BACKGROUND: Problem drug use is associated with excess risk of infectious and other somatic diseases resulting mainly from injecting drug use. MATERIAL AND METHODS: At the end of 2013, a complete medical history and physical examination was done in 40 problem drug users (30 males and 10 females), mean age 35.5 years (37.0 and 30.9, respectively), recruited in 4 low-threshold facilities in Prague. Of them, 37 were ex- or active injecting drug users, predominantly of methamphetamine (pervitin) and less often of buprenorphine. RESULTS: The study physician rated the health status as -good or satisfactory in 35 participants and as unsatisfactory in five participants (12.5%). The most common pathologies were dental problems (36 participants, i.e. 90.0%) and skin conditions (15.0%). The most prevalent dental pathology was caries while dermatological disorders were mostly trophic skin lesions on the lower legs, including crural ulcers, and injection site infections. Gynaecological pathology was found in 2 of 10 females. The study subjects were most commonly diagnosed with chronic hepatitis C, status post hepatitis A and B, chronic caries, missing teeth, post-thrombotic swelling and trophic skin lesions on the lower legs, purulent skin lesions, and gastroduo-denal ulcer. A vast majority of the study participants were smokers. All were referred to various specialists for further examination or treatment, mostly to stomatology, hepatology, gastroenterology, and internal/general medicine departments. However, in reality the treatment participation rate is low among problem drug users due to the drug use-specific factors and needs that limit access to treatment. CONCLUSION: The incidence of diverse somatic comorbidities requiring standard general medical care is significant among problem drug users. Infectious, dermatological, and dental pathologies are predominant. In areas with high prevalence of problem drug use, implementation of a special program should be considered to provide comprehensive medical care taking account of the special needs of this target group.

The complex relation between access to opioid agonist therapy and diversion of opioid medications: a case example of large-scale misuse of buprenorphine in the Czech Republic