Substitution treatment for hard drug users in the Czech Republic may become more widely available in the future. For instance, methadone, a substitute drug used to break heroin addiction, is so far available only in 13 specialised centres in the Czech Republic. The National Monitoring Centre for Drugs and Drug Use now wants to make the substance accessible to addicts around the country. If it gains approval from the State Institute for Drug Control, methadone could in future be prescribed by GPs and available on prescription from chemists. I asked the director of the drug monitoring centre, Viktor Mravčík, to explain the reasons behind the proposal.
“Availability of methadone for patients is not sufficient. Just imagine that for example in the Pilsen region, where the estimated number of opiate drug users is relatively high, compared for example with Moravia, we have no specialised substitution treatment centre, which means that in the whole region of Pilsen, methadone is not available.”
There is another substitution substance called Subutex with a similar effect to methadone which could be prescribed by a general physician. Is that still available?
“Yes, the active substance in subutex is buprenorphine. There are two medicines used as substitution treatment registered in the Czech Republic. They are subutex and, since February this year, also suboxon. They have similar effects and they are used as substitution treatments, but the risk of overdose by buprenorphine is relatively low. On the other hand, the risk of overdose by methadone is higher. However, methadone is much cheaper compared to subutex.”
Since you mention money, will insurance companies take part in covering the cost?
“Currently, no insurance company covers the cost of substitution medicine. So in case of subutex, patients have to pay the whole price. There are negotiations with the biggest insurance company to improve the situation and to cover at least one substitution medicine by health insurance.”
Aren’t you afraid that some drug users could abuse it and use it as a drug instead of a substitute?
“Yes, there is always the risk of a leakage of the substance from the
legal to the illegal market. That’s why we are stressing the necessity of
a better control and organisational framework for provision of substitution
treatment in the Czech Republic. That should be the main message: to
strengthen the control mechanism, to prevent double prescribing by more
than one practitioner and so on.”