AddictionsCEE 2026 Memorandum

ADDICTIONSCEE 2026 MEMORANDUM

RATIONAL ADDICTION POLICY FOR

CENTRAL AND

EASTERN EUROPE

ADDICTION AND MENTAL HEALTH AS AN EVOLVING PUBLIC HEALTH CHALLENGE

Addiction and risky patterns of behaviour can no longer be understood as a narrowly defined drug policy agenda. Across Europe, they are increasingly moving into a broader framework of public health, mental health, chronic disease prevention, youth protection, digital safety, and general regulation. They concern legal and illegal substances, psychoactive medicines, gambling, the digital environment, and new psychoactive substances. The common denominator is the level of risk, the scale of health and social impacts, the vulnerability of users, and the capacity of public policy to prevent harm.

This shift is consistent with the development of European policy. In its comprehensive approach to mental health, the European Commission emphasises that mental health must be treated on a par with physical health, and that public policy should combine prevention, access to care, reintegration, and support

for vulnerable groups. The previous EU Drugs Strategy 2021-2025 established an integrated, balanced, multidisciplinary, and evidence-based framework supporting public health protection, demand reduction, harm reduction, security, research, coordination, and international cooperation. The European School Survey Project on Alcohol and Other Drugs (ESPAD 2024) also shows that monitoring risks among young people is no longer limited to legal and illegal substances, but also includes digital media use, gaming, gambling, and mental well-being.

Addictions are becoming a test of whether public institutions can respond to new types of risk faster than markets themselves. The expert debate on the design of public policies in this field must be rational, non-ideological, and grounded in data. A purely repressive policy that may push demand for legal and illegal substances or gambling into grey zones and illegal markets is unsustainable. So is the passive tolerance of commercial models that maximise consumption, attention, or addictive potential.

Modern addiction policy should combine prevention, treatment, harm reduction, social reintegration, regulation of availability, fiscal instruments, protection of minors, monitoring, and effective enforcement of rules. At the same time, it should be based on available evidence and examples of good practice. Its objective should be to reduce health, social, economic, and security-related harms.

AN AGENDA FOR CENTRAL AND EASTERN EUROPE

The region of Central and Eastern Europe (CEE) has a specific importance in this debate. Many countries share the experience of rapid transformation of public institutions, uneven availability of health and social services, social tolerance of certain legal substances, changing drug markets, and growing pressure on health and social systems. At the same time, it is a region where European priorities, such as mental health, youth protection, digital safety, chronic disease prevention, the fight against organised crime, and the reform of health and social services, meet practical implementation challenges.

For the CEE region, the key task is to develop a shared policy language and decision-making framework: to differentiate levels of risk, strengthen services, protect young people, improve data, use fiscal instruments, and set regulation in a way that reduces harms and does not expand the space for illegal markets. Regional cooperation matters precisely because it allows countries to compare different pathways of modernisation, from those with more integrated addiction policies to those that are only beginning to strengthen coordination, harm reduction, mental health, or new types of services.

This regional perspective also matters for European institutions. The EU can create strategic frameworks, support monitoring, standards, research, financing, and the sharing of good practice. However, real impact is determined at the national, regional, and local levels. It is there that strategies either remain declarations or are translated into accessible services, effective prevention, proportionate regulation, and measurable harm reduction.

THE RESILIENCE OF CARE IN ROMANIA DEPENDS ON COOPERATION BETWEEN THE STATE, SERVICES, AND CIVIL SOCIETY

In 2001, a sharp contraction in heroin availability, linked to developments in Afghanistan, triggered a market crisis among Bucharest’s heroin-using population. It was arguably the first moment people who use drugs became visible to Romanian society. Before then, as some of our opioid substitution treatment clients still recall, drug use was effectively invisible: “you could smoke heroin next to a police officer, and they wouldn’t recognize what it was.” Over the past quarter of a century much has changed, public and institutional perceptions, drug markets, consumption patterns, the profile of people who use drugs, legislation, treatment regulation, and political discourse alike.

