2010 Annual Report: The Czech Republic Drug Situation

Summary of the Annual Report on the 2010 Drug Situation in the Czech Republic

The preparation and enforcement of the national drug policyis the responsibility of the Government of the CzechRepublic. Its main advisory body for drug-related issues is the Government Council for Drug Policy Coordination(GCDPC), which met five times in 2010.

The evaluationof two previous drug policystrategic documents – the National Drug Policy Strategy for the Period 2005–2009 and the 2007–2009 Action Plan – was finalised in 2010.

In May 2010 the Government approved the new National Drug Policy Strategy for the Period 2010–2018. The Strategy will be complemented with action plans, each spanning a three-year period. The first of them, covering the period 2010–2012, defines four priorities: (1) to reduce the high level of the use of cannabis, in particular, and other legal and illegal drugs; (2) to adopt specific measures aiming at reducing the problem use of opiatesand methamphetamine(known locally as pervitin); (3) to strengthen the drug policyin relation to legal drugs (alcoholand tobacco), and (4) to develop and generally improve the drug policy’s legislative, financial, and coordinationmechanisms.

A new Penal Code has been effective in the CzechRepublic since 1 January 2010. It also introduced significant changes in the statutory provisions pertaining to primary drug crime. To a certain degree, the new legal regulation differentiates drugs according to their health and social risks, as it makes a distinction between cannabisand other drugs as regards the cultivation of cannabis for personal use and the possessionthereof for personal use. In addition to the above-mentioned differentiation of drugs, the Penal Code newly provides for the offence of the unauthorised cultivation of a small quantity of plants containing a narcotic or psychotropic substance. Subsequently, the Government passed two regulations determining greater-than-small quantities of drugs and plants or mushroomsthat contain narcotic or psychotropic substances.

Public expenditure on drug policyamounted to a total of CZK 627.4 million (€ 24,807 thousand) in 2010. This sum included CZK 371.6 million (€ 14,694 thousand) provided from the state budget, and the regions and municipalities contributed CZK 193.7 million (€ 7,660 thousand) and CZK 62.1 million (€ 2,454 thousand), respectively. In comparison to 2009, total expenses showed a nominal increase on all three levels by 3.3%; however, year-on-year changes in the data collection methodology need to be taken into account. On the central level, there was a significant decrease in expenditure on the part of the Government Council for Drug Policy Coordination. On the regional level, there was a marked increase in aggregate year-on-year expenditure – this particularly applied to the regions of Karlovy Vary, Zlín, and Moravia-Silesia. Over one third of regional expenditures, however, was earmarked to finance sobering-up stations and the treatmentof intoxicated people. The aggregate of funds expended by municipalities experienced a slight increase. Out of the total comprised of all three levels of public budgets, CZK 166.2 million (€ 6,572 thousand, 26.5%) was earmarked for harm reductionservices, CZK 108.9 million (€ 4,304 thousand, 17.4%) for treatment, CZK 62.3 million (€ 2,463 thousand, 9.9%) for primary prevention, and CZK 31.3 million (€ 1,238 thousand, 5.0%) for aftercare. The sobering-up stations, funded almost exclusively from the regional budgets, cost CZK 87.2 million (€ 3,449 thousand, 13.9%), and CZK 149.4 million (€ 5,906 thousand, 23.8%) was earmarked for lawenforcement.

Health insurers’ expenses incurred in relation to the use of drugs other than alcoholamounted to CZK 448 million (€ 7,703 thousand) in 2009 (the latest year for which relevant data are available).

The surveys investigating public attitudes to drug useindicate that the Czech population is relatively tolerant towards the use of cannabis: an absolute majority supports the legalisation of the cultivation and possessionof cannabis, especially for medical purposes. In 2010 and in the first half of 2011 discussions and initiatives on the use of medical cannabis took place. The general public, the professional community, and politicians and representatives of the public administration were involved in these events and activities.

