Report on Illicit Drugs in the Czech Republic 2022

Summary of the Report on Illicit Drugs in the Czech Republic 2022

Addiction policy

Czech addiction policy integrates the topics of licit and illicit substances and behavioural addictions. It focuses on licit (alcohol, tobacco) and illicit drugs, psychoactive medicines, gambling and digital addictions.
The main strategic document on addiction is the National Strategy for the Prevention and Reduction of Harms Related to Addictive Behaviour 2019-2027 and the implementation of its objectives is specified in three-year action plans.
The preparation of the Action Plan on Addiction Policy 2022-2025 was initiated in 2022. The action plan identifies five main policy topics and priorities in the area of addiction, which are:

(a) prevention and treatment of addiction;

(b) regulated market with addictive substances;

(d) promoting priorities of the Czech Presidency of the Council of the EU;

(e) minimising the impact of the crisis in Ukraine on the substance-use related situation in the Czech Republic.

The Council of the Government for the Coordination of Addiction Policy (Council) is the coordinating and advisory body of the government on addiction policy issues. With the approval of the new Council Statute, the functions of the National Coordinator for Drugs Policy and the Director of the Council Secretariat were separated in May 2022.
At the regional level, addiction policy is implemented via regional drug coordinators and regional strategic documents. Local drug coordinators operate at municipal level.
In addition to the area of illicit drugs, almost all regional strategies also deal with licit drugs and behavioural addictions. Five regions have a new strategy in place since 2022. An increasing number of municipalities with their own strategy for addiction policy are in place.
The Czech Republic holds the Presidency of the Council of the EU in the second half of 2022, and the priority of the Czech Presidency in the area of addiction is the promotion of an effective, modern, evidence-based drug policy based on the principle of the protection of public health and taking into account the rights of people using drugs.

Legal framework

Act No. 167/1998 Coll., on addictive substances was amended twice in 2021. In particular, the amendment relates to the introduction of an electronic prescription for medicinal products containing an addictive substance, which until now has been prescribed to the paper-based blue-stripe formulation, and to the introduction of a new licensing-based cultivation system for cannabis plants, which would ensure that cannabis-containing medicines are more economically and effectively available for medical use for Czech patients.
The Ministry of Health has issued a decree that, with effect from August 2022, specifies the conditions under which cannabis plants are grown and processed for therapeutic use - cultivation rules have been established, including those for harvesting, packaging and storing cannabis.
Amendments to Act No. 65/2017 Coll., on Health Protection against the Harmful Effects of Addictive Substances, extended with effect from 2022 the range of persons entitled to call for an investigation for the presence of addictive substances, to Probation and Mediation Services staff, and staff of the institutional or protective education and preventive educational care.
The list of addictive substances contained in Government Decree No. 463/2013 was expanded with a total of 332 new psychoactive substances through two amendments in 2021 and 2022.
The topics of political, professional and public discussions in 2021 and 2022 included cannabis used for both medical and non-medical purposes, the inadequacy of penalties for cannabis-related offences, and the use of psychedelics for treatment of mental disorders and for self-development.

Funding

Addiction policy is funded from two levels: the central level (the state budget) and the regional level (the regional and municipal budgets). Most of the expenditures from the regional and municipal budgets is spent on the operation of addictology services. Addictology services are also financed by public health insurance or European funds.
In 2021, public expenditures on addiction policy reached CZK 2,457.7 million (€ 92.95 million), i.e. about CZK 160.1 million (€ 6.05 million) more than in the previous year. Government budget expenditures increased year on year to CZK 2,008.4 million (€ 75.96 million) and regional budgets expenditures to CZK 364.6 million (€ 13.11 million). Only in case of the municipal budget expenditures a reduction was observed to CZK 84.6 million (€ 3.43 million).
Expenditures on treatment, harm reduction, sobering-up stations and law enforcement increased year on year. Expenditures on primary prevention have remained stable over the long term.
Law enforcement expenditures accounted for 53 % of the total identified public expenditures on addiction policy. Less than 4 % of primary prevention expenditures are committed to primary prevention over the long term.

