This article challenges drug prohibition advocated by UN conventions as the prevailing regulatory model for psychoactive substances, highlighting its ineffectiveness, harmfulness and outdated nature. At the same time, the conventions exclude some psychoactive substances from international regulation, leaving control to individual countries. Presenting an innovative approach, this article outlines an approach to the legal regulation of psychomodulatory substances (psychoactive substances with low health and societal risk) in non-medical contexts. Acknowledging the potential benefits of such psychoactive substances and balancing them with potential harms, it suggests stringent rules for marketing, safety, and preventing sales to minors. This approach aims to quell illicit markets, safeguard vulnerable populations, and encourage controlled use. Through a case study of the Czech Republic's introduction of a new category of psychomodulatory substances, this article showcases a paradigm shift from the prevailing repressive approach to drug regulation. This adaptive model effectively navigates the regulatory void, offering a viable alternative to the UN's prohibition framework.

• MeSH
• kontrola léčiv a omamných látek * zákonodárství a právo   MeSH
• lidé MeSH
• poruchy spojené s užíváním psychoaktivních látek prevence a kontrola   epidemiologie   MeSH
• psychotropní léky * zásobování a distribuce   MeSH
• zakázané drogy zákonodárství a právo   MeSH
• zákonodárství lékové MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

• Publikační typ
• abstrakt z konference MeSH

Substance use is one of the most important risk factors of overall mortality and morbidity, associated with high health and social burden. The study aims to analyse mortality, morbidity, and treatment participation of patients in the Opioid Maintenance Treatment (OMT) and to compare them with cohorts of patients in other forms of addiction treatment and with a history of substance use, and the general population. Design will be retrospective-prospective cohort approach utilising national health registers and information systems linking data by the civil registration number after anonymization. The study is unique by its extensive use of national health registers for research of long-term outcomes in sample of patients exposed to OMT and other substances. This study will provide evidence essential for understanding and improving treatment effectiveness and will formulate recommendations for increasing of accessibility, availability and affordability of addiction treatment in the Czech Republic.

Užívání návykových látek představuje významný rizikový faktor celkové mortality a morbidity spojený s významnými zdravotními a sociálními následky. Cílem studie je zkoumat úmrtnost, nemocnost a účast v léčbě u pacientů v opiátové substituční léčbě a porovnat je s ostatními kohortami pacientů v léčbě závislosti a s anamnézou závislosti na návykových látkách a s obecnou populací. Designem půjde o retrospektivně-prospektivní kohortovou studii využívající národní zdravotnické registry a informační systémy, propojené pomocí anonymizovaného rodného čísla. Studie je unikátní svým rozsáhlým využitím národních zdravotních registrů pro výzkum dlouhodobých dopadů na souboru pacientů v substituční léčbě a u uživatelů dalších návykových látek. Tato studie poskytne podklady k lepšímu pochopení a zvýšení účinnosti léčby a představí doporučení pro zlepšení v oblasti dostupnosti, přístupnosti a finanční dostupnosti léčby závislostí v ČR.

• Klíčová slova
• substituční léčba, buprenorfin, buprenorphine, metamfetamin, methamphetamine, Zdravotní registry, Health registers, substance use, užívání návykových látek, metadon, methadone, heroin, Opioid Maintenance Treatment, Heroin,

