• 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
• Drug-related research

Drug use among the general population and young people

The second general population survey on drug use was conducted in 2006 among persons aged 15–64. In 2006, marijuana/hashish was the drug with the highest lifetime prevalence, at 9 % (compared to 7.7 % in 2002). Cannabis was followed in terms of lifetime prevalence rates by amphetamines (2.7 %), ecstasy (1.2 %), hallucinogenic mushrooms (1 %) and cocaine (0.8 %). In terms of age distribution, the highest proportion of use was found in the age group of 15–24, and lifetime prevalence drug use is rare among the group aged 34 and older. Results indicated a correlation between marital status and drug use, where most of the respondents reporting occasional drug use were single.

Comparison between national ESPAD studies conducted in Poland among the 15–16 year old students, from 1995 to 2007 indicated a lifetime experience with cannabis varying from 8 % in 1995 to 14 % in 1999, yet increased to 18 % in 2003. The latest ESPAD results of 2007 showed that 16 % of the students had ever tried cannabis. In 2007, inhalants lifetime prevalence was reported by 6 % of the students (9 % in 2003). Lifetime prevalence of amphetamines use was reported by 4 % of the sample, 4 % reported ecstasy use, all other substances were reported by 2 % of the students. In addition, results indicated that 12 % of the sample used cannabis during the last year (14 % in 2003), 6 % during the last month (8 % in 2003). Finally, the reported lifetime prevalence of cannabis use among males was 22 % and 11 % among females.

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Prevention

The National Bureau for Drug Prevention (NBDP) and the State Agency for Prevention of Alcohol-Related Problems are central governmental agencies established to coordinate activities aiming at drug and alcohol prevention. The Ministry of National Education is responsible for universal drug prevention in schools. Schools and other units in the framework of the education system are obliged to implement a school prevention programme for children’s and young people’s problems which are coherent with a school socialising programme.

At schools and other units of the education system, universal and selective prevention programmes have also been implemented. For example, the programme ‘Zippie’s friends’ was addressed to kindergarten children (six-year-olds). Since its inception in 2004, over 35 000 children from all over Poland attended classes in 1 000 facilities. The educational programme ‘School for parents and educators’ aimed at increasing attitudes to upbringing, as well as ‘Short school intervention’ targeted at pupils with drug problems, are widely implemented nationwide Approximately 3 000 people were trained in the framework of ‘School for parents and educators’ and 2 900 in the framework of ‘Short school intervention’ since inception of the programmes and until the end 2010.

At a regional and local level, the responsibility for drug prevention belongs to provincial and communal self-governments. Within the National Programme for Counteracting Drug Addiction 2006–10, the percentage of communal self-governments who prepare and implement their own prevention programmes has increased from 39 % in 2006 to 93 % of the total number of communes in 2009. In 2009, provincial and communal self-governments funded more than 7 000 universal prevention projects and approximately 1 000 selective prevention projects.

Selective and indicated prevention activities are targeted at recreational settings, groups-at-risk and families-at-risk, and the NBDP supports their implementation by NGOs in Poland. Most of these programmes are implemented in urban areas, while only 7 % of selective and indicative prevention activities are conducted in rural communities. The programmes centre around community action in a number of areas: education on drug-related risk; motivation to change attitudes and behaviour; direct user-oriented interventions; providing information on drug outreach centres; and distributing information materials. Prevention activities targeted at the general population consist of drug prevention campaigns and the Internet Counselling Centre. In 2009, nationwide media and educational campaigns aimed to raise awareness on the risks of driving under the influence of drugs and also of the use of so-called `legal highs`.

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Problem drug use

An estimation of the number of problem drug users (where problem drug use was defined as regular (daily or almost daily) illicit drug use causing serious problems, with all illicit drugs included) was conducted based on 2005 data, and using the benchmark method within the framework of a country-wide population survey. According to the outcome of the study, it was estimated that there are 100 000–125 000 problem drug users in Poland (3.7–4.7 per 1 000 inhabitants aged 15–64), a significant increase on a previous estimate made in 2002 with an estimate of 33 000–71 000 problem drug users.

Due to the political changes over the last decade, the availability of imported heroin has increased and has overtaken homemade opiates known as ‘kompot’ or ‘Polish heroin’. In 2005, a new estimate of problem opioid use was conducted, amounting to 27 000 individuals in a range of 25 000 to 29 000 (1 per 1 000 inhabitants aged 15–64 with upper 1.1 and 0.9 lower bound).

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.