Illicit drug use among children and adolescents

According to 2019 ESPAD study, a total of 29 % of adolescents aged 15-16 had tried any illicit drug. Cannabis (28 %) and ecstasy (4 %) were the most common. Students' experience with illicit drug use has been declining for a long time, with the exception of cocaine.
In the long term, there has been an increase in the average age of adolescents at first use of addictive substances. First cannabis use occurs on average around the age of 14.5 years.
The results were confirmed by the latest UPOL study of 2021, which reported 38 % students aged 15‑20 years had used cannabis at least once in their lifetime, 26 % in the last 12 months and 12 % in the last 30 days. Prevalence of use of other illicit drugs was low among high school students in 2021, with ecstasy (4 %), hallucinogenic mushrooms (3 %) and LSD (2 %) being the most common.
According to a study among schoolchildren in Prague, the prevalence of cannabis use among children and adolescents has declined in recent years. Previously observed gaps in cannabis use among boys and girls have been closing. In the last three years, the prevalence of cannabis use among girls was even slightly higher than among boys.
The study confirmed an increase in experience with substance use with increasing age and after transition from elementary to secondary school. In the long run, high-school students report 3-10 times higher prevalence of illicit drug use compared to elementary school students.
Children and young people in institutional care are at higher risk of substance use, lower life satisfaction and poorer mental health, including elevated rates of suicidal behaviour.

Illicit drug use in the adult population

Among adults in the Czech Republic, cannabis is the most commonly used illicit drug, with around 21-34 % of population aged 15+ having tried cannabis in their lifetime. Lifetime ecstasy use has been reported by 4-5 % of the adults, 5-6 % have tried hallucinogenic mushrooms, and 2-3 % of those aged 15+ report lifetime use of pervitin (or amphetamines) and cocaine.
6-10 % of population aged 15+have used cannabis in the last 12 months and 2-3 % in the last 30 days. Illicit drug use is about 2-3 times higher among males and among young people under 34 years.
The current number of high-risk drug users (HRDU) is estimated at 44,900. Altogether 34,700 HRDU use pervitin and 10,200 use opioids, mainly buprenorphine (5,300) and heroin (3,100). An estimated 40,500 people use drugs by injection.
Cannabis for self-medication was used by 12-15 % of the population aged 15+ in their lifetime and by 5-7 % in the last 12 months. When extrapolated to the population of the Czech Republic, it is estimated that 440-590,000 people have used cannabis for self-medication in the last 12 months, and among them 190-250,000 used cannabis for self-medication only.
While prevalence of recreational use of cannabis decreases significantly with age, use of cannabis for self-medication increases with age of the respondents, showing the highest prevalence among the 55-64 and 65+ years age groups.

Health consequences of illicit drug use

The most significant negative health impacts associated with high-risk illicit drug use include infectious diseases and drug overdoses, both non-fatal and fatal (overdose deaths).
Injecting drug use is a major factor in the spread of infectious diseases among drug users. In the Czech Republic, injecting is the dominant route of administration among high-risk users of opioids or pervitin (methamphetamine).
In 2021, 233 new HIV/AIDS cases were reported. The proportion of transmission of HIV through injecting drug use has long been low in the Czech Republic, with 5-9 cases per year. In 2021, 17 new cases of HBV were reported, 1 of them among people who inject drugs (PWID). For hepatitis C viral, PWID have long accounted for around half of all cases. In 2021, 662 new cases were reported, of which 313 (47.3 %) were reported among PWID.
High-risk drug users also face additional somatic and psychiatric co-morbidity. The most frequently reported mental health problems include psychosis, depressive and anxiety disorders. There is an upward trend in the incidence of dual diagnoses, with an estimate of the proportion of clients with other mental health problems ranging from 1/4 to 2/3 of the total number of clients in different types of care.
Around 500 people a year are hospitalised for non-fatal intoxications, of which around 200 are caused by illicit drugs. The use of illicit drugs is present in around 1-2 % of all injuries per year in the Czech Republic.
Of the total number of road traffic accidents, 319 were caused under the influence of illicit drugs (i.e. 0.3 %), resulting in 8 deaths. The last decade has seen an increasing number of traffic accidents where the culprit of the accident was under the influence of illicit drugs.
A total of 64 fatal overdoses involving illicit drugs, inhalants and psychoactive medicines were detected in 2021 (96 in 2020). Of these, 54 were fatal overdoses involving illicit drugs and inhalants (58 in 2020), most often pervitin or amphetamine overdose (19 cases), and opioid overdose (18 cases). Inhalants were found in 10 cases, as well as benzodiazepines.
An additional 130-150 indirect deaths with the presence of illicit drugs and psychoactive medicines are recorded annually, the highest proportion being caused by illnesses (31 %), accidents (26 %) and suicides (25 %).