• NLK Publikační typ
• závěrečné zprávy o řešení grantu AZV MZ ČR

BACKGROUND: Knowledge of co-occurring mental disorders (termed 'dual diagnosis') among patients receiving opioid agonist treatment (OAT) is scarce. This study aimed (1) to estimate the prevalence and structure of dual diagnoses in two national cohorts of OAT patients and (2) to compare mental disorders between OAT patients and the general populations stratified on sex and standardized by age. METHODS: A registry-linkage study of OAT patients from Czechia (N = 4,280) and Norway (N = 11,389) during 2010-2019 was conducted. Data on mental disorders (F00-F99; ICD-10) recorded in nationwide health registers were linked to the individuals registered in OAT. Dual diagnoses were defined as any mental disorder excluding substance use disorders (SUDs, F10-F19; ICD-10). Sex-specific age-standardized morbidity ratios (SMR) were calculated for 2019 to compare OAT patients and the general populations. RESULTS: The prevalence of dual diagnosis was 57.3% for Czechia and 78.3% for Norway. In Czechia, anxiety (31.1%) and personality disorders (25.7%) were the most prevalent, whereas anxiety (33.8%) and depression (20.8%) were the most prevalent in Norway. Large country-specific variations were observed, e.g., in ADHD (0.5% in Czechia, 15.8% in Norway), implying differences in screening and diagnostic practices. The SMR estimates for any mental disorders were 3.1 (females) and 5.1 (males) in Czechia and 5.6 (females) and 8.2 (males) in Norway. OAT females had a significantly higher prevalence of co-occurring mental disorders, whereas SMRs were higher in OAT males. In addition to opioid use disorder (OUD), other substance use disorders (SUDs) were frequently recorded in both countries. CONCLUSIONS: Results indicate an excess of mental health problems in OAT patients compared to the general population of the same sex and age in both countries, requiring appropriate clinical attention. Country-specific differences may stem from variations in diagnostics and care, reporting to registers, OAT provision, or substance use patterns.

• MeSH
• diagnóza dvojí (psychiatrie) MeSH
• dospělí MeSH
• duševní poruchy * epidemiologie   farmakoterapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• opiátová substituční terapie * statistika a číselné údaje   MeSH
• opioidní analgetika terapeutické užití   MeSH
• poruchy osobnosti epidemiologie   MeSH
• poruchy spojené s užíváním opiátů * epidemiologie   farmakoterapie   MeSH
• prevalence MeSH
• registrace * MeSH
• senioři MeSH
• sexuální faktory MeSH
• úzkostné poruchy epidemiologie   farmakoterapie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH
• Norsko MeSH

Substance use is a global phenomenon that is particularly affecting the prison population. This study aimed to describe the prevalence of drug use among people in prison before and during incarceration in seven European countries and to compare it with the prevalence in the general population. Individual data collection was carried out between 2014 and 2018 with a model European Questionnaire on Drug Use among people in prison. A total of 12,918 people living in prison filled in the survey. People in prison report higher level of drug use when compared with the general population and the use of drug inside prison exist, although at lower levels when compared with predetention. Prisons can represent a point of access to engage individuals who use drugs in interventions that address drug use and risk factors related to both drug use and imprisonment.

• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• poruchy spojené s užíváním psychoaktivních látek * epidemiologie   MeSH
• prevalence MeSH
• průzkumy a dotazníky MeSH
• rizikové faktory MeSH
• uvěznění MeSH
• vězni * statistika a číselné údaje   MeSH
• věznice statistika a číselné údaje   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

Východiska a Cíle. Cílem studie bylo zjistit rozsah zkušeností respondentů s psychedelickými látkami a postoje k jejich výzkumnému a léčebnému využití. U uživatelů bylo zkoumáno, jaké jsou důvody jejich užití a zda dochází k řízené integraci psychedelické zkušenosti. Metody. Byla provedena průřezová dotazníková studie, dotazník byl rozšířen v online podobě pomocí WhatsApp a Messenger a obsahoval 11 otázek. Sběr dat proběhl v listopadu 2023. Výzkumný soubor tvořilo 101 osob (54 mužů a 47 žen) ve věku 18 až 50 let (vstupní kritérium) získaných sebenominací. Výsledky. Zkušenost s psychedeliky uvedlo 31 respondentů, nejčastěji motivovaných zábavou, následovanou duchovními a terapeutickými důvody. Náročnou psychedelickou zkušenost zažilo 16 (51,6 %) respondentů, přičemž 84,2 % respondentů po psychedelické zkušenosti vyhledalo podporu u přátel, zatímco pouze 6,5 % se obrátilo na odborníky v oblasti psychologie či psychoterapie. Mezi respondenty, kteří mají osobní zkušenost s psychedeliky, 67,7 % věří v jejich pozitivní vliv na duševní zdraví, zatímco u respondentů bez osobní zkušenosti s psychedeliky to bylo pouze 31,4 %. Rovněž podpora pro další výzkum této oblasti je výraznější mezi jedinci s osobní zkušeností (67,7 % vs. 31,4 %). Závěr a doporučení. Pozitivnější postoj vůči psychedelikům je patrný u lidí s osobní psychedelickou zkušeností. V České populaci existuje zásadní nedostatek adekvátní integrace psychedelických zkušeností. Integrace je často ponechána na neformálních podpůrných systémech, jako jsou přátelé, což může být neadekvátní z hlediska kvality a bezpečnosti. To poukazuje na klíčový problém absence odborných služeb, nástrojů a platforem, které by lidem umožnily integrovat a případně zprostředkovat psychedelické zkušenosti.

