Open letter to the Prime Minister of the Czech Republic to preserve its successful drug policy model

This is an open letter to the Prime Minister of the Czech Republic, and to whom it may concern.

Dear Mr. Babis, we, the undersigned academics, professionals with expertise in drugs and drug addictions, and citizens, are concerned that one of the most successful modern drug policies – such that of the Czech Republic – is under a threat of misled administrative and political decisions. We have reasons to believe that this can cause irreversible damage to an evidence-based policy and a significant risk to the public health situation in the country.

The Czech drug policy is considered as a successful model of decriminalisation and balanced approach to drugs, with excellent public health outcomes (Csete, 2012). Since the early 1990s, it has had a four-pillar, integrative and inter-departmental approach to drugs and drug addiction that reflects the bio-psycho-social nature of drug use and addictive disorders and includes prevention, demand reduction, and supply reduction, as well as harm reduction measures. Drug services are being delivered by healthcare providers and, importantly, by a network of non-governmental organisations that provide harm reduction programs and social services.

The system is currently managed by the inter-ministerial Government Council for Drug Policy Coordination (SGCDPC) and is continuously informed by its National Monitoring Centre for Drugs and Drug Addictions (NMCDDA) that collects up to date data on the epidemiological situation and makes part of the SCDC. Also, the SGCDPC currently certifies the quality of drug service provision, assigns funding, and manages a network of drug policy coordinators who operate on the regional level. Both SGCDPC and NMCDDA have been located at the Office of the Government of the Czech Republic – this has assured an interdisciplinary and inter-departmental policy focusing not only on health, but also on psycho-social aspects of drug use.

This open letter responds to a recent intention of the Czech Government to move the SGCDPC and NMCDDA from the Office of the Government to the Ministry of Health. Such move presents a serious threat in terms of narrowing the drug policy to its health aspect and, potentially, restricting the drug service funding to existing healthcare providers. This would put at risk the continuation of existing network of (NGO-operated) harm reduction and social programs.

In other words, there is a real threat that – in consequence to such change – the Czech Republic will make a step back from its modern, inter-disciplinary approach to illicit drugs, and that the administrative decision will dismantle the wide network of harm reduction services. Of notice is that the present drug policy model has yielded excellent outcomes, as witnessed by the statistics of the European Monitoring Centre for Drugs and Drug Addiction.
According to these, the occurrence of drug related harm is among the lowest in the European region:

• Between 2002 and 2015, the prevalence of hepatitis C among people who inject drugs in the Czech Republic ranged between 12% - 22% HCV; in other European countries which provided estimates, this has been 27 % - 81 % (EMCDDA, 2018a);
• in the same period, HIV prevalence among people who inject drugs in the Czech Republic ranged between 0.1% - 0.4%, compared to 0.4% - 49% in the remaining European countries (EMCDDA, 2018a);
• in 2015, there were only 7 cases of drug related deaths per 1 million population aged 15-64, which was among the lowest rates of such deaths (together with Portugal, Latvia, Bulgaria and Luxembourg) (EMCDDA, 2018b).

These important measures come together with an increasing, but still average rates of high-risk drug use. Estimated at 4.4 – 6.7 HRDUs per 1000 of Czech population in 2008 - 2015, it compares with 3.8 - 7.1 HRDUs per 1000 population in other European countries. Also, the low occurrence of harms is very much despite a relatively high proportion of the Czech population who report experiences with cannabis use.

We understand that drug policy is a complex, costly, and sometimes also politically difficult agenda for any government to manage. With this open letter though, we would like to express international recognition of the current Czech drug policy model in terms of its interdisciplinary, inter-departmental coordination, and its excellence in public health outcomes.

We would like to encourage the Czech Government to preserve its successful drug policy model and urge that the said Government avoids its intention to move the SGCDPC and NMCDDA under a single-department competence (Ministry of Health), as the move might cause irreparable changes to the provision of drug services and, related to that, create a risk of increasing (preventable) drug-related harm.

UNDERSIGNED
Vendula Belackova, Ph. D., Research Analyst (ResAd ltd., Prague, Czech Republic) and Senior Adjunct Lecturer (Drug Policy Modelling Program, Social Policy Research Centre, University of New South Wales, Australia)

Josef Radimecky, Ph. D., Clinical Director (White Light I, Usti nad Labem, Czech Republic), Board Member (A.N.O. – Association of Non-Governmental Organisations, Prague, Czech Republic) and Former National Drug Coordinator (Secretariat of the Government Council for Drug Policy Coordination 1998 - 2004)

Jindrich Voboril, MA, Former National Drug Coordinator (Secretariat of the Government Council for Drug Policy Coordination, 2010 - 2018)

And all the respective signatories.

REFERENCES
Csete, J. (2012). A Balancing Act: Policymaking on Ilicit Drugs in the Czech Republic Global Drug Policy Program. New York: Open Society Foundations.

EMCDDA. (2018a). Statistical Bulletin 2018 - drug related infectious diseases. http://www.emcdda.europa.eu/data/stats2018/drid

EMCDDA. (2018b). Statistical Bulletin 2018 - overdose deaths. http://www.emcdda.europa.eu/data/stats2018/drd