Open letter - Questions on moving the drug policy agenda and merging mental health policy under the Ministry of Health

Addressed to:

Dear Ms.

Mgr. Tünde Bartha

Head of the Office of the Government of the Czech Republic

Dear Ms.

MUDr. Dita Protopopová, Ph.D.

Incoming National Coordinator for Mental Health Care and Drug Policy

Attn:

Ing. Andrej Babiš, Prime Minister of the Czech Republic

Mgr. et Mgr. Adam Vojtěch, MHA, Minister of Health of the Czech Republic

Government Council for the Coordination of Addiction Policy

State Security Council

Health Committee and Security Committee of the State Security Committee of the Czech Republic

Brno, May 25, 2026

Dear Head of the Government Office, Dear Coordinator,

Following the government's decision of May 18, 2026 to transfer the drug policy agenda to the Ministry of Health (MOH) and your public statements in the media, we have prepared a number of questions as part of constructive negotiations, the answers to which could resolve fundamental concerns about the future form of this policy. We will now leave aside our preferred solution - the establishment of an independent office or agency. In the event of the real abolition of the role of the supra-ministerial coordination point, we therefore ask for substantive answers to the questions listed below before the planned transfer. We request this due to the seriousness of the step in question and the negative consequences that could occur without resolving these issues.

Maintaining a network of non-healthcare services for approximately 40 thousand clients of these facilities

According to data from the National Monitoring Center (NMS), the Czech network of addiction services serves approximately 37-40 thousand problem users of addictive substances, mainly through low-threshold contact centers, outreach programs, after-treatment facilities and the social component of services – i.e. activities that are not health services by their nature and which the Ministry of Health has historically repeatedly declared that it cannot finance due to the competence law.

1. Under what specific legal title will the Ministry of Health pay subsidies for the non-healthcare (social) component of addiction services from July 1, 2026 – i.e. mainly for outreach workers, contact centers, low-threshold programs and after-treatment, which currently admits approximately 37-40 thousand people annually?
2. If this legal title does not exist as of July 1, by what specific legislative act and by what date will it be supplemented so that funding for this network is not interrupted as of January 1, 2027?
3. What guarantee do you give to the providers of these services (Sananim, Drop In, Podané ruce, Renarkon, Magdaléna and dozens of other organizations) that their clients will not be threatened with interruption of continuity of care after July 1, 2026? Or is there no plan to simply stop paying this financial support to these services?
4. If the relocation results in a reduction in the availability of low-threshold services and an increase in epidemiological indicators (HIV, hepatitis, overdose), who will bear political responsibility and by what mechanism will the decision be revoked?

Mandate and competences of the Ministry of Health

Current drug policy coordinates agendas far beyond public health – gambling, tobacco and alcohol taxes, regulation of nicotine products, customs, illegal market, law enforcement, social services. The Ministry of Health does not have a legal mandate or professional and analytical capacity for most of these areas.

1. Which specific provision of the Competence Act (No. 2/1969 Coll.) gives the Ministry of Health and the national coordinator the authority to coordinate the agenda of gambling, tobacco and alcohol taxes, customs, illegal market regulation and law enforcement as of July 1?
2. If the Ministry of Health does not acquire this authority, who and by what formal decision will coordinate these areas from July 1, given that in the past the Ministry of Health had exclusive responsibility for the alcohol and tobacco agendas and completely resigned from this coordination, and therefore the so-called integrated policies were transferred and coordination was transferred to the national coordinator operating directly under the prime ministers of the Czech Republic due to the serious increase in all problems?
3. What professional and analytical capacities in the field of regulation of addiction markets, tax policy for addictive substances, gambling and illegal trade does the Ministry of Health have today?

Security and fiscal dimension - the new reality of the shadow economy

The market for illegal tobacco, alcohol, pharmaceuticals, PML, synthetic drugs and illegal gambling in the Czech Republic and across the EU has been growing at a pace in recent years that makes it a qualitatively new phenomenon. It is no longer about isolated tax evasion, but about interconnected networks of organized crime with links to hybrid actors, precursor chains, financing through crypto-assets and the merging of legal and illegal distribution channels. EU agencies (Europol SOCTA 2025, EUDA, EMPACT) explicitly describe this shift as a threat to the internal security of the member states. The Czech Republic, as a transit country and a key European producer of methamphetamine, is in an exposed position in this geography. This reality fundamentally changes the nature of the agenda – from primarily health to primarily defense-security and fiscal.

