Substituční léčba závislosti na opioidech v čr: Kritický pohled

Objective: Review of the recent situation regarding opioid agonist treatment OAT in the Czech Republic (CR). Method: A review of the Czech bibliographical resources was carried out, including grey literature, focusing on the issue of substitution treatment and illicit market with substitution formulations. Results: The number of problem opioid users in the CR was estimated as 13,100 persons in 2017. In the same year, 2249 patients (2266 patients in 2016) were registered in OAT, of which 743 (33%) prescribed methadone and 1,506 (67%) preparations containing buprenorphine. The number of people treated in OAT has stagnated in the last 5 years. There are significant geographical differences in the availability of OAT in the Czech Republic. Especially in Prague, where more than 70% of the total estimated number of problem opioid users in the country are estimated, availability and coverage are limited-only 13,6% of the estimated number of opioid users in Prague is registered in OAT. Most patients in OAT in the Czech Republic receive BUP uncovered by health insurance, so they pay CZK thousands per month (€ hundreds) for medication. Doctor shopping associated with BUP is common and reselling BUP represents source for funding their own treatment. Conclusion: Low availability and low affordability of OAT drive BUP misuse and the black market with BUP. Geographical availability, accessibility and affordability of OAT should be improved.