Policy paper – National Agency for Addictions

Executive summary

The addiction policy in the Czech Republic is one of the internationally recognized systems. It is based on thirty years of building interdepartmental coordination that connects public health, social services, harm reduction, security policy, market regulation and tax policy. By the government decision of May 18, 2026, coordination was transferred to the Ministry of Health — without a standard comment process, without consultation with the professional community, without an impact analysis.

Neither a transfer to the ministry nor maintaining the status quo is a permanent solution. The permanent solution is the establishment of the National Agency for Addictions through the adoption of an addiction law, the full text of which is ready from 2021. The agency would be located outside individual ministries, would be organizationally subordinate to the Office of the Government, and would ensure the financing of addiction services, policy coordination, the creation and management of a database, and independent strategic planning.

Key recommendations: (1) initiate the legislative process for the adoption of an addiction law; (2) maintain the Government Council for the Coordination of Addiction Policy and the Drug Policy Department under the Prime Minister during the preparation of the approval of the law; (3) ensure transitional financing of non-healthcare addiction services independent of the health system until the law comes into effect.

1. Scope and complexity of the agenda

Addictive behavior is one of the largest public health and socio-economic problems in the Czech Republic. An estimated 2.1 million people over the age of fifteen smoke daily. One million people drink alcohol daily, and the Czech Republic is among the countries with the highest per capita alcohol consumption in Europe. Up to 1.4 million people abuse psychoactive drugs, another 450 thousand are at risk of digital addiction. Problematic use of illegal drugs affects approximately 45 thousand people (Pleva et al., 2021a).

The economic scope of the agenda is extraordinary. Smoking alone causes an estimated loss of 100 billion crowns to public budgets annually, and alcohol another 59 billion. Added to this are losses from the illegal tobacco, alcohol and drug markets, the volume of which and its connection to organized crime have been growing significantly in the last decade (Pleva et al., 2021a).

These figures alone show why addiction policy does not fall within the purview of a single department. In addition to the Ministry of Health, which is responsible for treatment and prevention, addiction agendas affect at least fourteen other state administration institutions (RAS Implementation Team, 2021):

• Ministry of Finance — alcohol and tobacco tax policy, gambling regulation, Customs Administration
• Ministry of the Interior — Police of the Czech Republic, National Drug Control Center, security dimensions of illegal markets
• Ministry of Justice — criminal law framework, Prison Service, Probation and Mediation Service
• Ministry of Labor and Social Affairs — social services, financing of non-health programs
• Ministry of Education — primary prevention, certification of prevention programs
• Ministry of Industry and Trade — regulation of tobacco and alcohol advertising
• Ministry of Agriculture — EU tobacco directive, registration of cannabis and poppy
• Ministry of Transport — road safety in relation to addictive substances
• Ministry of Foreign Affairs — fulfillment of obligations to the UN, coordination within the EU
• Regions and municipalities — regional networks of addiction services, Drug coordinators
• Health insurance companies — financing the health component of addiction services

International comparative research confirms that this structural complexity requires coordination above the level of individual ministries. An analysis of 13 countries shows a long-term trend of strengthening interdepartmental integration and administrative coordination for cross-cutting issues (Trein & Maggetti, 2019). Coordination through a supra-ministerial body under the prime minister is considered the most advantageous in a coalition environment, because only the prime minister has sufficient legitimacy for effective interventions across ministries (RAS Implementation Team, 2021).

2. Thirty years of building the system

Drug policy coordination mechanisms in the Czech Republic have been developing since the early 1990s. Act No. 379/2005 Coll. was the first to precisely define the role of individual actors. Act No. 65/2017 Coll., on the Protection of Health from the Harmful Effects of Addictive Substances, transferred coordination to a higher level and established the Government Council for the Coordination of Drug Policy (RVKPP) as an advisory, coordinating and initiating body of the government headed by the Prime Minister (sRVKPP, 2019).

In 2016–2021, the Drug Policy Department of the Office of the Government implemented the RAS project (Systemic Support for the Development of Addictological Services within the Framework of an Integrated Drug Policy), financed by the European Social Fund. It was the first comprehensive systemic analysis and modeling of coordination mechanisms at the level of public administration in the history of Czech drug policy. Among other things, the project mapped coordination systems in all EU Member States and confirmed that all of them, without exception, have an interdepartmental body ensuring strategic planning, with most of them reporting directly to the government (RAS Implementation Team, 2021).

The RAS project produced extensive analytical materials and specific legislative proposals. Its outputs include a new typology of addiction services, revised professional competence standards, tools for creating service networks, a funding methodology, and a proposal for training coordinators. The addiction law and the law on the National Agency for Addictions were prepared as a legislative output. Both documents are ready for adoption as of 2021.

