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.