Report on Illicit Drugs in the Czech Republic 2023

This is a summary of the report, which has been published in full in Czech only. The full report is available on the Czech version of this website under the title Zpráva o nelegálních drogách v České republice 2023.

Summary of the Report on Illicit Drugs in the Czech Republic 2023

Addiction policy

The Czech addiction policy integrates substance and non-substance dependence. It focuses on legal (alcohol, tobacco) and illegal drugs, psychoactive medicines gambling and digital addictions.
The National Strategy for the Prevention and Reduction of Harm Related to Addictive Behaviour 2019-2027 is the main strategic policy document in the field of addiction, and the means of meeting its objectives is defined in the action plans.
In 2023, the Addiction Policy Action Plan 2023-2025 was approved, setting out five main themes: (1) prevention and treatment of addictions, (2) regulated market with addictive substances, (3) effective taxation taking into account the risks posed by products with addictive potential, (4) promotion of the principles of a balanced addiction policy following the priorities of the Czech Presidency of the EU Council, (5) minimisation of the impact of the crisis in Ukraine on the addiction situation in the Czech Republic.
The Government's coordinating and advisory body on drug policy issues is the Government Council for Coordination of Addiction Policy (Council).
At the regional level, addiction policy is implemented through regional drug coordinators and regional strategy documents. At the municipal level, local drug coordinators operate.

Legal framework

In July 2023, a draft amendment to Act No. 167/1998 Coll., on Addictive Substances, was submitted to Parliament. The draft introduces new categories of addictive substances, namely so called psychomodulatory substances and new psychoactive substances, and their regulatory system.
An intense professional and societal debate continues on the regulation of the non-medical cannabis market.
Act No. 65/2017 Coll., on the protection of health against the harmful effects of addictive substances, was amended twice during 2023. As of March 2023, nicotine pouches were included among the products subject to availability restrictions under the Act, and as of July 2023, the scope of people who are subjects to the obligation to undergo an orientation examination and a professional medical examination was extended to include people accommodated in asylum facilities.
The list of addictive substances included in the Government Regulation No. 463/2013 Coll. was expanded through two amendments in 2022 and 2023 by a total of 285 new psychoactive substances.

Funding

In 2022, labelled expenditures on addiction policy from state and local government budgets totalled CZK 1,524.1 million (CZK 2,457.7 million in 2021).
The labelled expenditure of the state administration amounted to CZK 1,080.8 million. Regions provided CZK 355.5 million for addiction policy and municipalities CZK 87.8 million, i.e. a total of CZK 443.3 million (CZK 449.2 million in 2021).
Compared to the previous year, however, no information was provided on the expenditure of regional police directorates (CZK 1,030.3 million in 2021); it is therefore not possible to assess annual changes in total public budget expenditure on addiction policy.

Illicit drug use among children and adolescents

According to the ESPAD 2019 study, a total of 29% of adolescents aged 15-16 years have had experience with any illicit drug. The most common substances included cannabis (28%) and ecstasy (4%). Students' experience with illicit drugs has been declining over the long term, with the exception of cocaine. The average age at first substance use has been rising for a long time.
The results are confirmed by the UPOL 2021 study, according to which 38% of secondary school students (aged 15-20) have used cannabis at least once in their lifetime, 26% in the last 12 months and 12% in the last 30 days. The prevalence of use of other illicit drugs was low among secondary school students in 2021, with ecstasy (4%), hallucinogenic mushrooms (3%) and LSD (2%) being the most common.
A study of Prague schoolchildren confirms a declining trend in the prevalence of cannabis use among children and adolescents. The gap in cannabis use between boys and girls has long been narrowing.
Kratom was the most reported non-cannabis drug in 2022, with 4% of adolescents having used kratom at least once in the last 12 months, and 1.5% having used it repeatedly.
Secondary school students report a long-term prevalence in the use of most illicit drugs that is 3-10 times higher than that for primary school students.