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Treatment demand

In Poland, information on the number of individuals admitted to the residential treatment for drug addiction is collected by the Institute of Psychiatry and Neurology. In 2008, 255 units submitted data on treated clients. The national focal point, in the framework of the TDI implementation pilot project, collected data from 33 treatment facilities: 14 counselling centres, one detoxification ward, one substitution treatment programme and 17 drug rehabilitation clinics. The total number of clients admitted to residential treatment in 2008 was 12 627, including 5 511 first-time treatment clients. The collected treatment demand data by NFP indicate that a total of 2 082 clients entered treatment, of whom 851 were first-time treatment clients. Thus, the total number of treatment demand is estimated at 14 709, from whom 6 362 were the first-time treatment clients.

Almost half of those admitted to treatment for the first time in 2008 reported cannabis as the primary drug (47.8 %), followed by those who claimed amphetamines (26.1 %) and opioids (13.4 %) as the primary drug. However, likewise proportions among all treatment clients indicated cannabis and opioids as the primary drug (32.5 % and 31.9 % respectively), while 25.2 % of all treatment clients reported amphetamines.

36 % of all clients entering treatment were aged less than 25 years. A higher percentage in age distribution was reported among new treatment clients, with 47 % under the age of 25 years. Men constituted the majority among all clients entering treatment in 2008, with 75 % for male and 25 % for female. Among new treatment clients, 72 % were males and 28 % were females.

Since the data presented above are from two different monitoring systems (the Pilot project for TDI monitoring and the Institute of Psychiatry and Neurology — aggregated data), a caution must be made when interpreting the data, as double counting could not be avoided.

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Drug-related infectious diseases

In Poland, data regarding HIV infection is collected by the National Institute of Public Health — National Institute of Hygiene. The Institute analyses data for the whole country reported by Provincial Sanitary and Epidemiological Stations (Sanepid). In 2009, the incidence of newly-reported cases of HIV infections among injecting drug users continued a declining trend (in 2006: 112 cases; in 2007: 66 cases; in 2008: 45 cases and in 2009: 39 cases). However, there is a risk of underestimation of cases as the transmission route for a large percentage remained unexplained. In 2009, the estimated prevalence of HIV among 1 176 tested IDUs in Poland was 5.5 %.
The Institute also collects data on hepatitis B and C infections in the country. Regarding chronic hepatitis B infections, 744 cases with known transmission route were reported in 2009, and only six cases were linked to injecting drug use. Out of 1 943 chronic hepatitis C infection cases with a known risk factor reported in Poland in 2009, approximately 105 had injection drug use as a likely transmission route. However, for both infections, almost one half of the reported cases do not specify likely risk factors. In a HBV and HCV seroprevalence study conducted among 184 IDUs in two sites in 2009, the HCV prevalence ranged between 44.3–72.4 %, while 26.3–56.7 % tested positive for hepatitis B infection.

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Drug-related deaths

The basic source of information concerning drug-related deaths in Poland is the data of the Central Statistical Office (GUS). Based on the general mortality registers, the number of drug-related deaths seems to be relatively stable. According to ICD-10, the trend for 1997–2004 showed that a peak in the number of deaths was reached in 2000. The number of fatal overdoses registered by the general mortality register indicates continuing declining trend in the last years, although in 2008, the total number of drug-related deaths was 244, which is slightly more than 214 registered death cases in 2007.

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Treatment responses

Poland is the central and eastern European country with the longest tradition of therapeutic communities aimed at rehabilitation and prolonged abstinence. The first centre was established in 1978. The role of these communities has superseded the overriding role given to psychiatric institutions in other central and eastern European countries.

The implementation of drug treatment falls under the responsibility of communities and provinces, while drug treatment is delivered by different providers. Funding for drug treatment is primarily covered by health insurance, yet also by the public budget of communities. However, there is an option to receive also treatment at private clinics or from private practitioners, but for an additional fee paid by a client/patient.

Drug treatment services are provided through the network of inpatient and outpatient treatment centres, detoxification wards, day-care centres, drug treatment wards in hospitals, mid-term and long-term drug rehabilitation facilities and drug wards in prisons, and also post-rehabilitation programmes. In line with the public health perspective of drug treatment, the treatment system in Poland can be differentiated into two approaches: ‘drug-free’ treatment and pharmacological treatment (i.e. substitution treatment). Treatment is provided in two modes: outpatient and residential treatment. Outpatient interventions for users of illicit psychoactive substances are provided through addiction counselling centres, mental health counselling centres and day-care centres located in large cities. Residential treatment is dominated by long-term and mid-term residential treatment lasting more than one year. Detoxification which is not a treatment in itself but is the first step to treatment is provided in detoxification wards and usually lasts 8 to 14 days. Outpatient and inpatient drug treatment is mainly delivered by NGOs, followed by public services and private providers. Detoxification is mainly provided by public services, as well as by private clinics and physicians. Polish post-rehabilitation programmes are also implemented, mainly by non-governmental organisations. These are subsidised from the state budgets and with resources from local authorities.