Romania’s first dedicated anti-drug law (Law 143/2000) defined the range of services available to people who use drugs. Between 2000 and 2008, harm reduction was formally written into this framework, which has since remained largely unchanged. Romanian law explicitly permits needle and syringe programmes, opioid substitution treatment and counselling delivered in person, by telephone, or online. Yet, several evidence-based interventions widely used elsewhere in Europe, such as supervised consumption facilities, take-home naloxone and drug-checking, remain outside the legal framework, partly out of concern that they could be read as facilitating use under existing criminal provisions. Services for minors are particularly underdeveloped, largely confined to psychiatric and psychotherapeutic care, with little provision for educational continuity during treatment.

Recent years illustrate how policy has often advanced through high-visibility episodes rather than evidence. Following a fatal 2023 road crash caused by a driver under the influence, the so-called “2 Mai”

Law (promulgated in 2024) amended Laws 143/2000 and 194/2011 to remove suspended sentences for high-risk trafficking and raise penalties. Around the same period, proposals to drug-test pupils in schools surfaced repeatedly, driven largely by public alarm and with little supporting evidence; the most indiscriminate versions were ultimately walked back by the health and education authorities, but the recurring impulse to test without clear clinical indication or therapeutic pathways is telling.

Public debate has rarely engaged with the unintended consequences of punitive approaches, including displacement toward new psychoactive substances, notably synthetic cannabinoids and stimulants, and the non-medical use of prescription psychotropics. A significant institutional reform took place in 2025, when responsibility for drug policy moved from the Ministry of Internal Affairs to the Government, and prevention and treatment services were reassigned to the Ministry of Health. This occurred amid growing, and at times exaggerated, public concern about the scale of drug use.

Against this backdrop, the relative success of Romania’s response has rested less on comprehensive public policy than on the resilience of a small number of public services, non-governmental organisations, and private providers. Despite chronic underfunding, legislative gaps, and shifting markets, these actors have sustained a minimum network of harm reduction and integrated treatment, keeping support available for some of the most vulnerable. The Romanian experience suggests that resilience is not only an individual trait but a property of service systems: where policy has been slow and resources scarce, continuity of care has depended on the capacity of a few organisations to adapt, collaborate, and persist. This is not a model built on declarations or ideology, but one assembled from the ground up through practice and professional expertise - and it is precisely this bottom-up resilience that has preserved access during periods of profound social, political, and market change.

CZECHIA AS A CASE STUDY OF A RATIONAL AND TRANSFERABLE APPROACH

Over the past 35 years, Czechia has developed an addiction model relevant to the CEE region primarily because of its methodology. It represents a gradually evolving, professionally grounded, and practice-tested approach. Czech policy has moved away from a narrow and fragmented drug policy framework towards an integrated understanding of addictive behaviour, covering illegal and legal substances, gambling, psychoactive medicines, and problematic use of

digital media. The National Strategy for the Prevention and Reduction of Harm Associated with Addictive Behaviour 2019–2027 defines addiction policy as

a comprehensive set of preventive, educational, treatment, social, regulatory, control, and other measures, including law enforcement, based on scientific evidence and aimed at reducing health, social, and economic harms.

A key strength of the Czech model is its capacity to connect areas that are often addressed separately in many countries. Alcohol is not excluded from addiction policy simply because it is culturally embedded. Tobacco and new nicotine products are assessed not only according to whether they contain nicotine,

but also according to the form of use and relative harmfulness. Psychoactive medicines are understood not only as an issue of prescribing practice, but also as a matter of mental health, addiction, and coordination of care. Problematic

use of digital media and online gambling is not reduced to individual failure but raises questions about service design, algorithms, monetisation mechanisms, and the protection of young people.

The Czech approach to new psychoactive substances is particularly important. The amendment to Act No. 167/1998 Coll., on Addictive Substances, effective from 2025, introduced the categories of psychomodulatory substances and listed psychoactive substances. This creates an intermediate regulatory space between an unregulated or illegal market and prohibition. It includes age restrictions, licensed sales, advertising regulation, information on composition, controlled dispensing, and the possibility of ongoing risk reassessment. The purpose of regulation is primarily to prevent new substances from automatically disappearing into grey zones or illegal markets, where the state loses control over composition, sale, and the protection of minors.