Illicit drug use in the adult population

Cannabis is the most commonly used illicit drug among adults in the Czech Republic, with 22-37% of people aged 15 and over having tried it at least once in their lifetime. Ecstasy has been used at least once by 7% of people aged 15+, as well as hallucinogenic mushrooms, while the use of methamphetamines (or amphetamines) is reported by 2-7% and cocaine by 4-7% of the adult population.
About 7-10% of people aged 15+ have used cannabis in the last 12 months and 3% in the last 30 days. The prevalence of illicit drug use is approximately 2-3 times higher among men and young people under the age of 34.
Prevalence of cannabis use in the general population and among young adults have been stable in the long run, as well as the prevalence of use of ecstasy, methamphetamine and hallucinogenic mushrooms. In case of cocaine, a long-term increase in the prevalence of use may be observed in the last 12 months.
Cannabis for self-medication has been used at least once in the lifetime by 21-24% of the population aged 15+, and by 9-10% report use in the last 12 months. When extrapolated to the entire population, this represents 800-900 thousand people who have used cannabis for self-medication in the last 12 months, approximately 250 thousand of whom have used it exclusively for self-medication.
While the rate of recreational use declines significantly with the age of the respondents, the use of cannabis for self-medication increases with age, being the highest among the 55-64 and 65+ age groups.
Experience of lifetime kratom use was reported by 6% of respondents aged 15+ (7% of men and 5% of women). In the past 12 months, 3% of the adult population has used kratom, mostly people aged 25-29 and 20-24.
The current number of high-risk drug users (HRDU)/people who use drugs (PWUDs) is estimated at 46.5 thousand. A total of 37.2 thousand HRDUs use methamphetamine and 9.3 thousand use opioids, mainly buprenorphine (5.1 thousand) and heroin (3.0 thousand). An estimated 42.7 thousand use drugs by injection, i.e., more than 90% of high-risk drug users.

Health consequences of illicit drug use

Infectious diseases and drug overdoses, both non-fatal and fatal, are among the most important harms related to high-risk illicit drug use.
Injecting drug use is a major factor in the spread of infectious diseases among drug users. In the Czech Republic, injecting is the primary mode of application of drug use among high-risk opioid or methamphetamine users.
In 2022, 292 new cases of HIV/AIDS were reported. The proportion of HIV transmission through injecting drug use in the Czech Republic has long been low, with 5-9 cases per year (8 in 2022). In 2022, 48 new cases of VHB were reported, including 7 among people who inject drugs (PWIDs). In the case of viral hepatitis C, IDUs account for approximately half of all infections in the long term. In 2022, 921 new cases were reported, 414 (45%) of which were among PWIDs.
Illicit drug users also face other somatic and mental health problems and comorbidities such as psychosis, depressive and anxiety disorders.
Approximately 500 people are hospitalised for non-fatal intoxication each year; approximately 200 of these cases are related to illicit drugs. Illegal drug use is reported in approximately 1-2% of all injuries in the Czech Republic each year.
Of the total number of traffic accidents, 277 were caused under the influence of illegal drugs (i.e., 0.3%), in which 5 people died. In the last ten years, the number of traffic accidents where the culprit was under the influence of illegal drugs has been increasing.
In 2022, a total of 64 fatal overdoses caused by illicit drugs, inhalants and psychoactive medicines were detected. There were 53 fatal overdoses caused by illicit drugs and inhalants, most commonly methamphetamine or amphetamine (22 cases) and opioids (15 cases). Inhalants were recorded in 11 cases, as well as benzodiazepines. An additional 130-150 deaths under the influence of illegal drugs and psychoactive medicines are recorded every year.

Social correlates and context of illicit drug use

People who use drugs often display a combination of negative social and economic factors - they find it difficult to enter the labour market, have poor relationships, financial problems and housing problems.
Unstable housing and debts are significant obstacles to recovery and social and economic integration. For high-risk drug users, they can present an intractable problem.
People who use drugs often have no stable income and are usually employed as short-term temporary workers, either without a contract or via employment agencies.
Many clients of addictology services are registered with the Labour Office and receive social support in the form of financial need benefits. Unstable accommodation or homelessness is reported by three quarters of people who use drugs, with the same proportion reporting debts.
The rising cost of living in the context of increasing energy prices and food prices is and increasing trend. In the area of housing, the impact of the wave of migration related to the conflict in Ukraine is getting more visible in some regions and housing in dormitories/shelters is becoming less affordable.
Czech households have spent approximately CZK 10 billion on illegal drugs in recent years (which corresponds to 0.5% of all household expenditures), which is 10 times less than expenditures on alcohol or tobacco.

Addiction prevention

Addiction prevention targeting children and young people is part of a broader framework of prevention of risk behaviour coordinated by the Ministry of Education.
Only half of the school prevention methodologists have completed accredited studies to perform specialised activities.
The system used to certify the proficiency of school-based prevention programmes remains suspended. To date, 80 services providing prevention in addictology have been certified within the prevention system, 52 of which were in universal prevention, 20 in selective prevention and 8 in indicated prevention.
Since 2016, the System of Evidence of Prevention Activities has been in place in school prevention, which is optional for schools. In the 2021/2022 school year, 40% of all primary and secondary schools in the country registered with the system.
Prevention of illicit drug use was the focus of 6% of the programmes implemented in schools. Mental health activities have also been implemented in recent years.
There is a shortage of selective and indicated prevention programmes. The network of pedagogical-psychological counselling centres (47 in total) and educational care centres (33 in total) complements the indicated prevention implemented by NGOs.
Illicit drug use accounted for a very small proportion of the risk behaviours addressed in schools in the 2021/2022 academic year (2%).

