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 a 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; however, the Ministry of 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.
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 health outpatient clinics, and outpatient units in psychiatric hospitals. Inpatient drug treatment is provided by specialised wards in psychiatric hospitals, Centres for the Treatment of Drug Dependencies or psychiatric wards in 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 varying 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 health 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 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 non-governmental organisations 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 with buprenorphine since 1999; the buprenorphine/naloxone combination was introduced in 2008. Methadone maintenance treatment dominates in Centres for the Treatment of Drug Dependencies, while buprenorphine-based medication is provided on prescription by psychiatrists with a drug dependency treatment licence in outpatient psychiatric clinics.
In 2015, the majority of people who entered drug treatment were treated in outpatient settings.
More than 4 out of 10 new treatment clients indicate stimulants as their primary substance of use, mainly methamphetamine. Many clients entering treatment for the use of methamphetamine are polydrug users, the majority of whom frequently combine it with cannabis, alcohol and sometimes heroin. In 2016, the proportion of clients entering treatment who reported primary opioid use slightly increased compared with the previous year, while the proportion of clients reporting primary cannabis use remained stable.
In 2016, 642 clients received OST in Slovakia, mainly methadone.