Social consequences and correlates of illicit drug use

Among people who use drugs, a combination of negative social and economic factors often takes place - in particular, housing problems, financial problems (frequent debt traps), unemployment or precarious and informal employment, damage to family relationships.
Unstable housing and indebtedness are major obstacles to recovery and to social and economic re-integration, and are often an insoluble problem for people who use drugs.
People who use drugs are often at risk of unstable income, they are often employed for short-term jobs, mostly without a formal job contract or hired by employment agencies. Jobs and incomes of people who use drugs were negatively affected by the COVID-19 pandemic.
Many clients are registered at labour offices and receive social support in the form of material need benefits. Some clients face punitive exclusion from the labour office records, and are left with no financial support at all. The tightening of the conditions for entitlement to material need benefits has led to a destabilisation of the income and housing situation of many high-risk drug users.
Unstable accommodation or homelessness is reported in 3/4 of people who use drugs, while indebtedness is cited in a similarly high proportion.
People who use drugs were often willing to get rid of the foreclosure condition within the so called Gracious summer, a help intended for all those who have judicial foreclosures with public institutions. However, this condition requires the payment of an original debt, plus an administrative charge, which is a condition that high-risk drug users in contact with services cannot meet.
Total household expenditures on illicit drugs has been around CZK 10 billion (€ 378 million) in recent years (accounting for 0.5 % of total household expenditures), which is 10 times less than expenditures on alcohol or tobacco per year.

Addiction prevention

Addiction prevention targeted at children and youth is a part of a broader risk behaviour prevention framework, coordinated by the Ministry of Education.
Only half of school prevention methodologists have completed accredited studies to carry out specialised activities. Most school-based prevention methodologists perform their role only in part-time, having also other functions in schools, most often class teachers.
The system of certification of professional competences of school prevention programmes has been suspended. So far, 80 programmes have been certified so far for addiction prevention; of these, 52 were certified for universal prevention, 20 for selective, and 8 for indicated prevention.
A system of evidence of prevention activities in the field of school prevention has been in place since 2016 and is optional for schools. In total, 37 % of all primary and secondary schools in the Czech Republic reported to the system in 2020/21.
Prevention of illicit drug use was targeted by 6.4 % of school programmes implemented. Prevention in the field of mental health has been carried out increasingly in recent years.
Selective and indicated prevention programmes are scarce. Indicated prevention provided by NGOs is complemented by a network of pedagogical-psychological counselling centres (47 in total) and educational care centres (32 in total).
Illicit drug use accounted for only a very small proportion of cases of risk behaviour handled by schools in 2020/2021 (1.5 %).

