Opinion on the transfer of addiction policy coordination to the Ministry of Health

The government's legislative work plan contains a number of partial changes in the areas of addictive behavior, public health and social policy without a unifying framework that would show how they contribute to reducing the health and social impacts of addiction. The addictive behavior policy thus remains fragmented between individual departments without a clear common goal, which limits its effectiveness and makes long-term planning difficult. In addition to the legislative plan, the government has simultaneously adopted a decision that deepens this fragmentation: the transfer of the drug policy coordination agenda from the Government Office to individual ministries. The result is a situation where the legislative plan lacks systemic solutions and the institutional framework that would enable their enforcement is actively weakened.

The proposed changes largely focus on technical and administrative adjustments. A typical example is the amendment to the Act on Addictive Substances, which focuses primarily on eliminating legislative inconsistencies and the functioning of control mechanisms. Such an approach may bring partial improvements in the functioning of the system, but it does not address the main problems associated with the use of addictive substances. The legislative plan lacks measures that would systematically develop prevention, increase the availability of treatment and strengthen risk reduction services. The development of public health monitoring tools, including the monitoring of selected indicators in wastewater, has positive potential. This approach can significantly contribute to a better understanding of usage trends and enable more targeted public policy interventions. However, an isolated tool without a strategic framework and functional coordination between departments will only fulfill its potential to a limited extent.

At the same time, a trend is emerging that may have negative impacts on the most vulnerable groups. Amendments to criminal law, especially regarding the definition of a quantity larger than a small one, may significantly affect the level of criminalization of addictive substance users. Even a seemingly technical change may lead in practice to a higher number of criminal sanctions and a deepening of stigmatization. In the social sector, there is an emphasis on control and conditionality of benefits, which can make it difficult for people in unstable life situations to access support. The combination of repressive instruments and restrictive social policies increases the risk that people with addictions will remain outside the reach of services, which leads to a further deterioration of their health and social status. Stigmatization of people with addictions also brings specific fiscal costs. People who fear repression, loss of housing, employment or social support often postpone contact with health and social services. This leads to delayed resolution of health complications, a higher number of hospitalizations, a greater burden on acute health care, an increase in homelessness, debt and contact with the criminal justice system. The costs of a repressive and stigmatizing approach thus exceed the costs of available prevention, treatment and risk reduction services in the long term.

From the perspective of public health and effective addictive behavior policy, more systematic changes are needed. The policy on addictive behaviour should be clearly anchored as part of public health and coordinated across the health, justice and social affairs departments. It is precisely this condition that the transfer of the agenda from the Government Office to the Ministry of Health undermines. The supra-departmental status of coordination was a functional condition for its effectiveness: under a single department, coordination is subject to its priorities, personnel cycles and departmental logic. The ability to work across ministries and other institutions will gradually and irreversibly disappear. The transfer took place without a comment procedure, without an impact analysis and without real social dialogue. The analysis itself, on which the government declaratively relied in its defense, did not recommend the transfer of agendas to individual ministries. Neither employees of the Government Office nor representatives of government councils were allowed to see it. The unions declared a strike alert, the strike took place, and yet the head of the Government Office informed employees that the decision stood.

A fundamental systemic deficiency remains the absence of a separate addiction law that would clearly define the network of addiction services, standards of their availability, financing and competences of individual actors. The current situation leads to fragmentation of the system, uncertainty of providers and significant regional inequalities in the availability of care. Without legislative anchoring of addiction services, it is impossible to ensure a stable and effective system of prevention, treatment and risk reduction in the long term. Transferring the coordination agenda to the ministry exacerbates this problem: it reduces pressure on interdepartmental solutions and weakens the position of the national coordinator in promoting systemic changes. It is essential to strengthen the availability of risk reduction and treatment services, develop outreach programs, low-threshold centers, accessible substance testing and other interventions that enable early contact with people at risk. These services have a demonstrable impact on reducing the transmission of infectious diseases, the number of overdoses and overall social costs. Their development should be stably financed and geographically accessible to cover even smaller cities and regions.

