Summary of the report
The preparation and enforcement of the national drug policyi s the responsibility of the Government of the Czech Republic. Its main counselling body for drug-related issues is the Government Council for Drug Policy Coordination, which met four times in 2008. The National Drug Policy Strategy for the Period 2005 to 2009 and the Action Plan for the Implementation of the National Drug Policy Strategy for the Period 2007 to 2009 are in force. All regions drew up their documents on regional drug policy strategies in 2008. In the first half of 2009, the CzechRepublic held the presidency of the Council of the European Union. In relation to that, the Government Council for Drug Policy Coordination considered a number of documents pertaining to the preparation and the course of the presidency and its Secretariat was responsible for the leadership of the Horizontal Drugs Group, a working group of the EU Council.
In early 2009, Act No. 40/2009, Coll. Penal Code, effective from 1 January 2010, was adopted and included in the Collection of Laws. The new Penal Code includes significant changes in how to address illegal drugs. In comparison to the previous sentencing guidelines, a lower punishment range will apply to people who possess cannabisin a quantity greater than small. A significant change was also introduced by the new provision concerning the illegal cultivation of plants containing a narcotic or psychotropic substance: the growing of designated plants or mushroomsfor personal use will be covered by less strict sentencing guidelines than was the case under the previous legal regulations and the cultivation of a small quantity of plants or mushrooms for personal use will be punished under the Misdemeanour Act rather than the criminal law. In relation to the act on pharmaceuticals, restrictions on the over-the-counter supply of medicinal products containing up to 30 mg of pseudoephedrineper tablet were imposed. This measure involves a ban on mail order sales, the setting of a maximum monthly dose of 1,800 mg of pseudoephedrine (i.e. 60 tablets of 30 mg) per person, and the control of supply by means of the central database of electronic prescriptions.
Two surveys covering the adult population were carried out in the CzechRepublic in 2008: a general population surveyspecifically addressing the use of illicit drugs and a surveyfocusing on the health of the population in general. Both studies differed significantly in the methodology used and also provided different results. The former study(using a sample of respondents aged 15-64) showed that 37% of the population have had at least one experience with any of the illicit drugs under study; 34% have used cannabisand 17% of the population has had experience with a drug other than cannabis. In the past year and the past month, cannabis had been used by 15% and 9% of the respondents respectively. According to the latter study (working with a sample of respondents over 15 years of age), 15% had used an illicit drug at least once; cannabis had also been used by 15%, while any other drug than cannabis had been used by 4% of the respondents. Despite the above-mentioned differences, the results of both studies indicate that the proportion of people in the population who have experience of addictive substances is on the rise, with cannabis use showing the greatest increase. While in 2002 and 2004 at least one experience with cannabis was reported by one fifth of adult respondents, the 2008 study on illicit drug userecorded positive answers to this question from one third of the respondents. An increase over time has also been recorded in the surveys studying the population’s health in general, although the prevalencerates reported by them are lower.
Out of the respondents included in the surveyon the use of illicit drugs who reported having used cannabisin the past month, 9% used cannabis daily or almost daily. After extrapolation to the Czech population in the 15-64 age group, the number of daily, or almost daily, cannabis users may be estimated to amount to approximately 57 thousand (0.8% of the population aged 15-64). The survey also sought to identify the level of risky cannabis use. The use of cannabis poses a moderate risk for 26% and a high risk for 12% of the respondents who had used the drug in the past year. Men and people aged 25-34 comprise the most vulnerable group. After extrapolation to the Czech population in its entirety, the number of cannabis users at significant risk of dependency may be estimated to amount to 150 thousand, with people in the 15-29 age group accounting for approximately two thirds of them.
The international comparison of the results of the ESPADschoolsurveyindicates that, within the European context, the Czech Republic ranks among the countries with the highest prevalencerates concerning the use of most of the drugs under study, with the exception of inhalants. As far as cannabisuse is concerned, the CzechRepublic’s prevalence rates are by far the highest in Europe; at least one experience with cannabis use has been reported by 45% of 16-year-old Czechs.
