2007 Annual Report: The Czech Republic Drug Situation
Summary of the Annual report 2007
In July 2007, the Government Council for Drug Policy Coordinationwas enlarged. The Council, which is the government’s main initiating, advisory, and coordinating body for drug issues, convened three times in 2007, one of these being in its enlarged format.
The National Drug Policy Strategy for the Period 2005 to 2009 is in force. In 2007 the Action Plan for the Implementation of the National Drug Policy Strategy for the Period 2007 to 2009 was adopted, and in April and June 2008 the Council considered the reports on the fulfilment of the tasks for 2007 and/or the ongoing tasks. In general, it was concluded that the tasks were fulfilled successfully.
In November 2007, the Drug Policy Action Plan of the Prison Service of the CzechRepublic for the Period 2007-2009 was developed and in February 2008 the Government passed the Czech National HIV/AIDS Programme for the period 2008-2012, which concerns HIV/AIDS preventionand harm reductionamong injecting drug users.
In September 2007 the Government updated the
Rules for Granting Financial Resources from the State Budget on Drug Policy, which also define general conditions for proceedings involving drug policysubsidies from the state budget.
In 13 out of 14 regions the regional drug coordinators were appointed (the Moravian-Silesian region has not established this office). They make use of a network of drug coordinators in individual municipalities with extended competencies in their region. With the exception of the Pilsen region, all regions have drawn up a regional drug policystrategy. The local coordinators have been appointed in most of the municipalities with extended competencies.
In 2007 the Czech Government approved the bill for a new Penal Code and submitted it to the Parliamentin February 2008. The bill includes significant changes in how to address illegal drugs. In particular, the changes concern the stipulation related to drug possession, where drugs are differentiated according to their social and health risks. A dramatic change would also be introduced by the new provision concerning the illegal cultivation of plants containing a narcotic or psychotropic substance. Accordingly, the growing of a small quantity of cannabisor mushroomswould be punished under the Misdemeanour Act in the future.
As opposed to the situation in the 1990s, when the public showed rather repressive viewpoints, both tolerance towards drug users and support for preventive measures are on the rise. Cannabis smokingis still considered as generally unacceptable behaviour. On the other hand, however, the number of people supporting the legalisation of cannabishas doubled for the past ten years.
Public expenditure on drug policyreached a level of CZK 557.6 million (€ 20,084 thousand) in 2007. This amount included CZK 367.0 million (€ 13,217 thousand) provided from the state budget, and the regions and municipalities contributed amounts of CZK 128.4 million (€ 4,624 thousand) and CZK 62.3 million (€ 2,243 thousand) respectively. In comparison to 2006, total expenses increased on all three levels; on the central level, there was a decrease in expenditure on the part of the Ministry of Defence and, in particular, the GCDPC and the Ministry of Justice. On the regional level, the expendituresespecially declined in the Ústí nad Labem and Liberec regions, as well as in the Pilsen Region. Out of a total of CZK 557.6 million (€ 20,084 thousand), CZK 160.8 million (€ 5,792 thousand)(28.8%) was spent on lawenforcement, CZK 152.6 million (€ 5,496 thousand) (27.4%) on treatment, CZK 141.0 million (€ 5,078 thousand)(25.3%) on harm reduction, CZK 48.7 million (€ 1,753 thousand) (8.7%) on primary prevention, and CZK 20.5 million (€ 739 thousand) (3.7%) on aftercare. Because of GDP and the total state expenses, expenditure on drug policy from the state budget has seen a relative decline in the past five years.
No general population surveyfocusing on the scope of drug useamong the adult population was conducted in 2007; the Czech Republic participated in the ESPADinternational schoolsurveycarried out among 16-year-old students. Approximately 20% of the adult population have had at least one experience with an illicit drug; the prevalenceof experiences with drugs is higher among young people (approximately 35% of pupils in the last grades of basic schools and 45% of first-year secondary school students). The most commonly used illicit drugs include cannabis; basic school pupils show a relatively high level of experience with inhalants. Experience with opiatesand cocaineon the part of the adult population, basic school pupils and students has stabilised at a very low level in the Czech Republic.
The ESPADstudyconfirmed the trend observed in the 2006 HBSC surveycarried out among 15-year-old basic schoolpupils: the dramatic increase in experiences with drug useobserved since the mid-1990s has stopped; the situation has stabilised in terms of cannabis, and a decline in the prevalenceof experiences with other illicit drugs, including ecstasyand hallucinogenic mushrooms, has been observed.
A significant rise in cocaineuse and a slight increase in pervitinconsumption have recently occurred among dance party-goers. On the other hand, the latest prevalenceof ecstasyuse showed a drop, which confirmed the general trend in the population.
