Evaluation of addiction services in Cyprus

Abstract

In April 2007 a European twinning project started between Cyprus and Germany, in order to assist Cyprus in the implementation of adequate drug services and harmonisation with the European Community’s legislation. The overall objective of the twinning project was to enhance the capacity of the Mental Health Services (MHS), a body of the Ministry of Health, as regards the implementation of a continuum of care for drug addicts. Hereby, the evaluation of the governmental and non-governmental drug services in Cyprus and their coordination, as well the improvement of existing and the introduction of new drug treatment services were main targets. The evaluation of this process was undertaken by a team of German experts. A field investigation studied parameters as population in need, treatment demand and coverage, showing an individual place of Cyprus in the international drug ranking, with cannabis being the most widespread illicit substance used by adults (last-month prevalence). However, the life-time prevalence for cannabis use was among the lowest compared to other European countries. But while the life-time prevalence of illicit drug use among the general population in Cyprus is comparable low, the last month prevalence is relatively high, especially for amphetamines, cocaine and ecstasy. In particular the last month use of ecstasy (0.8%) among young population was on top in Europe. The last month prevalence is one indicator for current drug use, therefore showing the extent of treatment needs within a community. Considering the high last month prevalence, it can be assumed that current users might develop a problematic drug use and are consequently a target group for drug services. Nevertheless heroin remains the primary drug of abuse in persons seeking treatment, although Cyprus was until 2008 the only country of the European Union without a substitution treatment. In comparison with other European countries, current heroin injecting is on the highest level along with countries such as Czech Republic, Latvia, Lithuania and Bulgaria. In 2007 there were 20 treatment units located mainly in the capital Nicosia but also in Limassol, Larnaka and Pafos. In relation to the estimated total number of problem drug users, the treatment coverage in Cyprus accounts for 59%. In 2006, 560 drug users made use of one of the six governmental drug services. The clients were on average 28 years old and 87% of them were male. For 41% of the clients it was the first contact with addiction services. In the last years the number of new clients increased, implying that the total number of drug users in Cyprus may have increased as well. Among all clients, heroin users were the main group (55%) requesting treatment. Cannabis users were the second main client group accounting for one fourth of all clients, followed by cocaine users, representing 15% of all clients in treatment. Within the period from 2001 to 2006 the number of new clients with primary use of cannabis increased from 30% to 43%, a high number when compared with other European countries. In the same period the number of new clients with primary use of cocaine tripled up to 18%. The proportion of new clients with heroin use decreased from almost 53% to 35%. The coverage and gaps in the Cyprus treatment system were evaluated with special attention drawn to the concordance with standards for drug treatment services within the European Union. The evaluation of the current situation as to health policy tasks, coverage and functioning of the current drug treatment services, and the assessment of the existing drug services as regards European standards resulted in the elaboration of recommendations, which describe future demands for an improvement of the drug treatment policy in Cyprus. Cyprus belongs to the EU countries where the provision and financing of drug treatment services is provided by both public agencies and NGOs. With the introduction of high-dosage buprenorphine maintenance treatment in Cyprus in 2007, substitution treatment is now available in all Member States. Nevertheless, Cyprus shows a poor diversification of treatment provision and services in comparison to other EU Member States. Thus, suggestions were aimed at more harm reduction measures, including maintenance treatment with other substances, and a good balance between multifunctional services with a low threshold and specific treatment options. In addition, Cyprus does not manage to keep up with international standards concerning specific target group specialised treatment options: Gender specific programmes for women, special migrant programmes, prison-based substitution treatment and other harm reduction programmes are lacking. There is also a lack of communication between the involved public bodies, which limits an effective planning and coordination of drug treatment. Finally, there is no clear structure for the distribution of the budget, while the strategic planning of the national drug policy remains unclear. The Cypriot addiction services offer the presuppositions for an efficient and good functioning drug care system in the future. As drug services in Cyprus are still adapting to the increasing special needs of the population, an evaluation can guide needed reforms to achieve a more efficient system. Some crucial changes with respect to the structure and coordination of the facilities, in combination with a redefinition of several objectives, in order to cover existing gaps in the treatment offer, can guarantee the continuity of care within a drug treatment conformed to the international state of the art.