Summary Report on Addictions in Czechia 2021

This is an introductory summary of the report, which is published in full under Publications - Annual Reports.

Current situation and main trends in the field of addictive behaviour in the Czech Republic

Use of tobacco, nicotine and related products and its impact

In the Czech Republic, approximately 20% of the population aged 15 and over smoke daily, i.e. approximately 2 million people. The proportion of smokers in the adult population declined slightly until 2015, but has not changed substantially in recent years. The proportion of adolescent smokers has been declining over the long term. In 2019, ESPAD survey reported that 10% of
16-year-old students smoked daily, which is three times less than in the late 1990's.

Each year, 16-18 thousand people die as a result of smoking, most often due to cancers of the trachea, bronchi and lungs, or chronic obstructive pulmonary disease. For every deceased smoker, 15 years of life are estimated to be lost.

Approximately 1-2 thousand people per year are in contact with services and in treatment for tobacco addiction. Smoking cessation counselling is provided by outpatient doctors of various specializations, pharmacies and addictology programmes, and a significant proportion of smokers attempt to quit without professional help.

In recent years, alternative products, especially electronic cigarettes (or vaporizers) and heated tobacco products, have been growing in popularity, especially among young adults. E-cigarettes are currently used by approximately 5% and heated tobacco products by 3% of adults. These products, which are used for vaping rather than smoking, are less risky from the health perspective than cigarettes, cigars and pipes.

Alcohol use and its impact

Alcohol consumption in the Czech population has long been at a high level. Alcohol consumption in the Czech Republic is equivalent to 10 litres of pure alcohol per capita. Approximately 10% of the adult population drink alcohol daily and the proportion of daily drinkers has been increasing in the long term. Frequent heavy episodic drinking is reported by 12% of the population. While frequent heavy drinking is highest among young adults and decreases with age, daily alcohol consumption increases with age. There has been a significant decline in alcohol consumption among adolescents since 2011, including regular consumption and risky forms of drinking.

An estimated 1.5-1.7 million adults are classified as high-risk alcohol users, with 800-900 thousand people falling into the category of harmful drinking. The proportion of people showing signs of risky and harmful drinking has been increasing over the long term.

Each year, 6-7 thousand people die from alcohol use, of which 2 thousand deaths are directly attributable to alcohol (e.g. deaths from alcoholic liver disease or alcohol intoxication). Another 600 cases a year are indirect deaths, i.e. deaths due to alcohol-related accidents or suicides. Injuries, traffic accidents and alcohol-related violence are also a burden on society and the health system. On average, alcohol addicts die 24 years earlier than the general population.

Approximately 30-35 thousand people are in contact with services and in treatment for alcohol addiction each year, of whom the largest proportion (approximately 27 thousand people) are in contact with psychiatric facilities (20-23 thousand in outpatient care, approximately 6 thousand in inpatient care).

Problematic use of psychoactive medicines

An estimated 14-15% of the population, corresponding to 1.25-1.45 million people, fall into the category of the problematic use of psychoactive medicines, defined on the basis of use of medicines for more than 6 weeks, subjective perception of overuse and/or obtaining medicines without a prescription. Sedatives and hypnotics are used problematically by an estimated 1.1 million people and opioid analgesics by 550 thousand people. Women are more likely to be concerned. Long-term trends in this field are not available.

Misused psychoactive medicines are mainly obtained from the official health system, as well as through family or the internet, but also appear on the illicit drug market.

In the long term, the quantities of benzodiazepines and barbiturates distributed to pharmacies are decreasing (calculated per million daily doses of drugs), while the quantities of Z-drugs, pregabalin and opioid analgesics distributed are increasing.

Approximately 40 people die each year from an overdose of psychoactive medicines, most commonly benzodiazepines. The category of opioids also includes overdoses of opioid analgesics (fentanyl, codeine, dihydrocodeine, hydromorphone, oxycodone). A further 70 cases of deaths under the influence of psychoactive medicines are reported annually due to illness, accident or suicide. Between 150 and 200 people a year are admitted to hospitals for accidents under the influence of psychoactive medicines.

Approximately 3-4 thousand people a year are in treatment for psychoactive medicine use, most of them in outpatient treatment, including 2.5 thousand for problems related to sedatives and hypnotics. Long-term users of psychoactive medicines account for 6% of the total number of patients in outpatient addiction treatment.

Use of illicit drugs

Cannabis is the most commonly used illicit drug in the Czech Republic, with approximately a quarter to a third of adults reporting experience with it. Approximately 8-10% of adults report current cannabis use (i.e. use in the last 12 months), corresponding to approximately
800-900 thousand people. The prevalence of cannabis substance use is higher among men and in younger age groups.

