The National Health Programme 2016-20 contains a number of measures related to drug treatment and rehabilitation. These aim to increase the availability of outpatient drug services and opioid substitution treatment (OST) programmes. Moreover, a wide range of other measures designed to improve the quality of drug treatment services are included in the National Drugs Strategy 2016-20.
The system of specialised drug services in Poland is integrated into mental health care, and a number of legal acts govern drug treatment in Poland. The implementation of drug treatment is the responsibility of the communities and provinces, where it is delivered by a range of providers who have signed contracts with the National Health Fund (NHF). Treatment activities that are not covered by the NHF can be funded through other resources on a competitive basis. Treatment at private clinics or from private practitioners is also available, although an additional fee must be paid by the client.
Drug treatment services are provided through a 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, drug wards in prisons and post-rehabilitation programmes. In territories where there are no specialised drug treatment services, treatment is delivered by mental health counselling or alcohol rehabilitation clinics. In line with the national public health perspective on drug treatment, the treatment system in Poland has two approaches: ‘drug-free’ treatment (psychosocial models) and pharmacological treatment (i.e. OST). Of these two, the ‘drug-free’ model prevails and includes therapeutic communities, cognitive-behavioural psychotherapy, 12-step programmes, case management and self-help groups.
Outpatient and inpatient drug treatment are mainly delivered by non-governmental organisations (NGOs), followed by public services and private providers. Detoxification is mainly provided by public services, and private clinics and physicians. Polish post-rehabilitation programmes are also implemented mainly by NGOs. These are subsidised by the state budget and resources from local authorities. In recent years, a new treatment programme aimed at cannabis users, CANDIS, has been promoted in Poland.
OST with methadone has been available in Poland since 1993. Only public healthcare units that have received permission from the governor of the province, in collaboration with the Ministry of Health, can deliver OST. NGOs can also provide OST.
In 2012, a new treatment registration system was put in place, which has expanded in recent years to cover around half of specialised outpatient and inpatient treatment centres. Caution must be exercised when interpreting data because of the evolution of the national monitoring system, particularly with regard to coverage. In 2017, the majority of clients treated for drug dependence in Poland received treatment in outpatient settings. Among those who entered treatment in 2017, around one third entered treatment for primary use of cannabis and one third for stimulants, mainly amphetamines. Opioids, mainly heroin, and new psychoactive substances were the other most common primary drugs reported by clients entering treatment in this year.
Data from the National Bureau’s Registry of Substitution Treatment show that the number of clients receiving OST has increased significantly in the last decade. The majority of clients treated with OST received methadone, although buprenorphine-based medications are also available. It is estimated that fewer than one fifth of problem opioid users receive OST in Poland.