Addictology services

The network of addictology services covers the whole spectrum of problems related to substance use and other addictive behaviours and consists of various types of facilities and programmes that are embedded in different disciplines and departmental (legal) frameworks.
According to various data sources, there are approximately 250-300 programmes implemented by various types of addictology services in the Czech Republic. Of these, there are 55-60 low-threshold contact centres, 50 outreach programmes, 90-100 outpatient treatment programmes (10 of them are targeted for children and adolescents), 10-15 detoxification units, 25-30 inpatient health care units, 15-20 therapeutic communities, 35-45 outpatient aftercare programmes (20-25 of them are sheltered housing) and 5-7 homes with special regime for substance users; 60-70 facilities report patients in opioid agonist treatment (substitution treatment) and an estimated 600-700 general practitioners providing substitution treatment.
Most regions describe the existing network of services as minimal or insufficient. There is an acute shortage of outpatient psychotherapists, and psychiatrists in particular, but also a shortage of other doctors willing to work with people who use drugs. Regions also frequently report a lack of addictology programmes specialising in children and young people. Significant shortcomings are reported by the regions especially in the availability of opioid agonist treatment.
The private segment of addictology services is developing. There is a growing range of treatment and counselling interventions provided via the Internet and using new technologies. Participatory and self-help activities have been on the rise in recent years.
In 2022, 39.8 thousand people who use drugs were in contact with low-threshold programmes, including 28.0 thousand methamphetamine users, and 10.0 thousand opioid users (including 5.7 thousand buprenorphine users, 3.2 thousand heroin users, and 1.1 thousand users of other opioids), and 1.7 thousand cannabis users. A further 10,000 people were in mediated contact. In the long term, there is a gradual increase in the number of methamphetamine users.
The most common service provided by the low-threshold centres is the needle and syringe exchange programme, and interest in medical services and hygiene services has long been growing. A total of 9.2 million syringes were distributed in 2022, i.e., 215 syringes per injecting user, which is above the limit of high coverage according to WHO in the prevention of HIV transmission.
In 2022, 26 low-threshold programmes in a total of 13 cities were involved in the project of naloxone distribution in the form of Nyxoid nasal spray. In 2022, 222 doses were distributed. The facilities reported 42 cases where opioid overdoses were averted through use of the spray.
Gelatine capsules for oral use, which are an alternative to injecting, are distributed probably by all the low-threshold programmes; with an estimated 240,000 capsules dispensed annually in the Czech Republic.
Low-threshold programmes offer testing for HIV, VHB, VHC and syphilis. The rate of testing among injecting drug users is low, with approximately 7-8% of the estimated number of people who inject drugs (PWIDs) tested annually. The prevalence of infections among clients of low-threshold programmes remains relatively low.
Specific harm reduction programmes at dance and music events are not widespread in the Czech Republic, although they have been more active in recent years. There are about 10-18 programmes in the recreational setting in the Czech Republic. The low number of these programmes corresponds to the limited financial support for these activities.
Outpatient care for PWUDs is provided mainly in psychiatric outpatient clinics, while AT outpatient clinics can be considered specialised. In total, there are approximately 90-100 outpatient programmes in the Czech Republic.
A total of 36.9 thousand users were in contact with psychiatric outpatient clinics in 2022, 10.2 thousand of them were in contact with AT outpatient clinics. Of the total, 12.9 thousand were users of illicit drugs and inhalants. The majority are polydrug users (3.9 thousand), methamphetamine and amphetamine users (3.7 thousand) and opioid users (3.5 thousand).
According to the National Register of Treatment of Drug Users, approximately 2.0-2.4 thousand people per year are registered in treatment with opioid agonists (substitution treatment); the number of patients (especially those treated with methadone) has been stagnating for a long time. Psychiatric outpatient clinics also provide specialized treatment (2,385 patients). GPs provide substitution products to an estimated 5,400 patients. An estimated 20-40% of people in treatment with opioid agonists are high-risk opioid users.
Residential care is provided by detoxification and inpatient units of medical treatment facilities, particularly psychiatric hospitals, therapeutic communities, special education facilities, and sheltered housing programmes.
Annually, 12-13 thousand people are hospitalized in psychiatric inpatient facilities in connection with substance abuse, approximately 5 thousand of them (42%) are users of illicit drugs and inhalants.
In 2022, 399 people were treated in 10 therapeutic communities subsidised by the Office of the Government of the Czech Republic.
According to the Register of Social Service Providers, there were a total of 42 aftercare programmes in the Czech Republic in 2022, 23 of them were residential. In 2022, these programmes reported 1.1 thousand clients, including 617 illicit drug users.
The availability of addictology services in prisons is increasing.
In 2022, there were 14 addictologists working in 12 prisons. Drug prevention counselling centres are available in all prisons, with just under 12,000 people using the services every year (illicit drug users make up 79%). Drug-free zones are available in all prisons and are used by almost 4 thousand people a year.
Treatment in prisons was available in 14 prisons. A total of 603 people took the option of treatment in voluntary treatment units, and 204 people underwent court-ordered protective treatment.
Detoxification was carried out in 6 prisons in 2022 and 23 people completed the programme.
Treatment with opioid agonists (substitution treatment) was carried out in 6 prisons, with 56 people registered. Methadone is the available substitution. For people going into prison with buprenorphine substitution, treatment may be continued provided that the medication is paid by their own resources. In 2022, treatment was not initiated for any prison inmate.