• Are you aware that the illegal market for tobacco, alcohol, pharmaceuticals and drugs in the Czech Republic has been growing at a pace in the last ten years, which, according to the methodology of Europol, EUDA and OECD, moves it from the category of a tax and health problem to the category of a threat to the internal security and financial stability of the state?
• Do you reflect that the shadow economy associated with addictive substances in Europe is interconnected with organized crime, precursor chains and, in some countries, even with hybrid security actors? How can this unprecedented phenomenon be effectively coordinated by a ministry whose competence ends with public health?
• The Ministry of Health does not have analytical competence for working with data from the Customs Administration, the Financial Analytical Office, BIS, ÚZSI, the Police of the Czech Republic or Europol. What mechanism will the national coordinator under the Ministry of Health use to obtain, integrate and evaluate this data, which is necessary for a real understanding of the market?
• How specifically will systemic coordination with the Customs Administration, the General Directorate for Drug Control, the Federal Anti-Drug Administration, the Police of the Czech Republic (NCOZ, NPC) and intelligence services be ensured from July 1 onward on issues of the illegal market in addictive substances? Is there an interdepartmental memorandum, government resolution or other binding document for this, or is such a step planned?
• According to EUDA and UNODC, the Czech Republic is one of the main EU producing and transit countries for methamphetamine and is also growing as a hub for synthetic opioids. This role is primarily a security-intelligence issue. Who will be in charge of this agenda at the government level from July?
• The estimated annual loss to the state budget from the illegal tobacco, alcohol and gambling market in the Czech Republic is in the order of tens of billions of crowns. By what mechanism will the Ministry of Justice – a department that does not collect taxes and does not have repressive or analytical tools – coordinate this fiscal dimension with the Ministry of Finance, the Customs Administration and the security forces? Does the Ministry of Justice expect to accept this role from the upcoming Action Plan, or will it resign from this coordination role and the Czech Republic will return to established mechanisms, which have completely failed, as shown by the growth trends?
• The EU agenda in this area (Horizon Europe Cluster 3 – Civil Security for Society, EMPACT priority areas, EU Roadmap to Fight Drug Trafficking and Organised Crime 2023–2028) explicitly places the fight against the illegal market in addictive substances within the security framework. How will the Czech Republic approach these European priorities when the responsibility is transferred to a purely health sector?
• Was the State Security Council invited to the proposed agenda transfer? Was the opinion of the BIS, the ÚZSI, Military Intelligence and the National Anti-Drug Centre requested? If not, why was a decision of strategic importance for internal security made without consulting the security community?

The supra-departmental nature and the position of the coordinator

In an interview with iDNES.cz, you claim that the supra-departmental nature of the agenda remains preserved. On the contrary, Minister Vojtěch in Events, Comments speaks of a unified policy of the Ministry of Health without supra-departmental contradictions. The national coordinator is to be an employee of the Ministry of Health and the head of its new section, while at the same time providing secretarial support to the Government Council, which should be politically superior to her.

• Will the national coordinator for mental health care and drug policy be in an employment relationship with the Ministry of Health or the Government Office? To whom will she be subordinated in terms of service?
• If she is subordinate to the Ministry of Health: by what specific mechanism will she be able to oppose the position of her employer – the Minister of Health – in the Government Council?
• Who will be the secretary or secretary of the Government Council for the coordination of addiction policy from July 1? If the secretary is also the coordinator and head of the MZd section, how is it systematically ensured that the Council will also receive opinions that contradict the MZd line and, for example, will not support the commercial interests of certain industries, such as multinational pharmaceutical companies that have a vested interest in this agenda?
• Will the Government Council after the reorganization have its own analytical and secretarial background independent of the MZd, or will any basis for its deliberations first pass through the MZd leadership?
• Minister Vojtěch stated in Events, Comments that there will no longer be supra-ministerial contradictions and policy will be unified under the MZd. In an interview for iDNES.cz, you claim the opposite. Which interpretation is the official government position?