In 2007, the estimated number of problem drug users increased slightly to approximately 30.9 thousand, including approximately 20.9 thousand pervitinusers and approximately 10 thousand opiate users (comprising 5.75 thousand and 4.25 thousand heroinand Subutex® users respectively). In comparison to the previous year, the central estimate of the number of problem opiate users (for both heroin and Subutex®) declined in 2007, while the estimate of the number of problem pervitin users rose. Approximately 29.5 thousand people, i.e. most opiate and pervitin users, inject drugs. It is estimated that the highest numbers of problem drug users are in Prague (10 thousand) and in the Ústí nad Labem region (4.1 thousand); at the same time, these areas also show the highest estimates of problem opiate users.
The number of drug users demanding treatmentincreased slightly in 2007. In particular, there was an increase in the number of pervitinusers, as well as, to a certain degree, cannabisusers, while opiate users’ treatment demands declined. An increase in the number of injecting drug users was observed; however, the proportion of injecting users, as far as both pervitin and heroin are concerned, among first treatment demands continues to decline. The average age of users of all types of drugs is on the rise. The relative number of treatment demands was highest in Prague and the Ústí nad Labem and South Moravia regions. Pervitin was the most common primary drug among those demanding treatment in all the regions; traditionally, the highest rate of opiate users has been in Prague and the Ústí nad Labem and Central Bohemia regions.
HIVseroprevalence among injecting drug users remains far below 1%. However, 2007 saw a rise in the number of injecting users newly infected with HIV; in comparison to the annual incidencein the previous years, the number tripled. The prevalenceof hepatitisC virus among injecting drug users tested in low-thresholdprogrammes in 2007 was under 20%.
In February 2008 a studyof the occurrence of infection among Russian-speaking injecting drug users in Prague was completed. The prevalenceof all the infections under investigation significantly exceeds the level shown for Czech injecting drug users; HIVinfection was detected in 3.5%, HCV in 83.1% and HBV in 53.3% of the people tested.
Since May 2008 there have been HAV epidemics among injecting drug users in Prague; while in 2007 five cases were reported in injecting drug users for the whole of the CzechRepublic, between January and August 2008 there were 75 cases.
In 2007 the number of fatal overdoses on the main groups of street drugs which in the Czech Republic are traditionally involved in overdoses remained very low (fourteen cases of an overdoseon opiates, eleven on pervitinand fourteen on inhalants); there was a slight increase as far as opiates are concerned, while pervitin and inhalants remained on the same level and almost on the same level respectively. Sporadic cases of overdoses involving ecstasyand cocainehave been reported in the last three years. One death with the presence of methadoneoccurred in 2007, but none with the presence of buprenorphine(Subutex®). As regards causes of death other than overdoses, in comparison to 2006, there was a decline in the number and proportion of positive findings of pervitin, but the frequency of positive tests for cannabisincreased. As for deaths in traffic accidents, the rate of positive findings increased for benzodiazepines and decreased for pervitin and cannabis. In 2007, of the drivers killed in accidents, 5.8%, 5.8% and 4.5% respectively tested positive for these three most frequent non-alcoholic drugs.
In January 2008 the GCDPC set up a working group concerned with preventionand harm reductionin relation to drug usein the recreational setting. The outcome of its efforts is the pilot project Safer Party Tour 2008, carried out in July and August 2008 at major music and dance festivals.
A wide range of services with good accessibility provides harm reduction, treatment, and resocialisation to drug users in the Czech Republic. The network of low-thresholdprogrammes has remained stable (in the past five years the rate of problem drug users maintaining contact with these agencies has risen from about 60% to about 70%). The network of inpatient health facilities and therapeutic communities did not change markedly in 2007.
The number of needles and syringes distributed by means of exchange programmes carried out in the CzechRepublic in 2007 increased to 4.5 million (3.9 million in 2006). It is estimated that 1.5 million more were sold to injecting drug users in pharmacies.
The year 2007 experienced a further drop in the number of tests for HIVperformed on drug users, and a particularly dramatic decline was observed as far as tests for HCV are concerned. In 2008 the absence of quick HCV tests from capillary blood was partly compensated for by the offer of quick HCV tests from blood serum.
The situation in the field of providing special outpatient health care continues to be unclear; the numbers and
availability of AT clinics, i.e. outpatient healthcare facilities specialising in addiction treatment, and their utilisation by drug users are not known accurately. In 2007 there was a decrease in the number of psychiatric outpatient facilities reporting the provision of care for drug users and the number of drug users maintaining contact with them also declined. This concerned all the groups of substances, including opiates, except for stimulants (pervitin); the number of patients using multiple substances remained approximately the same as in 2006.