The surveys carried out in the past three years indicate that the level of experience with the use of illicit drugs among the general population remains stable; the most frequently used illegal drug is cannabis(23–34%, according to the study), followed by ecstasy(4–10%). The last-year use of cannabis was reported by 10–15% of respondents, while less than 4% of the adults that were interviewed reported the use of other illegal drugs. The last-month use of illegal drugs other than cannabis has long been reported by less than 1% of respondents. Young adults aged from 15 to 34 years show higher prevalencerates: approximately one fifth of them had experienced cannabis in the last year, and 2–4%, approximately 2%, and 1–2% had used ecstasy, hallucinogenic mushrooms, and pervitinrespectively. The current prevalence rates of the use of other drugs (including cocaine) among young adults are below 1%.

The 2010 HBSC international surveyshowed that 30.5% of students in the ninth grade of elementary schoolin the Czech Republic have tried cannabisat least once in their lifetime. 21.5% and 10.9% of ninth-graders had used cannabis in the last year and last month respectively; the differences between boys and girls were very small. In comparison to the previous round of HBSC, carried out in 2006, a rise in both the lifetime and last-year prevalencerates of cannabis use was observed.

In 2010 the very first representative studyon drug useamong the prisonpopulation was conducted. It was found that the individuals starting their prison sentences show much greater experience of drug use than the general population. This particularly applies to women in general and to both genders as far as the use of heroin, pervitin, and cocaineis concerned.

Dance party-goers and people associated with nightlifesettings constitute another subpopulation showing a significantly higher level of the prevalenceof illicit drug use. Apart from cannabis, the main drugs used among this group include ecstasy, pervitin, cocaineand hallucinogens.

A special studyfocusing on the use of new synthetic drugs (legal highs) showed that almost 5% of young adults in the Czech Republic aged 15–34 have tried them; a similar result was also generated by the Eurobarometer surveyconducted among young Czechs aged 15–24 (4%).

The estimated number of problem drug users continued to rise in 2010; the mean estimate reached the level of 39.2 thousand people. In comparison to the previous years, however, this increase is not statistically significant. While the year 2010 recorded a dramatic increase in the number of problem users of pervitin(28.2 thousand), the number of problem opiate users fell significantly (11.0 thousand). The number of injecting drug users also rose (to approximately 37.2 thousand). Traditionally, Prague and Ústí nad Labem are the regions showing the highest rates of problem drug users, as well as of opiate users. In Prague and other Bohemian regions, in particular, the injecting use of Subutex® became widespread. The concurrent use of pervitin and opiatesis common. In general, 0.5% of the Czech adult population is affected by problem drug use.

It is estimated that one tenth to one quarter of offenders, i.e. approximately 2–5 thousand people, show signs of current problem drug usewhen starting their prisonsentences. Thus, their prevalenceof problem drug useis about 20–50 times higher than that among the general population.

In addition, the levels of the current heavy or problem use of other drugs were estimated. In the Czech Republic, at least once per week in the last month, sedatives were used by almost one million people, cannabisby 360 thousand people, ecstasyby 35 thousand people, hallucinogenic mushroomsby 30 thousand people, and cocaineby almost 15 thousand people aged 15–64, with young adults accounting for the largest proportion of users of these drugs. While for 70% of cannabis users, the use of this drug poses a relatively minor risk, up to 10% of cannabis users are exposed to a significant risk of cannabis use-related problems and dependence.
When extrapolating this proportion to the entire population of the CzechRepublic, we may conclude that approximately 1.0–1.5% of the adult population, i.e. 75–110 thousand cannabis users, is at high risk. Hazardous or harmful use of alcoholis attributed to 1 to 1.4 million people in the Czech Republic, with an estimated 50–150 thousand individuals up to the age of 64 being at high risk of dependence or already dependent.

The relatively favourable situation concerning the occurrence of infections among injecting drug users continued in 2010; HIVseroprevalence among this high-risk group remains below 1%. In 2010 seven HIV-positive people who may have contracted the virus through injecting drug use were newly identified. The numbers of newly reported cases of viral hepatitisC among injecting drug users have also been declining in recent years. The number of HBV cases recorded a slight year-on-year increase in 2010. Depending on the studysample’s characteristics and selection criteria, the prevalenceof viral hepatitis C among drug users ranges from approximately 20% in low-thresholdprogrammes to 40% in prisons or 70% among the clients of substitution treatment. An increased level of the incidenceof syphilis among injecting drug users continued to be observed in 2010.