A significant problem remains the instability of financing addiction services, which are often dependent on short-term subsidy mechanisms and annual uncertainty. Such a system complicates long-term planning, stabilization of professional staff and development of services in the regions. An effective addictive behavior policy requires multi-year and predictable financing based on the real needs of the population. There is also a long-term systemic mismatch between government decisions on increasing salaries and wages in the public sector and the financing of addiction services. Although service providers have repeatedly drawn attention to this problem, there have been no corresponding adjustments to the subsidy mechanisms. Providers are thus forced to absorb increasing personnel costs without adequate compensation from public funding. This approach weakens the stability of the system, increases pressure on the personnel capacities of services and deepens uncertainty in the area of ​​access to care. The transfer of coordination to the Ministry of Health carries the risk that this structural problem will become even less visible across the system, because the agenda will no longer have an institutional bearer with an interdepartmental mandate.

In the area of ​​criminal policy, it is necessary to reassess the setting so that it complies with the principle of proportionality and does not lead to excessive criminalization of users. The criminal justice system should focus primarily on serious forms of crime, while for users it should emphasize health and social interventions. This includes adjusting the limits for quantities larger than small, using alternative measures and strengthening the connection to treatment and social services. Social policy plays a key role in the area of ​​addiction. Stable housing, the availability of basic services and the security of a minimum income are prerequisites for successful treatment and long-term stabilization. The setting of benefits should therefore take into account the needs of people in complex life situations and create conditions for contact with the assistance system. The interconnection of social services with addiction services and the emphasis on individual work with the client are also important. At the same time, the current legislative plan shows the absence of truly functional interdepartmental coordination of addictive behavior policy. Measures are created separately under the responsibility of individual ministries without a unified framework and without systematic evaluation of mutual impacts. The result is a mismatch between health, social and repressive policies, which reduces the effectiveness of public interventions. The policy of addictive behavior should therefore be based on the principle of "health in all policies", i.e. systematically taking into account the impacts on public health across the areas of social policy, education, housing, employment and criminal policy.

A fundamental gap in the legislative plan is the absence of a systematic approach to alcohol. Alcohol is the most widespread addictive substance in the Czech Republic and is associated with the greatest health and economic impacts. An effective policy should include regulation of availability, restrictions on marketing and pricing measures, which are among the most effective tools for reducing consumption. At the same time, there is a need to strengthen prevention aimed at young people and early intervention in risky drinking. Similarly, the area of ​​digital addictions is insufficiently reflected. These have a growing impact, in particular, on the mental health of children and adolescents. Public policy should respond by developing preventive programs focused on digital literacy, regulating some elements of digital platforms and supporting a balance between online and offline activities. This should also include systematic work with schools and families.

An effective policy on addictive behavior cannot do without high-quality data. Therefore, it is necessary to further develop monitoring tools, including innovative approaches, and use them systematically for policy management. This includes not only collecting data, but also sharing it between institutions and using it to set specific measures. It is also important to strengthen evaluation capacities so that the effectiveness of individual interventions can be continuously assessed. At the same time, it is appropriate to support the creation and development of innovative services that respond to the changing form of addictive behavior. This applies to both new psychoactive substances and changes in user patterns and the emergence of digital platforms. The flexibility of the system and the ability to respond quickly to new challenges should be one of its basic principles.

The legislative plan in its current form shows that the government has the ambition to solve individual problems in the areas of public health, law and social policy. However, without a clear strategic anchoring of the addictive behavior policy, there is a risk that the individual steps will not be sufficiently interconnected and their impact will remain limited. The transfer of drug policy coordination from the Government Office to the ministry confirms and deepens this trajectory: it weakens the interdepartmental position, reduces coordination capacity, and creates conditions for the addiction agenda to become one of the departmental items instead of a cross-cutting political priority. If the Czech Republic is to truly reduce the health and social impacts of addiction, it is necessary to move from fragmented and predominantly technical changes to a systematic, data-based policy that connects prevention, treatment, risk reduction, and social support. It is equally important to reflect the entire spectrum of addictive behavior, including alcohol and digital addictions, which today represent major challenges for public health. Without systemic changes, stable funding, legislative anchoring of addiction services, and functional interdepartmental coordination, the Czech Republic will continue to address the consequences of addictions predominantly in a repressive and crisis-based manner, instead of effectively reducing their health, social, and economic impacts.