Independence of decision-making from private interests

In recent years, drug policy in a number of European countries has become the target of increased interest from private actors – especially pharmaceutical companies (substance drugs, psychotropic drugs), manufacturers and distributors of nicotine products, the gambling industry and the alcohol industry. The European Medicines Agency, the European Commission and Transparency International EU have repeatedly documented specific cases where the interests of these actors have manifested themselves in decision-making processes to the detriment of patients and taxpayers. Moving the agenda to a ministry that is also the main regulator of the pharmaceutical market and the main contractor of healthcare contracts systematically increases, not reduces, the risk of conflict of interest.

• What specific systemic guarantees of transparency and independence of decision-making will you introduce so that the formation of addiction policy under the Ministry of Health is not influenced by the interests of the pharmaceutical industry, manufacturers of nicotine and tobacco products - i.e. including the competitive advantages of one industrial interest, here primarily pharmaceutical companies, but also the alcohol industry and gambling operators?
• Will the coordinator, the leadership of the new section and members of the expert working groups be required to disclose their contacts with lobbyists and commercial interest groups in a regime comparable to the rules of the European Commission (transparency register)?
• How will you ensure that subsidy decisions for addiction services are structurally separated from decisions on reimbursement of medicines and healthcare contracts, which fall within the same institution?

Expert substrate and procedural correctness of the decision

• What expert analysis preceded the decision to transfer? We request the publication of all analytical documents, impact studies (RIA) or comparative materials on the basis of which the decision was prepared, given the fundamental binding nature of this change.
• Which experts in addictology, harm reduction, regulation of addiction markets and security issues were invited for consultation – namely, with the dates of the meetings and the content of their opinions?
• Was the decision consulted with the Government Council for the Coordination of Addiction Policy, which is, according to the statute, an advisory body to the government for these issues? If not, why was this advisory body bypassed and on the basis of what competences was this done?

Argument about alleged duplications

• Name a specific agenda that the Drug Policy Department has duplicated with the activities of the Ministry of Health in the last five years.
• What agenda was duplicated by the National Monitoring Center for Drugs and Addiction (NMS), which was the only one in the Czech Republic to supply data for the European Agency EUDA and also in annual reports to the government as a fundamental expert basis for important decisions on this agenda?
• The subsidy program Anti-Drug Policy of the Government Office went directly to non-state service providers. Which line of the Ministry of Health performed the same function for the same target group, so that we could talk about duplication?
• If the agenda was truly duplicated, why has no government canceled it in thirty years and what specifically changed between December 2025 and May 2026 that the decision became so urgent? Is it not just an administrative ambition without an expert impact assessment?

Responsibility and measurability of the reform

• What specific measurable indicators do you propose for evaluating the reform in the 12 and 24 month horizon? We ask that you provide at least: HIV prevalence among injecting drug users, prevalence of hepatitis B and C (here it is more appropriate to monitor the necessary decrease), number of overdose deaths, coverage of substitution treatment, number of contacts in low-threshold services, revenue from excise taxes on tobacco and alcohol, estimated volume of the illegal market and stopping the growth trend and the necessary decrease of this phenomenon.
• What will be the initial baseline as of June 30, 2026 for each of these indicators, against which the reform will be evaluated?
• If the key indicators worsen after 24 months - are you, the Minister of Health and the Prime Minister, ready to revoke the reform and take political responsibility?

Conclusion

Czech drug policy is one of the internationally recognized models precisely because it has been built for three decades as a supra-departmental, evidence-based and balanced across four pillars (prevention, harm reduction, treatment and resocialization, repression). Its de facto transfer to a single ministry – without consultation with the professional community, without the opinion of the State Security Council, without an impact study and in contradiction with the growing security and fiscal dimension of the agenda – represents a decision whose consequences may be long-term and difficult to reverse.

We therefore request a factual and written response to the above-mentioned questions before the specific act of transferring the given agenda to the Ministry of Health.

This letter and your responses will be made available to the public, the professional community and the media in the interests of transparency.

Thank you for your attention to the matter.

Sincerely,

Mgr. Jindřich Vobořil, Pg.Dip.

Chairman of the Board of Directors