Czechia has also demonstrated the ability to respond flexibly to new challenges, for example by regulating nicotine pouches, first in 2021 and again in 2023. It is therefore among the first EU Member States to address this issue legislatively. One source of inspiration has been the Swedish experience, according to which the transition of some smokers to less harmful nicotine products may contribute to lower smoking prevalence and a lower burden of smoking-related disease.

A similar principle is reflected in cannabis policy. From 2026, Czech legislation distinguishes between personal use, limited home cultivation, medical use, and the organised market. This makes it possible to focus criminal policy on higher-risk conduct and public health on prevention and regulation.

Harm reduction is a core element of the Czech experience. In practice, it has long been associated with contact centres, outreach programmes, needle-and-syringe exchange, infection prevention, substitution treatment, and low-threshold services. Its broader significance, however, lies in the need to apply the principle of harm reduction beyond the field of illegal drugs. In alcohol policy, this means systematically expanding brief interventions and screening for risky drinking in primary care, targeting prevention at risky patterns of

consumption, and weakening the social normalisation of drinking, including the

stigmatisation of abstinence. In tobacco and nicotine policy, it means distinguishing between combustible and non-combustible products, supporting cessation, and holding a realistic debate on less harmful alternatives for adult smokers.

The fiscal dimension is also significant. The Addiction Policy Action Plan 2023-2025 identified as one of its priorities the effective collection of taxes that should take into account the risk profile of products with addictive potential. Since 2024, for example, differentiated excise tax rates have been introduced for different categories of tobacco and nicotine products. In the field of alcohol, the Action Plan opens a debate on taxation according to ethanol content, a minimum price per unit of alcohol, and the abolition

of the zero-tax rate on still wine. Fiscal instruments must, however, be designed with the illegal market in mind. Excessively high, abrupt, or poorly differentiated taxation may shift consumers towards unregulated products, weaken consumer protection, and strengthen organised crime.

The Czech model also has limits that must be acknowledged. The availability of services differs across regions; psychiatric care, and especially mental health care for children and young people, faces capacity constraints; substitution treatment is not sufficiently available everywhere; and the financing of addiction services remains uncertain. Precisely because the Czech model is not perfect and actively addresses its limitations, it is transferable for the CEE region. It offers a realistic pathway for countries facing similar constraints to gradually build coordination, services, data, and regulation.

RECOMMENDATIONS

The recommendations are based on the principle that modern addiction policy must be public-health-oriented, social, regulatory, fiscal, and security-conscious simultaneously. The objective is not to unify national models, but to strengthen a common framework that enables countries to respond in a coordinated way to both new and long-standing challenges.

ADOPT AN INTEGRATED ADDICTION STRATEGY.

Policy should not be divided between legal and illegal substances. A unified framework makes it possible to compare harms, define priorities, plan services, and allocate public resources more effectively.

REGULATE ACCORDING TO RISK.

Rules on availability, advertising, packaging, price, age limits, and sanctions should correspond to the actual harm posed by products and behaviours. Combustible tobacco, alcohol, unregulated psychoactive substances, and high-risk forms of gambling require a different regime than lower-risk addictive products. These instruments create an environment for a substituted market with less harmful substances.

STRENGTHEN FISCAL INSTRUMENTS AS PART OF PUBLIC HEALTH.

Tax policy should encourage less risky behaviour, reduce consumption of the most harmful products, and at the same time avoid supporting illegal markets. Part of the revenue from excise taxes, gambling taxation, and potentially newly regulated products should be systematically directed towards prevention, treatment, harm reduction, monitoring, and research.

MODERNISE ALCOHOL POLICY.

Alcohol must be a full part of addiction policy. It is necessary to open a debate on taxation according to ethanol content, availability, advertising, brief interventions, treatment, and the social normalisation of drinking, as well as the stigmatisation of abstinence.

DEVELOP REGULATION OF NEW PSYCHOACTIVE SUBSTANCES.