The proportion of adults using cannabis has been stable over the long term, but the proportion of cannabis users among young adults (up to the age of 34) has slightly increased. In contrast, in the adolescent population, experience with cannabis has been declining since 2007. In the last year,
5-10% of the adult population, i.e. an estimated 400-900 thousand people, used cannabis for
self-medication. Estimated 200 thousand people used cannabis exclusively for self-medication (i.e. after exclusion of those who also used cannabis for recreational purposes).

Approximately 400 thousand people are at risk of intensive cannabis use, of whom half (200 thousand) are at high risk. There are an estimated 30 thousand daily users of cannabis.

Other illicit drugs are much less commonly used. About 5-7% of adults report use of ecstasy in their lifetime, 4-6% report having used hallucinogens and 2-4% methamphetamine and cocaine.

An estimated 44 thousand people are high-risk drug users, mostly users of methamphetamine (33 thousand) or opioids (11 thousand). In the last ten years, the number of high-risk drug users has increased by about a quarter. An estimated 42 thousand people use drugs by injection.

The prevalence of HIV/AIDS in the Czech population and among people who inject drugs has been low. The prevalence of HCV has been stable over the long term, however it is the most prevalent infection among drug users and represents a burden on the health system.

Between 40 and 60 people die each year from an overdose on illicit drugs, and a further 150 cases of deaths associated with illicit drugs are reported annually due to illness, accident or suicide. 
Drug-related injuries and traffic accidents also represent a burden on society and the health system.

An estimated 14 thousand people are treated in relation to illicit drug use annually in psychiatric outpatient clinics and approximately 5 thousand in inpatient facilities. Nearly 40 thousand drug users are in contact with low-threshold programmes annually, and in the long term there is a noticeable increase in the number of methamphetamine users, as well as opioid users in recent years. The average age of drug users in contact with addiction services is increasing, reaching 35 years among those in contact with low-threshold programmes.

Gambling and its impact

Gambling in the last 12 months has been reported by 35-50% of adults, with lotteries being the most preferred game, which have long not been considered gambling. After exclusion of lotteries, gambling is reported by 8-19% of the adult population.

In the long term, there has been a slight increase in the prevalence of gambling in the adult population, both for lotteries and for other games (technical games, live games and betting). Gambling is significantly higher among young adults aged 15-34, with the prevalence among males being several times higher than among females.

In the long term, an estimated 150-250 thousand people have been identified at risk of developing gambling-related problems, with 80-100 thousand people falling into the high-risk category. The highest share of people at risk is among players of technical games and online betting. The estimated number of people at risk of problem gambling has been stable over the long term, but the number of people at high risk has slightly increased.

Problem gambling leads to financial, family and work-related problems. The health consequences of problem gambling include a high incidence of psychiatric comorbidity; compared to the general population, people at risk of problem gambling have significantly poorer mental health and are more likely to attempt a suicide.

Approximately 2-3 thousand people per year are in contact with gambling-related services, of which around 1 thousand are in psychiatric care facilities. This is especially true for men, who are treated 5 times more than women. The average age of players in treatment is around 35 years. Most of those in treatment report problems related to technical games (slot machines), but their proportion is decreasing. A significantly increasing proportion of people in treatment report problems related to online betting.

Overview of the situation in the Czech Republic in figures

Prevalence of addictive behaviour in the adult population

• 17-23% of the population aged 15+ years, i.e. 1.5-2.1 million people, smoke cigarettes daily or almost daily
• 10% of people aged 15+ years, i.e. 800-980 thousand people, drink alcohol daily or almost daily
• 17-19% of the population, i.e. 1.5-1.7 million people, are classified as high-risk alcohol consumers, of which 9-10% (800-900 thousand people) fall into the category of harmful drinking
• 14-15% of adults, an estimated 1.25-1.45 million people, fall into the category of the problematic use of psychoactive medicines
• 8-10% of people aged 15+, an estimated 800-900 thousand adults, used cannabis in the last 12 months, approximately 207 thousand adults are at high risk of developing problems related to cannabis use
• 5-10% of the adult population used cannabis for self-treatment in the last 12 months, i.e. an estimated 400-900 thousand people
• 1% of adults have used ecstasy in the last 12 months, 1.5% hallucinogenic mushrooms, less than 1% methamphetamines (or amphetamines) and cocaine
• 44.2 thousand people are high-risk users of methamphetamine or opioids, including 33.1 thousand methamphetamine users, 6.4 thousand buprenorphine users, 3.3 thousand heroin users and 1.4 thousand users of other opioids
• 2-3% of the population aged 15+ years fall into the category of problem gambling (i.e. approximately 170-220 thousand people), of whom 90-120 thousand fall into the category of high risk

Table 0‑1: Prevalence of addictive behaviour in the population of the Czech Republic aged 15+ years

The table is only available in the full report.