There has been a long-term steady decline in the rate of injecting among pervitinand heroinusers; the administration of Subutex® by injecting is common. Injecting users among heroin and pervitin users account for approximately 60% of clients of outpatient psychiatric services and 90% and 80%, respectively, of cases recorded in the register of drug treatmentdemands. The available data suggest that there has been a long-term steady decrease in the level of high-risk behaviour, such as needle sharing, among injecting drug users.

The information provided by the register of autopsies maintained by forensic medicine departments shows that the year 2010 witnessed another increase in the number of fatal overdoses on illicit drugs and inhalantsto a total of 55 cases. In comparison to 2009, the number of fatal overdoses on inhalants, in particular, grew dramatically; 16 cases meant double the previous year’s figure. The numbers of cases of fatal overdoses on opiates/opioids (19 cases) and pervitin(18 cases) remained almost on the same level. Cocaine was not detected in any cases of fatal overdosein 2010. For the very first time in Czech history, two fatal overdoses with the presence of the synthetic opioid fentanyl were reported. Similar trends in the occurrence of fatal drug overdoses may be observed from a long-term perspective in the CzechRepublic’s general mortalityregister; the comparison of data collected on the basis of various selection criteria shows that in recent years there have been 30–70 cases annually of fatal overdoses on street drugs in the CzechRepublic. Calculated on the basis of analogical selection criteria, the rate of fatal overdoses on alcoholis approximately tenfold. The year 2010 recorded a further increase in pervitin-related deaths other than by overdose, while the number of such indirect deaths with the presence of THCfell.

The traffic police records indicate that the number and proportion of accidents caused while under the influence of alcohol, as well as the number of people killed in such accidents, dropped in 2010. This positive trend has been confirmed by the data on autopsies of road accidentcasualties examined at forensic medicine departments. On the contrary, the numbers of accidents caused while under the influence of drugs other than alcohol and of people killed in such accidents are growing; the comparison with the data provided by forensic surgeons suggests, however, that the rates are still underreported by the police.

In the CzechRepublic, drug users and addicts may seek help from a network of services providing a wide range of interventions which experienced no major changes in 2010.

The number of drug users listed in the
Public Health Service’s Register of Treatment Demands has been rising in recent years. 9,005 drug users sought treatmentservices in 2010, i.e. approximately 200 persons more than in 2009. In comparison to the previous years, the slightly declining trend has been reversed, and the number of those in treatment returned to its 2004 and 2005 levels. Stimulant users have long predominated among those demanding treatment. They comprised the largest group among all treatment demands (62.9%) and among clients demanding treatment for the first time in their life (67.5%); the number of pervitinusers also showed the highest year-on-year increase in 2010. The second most numerous group was still made up of opiate users (23.1%), while cannabisusers ranked second among first treatment demands (15.9%). A slight aging of the treatment demand population is apparent; their average age has increased by more than four years over the past decade, reaching 27.3 years in 2010. Women continue to account for one third of treatment demands. The Ústí nad Labem and Prague regions report the highest prevalenceand incidenceof treatment demands.

There has been a long-term increase in the number of patients in substitution treatment. This applies to both specialised (methadone) centres and other facilities providing clients with products containing buprenorphine(primarily Subutex® and Suboxone®); however, treatmentwith these preparations has not been fully included in the substitution register, despite the existing statutory requirement.

The number of psychiatric outpatient services reporting the treatmentof users of alcoholand other drugs rose by almost one third to 453 facilities in 2010. A maximum of 50–70 of those, however, may be considered the so-called AT outpatient services, i.e. facilities specialising in clients with addiction issues. The number of patients engaged with psychiatric outpatient services recorded a year-on-year decline, including all three of the largest groups of patients, i.e. those in treatment for opiate/opioid, stimulant, and polydrug use.

