Opioid agonist treatment – the current situation in Europe (European Drug Report 2025)
Opioid users represent the largest group undergoing specialist drug treatment, mainly in the form of opioid agonist treatment. On this page, you can find the latest analysis of the provision of opioid agonist treatment in Europe, including key data on coverage, the number of people in treatment, pathways to treatment and more.
This page is part of the European Drug Report 2025, the EUDA’s annual overview of the drug situation in Europe.
Last update: 5 June 2025
Opioid treatment access remains low in some EU countries, as new challenges emerge
While a greater diversity of people now seek help for drug problems, the long-term nature of opioid agonist treatment means that those receiving it still account for a significant share of the resources invested in drug treatment services in many countries. Despite this, access to opioid agonist treatment varies across the European Union and in some countries it is inadequate. Moreover, our responses to opioid dependence are further challenged by emerging shifts in the opioid drug market, potential impacts on the optimisation of treatment and challenges related to the treatment systems’ workforce.
An estimated 1.7 million people received treatment for problems related to the use of illicit drugs in the European Union in 2023 (2.1 million, including Norway and Türkiye). Specialist drug treatment encompasses a range of medical (including pharmacological), psychological, social and behavioural approaches to stop or reduce drug use and injecting. Overall, an estimated half a million high-risk opioid users in the European Union received some form of opioid agonist treatment, which remains the main pharmacological treatment approach for people with opioid dependence and may be combined with psychosocial interventions.
Treatment goals and outcomes can vary considerably, depending on the type of intervention and client needs. Goals of treatment can range from abstinence or reduction of illicit drug use to prevention of harms, social reintegration and recovery.
Recent guidance from the EUDA and ECDC on the prevention and control of infectious diseases among people who inject drugs recommends the provision of opioid agonist treatment, in both community and prison settings, to prevent transmission of HCV and HIV and to help reduce injecting risk behaviour and injecting frequency. The guidance also recommends the provision of sterile injecting equipment alongside opioid agonist treatment to maximise the coverage and effectiveness of the interventions among people who inject opioids (see also Injecting drug use – the current situation in Europe and Drug-related infectious diseases – the current situation in Europe).
There remain, however, differences between countries in the settings and form in which treatment is provided and the extent to which the availability of opioid agonist treatment is sufficient to meet the needs of those requiring this form of care. The provision of opioid agonist treatment remains insufficient and below the levels recommended by the WHO in some EU Member States that report a high prevalence of high-risk opioid use (see Key data and trends, below).
The balance between outpatient and inpatient provision within national treatment systems also varies greatly between countries. About 13 % of drug treatment in Europe is provided in inpatient settings, mainly hospital-based residential centres, such as psychiatric hospitals, though also in therapeutic communities and, in some countries, specialist residential treatment centres in prisons. Overall, however, opioid agonist treatment is more commonly provided in outpatient settings. These can include specialist drug treatment centres, low-threshold agencies, and primary healthcare centres, which can include general practitioners’ surgeries. Some countries also introduced more flexible outpatient treatment options during the COVID-19 pandemic, with many of these still in place. In addition, a small number of countries also began providing new modes of treatment administration, such as extended-release formulations of buprenorphine, allowing clients to have sustained opioid agonist treatment with a single monthly injection. Although more research is needed, emerging evidence indicates that this modality may help alleviate pressure on prescribers by reducing the number of visits each client requires, and may also support the extension of coverage to rural or remote areas. The diversity of providers, regardless of the medication, presents a challenge for the monitoring of opioid agonist treatment provision and client characteristics. In some countries, there are signs of a reduction in the addiction treatment workforce, with some treatment personnel, such as general practitioners, not being replaced as they retire or leave the service, potentially challenging the ability of treatment systems to provide care.
Opioid treatment clients now have more complex needs
The long-term nature of opioid problems is underlined by the data available on the characteristics of those receiving opioid agonist treatment. The data also indicate that Europe’s cohort of those who have had problems with heroin is ageing. This is illustrated by the fact that almost 70 % of clients in opioid agonist treatment are now aged 40 or older, while less than 10 % are under 30 years old. This has important implications for service delivery and costs, with providers now having to address a more complex set of healthcare needs in a population that is becoming ever more vulnerable. An important consideration here is the need to ensure the existence of effective referral pathways to more generic services offering treatment for other conditions associated with the ageing process. This is becoming increasingly necessary in order to support older opioid treatment clients in need of geriatric care due to the long-term effects of illicit drug use, but also tobacco and alcohol use, on their physical health. The treatment of this marginalised group also needs to respond to a complex and often long-established set of problems related to mental health issues, social isolation, employment and housing. The development of integrated, multidisciplinary and age-specialised care services for this group will remain an important consideration in policy and provision as the demographics of opioid use in Europe continue to change.