Addictology services

In June 2021, the Council of the Government for the Coordination of Drug Policy endorsed the Concept for the Development of Addictology Services. The concept provides the framework and content of the specialization of addiction and addictology services, and describes their typology. The concept redefined 6 basic types of services.
The network of addictology services covers the full spectrum of problems related to substance use and other forms of addictive behaviour, and comprises facilities and programmes of different types, embedded in different disciplines and sectoral (legislative) frameworks.
According to different sources, there are around 250-300 programmes (centres) in the Czech Republic of different types of addictology services. These include 55-60 low-threshold contact centres, 50 field programmes, 90-100 outpatient treatment programmes (of which 10 programmes for children and youth), 10-15 detoxification units, 25-30 inpatient health care units, 15-20 therapeutic communities, 35-45 outpatient treatment programmes (of which 20-25 with sheltered housing), and 5-7 homes with special treatment regime for people with addiction; 60 facilities report patients in substitution treatment and an estimated 600-700 general practitioners provide substitution treatment.
Most regions describe the current network of services as minimal or insufficient. Particularly, there is an acute shortage of outpatient psychotherapists and psychiatrists, as well as of other physicians willing to work with people with addiction. Regions often also report the absence of supportive programmes specialised in children and young people. Significant gaps are reported particularly in the availability of substitution treatment.
The private segment of addictology services is developing. There is also an increase in the supply of treatment and counselling interventions provided via the internet and new technologies. In recent years, there has also been an increase in the supply of participative and self-help activities.
Low-threshold programmes were in contact with 38,900 drug users in 2021 (25,400 pervitin users, 10,000 opioid users and 1,700 cannabis users). A further 11,100 clients were in mediated contact.
The most commonly provided service in low-threshold centres includes the needle and syringe exchange programme for people who inject drugs, while the demand for healthcare and hygienic services has been growing for a long time. In total, 9.4 million syringes were distributed in 2021, i.e. 279 needles and syringes per one injecting drug user in contact with exchange programmes on average, and 232 needles and syringes per one estimated injecting user, which above the WHO target for high coverage rate for needle and syringe distribution with respect to HIV prevention.
Since April 2021, a pilot naloxone distribution programme among clients and service workers has been running in 7 cities (Prague, České Budějovice, Plzeň, Ústí nad Labem, Brno, Mladá Boleslav, Hradec Králové) in 14 low-threshold programmes. Between April and December 2021, altogether 262 doses were distributed, with 20 uses being reported to prevent opioid overdose.
Gelatine capsules for oral drug use, which are an alternative to injection, are likely to be distributed by all low-threshold programmes, with an estimated almost 350,000 capsules issued annually in the Czech Republic.
Low-threshold programmes offer testing for HIV, HBV, HCV and syphilis. In 2021, the number of tests performed in low-threshold programmes increased significantly. The testing rate of people who inject drugs is low, with around 7-8 % of the total estimated number of people injecting drugs tested annually.
Specific harm reduction programmes at dance and music events are not widespread in the Czech Republic, although their activity has been increasing in recent years. In nightlife settings, 10-18 programmes are active in the Czech Republic. A low number of these programmes are related to limited financial support for these activities.
Outpatient care for drug users is mainly provided in psychiatric outpatient settings, with the so-called AT outpatient units being considered as specialised. In recent years, there has been an increasing number of non-medical addictology outpatient facilities, i.e. those providing care in the healthcare sector of addictology services, and a number of social-services-based outpatient programmes have been in place in the Czech Republic as well.
A total of 40,600 substance users were in contact with psychiatric outpatient facilities in 2021, of which 11,000 were in contact with AT outpatient facilities. Of the total number, 14,500 were users of illicit drugs and volatile substances. The largest numbers include pervitin and amphetamines users (4,300), polyvalent users (4,200) and opioid users (3,800).
Substitution treatment, according to the National Registry of Treatment of Drug Users, accounts for around 2,400 people per year, and the number of patients has been stagnating for a long time (mainly patients in methadone treatment). Psychiatric outpatient facilities also reported substitution treatment (2,418 patients). GPs provide substitutions to an estimated 3,900 patients. An estimated 20-40 % of high-risk opioid users are in substitution treatment.
Residential care is provided by detoxification and inpatient units of medical treatment institutions, mainly psychiatric hospitals, therapeutic communities, special education establishments, and sheltered housing programmes.
Annually, 11,500-13,000 persons are admitted to psychiatric hospitals for substance use, of which around 5,000 (42 %) are users of illicit drugs and inhalants.
In the 10 therapeutic communities subsidised by the Office of the Government of the Czech Republic, 372 people were treated in 2021.
Detoxification from addictive substances in 2020 was provided to 10,200 substance users, of which 4,000 (39.3 %) in relation to illicit drugs and inhalants, most often for polyvalent use (2,100) and for stimulants, in particular pervitin (1,000).
In the Czech Republic, according to the Register of Social Service Providers, a total of 38 aftercare programmes provided services in 2021, of which 23 were residential programmes. In 2021, these programmes reported 1,000 clients (603 illicit drug users).
The availability of addictology treatment services in prisons is increasing.
In 2021, altogether 14 addictologists worked in 11 prisons. Drug prevention counselling is available in all prisons, with almost 11,000 people per year were in contact with these services (83 % of illicit drug users). Drug-free zones are available in all prisons, with almost 4,000 clients reported annually.
Treatment for dependence was possible in 14 prisons. A total of 613 individuals benefited from treatment options in the sections on voluntary treatment, with 156 individuals receiving court-ordered protective treatment.
Detoxification was performed in 3 prisons in 2020 (2 prisons in 2019), reaching 28 people (25 in 2019).
Data on substitution treatment were reported by 7 prisons (113 patients). Methadone is available as a substitution substance. Among those entering prison with buprenorphine substitution treatment, treatment may be continued under the condition of coverage of medicines from patients´ own resources.