Cannabis and ecstasyremain the most popular non-alcoholdrugs in the nightlifesetting, although experience with pervitinand cocainehas shown a rising trend recently.
In 2008 the estimated number of problem drug users rose to approximately 32.5 thousand, including approximately 21.2 thousand pervitinusers and approximately 11.3 thousand opiate users. Approximately 31.2 thousand people, i.e. most of the users of opiatesand pervitin, use drugs by injecting. In comparison to 2007, the number of problem users of all types of drugs increased in 2008. It is estimated that the highest numbers of problem drug users are in Prague (11.5 thousand) and in the Ústí nad Labem region (4.2 thousand); these regions also show the highest estimates of problem opiate users.
The relatively favourable situation concerning the occurrence of infections among (injecting) drug users continued in 2008; HIVseroprevalence remains far below 1%. The prevalenceof hepatitisC virus among clients tested in low-thresholdprogrammes was approximately 12%. However, such a low level of HCV seroprevalence may result from the fact that the testing is mostly sought by young users with a shorter history of injecting drugs. In 2008 HIV was newly diagnosed in 13 people, who may have contracted it through injecting drug use. While it is less than in 2007, it is a relatively high number when compared to the period prior to 2006. An HAV epidemic developed in the CzechRepublic in 2008. InPrague, particularly at the beginning, it was associated with injecting drug users.
The number of overdoses on street drugs (illicit drugs and inhalants) remained very low in 2008; a total of 44 cases (15, 19, and 10 fatal overdoses on opiates, pervitin, and inhalants, respectively) were reported, which is 4 more than in 2007. There was a slight increase in opiates, pervitin overdoses recorded a significant increase, and the number of fatal overdoses caused by inhalants declined. No deaths by overdoseon cocaine, ecstasy, hallucinogens, or THCwere registered. One fatal overdose with the presence of methadoneoccurred in 2008, but none with the presence of buprenorphine. As regards causes of death other than fatal overdoses (especially accidents/injuries and suicides), the involvement of pervitin and THC has been detected with a rising frequency since 2004; 49 and 37 cases, respectively, were reported in 2008. Opiates/opioids accounted for 12 cases, including 5 cases of an active substance from a substitution product being detected. In addition, there was a significant year-on-year increase in the rate of positive findings for pervitin and cannabisin people who died in traffic accidents, or in consequence thereof, and were subjected to an autopsy at forensic medicine departments; 9.2% and 6.2% respectively of the drivers killed in accidents tested positive for these substances. However, the police have only registered sporadic cases. The increase concerning pervitin-related cases is also apparent in admissions to hospital for non-fatal overdoses. On the other hand, the number of non-fatal overdoses on heroinshows a declining tendency.
In the CzechRepublic, drug users and addicts may seek help from a variety of easy-to-access services providing a wide range of interventions. The network of helping organisations experienced no major changes in 2008. The profession of an addictologist (addiction specialist) was incorporated in the lawon non-medical health professions and the professional competencies required for the performance of this profession were defined.
Men outnumber women in all the types of treatmentfacilities; they account for approximately two thirds of the clients. The proportion of women tends to be higher in younger age groups. The average age of drug users in treatment continues to rise in the long term; this tendency is apparent across various sources of data. In the CzechRepublic, the largest group of drug users in treatment comprises pervitin(methamphetamine) users, followed by the users of opiates/opioids (heroinand Subutex®) and cannabis. Polydrug use (the concurrent use of more than one drug) is commonplace. Injecting is the most frequent route of pervitin and opiate administration among users in treatment. The regions with the highest numbers of drug users in treatment include the CapitalCity, Prague, and the Ústí nad Labem region, where, as in the other regions of the Bohemian part of the country, high numbers and rates of opiate users are reported.
