Airi Partanen

From political controversy to a technical problem? Fifteen years of opioid substitution treatment in Finland

BACKGROUND The aim of the article is to analyze changes in opioid substitution treatments (OST) in Finland. OST spread in Finland in the late 1990s and early 2000s (Phase 1). Since then, OST has become an integrated part of Finnish drug policy and is provided in various substance abuse treatment units as well as in municipal health centers (Phase 2). METHODS The paper analyses the policy around the implementation of opioid substitution treatment in Finland, focusing on identifying the key factors and the relations between them that have contributed to the implementation of OST in Finland. RESULTS OST has become accepted in Finland during the past ten years as a crucial element of a harm reduction strategy. Present incentives behind this development are not as clearly related to drug-specific policies as in the late 1990s; rather, they stem from both the restructuring of health care services (e.g. cost-effectiveness) and the strengthening of the medical or technico-administrative approach to the development of OST. CONCLUSION Since the early 2000s, the development of substitution treatment in Finland has not taken place under explicit drug-political guidance, but largely as a result of many differing intended and unintended effects. One of the unintended effects is the fact that buprenorphine has replaced heroin as the most commonly misused opioid in Finland.

Administrative Challenges in the Finnish Alcohol and Drug Treatment System

This article examines the National Plan for Mental Health and Substance Use Work (the MIELI plan), published in Finland in 2009. We place the plan into a wider context of changes in Finnish social and health services and have also studied responses to the plan. The data is provided by national documents, complemented by an online enquiry and some journal articles as feedback material. The MIELI plan is implemented in conjunction with a municipal and service system reform in Finland. While the proposals of the plan clearly carry a potential for change in the treatment system, there are also great challenges. For instance, to what extent can this kind of plan influence reality? Can the proposals really change anything in the treatment system, or does the potential change emerge from elsewhere? Responses to the plan indicate that referral-free access to treatment, the principle of a single entry point and primary-level services in general were considered important proposals in the MIELI plan. At the other end of the scale, the implementation of the plan and its medical orientation were received less positively.

Opioid substitution treatment in Finland and other Nordic countries: Established treatment, varying practices

The authors would like to express their thanks to Helge Waal (Norway), Kirsten Frederik-sen (Denmark), Ulf Malmstrom (Sweden) and Valgerður Runarsdottir (Iceland) for searching data on Nordic countries, and to Anssi Vartiainen, Aila Ronkanen, Tarja Koskinen, Mia-Veera Koivisto, Martti Marila, Pasi Lehti, Paivi Martikainen, Tuomo Seppanen, Maiju Hakala-Kallio and Jukka Makinen for collecting the data concerning Finland.