The state of addiction treatment in Poland

August 20, 2013

The Polish model of addiction treatment is facing deepening trouble. The consequences are serious and largely irreversible.

Polish society has a harmful belief that therapy based on isolation is the only proper form of treatment. The poor financial situation of outpatient clinics, driven by this belief, prevents them from responding quickly and effectively.

Polish therapists – despite contradictory scientific data – only acknowledge the objective of abstinence, though abstinence is often an impossible goal. Furthermore, the exclusive pursuit of that goal leads to similar failures, while success is only rarely achieved.

This is especially worrying in the light of successful substitution programs, static treatment centres and ambulatory outpatient clinics - which are well-functioning, proven tools in harm reduction, peer education and at the end of the day, in reducing demand for psychoactive substances.

Moreover, we could achieve these goals with the available resources, through better-targetted organisational financing across the country. It is important to stress that the Polish treatment system does not need more funds, but better financial distribution.

Take for example injecting drug users. Six years ago, in Poland there were about 25-30,000 people living with opiate addiction. By 2009, this figure had reduced to 15,000 - mainly, according to NGOs in the field, because of the high mortality rate among injecting users. Though according to official state statistics, the annual number of deaths among drug users is around 2-300.

The official statistics, however, only reflect deaths directly attributed to drug use, such as overdoses. They do not take into account deaths caused by other factors, such as addiction-related diseases. According to Polish experts, the real mortality figures would be several times higher then the official statistics.

In Poland, people living with illegal psychoactive substance addictions are treated primarily in static treatment centres based on the abstinence approach mentioned above. Around 15,000 people go through this system every year. But these abstinence-oriented treatment centers do not deliver significantly better results than so-called self-cures. Comprehensive data from 30 static treatment centres shows that in one in three centres there were 0.8 patients for 1 therapist, clear evidence of overstaffing. But more worryingly, there are hundreds of patients who have completed the program several times, returning to the treatment system over and over again.

Ultimately, methadone maintenance treatments - which by nature has to be seen as a sustaining treatment - should not be based on abstinence as the primary goal, but as a tool to help patients achieve a better quality of life and improve their health.

On top of the misguided objective, only about 1,700 people are receiving substitute treatment - nearly half of them living in the capital city, Warsaw. As a result, methadone substitution therapy is only available to about 11 percent of the 15,000 opioid users in Poland.

Agnieszka Sieniawska/Warsaw
Polish Drug Policy Network