Úřad vlády České republiky
Odbor protidrogové politiky
National drug coordinator Jindřich Vobořil presents National Drug Strategy for the next nine years
It is time to change the Czech’s approach to alcohol and tobacco, integrate new phenomena and be more active on the international scene
Prague, 28.6.2018 – At a symposium on the future of Czech drug policy the national drug coordinator Jindřich Vobořil presented the orientation and tasks of the new National Drug Policy Strategy for the period 2019-2027. For the last eight years Jindřich Vobořil has worked at the Department of Drug Policy of the Office of the Government and in the Government Council for Drug Policy Coordination. Now he is leaving the position and on this occasion he calls for/urges for a new approach towards the issue of drugs. He rejects the tendency towards repression and prohibition and advocates a principle of harms and risk minimization. He also addresses the issue of taxation of legal drugs, to decrease the accessibility of alcohol and tobacco to minors and provide targeted prevention and help for people with addictive behaviour problem. The National Drug Policy Strategy will also monitor the phenomenon of pharmaceutical overuse and addictive behaviour in the area of new technologies.
The main aim of the National Drug Policy Strategy for 2019-2027 is:
to minimize negative consequences of drug use in the field of public health, in the field of the social situation of individuals, family and local communities, and also to minimize the negative impacts on the public budget and maintenance of public order.
The current National Drug Policy Strategy for 2010 to 2018 was devised on the basis of conclusions of evaluation of the success of the previous strategy and reflects the experience gained and the current state of scientific knowledge about drug use. The strategy was adopted by government resolution of 10 May 2010. The new National Drug Policy Strategy for the period 2019-2027 is expected to be adopted by the end of this year.
The strategy will be implemented by three Action Plans (APs) 2019-2021, 2022-2024 and 2025-2027. For each period, one AP will be applied covering all topics (legal and illegal drugs, gambling). The APs will be approved by the government, will be under the authority of the Government Council for Drug Policy Coordination chaired by the country's prime minister, thereby ensuring inter-departmental management and coordination of tasks.
“As in the past, in the strategy we focus not only on illegal drugs but also on alcohol, tobacco and gambling and other areas. We build on the European best practices, integrating policies for both legal and illegal drugs,” says National Drug Coordinator, Jindřich Vobořil. The basic concept applied in all areas of addiction should be based on the principle of minimising harms and risks, the so called “harm reduction” approach, and adds: “I expect the new strategy to trigger fiery debate within state administration because we are still encountering a low level of knowledge and competence, and thus misinterpretation of all the evidence that a drug-free world is an illusion and that drugs cannot be eradicated. But we do have enough tools to minimise the risks and harms, so we need to adapt legislation, its enforcement as well as rethinking the country budget.”
National budget should be quantified at 4.5-6.75 billion CZK for prevention and treatment for a period of nine years, while the cost for repression alone for the same period is in the region of 8 billion. The budget for repression should also be subject to better clearer indicators and evaluation based on those targets. Targets for repression and regulatory measures should not be based on how many people are put to prison but how it really affects the demand for problem drugs use.
An unregulated market means enormous risk, but complete prohibition too
It is clear that a free market without regulation brings enormous risk. Likewise, excessive repression brings similar risks and damage. The society expenses in Czech Republic caused primarily by the legal alcohol, tobacco and gambling is estimated around 150 billion CZK every year and that is only in direct costs.
In the new strategy Vobořil tends towards a regulated market. “Regulated policies have proved to be the most effective. In addition, it is necessary to provide accessible substitutes to all substances as well as therapeutic facilities”, describes the current National Coordinator and refers to WHO recommendations that he would like to apply in the Czech Republic: “The WHO points to the successful policies through price regulation, limited accessibility with special regard to those under the age of 18 and 15, but also a sufficient and affordable offer of intervention and targeted prevention for every citizen of the Czech Republic. The state must earmark one time more money for prevention and treatment than at present for this policy to work. Furthermore, it is necessary to put into practice the approach to minimising harms and risks in the field of legal drugs. This is reflected, for example, in the fact that the high price of cigarettes should encourage into the market to favour lower-risk substitute products, such as orally used tobacco or no burn nicotine products, which are significantly less harmful to users. Substitution is also often the first step towards giving up smoking as it is with any other addictive substances.”
One of the tools in Vobořil’s eyes is excise tax. “Even liberal economists have confirmed that we should reduce direct taxes in this country, but increase indirect taxes, such as excise duty. Direct taxes will positively affect everyone, including employees, while alcohol and tobacco are somewhat luxury goods and at the same time together make up nearly 10 percent of the state's tax revenue," Vobořil explains, pointing out "We are one of the five countries with the cheapest tobacco in the EU. We have the will to make more money for the state, because 8 percent of tax revenue comes from tobacco alone; that's 3 percent of all state revenue.”
