Croatia Country Drug Report 2018

Treatment

The Strategy on Combating Drug Abuse 2012-17 and the related action plan emphasise the enhancement of treatment quality to meet clients’ needs. In Croatia, treatment is primarily implemented in the healthcare system and certain forms of psychosocial treatment are also available through the social welfare system, in therapeutic communities and associations, and in the prison and probation systems. In addition, treatment of minors or young adults is also provided in homes for children without adequate parental care and for children and young people with behavioural disorders.

Treatment services carried out under the authority of the state are funded by the Ministry of Health, the counties and the Croatian Institute for Health Insurance. Therapeutic communities and some associations are funded by the Office for Combating Drug Abuse of the Government of the Republic of Croatia, the responsible ministries, the counties and other donors.

The central element of the Croatian drug treatment system is the provision of care through outpatient treatment facilities and primary healthcare, although hospital-based inpatient treatment and therapeutic communities are also available. Outpatient treatment is organised through a network of services for mental health promotion and dependence prevention at county institutes of public health. These services include individual and group psychotherapy, prescription of and continuation of opioid substitution treatment (OST) and other pharmacological treatments, testing, and counselling on a wide range of issues. Owing to the characteristics of the treatment population, medication-based treatment (namely OST) is the most common treatment modality. Outpatient drug treatment is also provided by some associations that provide psychosocial treatment alongside social reintegration interventions and some outpatient units in general hospitals. Inpatient treatment is provided by hospitals and covers detoxification, adjustment of pharmacotherapy, drug-free programmes, and individual and group psychosocial treatment. Therapeutic communities offer long-term rehabilitation options. Psychosocial treatment, focused on improving the interpersonal relationships and life situations of clients, can be provided as part of a drug-free treatment approach, and this frequently complements OST and other treatment forms.

OST using methadone was introduced in 1991, buprenorphine was introduced in 2004 and Suboxone was introduced in 2009. The costs of the treatment are covered by the Croatian Institute for Health Insurance. Only specialised office-based medical doctors (e.g. psychiatrists and, in exceptional cases, some other specialists trained in the prescription of OST) and treatment centres can prescribe OST. However, this treatment is predominantly administered by general practitioners (issuing of prescriptions and dispensing of treatment).

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Treatment provision

Overall, available data indicate a decline in the number of people in drug treatment in Croatia in recent years. The majority of those who received treatment in 2016 were treated in outpatient settings. In terms of the primary drug, opioids, mainly heroin, remain the most common primary problem drug among all clients entering treatment.

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Most clients who seek treatment as a result of opioid use are treated with OST. Data indicate that the number of OST clients increased up to 2012, followed by a slight reduction in the number of treated clients. In 2016, most of the 4 256 clients enrolled in OST received treatment with buprenorphine-based medications.

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Methodological note: Analysis of trends is based only on those countries providing sufficient data to describe changes over the period specified. The reader should also be aware that monitoring patterns and trends in a hidden and stigmatised behaviour like drug use is both practically and methodologically challenging. For this reason, multiple sources of data are used for the purposes of analysis in this report. Caution is therefore required in interpretation, in particular when countries are compared on any single measure. Detailed information on methodology and caveats and comments on the limitations in the information set available can be found in the EMCDDA Statistical Bulletin.