Opioid Consumption and Substitution Treatment in Finland and Sweden

While heroin use is on the decline in some Member States, heroin and other opioids still account for most of the drug-related morbidity and mortality in the European Union. This case study looks at two Nordic neighbours that are quite similar by a number of socio-economic measures, but have had different experiences with opioids over the past two decades: Finland and Sweden. Indicators from both countries suggest heroin use has decreased since the late 1990s; however, the size of the decline in heroin use has differed considerably. In Finland, problem heroin use, which has always been comparatively low in European terms, is nowadays extremely rare, whereas in Sweden, its abuse continues to be much more frequent than in Finland. Both countries started prescribing buprenorphine to treat heroin dependence in the late 1990s, but with different consequences. In Finland, buprenorphine abuse largely replaced heroin abuse and is now the main reason for individuals seeking treatment as well as the leading cause of drug-related death. This has not been the case in Sweden, where mortality figures attributable to buprenorphine are lower than in Finland, even though the extent to which buprenorphine is abused is Sweden could be somewhat underreported, as abusers of this drug do not usually qualify for OST programs. This chapter seeks to develop plausible hypotheses to account for the observed differences in opioid-consumption prevalence between the countries. At this stage the available data do not permit adequate testing of the different hypotheses advanced.