Alcohol is consumed in risk quantities by over 600,000 Czechs. More than 2.5 million Czechs smoke daily. Up to 11% of children in year nine smoke a cigarette every school day. Children in this country can get hold of legal addictive substances without any problem.
“Repeatedly, in most developed countries of the world, changes in availability and pricing have had a significant effect on both tobacco and alcohol, both in terms of reduced use and frequency of use. There’s simply a great difference between drinking 10 beers a day or two, or if I have 5 shots of a spirit or just one or two,” explains Vobořil.
According to the New National Strategy, the national policy should be legislative regulation of availability and price, but also to create conditions for preventive and treatment measures, early detection and early intervention with individuals who are at risk or who have addictive behaviour problems.
As for tobacco, for Vobořil the Swedish and the Norwegian situation serve as a model example, where the introduction of the harm reduction principle significantly reduced the incidence of heart disease, heart attacks and pulmonary diseases. “That's exactly where we should be heading, and experts agree. The solution should also involve industry that can develop lower risk products. On the contrary, the state should disadvantage harmful products. It will be a hard fight, because in public administration ignorance and reluctance to change something in this area often wins,” Vobořil explains.
The harm reduction principle is nothing unusual in Europe, for instance in Britain, Holland and Switzerland the harm reduction principle is the preferred national policy advocated too by their healthcare authorities. “For instance, the United Kingdom was a pioneer with the harm reduction principle. The first political strategy in this respect in the entire world was created under the administration of Margaret Thatcher. UK administration at the time declared that harm reduction approach is more important for us than abstinence because we have to deal with the consequences, such as HIV/AIDS.”
The National Strategy also proposes to find in current illegal drugs ways of strictly regulated availability of less hazardous substances such as cannabis, MDMA, cocaine, some opioid substances, etc. Strictly controlled availability will favour substitutes.
“It has proved that blind prohibition brings on a balloon effect. This means that after a successful wave of repression, the problem rises as a balloon, mutates, making for better organised criminal groups, only more dangerous drugs appear on the market, resulting in many dead, many more seriously ill and more money in concentrated criminal organisations. Therefore, it is now necessary to look for a much more balanced, less extreme and more evidence-based approach,” says Vobořil.
A special approach in this respect should be devoted to cannabis. Vobořil confirms that we are in a situation where many are making cannabis legal for recreational purposes, including already two G7 countries, and there is clearly talk of changing international control. “In a situation where large multinational industries have invested in a commodity called cannabis, it is unrealistic to think that change will not occur. Therefore, cannabis needs to be given special attention and to prepare legislation so that the notional pendulum does not swing towards wide scale commercialisation. I propose finding a legislative solution that would avoid the risk associated with some extra strong products, prevent availability of cannabis to those under the age of 18, regulate cannabis advertisements and try to prevent the risks associated with everyday smoking of many joints of cannabis,” says Vobořil.
Integrated approach of policies and new phenomena
The Czech Republic is the 11th country to decide not to base policy on the legal status of individual substances, but takes into account that this is a disorder generally known as addictive behaviour. Therefore, under the national policy of the Czech Republic since 2014 has decided also to address both illegal and legal drugs, such as alcohol, tobacco and also the issue of gambling addiction.
The National Strategy will continue with follow up action plans in this respect. However, it will open up to new phenomena and address the issue of pharmaceutical abuse and addictive behaviour in new technology environments." Policy on addictive behaviour must recognise the interconnection between issues of availability and use of different types of addictive substances, both legal and illegal, and their interaction," Vobořil stresses.
Pharmaceutical abuse is a topical issue in Czech society. Addiction easily originates with tranquilisers, sleeping pills and some analgesics. Currently, more than 900,000 Czechs are high risk of pharmaceuticals users. “For example, women often take tranquillisers, as much as three times as often as amongst men.”
Problem use of different substances and gambling tend to interconnect and swap. According to Vobořil, the patients cured from addiction to illegal drugs turn often to pharmaceuticals or binge drinking, or playing on slot machines. Often it all goes together. According to Vobořil, insurance companies should play a much more important role in the treatment of dependencies in terms of more effective channelling of financial flows into specific and targeted care. So far the estimated 1,5 billion CZK spent on the diagnoses F10 – F19 according the international medical manual are spent inefficiently, often on off general intervention. Only 200 milion CZK are used in specific interventions in the medical system.