The result of this system was, among other things, an internationally exceptional epidemiological indicator: the Czech Republic has maintained a very low prevalence of HIV among injecting drug users for a long time, significantly below the average of comparable European countries. This result is based on a network of harm reduction and outreach programs, the continuity of which depends on stable and predictable funding (Pleva et al., 2021a).

3. Why departmental anchoring is not enough

3.1 Legal mandate

The Ministry of Health has legal competence for addiction treatment, public health protection and regulation of tobacco and alcohol products from the point of view of health law. It does not have a legal mandate for the coordination of gambling policy, tax measures on alcohol and tobacco, customs agenda, issues of illegal markets or security overlaps. Competence Act No. 2/1969 Coll. assigns these areas to other ministries (RAS Implementation Team, 2021).

Therefore, transferring coordination to the Ministry of Health necessarily means one of two things: either the ministry coordinates only the part of the agenda for which it has a mandate, and the rest remains uncoordinated, or it de facto attempts to coordinate the agenda of other ministries without a legal basis. Neither option leads to a functional system.

3.2 Financing of non-health services

The Czech network of addiction services is built on a combination of health and social services, outreach programs and low-threshold centers. This health-social character is key: harm reduction, outreach workers and contact centers are not health services within the meaning of Act No. 372/2011 Coll. and cannot be financed from public health insurance. The network serves an estimated 37 to 40 thousand problem users per year (RAS Implementation Team, 2021).

The Ministry of Health has historically repeatedly declared that it cannot finance these non-health components of services for legislative and competence reasons. Transferring coordination to the Ministry of Health does not solve this problem. On the contrary, there is a risk of interruption of financing of programs whose existence directly affects epidemiological indicators (Fantuzzi & Mezzina, 2020).

3.3 Independence of strategic planning

A key function of a drug policy coordination office is to produce strategies, action plans, evaluations and analytical materials for the government. These documents, by their very nature, must assess whether the approach of individual departments is working and where it is failing. The coordinator and the expert team placed organizationally under the ministry cannot fulfill this function without self-censorship: evaluating the approach of one’s own superior is structurally impossible in a hierarchical relationship (Syarien & Samarah, 2023).

International research on coordination mechanisms confirms this repeatedly: coordination units located within a line ministry with limited authority and resources typically fail to involve other sectors and implement national approaches (Etiaba et al., 2023). Effective coordination, on the other hand, requires clear legal authorization and operational independence from day-to-day departmental politics (Sasie et al., 2026).

4. Agency Model

4.1 What the Agency is and what it does

The National Agency for Addictions is proposed as a central administrative body with its own legal personality and operational autonomy. At the same time, it is the statutory point of comment in the interdepartmental comment procedure for all legislation affecting addictive behavior, the regulation of addictive substances and gambling. The model corresponds to the National Sports Agency, which has been operating since 2019 and which, under similar conditions, manages sports policy as a cross-cutting agenda outside the ministries.

The agency would take over and perform the following functions:

• coordination of drug policy across ministries and submission of regulatory proposals to the government,
• execution of the agenda of the Inspectorate of Narcotic and Psychotropic Substances, including the regulation of psychomodulatory substances, tobacco and other controlled substances (transfer from the Ministry of Health),
• financing of addiction services through a separate budget chapter, covering both the health and social components of services,
• execution of gambling regulation in the full scope of Department 7302 of the Ministry of Finance (gambling regulation), including licensing, supervision and sanctioning proceedings (transfer from the Ministry of Finance),
• representation of the security dimension through seconded staff from the Ministry of the Interior, the National Drug Control Center and the Customs Administration, who are organizationally part of the agency,
• administration of the National Monitoring Center for Drugs and Addictions and the database,
• certification of addiction services and management of professional competence standards,
• creation and updating of the national strategy and action plans,
• coordination of the regional and local levels, training of drug coordinators,

representing the Czech Republic in international structures — EUDA, UNODC.

A separate budget chapter allows for stable multi-year funding of addiction services independently of the annual priorities of a single ministry. Predictability of funding is identified as one of the key factors in the quality and accessibility of addiction services (Duopah et al., 2024).

4.2 Why operational independence works

Research on coordination institutions in various policy areas consistently shows that effectiveness depends on a combination of three factors: a clear legal mandate, operational autonomy from departmental policy, and sufficient resources for analytical and coordination work (Akhtar-Schuster et al., 2024). The coordination body must be involved in the government system to have access to political decision-making processes, but it must not be completely absorbed by departmental logic, which naturally prefers its own agenda (Syarien & Samarah, 2023).

Australia’s National Drug Strategy, coordinated by an interdepartmental council and working groups outside departmental structures, has led to better mutual understanding, reduced conflict and more innovative cross-cutting approaches. Ireland’s regional Drug Task Force model in Limerick, coordinating police, health and community sectors outside departmental hierarchies, has led to faster local responses and better access to care (Duopah et al., 2024).