There has been a long-term decline in the number of psychiatric outpatient facilities reporting the provision of care for drug users; the number of their patients in 2008 remained approximately the same as in 2007. The numbers and regional availability of AT clinics, i.e. outpatient healthcare facilities specialising in addiction treatment, and their utilisation by drug users are not known accurately; 124 outpatient facilities have declared that they provide specialised addiction treatment services. In 2008 there was a decline in the number of individuals 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 slightly. The number of patients registered for substitution treatmenthas increased. This applies to both specialised centres and individual physicians who prescribe products containing buprenorphine(Subutex® and Suboxone®). Nevertheless, treatment with buprenorphine has not been fully included in the substitution register.
Drug-related harm reductionactivities in the CzechRepublic are pursued by the dense network of low-thresholdprogrammes, which have undergone no major changes in recent years. The number of needles and syringes distributed as part of exchange programmes saw a slight increase again (from 4.5 million in 2007 to 4.6 million in 2008). In 2008, for the first time after a long period, the number of tests for HIVand HCV performed on drug users in low-threshold facilities almost doubled.
The number of people arrested or prosecutedfor drug-related offences has remained relatively stable in recent years; in 2008 it ranged from 2,296 to 2,322 people, depending on the source. 2,100 people were chargedwith drug offences, which represents a slight year-on-year increase. Final sentences were passed on 1,360 individuals convictedof drug offences. Traditionally, the highest numbers of people prosecuted for drug-related criminal offences have been reported in the Ústí nad Labem region, followed by the CapitalCity, Prague, the Moravian-Silesian region, and the South Moravia region. As in the previous years, most of the drug offences were committed in relation to pervitin. 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.
Cannabis is the most widely available illegal drug in the CzechRepublic. The availability of pervitinis also high in the long term. Traditionally, the highest numbers of seizures were associated with both of these drugs. The 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 more than tripled in comparison to the previous years, and there was also a significant increase in the number of growing sites detected and cannabisplants seized. The amount of pervitin seized was lower than in the previous years, but the number of pervitin-cooking laboratories detected was the highest in the past six years and the seizures of precursors used to manufacture pervitin also increased in quantity. Since May 2009 restrictions have been imposed on the sale of medicines containing pseudoephedrineby pharmacies. In relation to this measure, an increase in individual imports of these pharmaceutical products from the neighbouring countries has been observed recently. The prices of most drugs continue to be stable, according to the available data. There was a year-on-year increase in the average potency of the cannabis seized and the average purity of the heroinseized.
The Report concludes with three chapters on selected issues, including Cannabis Markets and Production, page 96, Problem Amphetamine and Methamphetamine Use, Related Consequences and Responses, page 102, and Treatment and Care for Older Drug Users, page 115.
In the CzechRepublic, as in the rest of the world, cannabisis the most common illicit drug used. In the second half of the 20th century, cannabis was mostly grown and used among closed groups of people in the CzechRepublic. A commercial market in cannabis (marijuanaand hashish) opened up in the 1990s. At present, the Czech Republic ranks among the European countries with the highest prevalenceof cannabis use. According to the majority of the adult population, it is difficult to obtain cannabis, but three quarters of respondents in the 15-24 age group find it easy. The places where cannabis is most frequently obtained in the CzechRepublic include bars, restaurants, and clubs. Almost three quarters of the respondents reported that they had last obtained cannabis free of charge. Cannabis was most likely to be obtained from a friend, a relative, or a partner. The dealers tend to consume it themselves and do not usually sell any other drugs. The retail prices of marijuana and hashish remain stable; they are sold at approximately CZK 200 (€ 8) and CZK 250 (€ 10) per gram, respectively. On the occasion of their last sales transaction, three out of four respondents had bought cannabis in a quantity up to 2 grams. The average potency of marijuana shows a slight increase, while that of hashish is in decline. In the Czech Republic, the greatest proportion of cannabis, including that found on the commercial market, comprises indoor-grown marijuana, followed by outdoor-grown marijuana. Most of the cannabis users identified the CzechRepublic as the country of origin of the marijuana they had last obtained. In the Czech Republic there are several “grow shops” selling equipment needed for the cultivation of marijuana; seeds for the growing of cannabis plants may be obtained through social networks or via the internet, both from within the country and abroad. The annual number of marijuana seizures ranges from 550 to 600 and there has been an increase in the overall amount of marijuana seized; in 2008 the number of cannabis plants seized rose fourfold on a year-on-year basis. In the past three years, approximately 5% of marijuana seizures and only one hashish seizureinvolved an amount exceeding 1 kg. Since 2005 the number of large-scale indoor growing sites detected has increased; 79 such facilities were detected in the Czech Republic in 2008.
