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Drug treatment overview for the Czech Republic

Map of The Czech Republic

1. National context

Treatment-related objectives in the National Drug Policy Strategy 2010–18, and its Action Plan, place emphasis on enhancing the availability and quality of addiction treatment services in the country. Addiction treatment and care services in the Czech Republic are funded by subsidies from the Ministry of Health, the Ministry of Labour and Social Affairs, the Government Council for Drug Policy Coordination (GCDPC), regional and municipal administrations and health insurance companies. An independent agency is responsible for the accreditation of drug treatment at clinics and inpatient facilities.

In the Czech Republic addiction treatment is delivered through three different systems:(1) the network of low-threshold programmes and specialised outpatient and aftercare programmes and therapeutic communities (non-healthcare specific); (2) the network of specialised healthcare facilities that provide outpatient and inpatient services; and (3) outpatient smoking cessation programmes, which target smokers only. The core of addiction treatment services are outpatient and outreach programmes (in total 204), while 50 programmes provide residential in-patient care. Almost half of the facilities have valid professional competency certification by the GCDPC and 40 % of the facilities are registered as social services. Outpatient services are provided by outpatient psychiatric clinics and medical facilities, general practitioners and day-care centres. Opioid substitution treatment (OST), psychosocial support programmes and aftercare are available in these settings. Inpatient services are divided into short-term (four to eight weeks), medium-term (three to six months) and long-term (seven or more months) services and is provided by a network of psychiatric hospitals and hospital addiction treatment wards, and a network of therapeutic communities. In inpatient settings, detoxification, residential abstinence–oriented treatment, residential care based on the therapeutic community principle, or targeting special groups, such as adolescents, and aftercare programmes are available. However, there are large variations at district level in the geographical accessibility of different drug treatment programmes, with detoxification and specialised aftercare programmes being among the least available. These differences are attributed to lack of appropriate healthcare facilities and a shortage of professionals willing to work with drug users. Addiction treatment is primarily delivered by public organisations and also by NGOs. It is also delivered, to a lesser extent, by private institutions, which provide three main treatment services: detoxification, outpatient care and inpatient care. NGOs mainly provide low-threshold outpatient care, and some of these programmes are accredited as healthcare facilities; 15 NGO-based therapeutic communities also provide long-term residential care for drug users. Opioid substitution treatment and outpatient and inpatient medical drug treatment are mainly financed through health insurance, whereas outpatient and inpatient psychosocial treatment is primarily funded by the public budget at national and regional/local levels. Five facilities offer specialised treatment programmes for children and adolescents.

A discussion on a psychiatric care reform strategy for 2014–20, led by the Ministry of Health, is ongoing in the Czech Republic. The reform is based on a new concept of a network of specialised addiction treatment services adopted by the Committee of the Society for Addictive Diseases of the Czech Medical Association and aims to further shift the Czech treatment system towards community-type care and introduce flexibility for service provision based on regional needs and priorities. In 2013 the review of standards of professional competency for drug services at the national level was concluded, but is still awaiting approval by the GCDPC.

OST with methadone was introduced in the Czech Republic in 1998. Five substitution agents are available: methadone, three buprenorphine medications and a composite sublingual preparation that contains buprenorphine and naloxone. OST is delivered in specialised psychiatric facilities, and is also available in prisons. In addition, any medical doctor, regardless of his/her speciality, may initiate buprenorphine-based OST. According to newly implemented aggregated reports and a survey on substitution treatment among physicians in the Czech Republic, 215 general practitioners and 59 outpatient psychiatric facilities provided substitution treatment for approximately 2 485 clients in 2013. Around 2 311clients were reported in the substitution register (from 64 health care facilities), of which 26 % were on methadone and almost 74 % on buprenorphine-based medication. Since there is an overlap between the two sources it is estimated that in total 3 606 clients received opioid substitution treatment, of which about 3 000 received buprenorphine-based medication.

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2. Treatment registries and monitoring systems

There is a well developed system of client registration and monitoring in place, covering substitution and drug-free treatment. The Institute for Health Information and Statistics collects data from health facilities, and the treatment demand register, run by the national Hygiene Service, collects data from all agencies that provide specialized treatment services to drug users.

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3. Treatment demand

Table 1: Number of clients entering treatment in The Czech Republic by year
Clients in treatment 2010 2011 2012 2013
Number of all clients entering treatment 8484 9284 8955 9784
Number of all clients entering treatment with known primary drug 8446 9217 8896 9770
% of which for opioid use 23.1 19.4 18 17.2
% of which for cocaine use 0.2 0.3 0 0.2
% of which for cannabis use 11.8 13.2 12 11.0
% of which for stimulants use (other than cocaine) 63.1 65.3 67 70.4
Number of new clients entering treatment 4362 4512 4313 4634
Number of new clients entering treatment with known primary drug 4332 4486 4279 4625
% of which for opioid use 14.0 9.9 10 7.8
% of which for cocaine use 0.3 0.3 0 0.3
% of which for cannabis use 16.0 18.7 17 16.5
% of which for stimulants use (other than cocaine) 67.9 69.7 71 74.3
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 The Czech Republic
Opioid substitution treatment 2010 2011 2012 2013
Number of clients in opioid substitution treatment 5900 5200 4000 3606
of which with methadone 700 667 657 606
of which with buprenorphine 5200 4533 3343 3000
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 Tables 24 (ST24) on 'Treatment availability' submitted in 2014.
Table 3: Year of official introduction of opioid substitution treatment substances in The Czech Republic
Applied substances in opioid substitution treatment Officially introduced in
Methadone (MMT) 1998
Buprenorphine (HDBT) 2000
Heroin assisted treatment N.App.
Slow-release morphine N.App.
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 The Czech Republic
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. Yes
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, 04 June 2015