Polysubstance use and the appearance of highly potent new synthetic opioids on local drug markets can increase the risks from opioid use, especially for older people and those with complex healthcare needs. Where highly potent new synthetic opioids may be becoming more established in some drug markets, more research is needed to determine if adaptations are needed to ensure that current approaches to providing opioid agonist treatment remain optimal. Concern has been raised by the continued presence of fentanyl, carfentanil and nitazenes in some European countries. In addition, the evolving situation regarding heroin trafficked to Europe from Afghanistan has added further uncertainty to the assessment of Europe’s drug markets. If heroin availability in Europe is reduced, one consequence may be an increase in the need for care among people using highly potent opioids. This raises the question of the options available to drug treatment systems to help those dependent on such drugs. Although clinical practice in America is beginning to provide insights into the role that methadone and buprenorphine might play in treating a population who have switched from heroin to fentanyl, no evidence-based protocols currently exist. Policy and financial support are needed for further research, especially randomised controlled trials, to establish the potential utility of new approaches with existing medications in drug treatment systems.
The number of younger people receiving opioid agonist treatment remains relatively low and stable. This may be explained by a lower initiation of opioid use among young people and ageing cohorts of clients in opioid agonist treatment. However, a relatively high proportion of opioid-related fatal overdoses among people under 30 years old is reported by some countries, including Germany, Austria and Finland, and may indicate that barriers to accessing opioid agonist treatment still exist for this age group (see Drug-induced deaths – the current situation in Europe). Challenges here may include low treatment retention rates among young people, negative perceptions of opioid agonist treatment, a reluctance to prescribe among some service providers and a lack of age-appropriate treatment settings.
More information on health and social responses to opioid use, including among older people, can be found in the EUDA’s Health and social responses to drug problems: A European guide.
Key data and trends
Number of people in treatment
- Overall, opioid agonist treatment was received by over half of the estimated 860 000 high-risk opioid users in the European Union in 2023, an estimated 511 000 (523 000 including Norway and Türkiye) (Figure 12.1). However, there are differences between countries. In those countries where data from 2012 or 2013 are available for comparison, there was generally an increase in coverage. Levels of provision, however, remain low and insufficient in some countries estimated to have significant numbers of high-risk opioid users, such as Latvia, Lithuania, Poland, Romania and Slovakia (Figure 12.2).
- Data from countries that consistently reported on clients receiving opioid agonist treatment between 2013 and 2023 show an overall stable trend in treatment levels during this period, with little fluctuation in the number of clients receiving this treatment. The reasons for this stability vary. In countries with high treatment provision, it may reflect the often chronic, relapsing nature of opioid dependence and the need for treatment over a prolonged period; in others (e.g. Latvia), it may reflect the low capacity of treatment systems.
- In some countries, the number of people receiving opioid agonist treatment has increased, reflecting increased treatment provision, with 10 countries reporting an increase between 2018 and 2023, including Finland (75 %), Poland (50 %), Cyprus (20 %), Sweden (16 %) and Malta (15 %).
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Pathways to treatment
- Self-referral continues to be the most common route into specialist drug treatment for opioid clients. This form of referral, which also includes referral by family members or friends, accounted for about two thirds (64 %) of those with primary opioid problems entering specialist drug treatment in Europe in 2023. More than one fifth (23 %) of clients were referred by health, education and social services, including other drug treatment centres, while 7 % were referred by the criminal justice system.
Opioid agonist medications
- The provision of more than one opioid agonist treatment medication in 2023 is reported by 25 countries. Methadone is the most commonly prescribed medication, received by more than half (55 %) of opioid agonist treatment clients across Europe. Another 35 % are treated with medications based on buprenorphine, which is the principal medication reported to be used in 9 countries. Other substances, such as slow-release morphine or diacetylmorphine (heroin), are more rarely prescribed, being received by 10 % of opioid agonist clients in Europe. Seven countries have reported some provision of heroin-assisted treatment, if discontinued pilot projects are included.
- Five countries report the use of newer buprenorphine preparations: a prolonged-release solution for injection, and a subcutaneous implant. These preparations received a marketing authorisation valid throughout the European Union in 2018 and 2019, respectively.
Alternative treatment options
- Although less common than opioid agonist treatment, alternative treatment options for opioid users are available in all European countries. In the 11 countries for which data are available in 2023, between 3 % and 47 % of all opioid users in treatment receive interventions not classified as opioid agonist treatment, such as medically assisted detoxification and outpatient or inpatient abstinence-oriented interventions.
Source data
The data used to generate infographics and charts on this page may be found below.
The complete set of source data for the European Drug Report 2025, including metadata and methodological notes, is available in our data catalogue.
A subset of this data, used to generate infographics, charts and similar elements on this page, may be found below.