Drug law offences

In 2021, 4,196 primary drug law offences were registered. Criminal proceedings have, in the long run, been most frequently directed against those involved in illicit manufacturing and handling with psychotropic substances.
The proportion of those prosecuted for the offence of cultivation or possession for personal use is increasing (28 % of all primary drug law offences).
The largest share of people prosecuted is related to pervitin (48 %) and cannabis (42 %).
The number of people sentenced for primary drug offences was 2,597, most often for the illicit manufacture, trafficking and dealing of pervitin and cannabis. The most commonly imposed sanction was conditionally deferred imprisonment.
Around 4,500 drug offences were committed under the influence of Illicit drugs, or 6 % of the offences explained. The perpetrators were most likely to commit the crime of endangerment under the influence of addictive substances or drunkenness.
The Ministry of Justice's criminal records information system records 7,000 substance-related offences per year.

Illicit drug markets

In the Czech Republic, pervitin is produced and cannabis grown, both on a subsistence and commercial basis. The seasonal extraction and processing of raw opium from the food poppy by users directly in the fields takes place. Other illicit drugs are imported into the Czech Republic. In addition, pharmaceutical preparations containing addictive substances of different groups are available on the drug market.
Online drug sales and the use of courier parcel services to distribute drugs play an increasingly important role.
The police of the Czech Republic and the Customs Administration of the Czech Republic detected a total of 151 indoor cannabis cultivation sites in 2021. The proportion of small-scale domestic cultivation sites detected has been increasing for a long time (68 % of those detected in 2021).
In 2021, altogether 188 pervitin laboratories were detected in the Czech Republic, dominated by smaller domestic production sites. Large-scale production is moving abroad, mainly to Poland, Germany, the Netherlands or Belgium. The main precursor for the production of pervitin has been pseudoephedrine extracted from the medicines most commonly imported from Poland.
The countries of origin of cocaine imported into the Czech Republic are Colombia, Bolivia and Peru. However, cocaine processing has increased in European countries such as Belgium, Spain and the Netherlands.
Ecstasy availability is increasing, shipments by transport companies are used for transportation or drugs were imported by people of different nationalities, mainly from the Netherlands or Belgium. Since 2020, the involvement of organised groups originating from Vietnam in the MDMA trade has been reported.
In the case of heroin, the Czech Republic has remained a transit country. Heroin enters Europe mainly from Afghanistan. In 2021, 3 opioid laboratories were detected in the Czech Republic, the raw material being poppy straw.
In criminal proceedings, 1,178 seizures of cannabis dry matter (1,356.0 kg), 285 seizures of cannabis plants (16,800 plants), 912 seizures of pervitin (30.4 kg), 30 seizures of cannabis resin (1.0 kg), 90 seizures of cocaine (180.6 kg), 42 seizures of heroin (107.2 kg), 147 seizures of ecstasy (8,700 tablets and 41.9 kg), and 39 of LSD (2,865 trips) were reported in criminal proceedings in 2021.
The average purity of cannabis in dry matter was 8.6 %, cannabis resin 27.1 %, pervitin 68.2 %, heroin 26.2 %, cocaine 60.1 %, ecstasy tablets 33.7 % and ecstasy powder 62.1 %.
In the Early Warning System on New Drugs, coordinated by the National Monitoring Centre, a total of 21 new psychoactive substances were reported in the Czech Republic in 2021, and 6 of them were reported for the first time. Synthetic cathinones (7 substances) were the most common.

Effects of the crisis in Ukraine on the situation in the Czech Republic

The drug situation in Ukraine is different from that in the Czech Republic - the primary drug among high-risk drug users in Ukraine, used mainly by injection, are opioids, as opposed to the Czech Republic, where pervitin is the most prevalent primary drug. There is also a high prevalence of injecting drug use in Ukraine.
The incidence of HIV infection among people who inject drugs in Ukraine is about 100 times higher, and hepatitis C viral about twice as high as among people who inject drugs in the Czech Republic.
As of 31^st August 2022, a total of 486 HIV-positive people from Ukraine with temporary protection status came to HIV/AIDS centres (140 men, 328 women, 18 children under the age of 15). An overwhelming majority (92.5 %) have already been treated with antiretroviral therapy (ART) in Ukraine.
In the context of the conflict in Ukraine and the arrival of people from Ukraine in the Czech Republic, there is also an increase in the number of HIV positive cases among Ukrainians who do not have temporary protection status.
The arrival of people from Ukraine in the Czech Republic is associated with increased demand for addictology services. These include, in particular, first-contact services and harm-reduction interventions.
The overall financing needs for strengthening the network of drug services in the Czech Republic in the context of the Ukrainian crisis are estimated for at least CZK 17.5 million (€ 662 thousand) in 2023.