Czechia Country Drug Report 2019

Treatment

The treatment system

Treatment-related objectives in the Czech National Drug Policy Strategy 2010-18 and its action plans place an emphasis on enhancing the availability and quality of drug treatment services, as well as supporting the social rehabilitation of people who use drugs in the country. Drug treatment and care services are funded by subsidies and grants from the Ministry of Health, the Ministry of Labour and Social Affairs, the Government Council for Drug Policy Coordination, and regional and municipal administrations, as well as payments from health insurance companies. An independent agency is responsible for the accreditation of drug treatment at clinics and inpatient facilities. In Czechia, drug treatment is delivered through low-threshold harm reduction (drop-in) centres, specialised outpatient centres (specialised addiction treatment or specialised non-medical centres), non-specialised psychiatric outpatient centres, psychiatric units in general hospitals, special units in psychiatric hospitals and non-hospital-based residential treatment units, such as therapeutic communities.

The core drug treatment services, called ‘addictological services’ (272 programmes in total), are provided mainly in outpatient and drop-in (harm reduction) centres, and 50-60 of them provide residential care. Therapeutic communities (19 programmes) generally have the status of social services and are operated by non-governmental organisations; they cater mainly for users of illicit drugs. Specialised aftercare outpatient programmes are available, some of which provide sheltered housing.

Inpatient treatment includes detoxification, residential abstinence-oriented treatment and residential care based on the therapeutic community principle. However, there are significant variations at district level in the geographical accessibility of different drug treatment programmes, with specialised outpatient addiction treatment, detoxification and specialised aftercare programmes among the least available. Opioid substitution treatment (OST) using methadone was introduced in Czechia in 1998; it is delivered in specialised psychiatric facilities and has been available in prisons since 2009. Five substitution agents are available: methadone, three buprenorphine medications and a composite buprenorphine and naloxone preparation. OST may be prescribed by any medical doctor.

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Treatment provision

An estimated 41 000 clients were treated for drug problems in 2017. Most clients received treatment in outpatient services, whereas one in five received treatment in inpatient units. Prison inmates constitute a small proportion of the total number of treatment clients who received drug treatment in 2017.

2017, around half of the clients entering treatment reported primary use of methamphetamine (pervitin), which is mainly injected. The other half reported primary use of opioids, mainly heroin, cannabis and other substances. Polydrug use is common among clients entering treatment for methamphetamine use and this sometimes includes the use of heroin and the misuse of buprenorphine. A new treatment register was recently launched, with changed reporting practices; data are reported predominantly from treatment services since 2015. Given this, caution is needed when assessing trend data since 2014.

The estimated number of clients reported to be receiving OST was around 5 000 in 2017, with the majority receiving buprenorphine-based medication.

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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.