The year 2010 experienced a moderate drop in the number of users of alcoholand non-alcohol drugs admitted to psychiatric inpatient facilities. The decline in drugs other than alcohol was due to the lower numbers of patients admitted for disorders caused by polydrug and opiate/opioid use; on the contrary, the number of hospitalisations for disorders caused by the use of stimulants (i.e. mainly pervitin) grew. The number of hospitalisations for alcohol reached the level of approximately 10 thousand per year, while the number of people admitted to hospital for non-alcohol drugs roughly made up half of that number. In the CzechRepublic, detoxificationunits are situated in 16 inpatient facilities with 163 beds designated for this purpose. An additional 12 inpatient facilities provided detoxification in beds which were not specifically designated for this intervention. A total of 6,650 people underwent detoxification from addictive substances, including 3,092 cases of addiction to illegal drugs, during the year under observation.

There are 36 prisons in the Czech Republic where drug users are provided with drug-free zones and various types of counsellingand treatmentservices, such as drug preventioncounselling centres and specialised wings for both voluntary and court-ordered treatment programmes. Almost no changes in their number occurred in 2010; the number of prisons providing detoxificationrose from 4 to 5. Eight prisons provided methadonesubstitution treatmentin 2010. The care of drug-using inmates was complemented by additional services delivered by 15 non-governmental organisations in 32 prisons. It is estimated that approximately one quarter of the individuals starting their prisonsentencewho may be referred to as problem drug users are placed in specialised prison wings or other departments providing professional care, such as drug-free zones.

The number of low-thresholdprogrammes for drug users has fluctuated around 100 on a year-on-year basis. In the past six years, however, a significant increase in the number of clients in contact with these has been observed. There has also been a long-term rise in the number of contacts with IDUs and the amount of injecting equipment and paraphernalia exchanged; almost 5 million hypodermic needles and syringes were distributed in 2010. The programmes for the distribution of gelatine capsules as an oral alternative to the administration of pervitinby injecting have also expanded. According to the available information, there are at least 30 capsule programmes in the Czech Republic, with one quarter of their clients being actively involved in the provision of the services. Almost 60 thousand capsules were handed out in 2010.

The past three years experienced a gradual increase in the number of tests for infectious diseases carried out among drug users in contact with low-thresholdservices. In comparison to the previous years, however, the rate of tests for infections performed on clients of low-threshold services remains relatively low.

Specific harm reductionservices aimed at club and dance settings were provided by four organisations as part of five programmes in 2010. However, the provision of these interventions has been discouraged recently.

In the Czech Republic, the treatmentand care of people infected with HIVor with AIDS is provided at seven AIDS centres and is predominantly covered by health insurance; the provision of dispensary care and therapy for uninsured HIV-positive clients, which potentially also applies to injecting drug users, poses a problem. A questionnaire surveywas conducted in centres for the treatment of viral hepatitisin the spring of 2011. Its outcomes included the estimate that injecting drug users (mostly ex-IDUs) were treated for viral hepatitis C in 39 centres in 2010.

Various police sources and information available from public prosecutors’ offices indicate that approximately 2.4 to 2.5 thousand individuals were prosecutedfor drug-related criminal offences in the CzechRepublic in 2010. Almost 2.2 thousand people were indicted, which corresponds to the enduring rate of 90% of those prosecuted. Almost 1.7 thousand individuals were convictedin 2010. Women account for 15% of drug offenders. The largest proportion of offences (approximately 80%) pertains to the manufacturing and traffickingof drugs and dealing in them. Drug crime associated with pervitin(approximately 55–70%, depending on the source of data) and cannabisshows the highest rates; the involvement of heroinand cocaine, respectively, in offending remains below 5%. The regions reporting the highest relative rates of drug offending include Prague, Central Bohemia, Karlovy Vary, and Ústí nad Labem. 1,021 misdemeanours of the possessionof a small quantity of a drug or the cultivation of a small quantity of a plant containing a narcotic or psychotropic substance for personal use were registered in 2010. In the majority of cases (94%), such misdemeanours involved the possession of drugs; only 6% of the misdemeanours concerned the cultivation of plants containing a narcotic or psychotropic substance.

