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Drug treatment overview for Slovakia

Map of Slovakia

1. National context

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, but the Ministry of Social Welfare and Family is responsible for social reintegration and aftercare of children and young adults with drug-related problems.

Within the health sector, treatment is delivered through five public specialised Centres for the Treatment of Drug Dependencies, mental outpatient clinics, psychiatric hospitals, and psychiatric wards at university hospitals and general hospitals. Private providers also deliver drug treatment. The distinctive features of the Slovak drug treatment services are close links to mental health services and integration with treatment services for alcohol addiction, which allows mental health issues among drug users and consequences related to polydrug use to be addressed. 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, with variable degrees of clients’ co-financing.

Centres for the Treatment of Drug Dependencies are the main providers of all types of specialised drug treatment, while 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, as clients who have initiated their treatment journey in an inpatient facility frequently continue their treatment programmes in outpatient settings. Physicians, psychologists, nurses and psychotherapists provide outpatient treatment as a systematic therapeutic service.

Drug-free treatment can be divided into two stages: detoxification and relapse prevention. Detoxification treatment is available in outpatient and inpatient treatment centres, and as a rule is pharmacologically assisted. Motivational enhancement therapy, cognitive behavioural therapy and structured relapse prevention are the main elements of psychosocial interventions. Residential drug treatment is delivered in inpatient departments, at specialised dependency treatment departments of psychiatric hospitals, and in Centres for the Treatment of Drug Dependencies, which are specialised psychiatric institutes. 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.

A legal provision exists in Slovakia to order compulsory drug treatment in a prison environment, and in public healthcare facilities after a sentence is completed; however, the rationale for this and the effectiveness of the measure is being widely debated among professionals and several studies on the topic were reported in the 2012 National report. Moreover, the treatment monitoring data indicate that the majority of clients enter treatment on voluntary basis.

Specialised drug addiction treatment facilities provide OST. Methadone maintenance treatment (MMT) has been available since 1997 and buprenorphine since 1999. In 2008 the buprenorphine/naloxone combination was introduced; it can be prescribed by psychiatrists who hold an additional licence to treat drug dependencies or by psychiatrists working at Centres for the Treatment of Drug Dependencies. OST is not available in prisons. Taking into account high co-dependence from amphetamine-type stimulants, alcohol and cannabis among opioid users in Slovakia, the OST programmes offer psychological and psychosocial services that aim to decrease and stop the use of other illicit and licit substances in addition to opioids.

In 2013 a total of 408 clients were in OST, and almost all of them received methadone.

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2. Treatment registries and monitoring systems

All the healthcare facilities in Slovakia including out- and inpatient treatment services and treatment in prison are obliged by law to report a treatment of drug addicts according to the Treatment Demand Indicator (TDI) protocol. (100% coverage). However, this protocol does not distinguish whether the client receives medically-assisted or drug-free treatment. Therefore, no special register exists for clients in medically-assisted, drug-free or substitution treatment.

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3. Treatment demand

Table 1: Number of clients entering treatment in Slovakia by year
Clients in treatment 2010 2011 2012 2013
Number of all clients entering treatment 2266 2313 2193 2484
Number of all clients entering treatment with known primary drug 2097 2052 2004 2263
% of which for opioid use 38.2 33.7 26 24.7
% of which for cocaine use 0.8 0.8 1 0.6
% of which for cannabis use 19.4 19.2 22 24.6
% of which for stimulants use (other than cocaine) 35.4 38.3 45 43.4
Number of new clients entering treatment 1087 1037 1036 701
Number of new clients entering treatment with known primary drug 1018 954 961 617
% of which for opioid use 25.7 22.7 13 30.0
% of which for cocaine use 1.2 1.6 1 0.8
% of which for cannabis use 26.8 27.3 32 59.8
% of which for stimulants use (other than cocaine) 41.0 42.1 49 0.5
Notes:
The variation across time, in particular with regard to the absolute numbers of clients in treatment, should be interpreted with caution as coverage data may have changed over time. For further information on coverage details please refer to the relevant EMCDDA Statistical Bulletin.
For an explanation of terms used, see the definitions of terms.
Sources:

Reitox national reports 2014 and TDI tables.
EMCDDA Statistical Bulletin 2015.

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4. Treatment provision

Table 2: Opioid substitution treatment provision in Slovakia
Opioid substitution treatment 2010 2011 2012 2013
Number of clients in opioid substitution treatment 610 500 465 408
of which with methadone 460 N. Av. 457 405
of which with buprenorphine 150 N. Av. 2 3
Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HSR section).
‘N. Av.’ stands for ‘No information available’.
For an explanation of terms used, see the definitions of terms.
Sources:
Standard Table 24 (ST24) on 'Treatment availability' submitted in 2014.
Table 3: Year of official introduction of opioid substitution treatment substances in Slovakia
Applied substances in opioid substitution treatment Officially introduced in
Methadone (MMT) 1997
Buprenorphine (HDBT) 1999
Heroin assisted treatment,including as trials N.App.
Slow-release morphine 2005
Buprenorphine/naloxone combination 2008
Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HSR section).
‘N. App.’ stands for ‘Not applicable’.
For an explanation of terms used, see the definitions of terms.
Sources:
Reitox national reports.
Table 4: Legal framework of opioid substitution treatment in Slovakia
Legal framework of opioid substitution treatment Methadone Buprenorphine
Do office-based medical doctors have the right to initiate the prescription of substitution treatment? N.App. N.App.
Do specialised medical doctors have the right to initiate the prescription of substitution treatment? N.App. N.App.
Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HSR section).
For an explanation of terms used, see the definitions of terms.
'Specialised medical doctors' refers to specifically trained or accredited office-based medical doctors.
Sources:
Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2014.

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5. References and links

Related EMCDDA resources

 

External links

Please note that the EMCDDA is not responsible for the content of external sites.

Treatment inventories

Treatment research centres

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About the EMCDDA

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the reference point on drugs and drug addiction information in Europe. Inaugurated in Lisbon in 1995, it is one of the EU's decentralised agencies. Read more >>

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Page last updated: Thursday, 28 May 2015