Another phenomenon in the field of addiction is also excessive lengths of time spent on the Internet and social networks among adolescents. The European School Survey Project on Alcohol and Other Drugs (ESPAD) conducted in 2015 showed that more than 28% of students play computer games daily or almost daily, 84% surf the internet and 41.5% of students spend on a normal weekday on the Internet 4 or more hours. “Since 2003, the proportion of adolescents spending leisure time surfing on the Internet has been steadily increasing, and the proportion of those who spend free time with friends outside is declining,” says Pavla Chomynová of the National Monitoring Centre for Drugs and Addiction at the Office of the Government who is also national coordinator of ESPAD study in the Czech Republic.National strategy is proposing to start monitoring trends and make analyses and proposals to decide what steps we should take.
International involvement and the principle of sharing responsibility
In terms of the impact of illegal drugs, the Czech Republic is doing very well in comparison with the rest of the world. With respect to problem indicators (transmissible diseases among intravenous users, social impacts of drug use, other serious health considerations such as overdose deaths, etc.), we are below the EU and the world average in this area and our approach to tackling illegal drugs is taken abroad as an example especially due to law cost and humane policy. At the same time, however, due to the irresponsible approach in the countries in the east of Europe (mainly outside the EU), extreme risk exists of the situation deteriorating in the Czech Republic (for instance about 3 million HIV / AIDS sufferers among intravenous users in the former Soviet Union alone). According to Vobořil, the Czech Republic should continue to be active on the international scene. But it is necessary to change the perception of, or even to re-evaluate international treaties.
“I consider it almost criminal to sit down with some countries at the negotiation table and to pretend that we have a consensus where one does not exist, for instance, negotiation with Philippine President Rodrigo Duterte, who extrajudicially executed 12,000 people according to his own country report. Likewise, we should not be silent about the involvement of some governments in organised crime. What in my view shoud concern the Czech government the most is the prohibition of medical and preventive procedures that can prevent millions of people from dying of AIDS or type C hepatitis and making it a global epidemic which is too close to the Czech doors.We have an obligation to either change the international control system or if not succesful it would be best to withdraw from the Single Convention on Narcotic Drugs, 1961 and related treaties,” Vobořil comments on the situation.
Over the next ten years, the national policy shall monitor and react to current changes in world policy leading to relaxation and a tendency towards ending full prohibition of certain substances, such as cannabis, coca leaves, cocaine, opium tincture and other products.
“In this respect, legislative and political changes must be made in order to uphold the principle of harm reduction. The national strategy will search for a perfect middle golden way, avoiding the pendulum effect and a completely unregulated open market. This approach will be promoted by the Czech Republic at all levels of international co-operation, thus joining the group of countries promoting a rational, fact-based and also humane policy,” concluded Vobořil.
Both the national and international Czech Republic policies shall sensitively assess the tension and degree between necessary preventive measures and individual freedoms, respect of fundamental human rights and also the principle of the free market.
Contact for the media (Czech Republic):
MgA. Renata Povolná
Media and PR, Department of Drug Prevention Policy
M +420 728 302 397
APPENDIX TO THE PRESS RELEASE
MAIN THESES OF THE NATIONAL STRATEGY FOR 2019 – 2027
1. The policy is based on monitoring and examples of best practice
The National policy will stand on clear analysis of monitored data and will search for the optimum solution with a balanced approach to regulative measures and the range of prevention and treatment on offer. On the basis of evidence, a state budget shall be created for this area in cooperation with local government and health and social insurance systems.
2. Minimising harm and risks
The impacts of a fully unregulated market are clearly the highest in terms of society costs. Similarly, a policy of over-regulation and prohibition is also highly risky. National policy will therefore be driven by the basic need to minimising harms and risks based on scientifically recommended practices. This means that it will regulate accessibility and price, while also creating conditions for preventive and curative measures, early detection and early intervention for individuals at risk of or with a problem as concerns addictive behaviour. The NS will also focus on creating conditions for the most effective penetration of the hidden population and the motivation of the risk groups of the population to cooperate with the helping institutions.
3. Balanced approach
Excessive repression brings with it unwanted consequences that outweigh intended protection of public order, public health and public resources. A balanced approach anticipates a balance between regulation / repression and preventive / curative interventions. This approach must be specifically reflected both in legislation and financial resources. Provisional predominant expenditure on repression should be balanced against prevention. Regulatory approaches based on legislation must be balanced by the range of help on offer. Regulation by high prices (excise duty on alcohol and tobacco) as recommended generally and by the WHO should be offset by the harm reduction approach, i.e. disadvantaging and the high price of tobacco should allow the market to "favour" and lower risk substitute products, etc.