Background and Aims. This study aimed to examine respondents’ experiences with psychedelic substances and their attitudes towards the research and therapeutic use. For users, the study focused on motivations for use and the integration of psychedelic experiences. Methods. A cross- sectional questionnaire survey was conducted. 11-item questionnaire was distributed online via WhatsApp and Messenger. Data collection took place in November 2023. The sample consisted of 101 individuals (54 men and 47 women) aged 18 to 50 years (inclusion criteria) obtained through self- nomination. Results. A total of 31 respondents (30.7%) reported experience with using psychedelic substances. Most of them indicated entertainment as the main motivation, followed by spiritual and therapeutic reasons. 16 respondents (51.6%) reported a challenging psychedelic experience, 84.2% sought support from friends afterward, while only 6.5% turned to professionals in psychology or psychotherapy. Among those respondents with personal experience with psychedelics, 67.7% believed in their positive impact on mental health, while only 31.4% of the respondents without personal experience did so. Support for further research in this area was also more expressed among individuals with personal experience (67.7% vs. 31.4%). Conclusions. Those with personal experience with psychedelics have more supportive attitudes towards them. However, among the Czech population, the integration of psychedelic experiences is often left to informal support systems, such as friends, which may lack quality and safety. This highlights the key issue of the absence of professional services, tools, and platforms that would enable people to integrate and potentially facilitate psychedelic experiences.

BACKGROUND: There is a lack of studies on methamphetamine (MA) exposure and morbidity in children beyond the perinatal period. OBJECTIVES: We compared morbidity in children (0-3 years) with prenatal MA exposure to opioid-exposed and to non-exposed children. METHODS: We used data from a Czech nationwide, registry-based cohort study (2000-2014). Children, who reached 3 years of age, of mothers hospitalized with (i) MA use disorder during pregnancy (MA; n = 194), (ii) opioid use disorder during pregnancy (opioids; n = 166), and (iii) general population (GP; n = 1,294,349) with no recorded history of substance use disorder (SUD). Information on inpatient contacts, length of stay, and diagnoses (International Statistical Classification of Diseases and Related Health Problems 10th Revision [ICD-10]) were assessed. Crude and adjusted odds ratios (aOR), 95% confidence interval (CI) for the risk of hospitalization, and for getting diagnosis from the ICD-10 diagnosis chapters were calculated using binary logistic regression. A stratified analysis on hospitalizations with SUD of mothers was performed. RESULTS: No significant differences were found in the measures of hospitalization between the MA and opioid groups. Children prenatally exposed to MA and opioids had higher numbers of hospitalizations and diagnoses and longer stays in hospital than children in the GP. Increased risks of certain infectious and parasitic diseases were found in both MA (aOR = 1.6; CI: 1.1-2.3) and opioid (aOR = 1.9; 1.3-2.8) groups as compared to the GP group. The most pronounced difference in stratified analysis on maternal hospitalizations related to SUD after birth was observed for injury, poisoning, and certain other consequences of external causes in the strata of the MA group who had hospitalized mothers (aOR 6.3, 1.6-24.6) compared to the strata without maternal hospitalizations (aOR 1.4, 0.9-2.3). CONCLUSION: This study suggests that children born to mothers using MA during pregnancy have similar morbidity during the first 3 years of life but higher than the GP. The excess of risk was primarily due to infections and injuries in the MA group.

