Stakeholders’ Role in Contemporary “Substitute Drug” Prescribing Policies in Italy

Abstract

This article, part of a comparative research project (WP2) funded by FP7 ALICE RAP, is based upon a review of literature and documents and 18 individual interviews with Italian national stakeholders (SHs) conducted in 2012. The goal was to identify the main shifts in opioid “substitution drug” treatment policies and understand the role played by different SHs during the last 30 years. The study confirms that opioid “substitution drug” treatment is a particularly suitable theme for improving knowledge in the field of SH analysis, even if results show that changes in policies are mainly due to external factors rather than to the action of SHs.

Keywords: :

• agenda-setting
• policy window
• stakeholder analysis
• “substitution drug” treatment
• “substitution drug” treatment policies

Notes

1 For example, official reports, guidelines, and ministerial newsletters.

2 Italy, governed by stakeholder coalitions, has had more than 50 shorter term as well as longer term governments since WWII–more than any other country in the modern world.

3 Association of Radical Party

4 Association of Transnational Non-Violent Radical Party (NGO)

5 The referendum promoted by the Radical party was primarily aimed at the decriminalization of the personal use of drugs. It achieved that the purchase and possession of drugs for personal use was punished by a fine. According to the Italian Constitution, the referendum has to be proposed by 500,000 citizens with the aim of repealing a law or a part of a law.

6 See for example, Ministero della salute (1994). Circ. n. 20 in 1994—Guidelines for the treatment of opiate addiction with substitution drugs.

7 Coordinamento Medici di Base per l'Assistenza Territoriale alla Tossicodipendenza (GPs Coordination for drug addicts local assistance).

8 According to the last Report on Addiction to the Parliament (2012), in 2011 the process of substitution treatment was: short-term (16.3%), medium-term (23.5%), long-term (60.2%).

9 In Italy the two basic sources are, one national producing methadone (Molteni) and the latter multinational producing buprenorphine (Reckitt Benckiser).

10 2001–2005; 2005–2006; 2008–2011.

11 For example, the diffusion of the WHO Guidelines by the Istituto Superiore di Sanità (National Health Institute) (2009), or the Guidelines disseminated by the DPA (2009),

12 The scientific committee is actually composed of 11 members of which 6 are foreign and in particular from USA (5). http://www.politicheantidroga.it/organismi/membri-comitato.aspx

13 For example, for many years the UN Office on Drugs and Crime (UNODC) was directed by an Italian; an Italian professor has been President of the European Opiate Addiction Treatment Association (EUROPAD) since its foundation in 1994 and is president of the World Federation for the Treatment of Opioid Dependence.