National Health Insurance Fund.
What regulates the content of OST programmes?
The first methadone programmes started to operate in 1995. The first professional protocol was issued in 2002. Currently substitution treatment programmes operate according to the ‘Professional treatment protocol of the Ministry of Health for opiate use related problems’ and the ‘Methodological letter of the Ministry of Health on methadone treatment’.
How many treatment centres provide methadone and buprenorphine/naloxone treatment in Hungary?
In 2015 the number of treatment centres providing opiate substitution treatment in the country was 15. The therapy is typically provided in the scope of outpatient treatment, but there are some service providers who provide this pharmacologically assisted therapy in the scope of inpatient treatment (in a hospital or therapeutic community).
How many clients received opiate substitution treatment (OST) in 2015?
Service providers participating in the national data collection on substitution treatment reported a total of 669 clients, that covers around 80% of all the clients according to expert estimates.
95.2% (637 persons) of those receiving methadone or buprenorphine/naloxone treatment received their substitution drug as maintenance treatment and 4.8% (32 persons) received it for the purpose of detoxification. 79.7% of the clients in maintenance treatment were given methadone which is quasi equal to the previous years’ results. Buprenorphine/naloxone may be prescribed so that the medication is financed by the patient, which makes possible to treat clients who are willing to undertake the costs but otherwise would not obtain it due to the limited treatment capacities.
European comparative data on the number of clients in OST
What trends can be observed in the numbers of clients?
The number of those treated in OST was relatively stable over the studied years: there was a minor increase following 2008, which can be linked to the introduction of buprenorphine/naloxone (and the introduction of the possibility of self-financed treatment), then a development in methodology of data collection, which caused a decrease in 2011. The reason for the relatively stable availability is that the financed treatment capacity has not changed over the years. The last estimate on the number of heroin users in Hungary was made in 2013 with respect to 2010-2011. On the basis of this in 2010 those receiving substitution treatment represented 22% of the total number of heroin users.