Drug-related crimes

In 2022, 4.2 thousand primary drug offences were registered. In the long term, criminal proceedings are most often brought against people who have committed the unauthorized illicit production and other handling of narcotic drugs and psychotropic substances.
The proportion of people prosecuted for the possession drugs for personal use is increasing (25% of all primary drug offences).
The largest proportion comprises people was arrested in connection with methamphetamine (50%) and cannabis substances (37%).
There were 2,735 convictions for primary drug law offences, mostly for the unauthorized production, trafficking and sale of methamphetamine and cannabis substances. The main sanction imposed most often was a suspended sentence.
4.5 thousand crimes were committed under the influence of illegal drugs, i.e. 6% of all solved crimes. The perpetrators were most often found guilty of endangerment under the influence of addictive substance or drunkenness.
In 2022, 8.8 thousand substance abuse related misdemeanours were committed, a 17% increase from the previous year. Most of these misdemeanours involved the possession of small quantities of drugs for personal use.

Illicit drug markets

Methamphetamine is produced and cannabis is grown in the Czech Republic, both on a subsistence and commercial basis. Raw opium from food poppies is extracted and processed on a seasonal basis. Other illegal drugs are imported into the Czech Republic. In addition, pharmaceutical preparations containing NPS of various groups are available on the drug market.
Online drug sales, courier distribution and cryptocurrency payments play a significant role.
The Police of the Czech Republic and the Customs Administration of the Czech Republic detected a total of 139 indoor cannabis cultivation facilities in 2022. There has been a long-term increase in the proportion of small-scale home growers detected (60%) and a decrease in the number of large-scale growers.
In 2022, 202 methamphetamine labs were detected in the Czech Republic, with smaller domestic labs predominating. Bulk production is being moved abroad, especially to Poland, Germany, the Netherlands or Belgium. The main precursors for the production of methamphetamine are pseudoephedrine and ephedrine extracted from pharmaceuticals imported mostly from Poland.
The trend of the increasing availability of cocaine and MDMA in the Czech Republic continues; the supply of heroin on the market is decreasing and the Czech Republic remains more of a transit country. In 2022, 3 opioid laboratories were discovered in the Czech Republic, the precursor was the poppy.
In criminal proceedings in 2022, 1,148 seizures of cannabis dry matter (907.1 kg), 221 seizures of cannabis plants (15.2 thousand plants), 952 seizures of methamphetamine (40.5 kg), 36 seizures of hashish (2.3 kg), 153 seizures of cocaine (1,194.6 kg), 27 seizures of heroin (0.1 kg), 170 seizures of ecstasy (18.8 thousand tablets and 1.8 kg) and 34 seizures of LSD (3.4 thousand trips) were reported.
The average purity of cannabis in dry form was 10%, 18% for hashish, 68% for methamphetamine, 18% for heroin, 64% for cocaine, 29% for ecstasy tablets and 59% for ecstasy powder.
In 2022, a total of 19 new psychoactive substances were reported in the Early Warning System on New Psychoactive Substances coordinated by the NMC in the Czech Republic, 3 of them for the first time. The most common were synthetic cathinones (7 substances).