Methadone maintenance treatment is available as opioid substitution treatment in Poland. The first methadone maintenance programme was introduced in Poland in 1993. Since 2005, such treatment was only carried out by public healthcare units which have been granted permission by the governor of the region in collaboration with the Ministry of Health. According to the new drug law from 2005, NGOs can also establish and carry out an opioid substitution programme, and the first programmes provided by non-public health centres and private facilities were established in 2007. In 2009, 22 substitution treatment programmes (including five programmes in prisons) provided services to 1 945 clients, of whom 1 921 received methadone as the substituting substance.

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Harm reduction responses

Harm reduction activities have been carried out in Poland since 1989 and consist predominantly of needle and syringe exchange programmes, prevention-related educational programmes and opiate substitution treatment programmes. Polish decision-makers generally support the idea of harm reduction, which is also reflected in the drug act and in the National Programme for Counteracting Drug Addiction (NPCDA). Programmes are mainly operated by NGOs and based in big cities; they include outreach work at the meeting places of drug users and sex workers (offered by 12 needle and syringe programmes), homeless shelters, and specialised agencies providing needle and syringe exchange programmes and one mobile needle and syringe programme. In 2009, the National Bureau co-financed 15 projects in the field, targeting active problem drug users; local governments also make important contributions to funding of 36 additional programmes. In 2009, in the programmes funded by the National Bureau for Drug Prevention 197 000 syringes were distributed. In addition, 259 220 needles were distributed. The programmes have served 3 100 drug injection users.

Generally, the geographical coverage is limited and programmes may not be available in all regions where injecting drug use is reported. Since several years, the National Health Fund aims to systematically increase the availability and reach of programmes aimed at reducing and treating infectious diseases among drug users, in particular by contracting antiretroviral treatment services, providing vaccination against HBV, as well as counselling and testing for HCV and HIV.

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Drug markets and drug-related offences

The Police Headquarters in Warsaw and the Provincial Police Headquarters report data on drug-related offences. Since 1997, it appears that the number of offences concerning illegal production of drugs has been stable, as well as reports on the cultivation of poppies or hemp. Since 2000, a continuous increase has been observed concerning offences related to the encouragement of persons to take drugs. In line with the change of the drug law in 2000, the number of drug-related offences has been increasing steadily. In 2006, the number of reported drug-related offences peaked at 70 202, but was attenuating in the two following years to 57 382 offences in 2008. However, in 2009, the total number of drug-related offences increased up to 68 288 offences again. In this year, 67.2 % were cannabis-related offences followed by amphetamine related offences at 21.5 % and 3.0 % for heroin-related offences.

Poland is both the transit country for drug trafficking from East to West, as well as the producer of synthetic drugs for the Western European markets. Amphetamines, illegally produced to Poland, are smuggled to Germany, France, Sweden, the United Kingdom and Ireland. Heroin reaches Poland through both the Balkan and the Silk routes, although the Polish homemade type of heroin, called ´kompot`, is also used in the national market. Cannabis is trafficked primarily from the Netherlands; however, it is also increasingly produced also domestically.

The analysis of quantities of drugs seized reveals a continuation in the upward trend of the amount of herbal cannabis seized since 2003 (233 kg in 2003, 493 kg in 2008 and 883 kg in 2009). In 2009, the police operations resulted in seizures of 99 275 plants, which is the highest ever annual amount of cannabis plants seized. The quantity of amphetamine seized increased in 2009 as well (422 kg) when compared to 2008 (356 kg), thus continuing the increasing trend observed over the period 2002–07. The biggest amount of cocaine seized was recorded in 2003 with a total of 801 kg; smaller quantities have been seized since that year (less than 30 kg), except for 2007, when 161 kg of cocaine was seized. In 2009, however, 117 kg of cocaine was seized. Furthermore, 86 kg of heroin was seized in 2009, which interrupted the declining trend observed since 2006 (155 kg in 2006 to 79 kg in 2008).