A strictly regulated regime based on risk assessment, protection of minors, quality control, and advertising regulation is preferable to repeated ad hoc bans that may shift supply towards more harmful substances.

INCLUDE PSYCHOACTIVE MEDICINES AMONG THE PRIORITY TOPICS OF ADDICTION POLICY.

Sedatives, hypnotics, anxiolytics, and opioid analgesics require better monitoring, responsible prescribing practice, early interventions, and linkage between addiction care, psychiatric care, and primary care.

BUILD MONITORING AND EVALUATION.

Every major regulatory measure should be evaluated according to its impact on the prevalence of use, the health of young people, the illegal market, demand for services, public budgets, and law enforcement.

ESTABLISH A PROPORTIONATE APPROACH TO SUBSTANCES.

Criminal policy should distinguish between user, possession or handling for personal use, medical use, commercial distribution, and organised crime.

LINK ADDICTION POLICY WITH MENTAL HEALTH.

Addiction treatment must be coordinated with psychiatry, psychology, primary care, social services, education, and community support. Particular attention should be paid to young people, people experiencing social exclusion, people in prison, people with trauma, and people with co-occurring mental disorders.

REGULATE RISKS IN THE DIGITAL ENVIRONMENT.

Addiction policy must also include the addictive design of digital platforms, online gambling, social media, gaming mechanisms, and monetisation models that may reinforce compulsive behaviour. Regulation should combine the protection of children and young people, algorithmic transparency, digital literacy, and access to professional help for people with problematic use of digital technologies.

Europe does not need another symbolic debate on whether addiction is a matter of morality, criminality, or individual weakness. It needs public policy that is based on scientific evidence, differentiates risks,

protects young people, supports treatment and harm reduction, works with markets, and at the same time is capable of confronting organised crime and commercial models that create addictive behaviour.

Central and Eastern Europe can be an important space for practical modernisation in this debate. The region knows the limits of capacity, political sensitivity, and uneven availability of services. Precisely for that reason, it can formulate a realistic agenda, not an ideal model on paper, but an implementable framework.

The Czech experience shows that such a framework can be built gradually: through data, services, coordination, professional continuity, and the courage to regulate according to the actual level of risk. Developments in Romania confirm the need for more integrated coordination and cooperation between public authorities, non-governmental organisations, and civil society.

Rational addiction policy is not a weaker policy. It is a more responsible policy. It rejects the false choice between prohibition and deregulation, between public health and security, between individual freedom and the protection of society. Its ambition is to regulate reality so that it causes less harm, rather than merely rejecting it symbolically.

Prague, 18 June 2026

RATIO - Think tank for rational addiction policies

Institute for Mental Health and Addiction Studies Romanian Association Against AIDS – ARAS

Institute for Mental Health and Addiction Studies (IMHAS), builds an international cooperation network focusing on the Czech Republic and the Central and Eastern European region. IMHAS activities include conducting research projects, developing methodological recommendations, analyzing legislation, and organizing professional platforms for sharing innovative approaches. As an organization, IMHAS contribute to the development of policy and practice in mental health and addiction based on current scientific knowledge and data.

RATIO - Think tank for rational addiction policies is a multi-disciplinary think tank based in Brno, Czech Republic, that gathers independent and renowned experts who study the topic of addiction from different perspectives (public and mental health, legislation, economics and market modelling,

tax issues, education, and sociological aspects). Together with prevention and awareness-raising activities, RATIO implements research projects to generate insight and important data that could serve as input for legislative and non-legislative discussions at the national and EU levels.

The Romanian Association Against AIDS was founded in 1992, in Bucharest, as one of the first NGOs working in the field of HIV in Romania. Ever since, ARAS has been working in prevention of HIV, viral hepatitis, STIs, TB among general population and in vulnerable groups, in support for people living with HIV, hepatitis, TB, in advocacy for access to medical and social services. ARAS is the first provider of harm reduction services for people who use drugs (started in 1997) and, as such, runs at present two methadone substitution centers and a drop-in and outreach harm reduction service. ARAS is also the only provider of PrEP services in Romania, in Bucharest, Cluj and Timișoara.