The current national drug strategy puts an emphasis on (i) the expansion of the availability and affordability of drug treatment; and (ii) the provision of effective and diversified nationwide treatment, with special focus on polydrug users and those suffering from mental and/or physical comorbidity. Implementation of drug treatment is the responsibility of the Ministry of Health, while the Ministry of Justice plays a role in the provision of treatment in prisons; however, the Ministry of Social Labour, Social Affairs and Family is responsible for social reintegration and aftercare of children and young adults with drug-related problems.
The distinctive features of the Slovak drug treatment services are close links to mental health services and integration with treatment services for alcohol, which permits mental health issues among drug users and consequences related to polydrug use to be addressed.
Drug treatment in Slovakia: settings and number treated
NBYear of data 2015.
Trends in percentage of clients entering specialised drug treatment, by primary drug, in Slovakia
NBYear of data 2015.
Opioid substitution treatment in Slovakia proportions of clients in OST by medication and trends of the total number of clients
NBYear of data 2015.
In the health sector, outpatient treatment is provided by the specialised Centres for the Treatment of Drug Dependencies, a network of independent, mostly private, mental outpatient clinics, and outpatient units of psychiatric hospitals. Inpatient drug treatment is provided by the specialised wards in psychiatric hospitals, Centres for the Treatment of Drug Dependencies or psychiatric wards at university hospitals and general hospitals. Inpatient and outpatient drug treatment is funded by public health insurance, while residential care outside the healthcare sector is funded through local or regional budgets, co-financed to variable degrees by clients.
The Centres for the Treatment of Drug Dependencies are the main providers of all types of specialised drug treatment, while the mental outpatient clinics — available nationwide — offer outpatient diagnostic services, detoxification and long- term opioid substitution treatment (OST). In general, there is continuity between these two forms of the treatment.
Detoxification treatment is available in outpatient and inpatient treatment centres. Residential drug treatment is delivered in inpatient departments. Aftercare and social reintegration services for people who are drug dependent are provided by NGOs outside the healthcare sector, in residential facilities or through self-help groups. There are also recognised socialisation centres accredited by the Ministry of Labour, Social Affairs and Family.
OST with methadone has been available since 1997 and buprenorphine since 1999; the buprenorphine/naloxone combination was introduced in 2008. Methadone maintenance treatment dominates in the Centres for the Treatment of Drug Dependencies, while buprenorphine-based medication is provided on prescription by psychiatrists with a drug dependence treatment licence in outpatient psychiatric clinics.
In 2015, a total of 2 720 people entered treatment, which is an increase from 2014, and most of them were treated in outpatient settings.
More than 4 out of 10 new treatment clients cited stimulants as their primary substance of use, mainly methamphetamine. Many clients entering treatment for the use of methamphetamine were polydrug users, the majority of whom frequently combining the use of methamphetamines with cannabis, alcohol and sometimes with heroin. In 2015, the proportions of clients entering treatment who reported primary cannabis use and primary opioid use were similar. In general, the long-term trend indicates a reduction in opioid-related treatment entries in Slovakia, while cannabis-related treatment entrants have been increasing steadily in the past decade.
There is no complete reporting mechanism covering all OST providers and the prescription of both medications. It is estimated that 600 clients received OST in 2015.