4. Integrated approach of policies
The Czech Republic is the 11th EU country to decide not to base its policy on the legal status of individual substances, but takes into account that this is a disorder generally known as addictive behaviour. That is why the Czech national policy decided to deal with so-called illegal drugs together with legal drugs such as alcohol and tobacco, as well as the issue of gambling. In this respect, the NS will continue to follow up on future periods and action plans. NS will be open on other topics such as the problem of pharmaceutical abuse or the new phenomenon of addictive behaviour in the environment of new technologies. The addictive behaviour policy must perceive the interconnection of issues of availability and use of different types of addictive substances, both legal and illegal, and their interaction.
5. Nation policy shall be managed in coordination
Due to the numerous areas where repression and prevention, the free market and its regulations, significant tax and social impacts, state and local government policies, the problem of so-called departmental insularism, the educational role of education with intermingling social and health issues overlap, the NS requires coordinated management. This means that governments will give attention to these topics at the highest level for the duration of the NS. All relevant government ministers will guarantee their duties based on the AP of this NS, will work together for effective funding, and will work on the tasks at hand with government coordination mechanisms.
6. Preparing for the change in the concept of international control
Over a period of ten years, the national policy will notice and react to the approaching changes in world policy towards mitigation and the tendency to end the full prohibition of certain substances such as cannabis, coca leaves, cocaine, opium tinctures and other opioid preparations, or MDMA, etc. In this respect, legislative and policy changes so as to preserve the principle of minimising harm and risks. With respect to perceiving these changes, it is necessary to take into account the results of successful policies around the planet on the basis of regulation of the available market, such as successful tobacco or alcohol control policies, and to support and transpose these experiences to regulatory policies for some currently illegal substances. In this sense, the NS will seek an ideal compromise, avoid the pendulum effect and a completely uncontrolled open market.
7. Principle of empowering local government
National policy will transfer significantly more capacity and competence to local government, including sharing the principle of coordinated decision-making on the joint financing of local policies, as well as enhancing the potential for increasing the strength of municipal by-laws.
8. Principle of the participation of professional associations and non-governmental organizations
National policy will continue to work with relevant professional associations and non-governmental organizations active in the prevention, risk and harm reduction and treatment of addictive behavior in the process of drug policy setting and development, drug policy evaluation and implementation of Action Plan activities. The professional associations and non-governmental organizations will be represented in the drugs policy coordination authorities at all levels - from the Government Council for Drug Policy Coordination (GCDPC) and its committees and working groups to local level advisory bodies. National policy will support the creation of patient organizations in the field of addictive behavior, that are a partner in the implementation of changes in the health care system in the Czech Republic, and a significant partner in the implementation of drug policy measures abroad.
9. Principle of sharing responsibility
The National Policy for the prevention of harms and risks related to addictive behaviour will take into account that it cannot be expected that this phenomenon may be addressed only within the borders of the Czech Republic. The Czech Republic must therefore be an active player on the international scene. Here, especially in the area of ilegal drugs, the increasing polarization of the world is clearly visible. Some countries perceive the need for a rational and evidence-based policy which is a clear departure from harsh repression to a harm reduction policy. The Czech Republic plays a significant role due to its policy of decriminalization of drug users with a very positive result in this respect. On the other hand, some countries have already clearly crossed all the boundaries of acceptable consensus both within existing drug conventions, in particular the United Nations Single Convention on Narcotic Drugs of 1961, and for instance in the area of international human rights conventions. This includes unprecedented executions without trial, long-term imprisonment for minor offences, deployment of the army and destabilisation of part of the state services, or prevention of access to lege artis treatment and unprecedented, unnecessary and globally threatening HIV / AIDS and HepC epidemics among intravenous drug users. In this respect, it is necessary to initiate changes on the basis of clear evidence in the perception of international conventions, advocating an evidence-based policy that respects fundamental human rights, and advocating for a possible amendment of the Conventions or complementing them in view of their long-term unsustainability. In the event of a failure to change the perception of the repressive role of the Conventions, the Czech Republic should consider whether to remain a signatory to these conventions. The Czech Republic will therefore promote the principle of rational, humane, evidence-based and integrated drug policy at international level.
10. Human freedoms vs. protection of the inhabitants of the Czech Republic
The national policy will take into account the health of individuals as well as their fundamental rights and freedoms. In the situation of mandatory and thus public health and social insurance, it is necessary to take into account the impacts on public budgets, including public insurance. In this sense, both the national and international policy of the Czech Republic will sensitively consider the tension and degree between the necessary preventive regulations and the freedom of individuals, respect of fundamental human rights or the principle of a free market.