Treatment-related objectives in the Czech National Drug Policy Strategy 2010-18 and its action plans place emphasis on enhancing the availability and quality of drug treatment services, as well as supporting the social rehabilitation of drug users in the country. Drug treatment and care services are funded by subsidies from the Ministry of Health, the Ministry of Labour and Social Affairs, the GCDPC, regional and municipal administrations and health insurance companies. An independent agency is responsible for the accreditation of drug treatment at clinics and inpatient facilities.
In the Czech Republic, drug treatment is delivered through low-threshold harm reduction (drop-in) centres, specialised outpatient centres (specialised psychiatric or specialised non-medical centres), non-specialised psychiatric outpatient centres, psychiatric units in general hospitals, special units in psychiatric hospitals and non-hospitalbased residential treatment units, such as therapeutic communities.
The core drug treatment services are provided at outpatient and drop-in centres (approximately 250-300 programmes), while 50-60 programmes provide residential inpatient care.
Therapeutic communities generally have the status of social services, are operated by NGOs, and cater mainly for users of illicit drugs other than alcohol and, exceptionally, for pathological gamblers.
Almost half the facilities have professional competency certification by the GCDPC, and 40 % of the facilities are registered as social services.
OST, psychosocial support programmes and aftercare are available in these settings.
Inpatient services are divided into short-term (four to eight weeks), medium-term (three to six months) and long-term (seven months or more) services. Inpatient treatment includes detoxification; residential abstinence-oriented treatment; residential care based on the therapeutic community principle; and aftercare programmes; the treatment targets special groups, such as adolescents.
However, there are large variations at district level in the geographical accessibility of different drug treatment programmes, with detoxification and specialised aftercare programmes being among the least available. These differences are due to lack of appropriate healthcare facilities and a shortage of professionals willing to work with drug users.
Drug treatment in Czech Republic: settings and number treated
NB Year of data 2015.
A discussion on a psychiatric care reform strategy for 2014-20, led by the Ministry of Health, is ongoing in the Czech Republic. The reform is based on a new concept of a network of specialised addiction treatment services that has been adopted by the Committee of the Society for Addictive Diseases of the Czech Medical Association. It aims to shift the Czech treatment system further towards community-type care and introduce flexibility for service provision based on regional needs and priorities.
Trends in percentage of clients entering specialised drug treatment, by primary drug in the Czech Republic
NB Year of data 2014.
Opioid substitution treatment in the Czech Republic: proportions of clients in OST by medication and trends of the total number of clients
NB Year of data 2015.
Nearly 50 000 clients were treated in 2014. Most clients received treatment in outpatient services, while one out of five received treatment in inpatient units. Prison inmates constitute a small proportion of the total number of treatment clients who received drug treatment in custodial settings in 2014.
In the last decade, the number of clients entering treatment has been rising, mainly due to demands linked to methamphetamine (‘pervitin’) use, which is mainly injected, while treatment demands linked to opioid use (mainly heroin) have been stable. Polydrug use is common among clients entering treatment for methamphetamine use, and this sometimes includes heroin and misuse of buprenorphine.
OST using methadone was introduced in the Czech Republic in 1998. Five substitution agents are available: methadone, three buprenorphine medications and a composite sublingual preparation that contains buprenorphine and naloxone.
Methadone maintenance treatment is delivered in specialised psychiatric facilities and has also been available in prisons since 2009. OST with buprenorphine may be initiated by any medical doctor, regardless of his or her specialty. The estimated number of clients reported to be receiving OST has been stable since 2012, at approximately 4 000 clients annually. More than 80 % of OST clients receive buprenorphine-based medication.