There has been a long-term increase in the number of people prosecutedfor drug-related offences, and the proportion of people prosecuted for the possessionof drugs for personal use is also rising. From the long-term perspective, there has been an increase in the number of pervitin-related drug crimes, while offending associated with ecstasyand heroinrecorded a decline; the number of cocaine-related cases remains relatively small.

Out of the aggregate of 117.7 thousand, 19.6 thousand (16.6%) criminal offences were committed under the influence of an addictive substance, 17.3 thousand (14.7%) and 2.3 thousand (1.9%) under the influence of alcoholand drugs other than alcohol respectively, in 2010.

Marijuana and methamphetamine(pervitin) were the most widely available drugs in 2010. The popularity and availability of cocaineis increasing. The prices and purity of drugs are stable or within the range where moderate year-on-year fluctuations may be observed in certain substances.

The majority of the marijuanaproduced is intended for the domestic market. Part of the production of cannabisgrown under artificial lighting is well organised and mostly involves people of Vietnamese origin. 278 kg of marijuana and almost 65 thousand cannabis plants were seized, which is twice as many cannabis plants as in 2009. The number of cannabis plantations detected is also growing – 145 were discovered.

Pervitin is made by domestic manufacturers, particularly in small home labs. Nevertheless, the large-scale production of pervitin, controlled by organised groups originating from Vietnam or Albania, is becoming a common practice. Pervitin is generally manufactured using medication containing pseudoephedrine, mainly imported from Poland. The drug is primarily intended for the Czech market. A minor proportion of the production is exported abroad, particularly to Germany, which is especially facilitated by German citizens who are involved in the individual traffickingof small quantities as part of drug tourism. A total of 21.3 kg of pervitin was seized, which is the largest amount in the past four years, and 307 pervitin cooking labs were detected.

Cocaine is mainly associated with the recreational and nightlifesettings in the CzechRepublic. In addition to Albanians, Romanians, and Bulgarians, people originally from West Africa, mostly Nigeria, are engaged in the import and distribution of cocaine. The body cavities of couriers (swallowers) are used to smuggle the drug. Couriers bring cocaine directly from South America or from Western European countries. Since 2008 there has been an increase in both the number of seizures and the quantity of the cocaine seized; the year 2010 recorded 42 seizures of cocaine in a total quantity of 14.2 kg.

The demand for heroinon the Czech market is satisfied by means of small shipments (up to 10 kg), and the drug is diluted (mostly with paracetamol and caffeine) before being sold at the street level. The purity of the street heroin seized ranged from 5 to 10%. The quantity of the heroin seized and the number of seizures remain stable; there are approximately 50–100 seizures annually, involving a total quantity of 20–40 kg.

Since 2010 the Czech Republic has experienced a rise in the emergence of legal highs. They are substances with effects similar to traditional drugs such as pervitin, marijuana, ecstasy, and hallucinogens, but are not subject to international and national illicit drug control systems, as they are not scheduled as illegal narcotic and psychotropic substances. They are primarily imported from Asia (China, in particular) and include mainly synthetic cannabinoids and cathinone derivatives, especially mephedrone. In 2010 the Customs Administration seized and analysed approximately 250 kg of new synthetic drugs (including 80 kg of mephedrone). In response to the increased supply of legal highs, Act No. 167/1998 Coll., on addictive substances, was amended in the spring of 2011; 33 new substances, including 30 synthetic drugs, were added to its schedules.

This annual report concludes with three chapters on selected issues addressing in greater detail the interventions for drug users in prison, drug-using parentsand their children, and drug tourism. The first chapter provides a thorough summary of drug-related health policies and services within the prison system of the CzechRepublic in the context of the general health care provided to incarcerated offenders. The aim of the second selected issue is to cover the prevalenceof pregnant drug users and those users who are already parents of minor children and trends and characteristics pertaining to them, as well as describing specific services designed for such users and their children in the Czech Republic. Given the complex nature of the topic and the lack of data, the last chapter on a selected issue provides a rather unsystematic outline of information about the association between cross-border travel and drug use, or drug tourism, in the CzechRepublic.