Psychoactive drugs in the Czech Republic – risks of addiction, prescription trends, combinations with alcohol and necessary precautions

Psychoactive drugs are an important part of the treatment of pain, anxiety, insomnia, depression and other health problems. At the same time, they represent a significant and still underestimated area of ​​addiction risks in the Czech debate.

The problem does not only affect a small, marginal group of patients. According to Czech data, in 2023, 12 to 22% of the population over 15 years of age used psychoactive drugs in the last 12 months, with an estimated 1.1 to 1.7 million people showing signs of problematic use. An estimated 820,000 to 1.1 million people abused sedatives and hypnotics alone, and 480 to 670,000 people abused opioid analgesics. At the same time, the use of psychoactive drugs is approximately twice as common in women and increases with age (Chomynová et al., 2025).

European and international literature shows that opioids, benzodiazepines, Z-hypnotics and gabapentinoids have the highest potential for misuse and addiction, and to some extent also some antidepressants (Araújo et al., 2023; Araújo et al., 2024; Schifano et al., 2019). Z-hypnotics, especially zolpidem and zopiclone, are associated with thousands of reports of abuse, addiction, overdose and deaths (Schifano et al., 2019). Among young people aged 12 to 25, misuse of psychoactive drugs is also significant, with some groups reaching 18 to 40% among users of this class, and some of them already meeting the criteria for substance use disorder (Agaku et al., 2021).

Czech data show that the problem also has a strong prescription and distribution dimension. In 2023, the distribution of benzodiazepines in the Czech Republic amounted to 43 million defined daily doses, i.e. 4.8 daily doses per inhabitant over 15 years of age per year. For Z-drugs, it was more than 80 million defined daily doses, approximately 8.8 daily doses per inhabitant, with the majority being zolpidem. Pregabalin is also growing steeply, from 5.4 million doses in 2013 to 31.9 million in 2023. The consumption of opioid analgesics is also growing in the long term, from 39 million defined daily doses in 2014 to 57 million in 2023. The Czech report also points out that the register of restricted medicinal products is not sufficiently used in practice to regulate the dispensing of psychoactive medicines and in 2024 there was no medicinal product from the group of sedatives, hypnotics, anxiolytics or opioids in it (Chomynová et al., 2025).

A significant risk is long-term use and polypharmacy. In foreign studies, chronic use outside recommended practices is common, for example, with benzodiazepines or short-term indicated hypnotics, as well as the combination of multiple psychoactive medicines at the same time (Araújo et al., 2024; Schenk et al., 2024). Czech data support this picture: 16% of users of sedatives and 10% of users of opioid analgesics in 2023 obtained these drugs other than with a medical prescription, i.e. from acquaintances, in a pharmacy without a prescription or via the Internet. According to the report, doctor shopping and illegal online offers are also significant sources (Chomynová et al., 2025).

The combination of psychoactive drugs with alcohol is particularly serious. Foreign research shows that the combination with alcohol and other substances increases the risk of serious poisoning and death, with the riskiest being the combination of multiple psychoactive substances at the same time (Chai et al., 2024; Holton et al., 2017; Barkla et al., 2015). Czech data show that in 2023, 3.0% of the population over 15 years of age were in the category of psychoactive drug abuse and simultaneous risky alcohol drinking, i.e. an estimated 275 thousand people. In a survey among citizens, 4.2% of the population reported using psychoactive drugs in combination with alcohol in the last 12 months and 1.8% in the last 30 days. Among 16-year-olds in the ESPAD study, 5.8% of respondents had experience using drugs together with alcohol (Chomynová et al., 2025).

The impacts of this situation are real and measurable. In the Czech National Registry of Autopsies and Toxicological Examinations, 75 fatal overdoses of illegal drugs, volatile substances and psychoactive drugs were reported in 2023, of which 4 were fatal overdoses of benzodiazepines; the opioid category included 26 cases and includes opioid analgesics. At the same time, the number of hospitalizations for injuries under the influence of psychoactive drugs increased, from 248 cases in 2022 to 276 in 2023. The report also points out that the health impacts of psychoactive drug use are not systematically monitored in the Czech Republic, which in itself poses a problem for policymaking (Chomynová et al., 2025).

Public policy should also reflect this. The first step is to more consistently monitor prescription and risky patterns of use, especially long-term use of benzodiazepines and Z-drugs, the combination of opioids with benzodiazepines or pregabalin, and the combination of psychoactive drugs with alcohol (Araújo et al., 2023; Chai et al., 2024; Soeiro et al., 2025). The second step is to systematically educate doctors and pharmacists, because in the Czech Republic, according to the report, only 42% of doctors implement brief interventions for risky or intensive users of psychoactive drugs, and educational prevention programs focused on this area are not systematically implemented. The third step is to develop deprescribing programs and strengthen non-pharmacological alternatives, especially for insomnia, anxiety, and chronic pain (Schenk et al., 2024; Figg et al., 2026). The fourth step is to strengthen harm reduction, including warnings in e-prescriptions about risky combinations, patient education about the prohibition of combinations with alcohol, wider availability of naloxone for opioid-dependent patients, and targeted interventions for risk groups (Morrison et al., 2025; Soeiro et al., 2025; Agaku et al., 2021). Czech data show that psychoactive drugs represent a significant public health burden and require systematic management in the areas of regulation, prescription, prevention, and treatment (Chomynová et al., 2025).

Key measures include:

• Introduction and strengthening of prescription monitoring, including identification of risky patterns such as long-term use of benzodiazepines or combinations of multiple psychoactive drugs.
• Systematic education of physicians about the risks of addiction, polycombination, and interactions with alcohol.
• Development of deprescribing programs aimed at reducing unnecessary polypharmacy.
• Strengthening the availability of non-pharmacological interventions, especially psychotherapy and behavioral approaches.
• Introduction of warning systems in e-prescriptions to warn of risky combinations
• Expansion of distribution of naloxone for patients using opioids.
• Education of patients about the risks of combining drugs with alcohol and safe use
• Prevention of diversion and misuse in young people, including work with parents and schools.

Psychoactive drugs represent a significant but often neglected source of health and social risks. Their regulation and management must be based on data, interdisciplinary cooperation and a realistic approach to human behavior. Without systematic measures, there is a risk of further increase in the health burden, which will be comparable to other areas of addiction that are already in the spotlight today.

References:

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Araújo, A., Casal, R., Goulão, J., & Martins, A. (2023). Misuse of psychoactive medicines and its consequences in the European Union – a scoping review. Journal of Substance Use, 29, 629 - 640. https://doi.org/10.1080/14659891.2023.2213325

Araújo, A., Guerreiro, J., Bulhosa, C., Da Costa, A., Goulão, J., & Martins, A. (2024). Use and misuse of psychoactive medicines: a descriptive cross-sectional study in a densely populated region of Portugal. Journal of Pharmaceutical Policy and Practice, 17. https://doi.org/10.1080/20523211.2024.2369319

Barkla, X., Mcardle, P., & Newbury-Birch, D. (2015). Are there any potentially dangerous pharmacological effects of combining ADHD medication with alcohol and drugs of abuse? A systematic review of the literature. BMC Psychiatry, 15. https://doi.org/10.1186/s12888-015-0657-9

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