For the first time in five years, there was a decline in the number of drug users hospitalised in inpatient psychiatric facilities, which especially resulted from a drop in the number of admissions to the psychiatric departments of hospitals. On the contrary, the number of admissions to psychiatric hospitals rose; there was an increase in all three major drug groups (opiates/opioids, pervitinand polydrug use), of which polydrug use disorders showed the most significant increase.
Three medicines are available for the substitution treatmentof opiate addiction – methadoneprepared from
an imported substance, which is only available in 13 out of a total of 15 specialised substitution centres, and two medicines, Subutex®and, since 2008, also Suboxone®,which feature beprenorphine as the active substance and can be prescribed by any physician, regardless of their specialisation.
Out of the fifteen substitution treatmentcentres, there were four in Prague and two in the Prague-Pankrác and Příbram prisons. In January 2007 another substitution centre was newly opened in the town of Jičín (in the Hradec Králové region). There are still no specialised centres in the Pilsen, Liberec, Pardubice, Vysočina, and Zlín regions. In 2007 the number of patients in specialised substitution centres rose to 1,064 individuals, of whom 620 were treated with methadoneand 444 with Subutex®.
The substitution register, an electronic internet application, was launched in November 2007. Since the beginning, however, the reporting system has faced a number of problems. As a result, treatmentwith Subutex® outside the specialised centres has not been fully registered. In the CzechRepublic, it is estimated that Subutex® is prescribed by approximately 150 psychiatrists and 240 general practitioners for adults; the number of people treated with Subutex® outside the specialised centres may be estimated at between 3,500 and 3,800. Any further increase in the number of Subutex® users in 2007 was very unlikely, given a certain drop in its distribution to pharmacies, as well as a decrease in the estimated number of problem users of the substance (see above).
The number of drug offences in the CzechRepublic has remained relatively stable in recent years. The number of people prosecutedfor drug offences in 2007 was the lowest in the past four years and ranged, depending on the source, from 2,023 to 2,282. 2,042 people were chargedwith drug offences, which represents a decrease of 12% in comparison to 2006 and the lowest total number of people charged with such offences since 2000. Courts passed final sentences for 1,382 individuals convictedof drug offences, which is not dramatically different from the levels registered in the past five years. In 2007 there was an increase in the proportion of individuals prosecuted for drug offences under Section 187a (possessionof drugs for personal use); the number of people charged with and sentenced for the same offence also rose slightly. Traditionally, the highest numbers of people prosecuted for drug-related criminal offences have been reported in the Ústí nad Labem region, followed by Prague and the Moravian-Silesian region; the most people (relative to the number of inhabitants) were prosecuted in the Karlovy Vary region. The most frequent drug offences were associated with pervitin(50-70%), followed by cannabis(20-30%); the proportion of cocainehas been increasing in recent years, although it still accounts for fewer than 3% of drug offences. The structure of the sentences for drug offences has not changed significantly in the past four years: a suspended prisonsentencehas been the type most frequently imposed. Nine hundred and sixty-six misdemeanours involving the possession of drugs for personal use were identified in 2007, which is four times more than the number of people who were subjected to criminal prosecution for the possession of drugs.
Cannabis is the most widely available drug in the CzechRepublic. The availability of pervitinalso remains high. Traditionally, both of these drugs also accounted for the highest numbers of seizures. Domestic production of marijuanawith a higher THCcontent has been on the rise. It is grown in artificial conditions and, with increasing frequency, on a large scale. The volume of the marijuana seized increased slightly, and there was a significant increase in the number of cannabisplants seized; both the number and volume of hashishseizures have declined in the last four years. There has been a slight increase in both the volume and purity of the pervitin seized. Pseudoephedrine contained in over-the-counter medicines for (self-) treatmentof common colds has been the main precursor used to manufacture pervitin in recent years. Pervitin is produced in the CzechRepublic exclusively, and is partly exported abroad, mainly to Germany. The availability and purity of cocainehas been increasing, particularly in recreational nightlife settings; its price has dropped slightly. 2007 experienced the highest ever volume of cocaine seizures. The availability of heroin, which especially reaches the CzechRepublic from Afghanistan via the so-called Balkan route, has not changed; the volume of the heroin seized showed a slight decrease. First and foremost, ecstasyis commonly available in recreational nightlifesettings; the number of seizures of this drug, although widespread, remains relatively low. Nevertheless, the quantity of ecstasy tablets seized in 2007 was the highest in the last three years. The prices of most drugs continue to be stable, according to the available data.