Journal of Drug Issues

Modern official Czech drug policies were initiated in 1993 when the government approved its first national drug policy program for 1993 to 1996. The current policy was defined in the National Drug Policy Strategy 2005–2009, a document that calls for an evidence-based drug policy and a balanced and interdisciplinary approach to the problem of drug use. In order to assess the existence of possible discrepancies between these official statements and their practical implementation, the author provides an analysis of Czech drug policy based on a review of official and other documents as well as interviews with representatives and key players in the Czech drug policy arena. The main finding is that several conflicts exist between the official policy and its practical application and that these disparities serve as obstacles to its effectiveness. These differences exist because of the wide variety of ways in which key players have conceptualized drug use per se and the manner in which they have constructed particular reform measures to implement and mirror their main interests and priorities. Particular areas of concern that have been especially impacted by these phenomena are illustrated and discussed below. In order to assure the effectiveness of future Czech drug policy, further research, especially regarding its practical application, needs to occur.

The author carried out a reconstruction of the development of the Czech Republic's drug scene on the basis of the results of key research studies that made use of qualitative methods; he also utilized a multilayer timeline according to target groups and socio-historical perspectives. The last decade of the 20th century was a period in which the Czech drug scene underwent a radical transformation, both in problem drug use (see the definition in the editorial) and recreational use of illicit drugs. The original “hard core” groups were usually comprised of individuals who shared close personal relationships. A system of home production and self-supply dominated the market, and this system was not very organized or hierarchical. The entire drug scene opened up in the course of the 1990s and started to “move” and communicate markedly, both internally and externally. A stabilization of prices, purity, and availability of drugs, as well as the relationships and rules of the black market, was characteristic of the second half of the 1990s. The field of recreational use (of cannabis and the so-called “recreational” drugs in particular) went through a different development during this period, when other changes that deepened the commercial nature of the market took place.

Drug users are generally thought to experience higher mortality rates than those found among the general population. This study analyzes mortality rates among different subgroups of drug users in the Czech Republic. For this project, a retrospective cohort mortality study was conducted. A cohort of 12,207 persons aged 15 to 49 who had been hospitalized for drug related behavioral disorders was followed from 1997 to 2002. The study findings indicate that direct standardized mortality for the cohort of drug users was 16.78 per 1000 person-years (PY); 22.38 for men and 11.18 per 1000 PY for women. After reaching a peak in 1998, mortality rates began to decrease and stabilized around 14 per 1,000 PY from 2000 to 2002. When compared to the rates found in the general population, drug user mortality is eight times higher than nonuser rates (SMR = 8.15; 8.13 for men and 8.22 for women). These mortality rates are highest among polyvalent drug and opiate users and lowest among stimulant users. The authors conclude that the overall mortality of opiate users in the Czech Republic is relatively low when compared with those reported in similar European and non-European studies. There were few overdoses found in the cohort, and in sharp contrast to other available studies, no AIDS related cases were observed.

The rapid dissemination of drug use among adolescents in the Czech Republic and other Central and Eastern European countries during the 1990s had a significant impact on health care and social services for this population group. This paper describes the current situation related to drug use among adolescents in the Czech Republic and in other European countries and discusses several attitudinal and behavioral correlates of drug use among young people. The results presented here have been extracted from a database of the European School Survey on Alcohol and Other Drugs (ESPAD) from 1995, 1999, and 2003. At the time of data collection, the average age of respondents in the sample was 15.4 years. Marijuana was the most common illicit substance used by European adolescents. The results also showed a marked increase in the number of adolescents who use substances repeatedly between 1995 and 2003. A marked increase in the popularity of ecstasy occurred in the same period. Between 1999 and 2003, the use of opiates and amphetamines in the Czech Republic decreased slightly. Attitudinal variables indicate that Czech adolescents tend to be more tolerant towards selected forms of drug using behavior than are their peers in Europe. The policy by which society tries to confront drug related health and social issues includes an expansion of the network of specialized facilities for treatment and resocialization and long-term programs in the field of prevention. In the future, the significance of programs that focus on early detection and intervention will increase.

This paper describes regional differences in the extent of drug use within the Czech Republic, especially in regard to wider demographic, socioeconomic, and institutional contexts. It documents the relationship that exists between the presence of environmental risk factors and the extent of related risk behaviors (e.g., criminal behavior or problematic use of psychotropic substances). Available sociodemographic and economic indicators collected from 14 regions were assessed in light of the data on the extent of criminality, distribution and funding of services for drug users, and the extent of drug use. Further on, correlation, factor and cluster analyses were made to closely observe the relationship of individual indicators and to assess the similarities within the regions. The analysis reveals that within the Czech Republic (its geographic size is similar to that of the state of South Carolina), substantial differences exist in terms of risk behaviors and drug use. The analysis illustrates that regions exhibiting the highest number of environmental risk factors also experience higher levels of personal risk taking. That is, both high drug use prevalence and negative indicators of drug use consequences are concentrated in regions experiencing extensive social problems. These findings can facilitate better targeting of the scarce resources that are designated every year for drug policy by directing them in the future to the neediest locales experiencing most severe drug-related problems. Existing regional differences should also be considered when formulating and implementing health, social, and drug policies at the national and regional levels.

The Czech Republic has a relatively long tradition in the addictive and problem use of methamphetamine, which is called “pervitin” locally. This paper attempts to provide as complex a picture of this phenomenon as possible by analyzing what is known about the Czech methamphetamine situation through scientific monitoring and research. It begins with a brief historical overview and then utilizes five key indicators (surveys, treatment demand, problem drug use estimates, blood borne diseases, and mortality) and some of the core indicators (namely, drug related crime, price and purity data, and estimates of market value) of drug epidemiology that were developed by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). By summarizing and carefully interpreting this data, the specifics of the Czech pervitin scene are described and future research directions are identified.

This paper begins with a brief overview of the status of Czech services for alcohol and drug users as they existed before 1990 (during the communist era). Particular attention is directed to the prominent figure of Jaroslav Skála and the treatment and training systems he pioneered. The second section of the paper concentrates on how the system of services evolved during the 1990s, after the fall of communism, and identifies the main factors affecting this development (the ongoing reform of health care, formation of the nongovernmental nonprofit sector, emergence of a national drug policy, and the reform of social services). The paper also describes characteristics of the current system of services for legal and illegal drug users. Included here are descriptions of the types of care available (low threshold services, ambulatory and hospital care, therapeutic communities, aftercare, and substitution programs), and an overview of their utilization. Specific features and weak points in the present system are addressed in broad terms. Financing and costs are addressed, with particular attention being paid to public grants at governmental, regional, and municipal levels. The paper also pays attention to the infrastructure of the system of services (coordination, training and education, quality assurance, etc.) as well as to research needs, training and quality assurance, and the effectiveness and efficiency of services based on sound financing, in order to promote innovative programs of care and to adjust existing services to the actual needs of the target population.