Prevalence of addictive behaviour among children and adolescents

• 10-11% of 13- to 16-year-old school students report regular or daily tobacco smoking
• 17% of 11-year-olds, 43% of 13-year-olds, 76% of 15-year-olds and 95% of 16-year-olds have drunk alcohol in their lifetime, with around half reporting drinking alcohol in the last 30 days
• 39% of 16-year-olds report binge drinking (i.e. drinking 5 or more glasses of alcohol on one occasion) in the last 30 days, 12% once a week or more often
• 24% of 16-year-olds have used illicit drug in the last 12 months, 23% having used cannabis, 3.5% sedatives without prescription, 3.3% volatile substances, 2.6% ecstasy, 1.1% hallucinogenic mushrooms, 1.9% LSD or other hallucinogens, and about 1% cocaine or methamphetamine
• 9-11% of adolescents have gambled for money in the last 12 months

Impacts of substance use

• 16-18 thousand deaths a year are caused by tobacco smoking
• 6-7 thousand deaths a year are caused by alcohol drinking, with alcohol being the main or only cause of death in 2 thousand cases, of which alcohol intoxication accounts for 400-500 cases per year
• 96 people died in 2020 as a result of fatal overdoses, of which 58 were overdoses of illicit drugs or volatile substances, and 38 related to psychoactive medicines
• 150 fatal cases were identified as being influenced by illicit drugs and psychoactive medicines, for causes other than overdose, most of them due to illness, accidents and suicide
• 14 new HIV diagnoses in 2020 were likely to be related to injecting drug use, another 5 people had a history of injecting drug use
• 800-1000 cases of viral hepatitis C are reported annually, including 400-500 cases among people who inject drugs
• 14-15 thousand hospital admissions are reported annually for injury under the influence of addictive substances, including 13.5-14 thousand cases under the influence of alcohol, 250 persons are hospitalised annually for injury under the influence of illicit drugs, 150-200 persons under the influence of psychoactive medicines and 10-15 persons under the influence of volatile substances
• 4.5 thousand traffic accidents per year are caused by alcohol, 260 by other drugs

Table 0‑2: Deaths caused annually by substance use in the Czech population

The table is only available in the full report. 

Network of services for clients with addictions

• 250-300 facilities provide specialised addiction services, including 55-60 low-threshold centres, 50 outreach programmes, 90-100 outpatient treatment programmes (including 10 programmes for children and adolescents), 10-15 detoxification units, 25-30 inpatient healthcare units, 15-20 therapeutic communities, 35-45 outpatient aftercare programmes (of which 20-25 with sheltered housing) and 5-7 homes with special regime for substance users; 60 facilities report patients in opioid substitution treatment and an estimated 600-700 general practitioners provide opioid substitution treatment

Table 0‑3: Estimated number of people per year in contact with addiction services and treatment in the Czech Republic

The table is only available in the full report. 

Financing, market, crime

• CZK 2,297.5 million (€ 86.9 million) were spent on addiction policy, of which 52% was spent on law enforcement, 16% on harm reduction, 12% on drug treatment, 4% on prevention, 5% on aftercare, 6% on sobering-up stations and less than 2% on coordination, research and evaluation
• CZK 938.0 million (€ 35.5 million) was spent by health insurance companies on the treatment of substance users
• the state revenues account for CZK 60 billion (€ 2,269 million) annually on excise duties on tobacco products, and CZK 13 billion (€ 492 million) on excise duty on alcoholic beverages
• 23 billion cigarettes are consumed annually in the Czech Republic, which corresponds to approximately 2,000 cigarettes per capita
• 166.7 litres of alcohol per capita are consumed annually, corresponding to 10 litres of pure alcohol per capita
• CZK 33 billion (€ 1,248 million) were lost by players in gambling in the Czech Republic, with CZK 393 billion (€ 14,864 million) invested in gambling and CZK 360 billion (€ 13,616 million) paid out in winnings
• 15 thousand offences were committed under the influence of addictive substances (68% under the influence of alcohol and 32% under the influence of other drugs)

Table 0‑4: Estimates of the social costs of addictive behaviour in the Czech Republic

The table is only available in the full report.