The objective of the second chapter on a selected issue is to describe the situation concerning the use of amphetamines, i.e. amphetamineand methamphetamine, and the related measures. In the past thirty years, methamphetamine has had a dominant position among problem drug users in the CzechRepublic, which makes the Czech situation exceptional within the European context. Therefore, this chapter deals almost exclusively with methamphetamine, which has been traditionally referred to as pervitin in the Czech Republic. It is estimated that there are approximately 20 thousand problem pervitin users in the Czech Republic, which amounts to two thirds of all the problem drug users in this country; 80-90% of those are injecting users. The level of pervitin use in the general population has remained very low over the years, although it has a rising tendency in nightlifesettings. Pervitin users comprise the largest group of all the drug users in treatment; from the long-term perspective, they account for approximately 60% of all the cases. Pervitin is often used in combination with other drugs, mostly cannabis, opiates, and alcohol. Long-term pervitin use is associated with psychiatric co-morbidity, involving toxic psychoses especially. The incidenceof infections is mainly related to pervitin use by injecting. However, it does not seem to differ significantly from that in (injecting) opiate users, as far as the level of risk is concerned. In the CzechRepublic, there are approximately 10-20 cases of fatal pervitin overdoses annually, which accounts for about one third of fatal overdoses on street drugs (i.e. illicit drugs and inhalants). Pervitin use treatment has long been integrated into the system of drug services. With few exceptions, no pervitin use-specific programmes are provided. There are differences in the provision of certain services: harm reductionorganisations have recently conducted programmes featuring the distribution of gelatine capsules intended almost exclusively for pervitin users and, as far as treatment is concerned, variations can be found in its pharmacotherapy. These are determined by a different course of withdrawal and detoxification, different psychological complications, and, in particular, the development of psychotic symptomatology and toxic psychosis. There is sporadic, although long-term, experience with the substitution therapy of pervitin addicts using various psychostimulants, presently mainly methylphenidate. Pervitin is manufactured using ephedrine, pseudoephedrinein particular, which is extracted from over-the-counter medicines. The availability of these medicinal products from pharmacies has been reduced significantly since May 2009 as a result of legal and administrative measures. The number of illegal pervitin manufacturing sites detected by the police rose from 188 in 2003 to 434 in 2008. The estimated annual pervitin consumption in the CzechRepublic has maintained a level of about 4 tonnes in recent years; every year, lawenforcement agencies seize approximately 5 kg of pervitin in total. The price of pervitin remains stable at CZK 1,000 (€ 40) per 1 g and its purity has been approximately 60% for a long time.
The third selected issue concerns older drug users(for the purpose of this selected issue, an older drug user means any user over 40 years old), both in treatmentand outside it, as well as specific services designed for older users. The prognosis announced by the Czech Statistical Office indicates that in 2050 people aged 65 and above will account for 31% of the Czech population. The demographic aging of the population results from the declining birth rate and the rising life expectancy, which are associated with better health care and a higher quality of life. The available data show that the population of drug users is also aging in the Czech Republic. There has been an increase in the average age of people in contact with low-threshold facilitiesfor drug users and the number of older drug users in treatment is also on the rise, although their proportion is still low. In comparison to those of a younger age, drug users aged 40 and above are more likely to be unemployed and homeless, and they also include more individuals with higher education. Nevertheless, the Czech drug policyseems neither to articulate specific measures nor implement them in order to address the issue of the aging of the population of drug users. In the CzechRepublic there is only one establishment specialising in services for older users of non-alcoholdrugs. The vast majority of the existing programmes deals with older clients’ specific problems, encountered in treatment or during the provision of low-threshold or outreach services, on the basis of individual demands and needs.