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National drug laws

Drug addiction in Poland is regulated by the Act of Law of 29 July 2005 on counteracting drug addiction. The act generally has a preventive and treatment-oriented character, and the stipulated sanctions should not be used against problem drug users. Nevertheless, according to the drug law, any possession of drugs is penalised, even a small amount for personal use. In minor cases, the offender can be fined or ordered to serve a sentence involving limitation of liberty or deprivation of liberty of up to one year. The court may, however, also decide to oblige a sentenced drug user to undergo treatment.

Trafficking of drugs is penalised by a fine and deprivation of liberty of between 6 months and 8 years. In the case of a minor offence, the perpetrator may be fined, subjected to limitation of liberty, or imprisoned for a maximum of one year. In cases where the amount of drugs is substantial, the perpetrator may be subjected of a fine and the penalty of deprivation of liberty for a term up to 10 years.

Despite the fact that treatment in Poland is voluntary, teenagers under the age of 18 can be obliged by the court to undergo treatment.

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National drug strategy

Poland’s latest ‘National programme for counteracting drug addiction 2011–16’, adopted in March 2011, is divided into five pillars: (i) prevention; (ii) treatment, rehabilitation, harm reduction and social reintegration; (iii) supply reduction; (iv) international cooperation; and (v) research and monitoring. The general aim of the programme is to reduce drug use and more effectively address drug-related social and health consequences. The programme contains actions intended to combat new drugs and substitute substances (so-called ´legal highs´). The evaluation of the actions is included as part of the new programme.

The previous programme was implemented between 2006 and 2010.

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Coordination mechanism in the field of drugs

The Council for Counteracting Drug Addiction is the coordination and advisory body in the field of counteracting drug addiction. The Council is comprised of:

• the Secretary or the Undersecretary of State in the office where a minister competent for health matters operates (chairman);
• the Secretary or the Undersecretary of State in the office where a minister competent for interior affairs operates (Deputy Chairman);
• the Director of the National Bureau for Drug Prevention (Secretary);
• Members — the Secretaries or the Undersecretaries of State in the offices where the following ministers operate: minister of Justice; National Defence; the ministers competent for matters of: education, agriculture, social security, public finances — the Head of the Customs Service, foreign affairs, science;
• Member — a representative of the local governments side in the Common Commission of the Central Government and Local Government, to be appointed by the local governments side.

The National Bureau for Drug Prevention, which is a state budget unit subordinated to the Ministry of Health, is responsible for coordinating the implementation of the National Program for Counteracting Drug Addiction and the preparation of an annual report on the state of its implementation. Its activities also include setting priorities in the field of drug prevention. The secretariat of the Council for Counteracting Drug Addiction is located in the Bureau.

At the provincial level, provincial drug coordinators are responsible for coordination of regional drug policy and of implementation of regional strategy which by law is in line with national strategy and action plan. Additionally, at the provincial level, there are provincial experts on drugs and drug addiction who collect and exchange information, data and documentation concerning drug problem. The provincial drug coordinators and experts are often the same person. Every year, provincial experts prepare reports on the situation of drugs and drug addiction. The summaries of these reports are available at the NFP website.

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Drug-related research

Research and monitoring constitute one of the five main areas of activity presented in the current ‘National Programme for Counteracting Drug Addiction’, with the main objective of providing information support on the national programme’s implementation. Coordinating the implementation of the national programme in the area of research and monitoring is carried out by the national focal point by the National Bureau for Drug Prevention. The National Bureau for Drug Prevention remains the main body commissioning and financing the implementation of research in the field of drugs and drug addiction, although Poland’s global Scientific Research Committee also represents a funding source for drug-related research. Numerous research projects are conducted on the basis of grants awarded by the Ministry of Science and Higher Education as well as by international programmes. Scientific activity in the field of drugs and drug addiction in the scope of statutory activities is also conducted by the Institute of Psychiatry and Neurology.

Scientific activity in the field of drugs and drug addiction in the scope of statutory activities is conducted by the Institute of Psychiatry and Neurology, but the national focal point, the National Institute of Public Health — National Institute of Hygiene, universities and research agencies functioning on the Polish market also carry out research projects. Research findings are disseminated through scientific journals, websites and national focal point activities, which also include the publications in a newsletter, a dedicated website and participation in conferences. Recent drug-related studies mentioned in the 2010 Polish National report mainly focused on aspects related to the epidemiology and responses to the drug situation, including results of prevalence studies and studies on the consequences of drug use.

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