Comparative work across 13 countries shows a long-term trend: countries that have introduced stronger integration and administrative coordination of cross-cutting policies consistently show more coherent outcomes than countries that rely on departmental management (Trein & Maggetti, 2019).

4.3 Prevention Fund

The model includes the establishment of a Prevention Fund, into which a portion of the revenue from excise duties on tobacco, alcohol, gambling and psychoactive substances would flow. The substances that cause the greatest social costs would thus finance a portion of their prevention and treatment. A similar mechanism operates, for example, in France or in the Irish Health Research Board system. The fund would be used to finance prevention programs, harm reduction, after-treatment and research. Compared to subsidy funding from the annual state budget, it brings greater stability and less dependence on political cycles.

Field programs, contact centers and harm reduction are by their nature long-term interventions. Their effect is measured in decades (HIV prevalence, numbers of problem users, length of abstinence). Financing them from one-year subsidies means structural inefficiency: providers repeatedly spend capacity on application administration instead of working with clients, staff cannot be employed stably, service networks cannot be planned in advance. From the perspective of public finances, this is wasteful. The state apparatus annually goes through the entire subsidy cycle for projects for which the public interest in continuity is undisputed and interruption would generate higher costs than maintenance. The multi-yearly prevention fund interrupts this cycle and replaces it with predictable mandatory expenditure tied to a legal title.

4.4 Legal entitlement to coordinators

The law currently establishes the function of drug coordinators at national, regional and local levels as an option. The proposed amendment changes this anchoring into a legal obligation: the state, each region and municipality with extended powers must appoint a coordinator. The national coordinator is legally responsible for the implementation of the national strategy and action plan in its territory and is subject to the methodological guidance of the agency.

5. Addiction Law

The Addiction Law was prepared as part of the RAS project and has been available in its full text since 2021. The law introduces three interrelated instruments: the law on the National Agency for Addictions, the law on addiction services defining their typology, standards and financing, and the addiction law as a framework norm (Pleva et al., 2021a).

The Addiction Services Act addresses a key legislative problem that permanently complicates financing in the current system: addiction services have a health-social character, but current legislation divides them into health (registration under the Health Services Act, financing from health insurance) and social (registration under the Social Services Act, financing through the Ministry of Labour and Social Affairs and regions). This duality means that a large part of the network — outreach programs, contact centers, harm reduction — encounters recurring legislative obstacles in financing.

The law introduces the category of addiction services as a separate type combining health and social components, with its own system of registration, certification and financing. This eliminates the need for double registration, reduces the administrative burden and ensures that the financing of harm reduction and outreach work has a legal title, not just a subsidy practice dependent on the annual will of the subsidy provider (Pleva et al., 2021a).

Global research on approaches to addictions confirms that systems combining health and social frameworks in an integrated model achieve better results in terms of accessibility of care, continuity of treatment and epidemiological indicators than systems strictly separating these two components (Johnson et al., 2022; Volkow & Blanco, 2023).

The law was prepared during the first Babiš government and submitted as an output of the RAS project. The Fial government did not submit it for adoption. Now is the opportunity to start the standard legislative process. The law is in line with current EU legislation, complies with the recommendations of both the EUDA and EMCDDA and does not require significant revision.

6. Recommendations

The Rational Addiction Policy Think Tank recommends three steps to the Czech government:

1. Start the legislative process for adopting the Addiction Law

The full text of the law is ready. We recommend submitting it to the interdepartmental comment procedure no later than the end of 2026 with the aim of adoption by the Parliament of the Czech Republic in 2027. The law creates a legal basis for the establishment of the agency, defines addiction services and their financing, and removes legislative obstacles that repeatedly complicate work with clients in the current system (Pleva et al., 2021a).

2. Maintain the Government Council for the Coordination of Addiction Policy and the Drug Policy Department under the Prime Minister

Until the adoption and entry into force of the Addiction Law, it is essential that the Government Council for the Coordination of Addiction Policy (RVKPZ) and the Drug Policy Department remain under the Prime Minister and that its secretariat has sufficient analytical capacity. Moving the secretariat under the ministry would effectively make independent coordination and preparation of documents for the government impossible at the very time when decisions are being made on the future architecture of the entire system.

3. Ensure transitional financing of non-healthcare addiction services

Until the addiction law comes into effect, it is necessary to ensure that the financing of outreach programs, contact centers, and harm reduction services — approximately 37 to 40 thousand clients per year — does not depend exclusively on the budget of the Ministry of Health, which does not have a legal title for these services. A specific solution is to maintain or transfer the subsidy program Anti-Drug Policy Outside the Healthcare Framework, with a clear legal title and a multi-year guarantee (RAS Implementation Team, 2021).

Literature

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The Rational Addiction Policy Think Tank is an independent analytical institution focused on evidence-based addiction policy. The full text of the Addiction Law and the RAS project documentation are available upon request.