Opioid* Substitution Treatment (OST): A French/Portuguese Lesson for Norway and Others

Opioid dependency is a chronic relapsing disease, with danger of overdose when the tolerance is lost. What is optimal handling in a mess of confusing factors? I have found clues to this from the annual reports on drug issues of the European Union (EU) with its 28 member countries – from their drug addiction agency (EMCDDA), based in Lisbon, Portugal. Norway has a costly opioid substitution treatment (OST) program with very high drug related death (DRD) rate, and due to my personal experience as a general practitioner (GP), I have been curious to find out why this is the case. I have elaborated EU statistics on DRD, in order to compare trends, related to populations and the type of OST in 20 out of 28 EU countries. I have included non-member Norway, which also reports drug statistics to EU. After 1990 with the HIV-epidemic, heroin substitution with a safe opioid drug was mobilized to combat injecting practice and criminality. The traditional methadone (MDN) became challenged by buprenorphine (BPN), first in France from 1996; 10 years later the BPN alternative with naloxone (BPN-X) became a supplement in Europe. All types of different methods were evolved, each country sticking only to one. OST differ mainly in two aspects: