• Drug use among the general population and young people
• Prevention
• Problem drug use
• Treatment demand
• Drug-related infectious diseases
• Drug-related deaths
• Treatment responses
• Harm reduction responses
• Drug markets and drug-related offences
• National drug laws
• National drug strategy
• Coordination mechanism in the field of drugs
• Public expenditure
• Drug-related research

Drug use among the general population and young people

In 2010, two independent surveys on representative samples of the population were carried out in Czech Republic. The Survey on opinions and attitudes of Czech citizens to the issue of health and healthy lifestyle (Citizen survey (CS)) was conducted in the autumn and 1 793 respondents of 15 years of age and older were interviewed. Another survey on Selected aspects of the drug problem from the perspective of citizens (ICSP) was implemented in September 2010, among the sample of 2 044 respondents older than 15 years using face-to-face interviews. 

According to the results of the surveys, lifetime prevalence of cannabis varied from 23.4 % (ICSP) to 30.5 % (CS), followed by ecstasy at 7.2 % and at 4.0 %, pervitin (methamphetamine) and amphetamines (3.4 % and 1.4 %), LSD (both studies 2.6 %) and cocaine (1.6 % and 0.9 %). Cannabis was also most frequently used illegal substance in the past 12 months — at 9.7 % (ICSP) and 10.4% (CS) and within the past month — 4.2 % (CS) and 4.5 % (ICSP). With respect to gender, drug use is more prevalent among males, with the highest prevalence rates among 15-to-24-year olds.  When comparing to the data of other studies implemented since 2008, the results indicate that the level of illicit drug use among general population in Czech Republic is stable with cannabis and ecstasy having the highest prevalence rates.

Results of ESPAD surveys on drug use among young people are available from 1995 and the most recent survey was done in 2011. Lifetime experience with an illicit drug other than marijuana/hashish among 15–16 year olds increased from 4.3 % in 1995 to 9.0 % in 1999, 11.2 % in 2003 and decreased back to 8 % in 2011 (ESPAD survey). In particular, marijuana (herbal cannabis) or hashish (cannabis resin) use is very prevalent among this age group. In 2011, 42 % reported that they had tried these substances at least once. Lifetime use of inhalants was reported to be 8 %, hallucinogens, 5 %, but ecstasy, 3 %.  A decline was noted for lifetime cannabis use (45% in 2007), amphetamine use, which decreased from 5 % in 1999, to 2 % in 2011, ecstasy (from 8 % in 2003 to 3 % in 2011). Last year prevalence of cannabis use was 3 % and last month prevalence was 15 %, and is declining when compared to the results of 2003 survey when the highest rates were reported (36 % and 19 % respectively).

The last Health Behaviour in School-aged Children (HBSC) study among 15-year-old students, conducted in 2010, reported 31 % for lifetime prevalence of cannabis. While there was a drop in lifetime prevalence rates between 2002 and 2006 (from 31 % to 25 %), an increase was observed between 2006 and 2010 (from 25 % to 31 %).  According to the last study, around one fifth of the students had used the cannabis in the past 12 months.

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Prevention

The Ministry of Education, Youth and Sports provides methodological guidance and also coordinates prevention activities in the Czech Republic.  Nevertheless the regions play an increasingly important role in these activities and a Committee of Regional School Prevention Coordinators established by the Ministry ensures better coordination of prevention activities with the regions.  Prevention activities are mainly implemented in schools  by NGOs that provide services in the field of treatment and help to drug users.

Since 2007, a ministerial guideline introduces prevention into the school curriculum, describes the individual institutions involved in the system of prevention and the role of the teacher, defines the Minimum Preventive Programme, and recommends specific practices for schools and school facilities if they detect specific risk behaviour among children and young people. It addresses a broad range of social problems like truancy, bullying, racism, xenophobia, hooliganism, crime and the use of addictive substances.

The international ‘Unplugged’ [www.EUDAP.net ] prevention programme was piloted in the Czech Republic between 2006–10 and its nationwide scale-up is recommended following the results of evaluation. 

A priority target audience for selective prevention activities are children and adolescents from ethnic minorities, while local projects addressing high-risk families and street children are also available.

Indicated prevention programmes are almost exclusively oriented towards working with individuals and their families.

In 2010, the project called ‘Safer Party Tour’ focusing on drug prevention and harm reduction interventions at large summer and music festivals was also continued.

A monitoring system gives an overview on existing prevention interventions in the country. Evaluation is mainly available in the area of universal prevention programmes.

View ‘Prevention profile’ for additional information.

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Problem drug use

The existing estimates on the number of problem drug users (¹) in the Czech Republic were carried out between 1999 and 2010 using the multiplier method, based on data from low-threshold centres and outreach programmes. In 2010, the national estimate suggests that there are 39 150 problem drug users (95 % CI: 32 000–46 300), which is higher than the estimate for 2008 and 2009. Rise in the estimated number of methamphetamine (pervitin) users from 21 200 in 2008 to 28 200 in 2011 accounts for most of that increase. While the estimated number of opiate users has decreased when compared to 2009 numbers. The data suggests that in 2010, there were  11 000 opiate users of which around 6 000 were heroin users and around 5 000 Subutex® users. The number of IDUs (injecting drug users) was estimated at 37 200 in 2010 (95 % CI: 35 950–38 450) and is increasing compared to 2007–09. Cocaine problem use still remains sporadic in the Czech Republic.

The EMCDDA defines problem drug use as intravenous drug use (IDU) or long duration/regular drug use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis are not included in this category.

(¹) The Czech definition of problem drug use is the use of drugs by injection and/or the regular or long-term use of opiates and methamphetamine. Problem cocaine use has not been included to estimation, due to a very low number of cocaine users in treatment or contact with services in the Czech Republic. Ecstasy and cannabis are not included in estimates by definition.

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Treatment demand

Data on treatment demand are available through three main sources: a nationwide system for reporting data within the framework of the Public Health Office in Prague, which also operates the Treatment Demand Register, the Czech Institute of Health Information and the Government Council for Drug Policy Coordination. In 2010, a total of 214 outpatient and inpatient treatment and low-threshold centres contributed to the Treatment Demand Register. The register however does not cover the treatment provided by general practitioners, substitution treatment centres and in prisons. 

In 2010, a total of 8 484 drug users entered in treatment whereas, 4 362 persons sought treatment for the first time. As in previous years, users of amphetamines (mainly methamphetamines) were the most commonly represented among all treatment clients entering treatment, at 63.0 %, as well as among first treatment clients with 67.8 %. This was followed by opioids users with 23.1 % among all treatment clients and 16.0 % of cannabis users among first-time treatment clients.

In 2010, 40 % of all clients entering treatment were aged less than 25 years. The age distribution for new treatment clients aged less than 25 years was 51 %. In 2010, the male to female ratio for all treatment clients was 68.1 % for male and 31.9 % for female clients. A similar distribution was also reported among new treatment clients, with 68.7 % being male and 31.3 % female. This gender distribution — male: female 2:1 — is also consistent with the estimated gender structure of problem drug users in the country.

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Drug-related infectious diseases

The rate of infections (HIV-AIDS, HBV and HCV) among drug users has remained stable in recent years. Data are available from national registers and studies involving different drug user groups in the Czech Republic.

HIV seroprevalence rates among injecting drug users (IDU) remained consistently below 1 % in the Czech Republic between 1996 and 2009 (0.0– 0.6 % in 2010). The number of newly-diagnosed HIV cases among the general population is relatively low, although it seems to have been increasing over the last four years. 180 new HIV cases were diagnosed in 2010, five of which are reported being related to injecting drug use.

For hepatitis, in 2010, a third of all newly reported HBV cases and two thirds of newly reported HCV cases with known transmission route were registered among IDUs. The HCV prevalence in the population of IDUs has consistently been reported the last three years, from 16.0 % in 2006 to 22.4 % in 2009, while in 2010 it dropped to 13.6 % in diagnostic testing of clients in low-threshold services. However, it is suggested that the data of diagnostic testing may underestimate the HCV infection rates among IDUs.  The data from the Treatment Demand register suggest that about third of IDUs in contact with treatment system are HCV-positive.

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Drug-related deaths

An automated system for collection of drug mortality data, which covers 13 departments of forensic medicine and forensic toxicology, provides information on overdoses on narcotic and psychotropic substances to the Czech national focal point. According to the drug-related deaths standard (deaths caused by an acute intoxication of drugs) for special registries, 55 deaths were recorded in 2010 (49 were registered in 2009, 44 in 2008, 40 in 2007, 42 in 2006 and 62 in 2005). All death cases were confirmed by toxicology. Around a third of all cases involved heroin (34.5 %) and another third involved methamphetamine as a principal drug (32.7 %). In 2010, the number of death cases attributed to inhalant use doubled when compared to 2009 (eight cases in 2009 and 16 in 2010). 89.1 % of all DRD were in males.

For the Czech Republic, the EMCDDA selection D was used instead of the national definition. National definition includes also poisoning by psychoactive medicines, which accounts for most cases (139 cases out of 194 in 2010).

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Treatment responses

The Council of the Government for Drug Policy Coordination is the main coordinating and initiating body on drug-related issues. The Secretariat of the Council organises the distribution of subsidies to service providers (mainly NGOs) in the sphere of treatment of drug addiction and reintegration. Furthermore, the Secretariat is also responsible for accreditation, monitoring, evaluation and coordination of delivery of drug treatment, medical and inpatient facilities at the regional/local levels.

In the Czech Republic, drug treatment is primarily delivered by public organisations, such as psychiatric clinics, specialised substance abuse facilities, detoxification units or specially allocated beds in general hospitals, and NGOs. To a lesser extent, private institutions and office-based medical doctors are also involved in treatment delivery. These organisations provide three main treatment services: detoxification, outpatient care and institutional care. Treatment inpatient services are also divided into short-term (4–8 weeks); medium-term (3–6 months) and long-term (seven or more months) services. Non-governmental organisations mainly provide outpatient care and substitution treatment, and some of these programmes are accredited as health care facilities. However, there are 15 NGO-based therapeutic communities providing also long-term residential care for drug addicts. Substitution maintenance treatment, out- and inpatient medical drug treatment is mainly financed through health insurance, whereas outpatient and inpatient psychosocial treatment is primarily funded by the public budgets at national level and regional/local levels.

In 2010, three substitution agents were available: methadone , buprenorphine and a composite sublingual preparation which contains buprenorphine and naloxone. In 2010, there were registered 96 substitution treatment facilities, out of which 11 centres were registered in 10 prisons. However, only 45 registered facilities reported administrating opioid substitution treatment in 2010. Furthermore, any medical doctor, regardless of his/her specialisation, may initiate high-dosage buprenorphine as well as Suboxone treatment. In 2010, around 2.6 % of surveyed physicians admitted that they prescribe substitution treatment for opiate addicts. In 2010, an estimated 5 900 clients were undergoing substitution treatment, 744 of whom were on methadone and approximately 5 200 on buprenorphine-based medication.

View ‘Treatment profile’ for additional information.

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Harm reduction responses

The National Drug Policy Strategy for 2010–18 endorses harm reduction as one of its four pillars, and defines following priority areas: (1) development of new interventions, (2) increase in testing uptakes among injecting drug users and (3) definition of harm reduction guidelines for nightlife settings.

The Czech network of low-threshold facilities established since 1992 includes low-threshold centres (drop-in) and outreach programmes providing needle exchange (altogether, 96 NSPs in 2010). There are also three vending machines operating in the Czech Republic. Programmes operate in all regions of the Czech Republic, providing a wide range of services. The Czech NFP estimates that in the past five years, the rate of problem drug users maintaining contact with these agencies has risen from 60 % to about 70 % (in Prague even about 80 %) of problem drug users. The number of syringes used has been increasing over recent years: in 2010, nearly 5 million syringes were distributed through NSPs in the Czech Republic, representing a 3.5 times increase compared to 2003. The main sources of sterile injecting material include exchange programmes (drop-ins and outreach work), but also pharmacy syringe sales. Taking into account the high proportion of pervitin users among problem drug users, 30 programmes distribute also gelatine capsules as an oral alternative to the injecting application of pervitin. Around 60 000 of such capsules were distributed in 2010.

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Drug markets and drug-related offences

Cannabis continues to be the most frequently trafficked drug and the domestic production of marijuana with a higher THC content has been on the rise. It is grown in artificial conditions and, with increasing frequency, on a large scale and also for export to Germany and other West European countries. In 2010, the volume of the marijuana seized increased after a drop in 2009 (278 kg in 2010, 172 kg in 2009 and 393 kg in 2008). The number of growing sites detected and cannabis plants seized doubled in comparison to 2009 (33 427 seized units in 2009 to 64 904 in 2010).

In 2010, pervitin was involved in 283 seizures and its production is mainly intended for the domestic market, however, the police data indicate that smaller amounts of substance are exported also to Germany. The volume of pervitin seized increased from around 4 kg in 2008–09 to a record amount of 21 kg in 2010. A restricted sale of pseudoephedrine containing medications introduced in 2009 was followed by significant rise in the illegal import of pseudoephedrine containing medications from neighbouring countries, especially Poland, Germany, Slovakia, Hungary and also Vietnam and China. The smaller number of pervitin production facilities were detected in 2010 when compared to 2008–09 (434 production facilities in 2008, 342 in 2009 and 307 in 2010).

Heroin reaches the Czech Republic, mainly through the Balkan route. Although 61 heroin seizures were reported in 2010, which is the lowest number since 2006, the quantity of heroin seized remains stable over the period 2006–09 (between 20–50 kg per year).

A further increase in cocaine seizures is reported compared with the previous year — 42 seizures with a total quantity of 14 kg in 2010, 26 seizures with a total quantity of 13 kg in 2009, 24 seizures with a total quantity of 8 kg in 2008. What regards ecstasy, it is not produced domestically but mainly is imported from the Netherlands, Poland and Slovakia. However, in recent years the demand for ecstasy has dropped mainly because of low levels of MDMA (the average purity has decreased from 27 % in 2007 to 15 % in 2010).

In 2010, a total 2 525 persons arrested for primary drug related crime according to the new Czech Penal Code were reported by the National Drug Headquarters. Around 54 % of cases were related to methamphetamine, followed by 36 % related to cannabis and 4 % related to heroin. In the Czech Republic, the supply-related offences exceeded those related to use. Reported data over the period 2004–10 do show that the proportion of use-related criminal offences is gradually rising from 8 % in 2004 to 14 % in 2010.

In addition, 1 021 misdemeanours involving the possession of small amounts of drugs or the cultivation of a small number of plants containing a narcotic or psychotropic substance were reported in 2010. If misdemeanours are included in the total number of drug-related offences, the proportion of use-related offences compose around a third of all drug-related offences.

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National drug laws

The Criminal Code and the Criminal Procedure Code are the major acts concerning drug-related offences. These acts regulate several aspects regarding drug-related offences such as drug trafficking, unauthorised possession of drugs, conditions of prosecution, diversion of prosecution, types of penalties, etc. On the other hand, licit handling of narcotic drugs and psychotropic substances and precursors is subject to regulation according to the Addictive Substances Act (Act No 167/1998).

Until the end of 1999, the Criminal Code (Act No 140/1961) stated that possession of narcotic drugs and psychotropic substances in greater than small quantities is a criminal offence, and could attract sentences of up to two years’ imprisonment (or 1–5 years in case of aggravating circumstances in the offence). In case of possession of small quantities without intention to supply, administrative sanctions (e.g. a fine or warning) were imposed under the Act on Misdemeanours (Act No 200/1990).

In 2010, the new Criminal Code (Act No 40/2009) firstly set out a distinction between cannabis and other drugs for personal possession offences, whereby a cannabis offence would attract a sentence of up to one year. The new Code also fixed binding limit quantities with which to determine whether an offence was administrative or criminal — these had previously been set in non-binding prosecutor and police directives.

Penalties for drug trafficking can be up to 10–18 years of imprisonment, depending on aggravating circumstances. In the case of addicts committing a drug-related crime, a range of alternatives to imprisonment is available to the court (e.g. suspended sentences, community service and probation with treatment). Since January 2009, security detention with compulsory treatment are possible responses to dangerous addicts.

In 2009, a new category of medicines was created to restrict sales of non-prescription medicines, such as those containing pseudoephedrine (a precursor for producing methamphetamine).

In 2011, 33 new psychoactive substances or pharmacological agents were put under control by means of amending the Act on Addictive Substances.

View ‘Legal profile’ for additional information.

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National drug strategy

In May 2010, the National Drug Policy Strategy for the period 2010–18 was approved. The strategy is comprehensive and is based on four pillars: prevention, treatment and resocialisation, risk reduction and supply reduction. It is complemented by three supporting domains: coordination and funding; monitoring, research and evaluation; and international cooperation. Focusing mainly on illegal drugs, but with some scope to address other drugs (alcohol, prescription drug misuse, the strategy defines four key objectives: (1) to reduce the level of experimental and occasional drug use, particularly among young people; (2) to reduce the level of problem and intensive drug use; (3) to reduce potential drug-related risks to individuals and society, and (4) to reduce drug availability, particularly to young people. The implementation of the strategy is supported by a series of consecutive three-year action plans, the first of which covered the period 2010–12.

View ‘National drug strategies’ for additional information.

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Coordination mechanism in the field of drugs

The Government Council for Drug Policy Coordination is responsible at the political level for the overall implementation of the national drug strategy. It is the main initiating, counselling and coordinating body of the government for drug issues. Presided over by the Prime Minister, the Council includes all ministries involved in the delivery of the national drug policy and three representatives of civil society respective regions (Czech Medical Association — Association for Addictive Diseases, Association of NGOs dealing with drug prevention and treatment, and Association of the Regions). In addition, its Secretariat ensures on a permanent basis the day-to-day implementation of the strategy and the coordination of the respective ministries’ activities. The Secretariat is part of the Office of the Government of the Czech Republic and also includes the Czech National Monitoring Centre for Drugs and Drug Addiction (Czech national focal point) which is responsible for collection, analysis and distribution of drug-related data.

At the local level, a network of 14 regional coordinators provides coordination of activities (including the implementation of the national drug policy) at the regional and local levels. However, their competencies vary from region to region. Each region draws up and implements also their own strategies and plans on drug-related measures and the extent of such plans and strategies also varies between regions. At the local level, local drug coordinators are installed in 205 municipalities (so-called ‘municipalities with extended competency’).

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Public expenditure

In the Czech Republic, the government has presented annual drug-related budgets, announcing planned labelled expenditures (¹), since 2002. Additionally, it provides an estimate of the money effectively spent. Estimates are based on a well-defined methodology, but data completeness has changed over time. In 2006, unlabelled expenditures were also estimated.

In 2006, the total drug-related public expenditure represented 0.17 % of GDP. About 90 % of the total was unlabelled expenditures, of which about 97% was for supply reduction activities and the remaining for demand reduction (institutional healthcare received the largest share). The analysis of labelled expenditures, which represented about 9 % of the total expenditure, had a different repartition: 66 % for demand reduction and 34 % for supply reduction activities.

Trend analysis can be based only on labelled expenditures. Over the 2005–10 period, these expenditures remained stable as a percentage of GDP (ranging between 0.15 % and 0.17 %), but grew in nominal terms. The exception was in 2009, when expenditures declined, probably associated to the public austerity measures following the economic recession of 2008. The year 2010 registered a positive growth again.

A new estimate for drug-related public expenditure is foreseen for 2012.

(1) This budget is not directly linked to national policy documents.

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Drug-related research

The current national drug strategy emphasises the role of research, evidence and evaluation of the measures taken in the drug policy field in the Czech Republic. The support of research in the field of drugs is mentioned explicitly as one of the tasks of the 2010–12 action plan. The evidence-based approach is currently applied in the certification process of addiction services and in the provision and development of services. Several public administration bodies and several grant agencies fund research in the field of drugs which is mainly conducted by academic centres. The National Monitoring Centre for Drugs and Drug Addiction coordinates the collaboration and the exchange of information between research institutions, service providers, and public administration bodies. It publishes an Annual report on the state of the drugs problem in the Czech Republic, which summarises available data about drug use and its consequences. National scientific journals are also an important dissemination channel for drug-related research findings. Recent drug-related studies mentioned in the 2011 Czech National report mainly focused on aspects related to the evaluation of interventions, consequences of drug use and prevalence and incidence of drug use.

View ‘Drug-related research’ for additional information.

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