• MeSH
• dítě MeSH
• kohortové studie MeSH
• lidé MeSH
• methamfetamin * škodlivé účinky   MeSH
• morbidita MeSH
• opioidní analgetika terapeutické užití   MeSH
• poruchy spojené s užíváním opiátů * epidemiologie   farmakoterapie   MeSH
• registrace MeSH
• těhotenství MeSH
• zpožděný efekt prenatální expozice * epidemiologie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Opioid maintenance treatment (OMT) has the potential to reduce mortality rates substantially. We aimed to compare all-cause and overdose mortality among OMT patients while in or out of OMT in two different countries with different approaches to OMT. METHODS: Two nation-wide, registry-based cohorts were linked by using similar analytical strategies. These included 3,637 male and 1,580 female patients enrolled in OMT in Czechia (years 2000-2019), and 6,387 male and 2,078 female patients enrolled in OMT in Denmark (years 2007-2018). The direct standardization method using the European (EU-27 plus EFTA 2011-2030) Standard was employed to calculate age-standardized rate to weight for age. All-cause and overdose crude mortality rates (CMR) as number of deaths per 1,000 person years (PY) in and out of OMT were calculated for all patients. CMRs were stratified by sex and OMT medication modality (methadone, buprenorphine, and buprenorphine with naloxone). RESULTS: Age-standardized rate for OMT patients in Czechia and Denmark was 9.7/1,000 PY and 29.8/1,000 PY, respectively. In Czechia, the all-cause CMR was 4.3/1,000 PY in treatment and 10.8/1,000 PY out of treatment. The overdose CMR was 0.5/1,000 PY in treatment and 1.2/1,000 PY out of treatment. In Denmark, the all-cause CMR was 26.6/1,000 PY in treatment and 28.2/1,000 PY out of treatment and the overdose CMR was 7.3/1,000 PY in treatment and 7.0/1,000 PY out of treatment. CONCLUSION: Country-specific differences in mortality while in and out of OMT in Czechia and Denmark may be partly explained by different patient characteristics and treatment systems in the two countries. The findings contribute to the public health debate about OMT management and may be of interest to practitioners, policy and decision makers when balancing the safety and accessibility of OMT.

• MeSH
• buprenorfin * terapeutické užití   MeSH
• lidé MeSH
• methadon škodlivé účinky   MeSH
• opiátová substituční terapie škodlivé účinky   metody   MeSH
• poruchy spojené s užíváním opiátů * farmakoterapie   MeSH
• předávkování léky * epidemiologie   farmakoterapie   etiologie   MeSH
• registrace MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

AIMS: We measured the association between a history of incarceration and HIV positivity among people who inject drugs (PWID) across Europe. DESIGN, SETTING AND PARTICIPANTS: This was a cross-sectional, multi-site, multi-year propensity-score matched analysis conducted in Europe. Participants comprised community-recruited PWID who reported a recent injection (within the last 12 months). MEASUREMENTS: Data on incarceration history, demographics, substance use, sexual behavior and harm reduction service use originated from cross-sectional studies among PWID in Europe. Our primary outcome was HIV status. Generalized linear mixed models and propensity-score matching were used to compare HIV status between ever- and never-incarcerated PWID. FINDINGS: Among 43 807 PWID from 82 studies surveyed (in 22 sites and 13 countries), 58.7% reported having ever been in prison and 7.16% (n = 3099) tested HIV-positive. Incarceration was associated with 30% higher odds of HIV infection [adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI) = 1.09-1.59]; the association between a history of incarceration and HIV infection was strongest among PWID, with the lowest estimated propensity-score for having a history of incarceration (aOR = 1.78, 95% CI = 1.47-2.16). Additionally, mainly injecting cocaine and/or opioids (aOR = 2.16, 95% CI = 1.33-3.53), increased duration of injecting drugs (per 8 years aOR = 1.31, 95% CI = 1.16-1.48), ever sharing needles/syringes (aOR = 1.91, 95% CI = 1.59-2.28) and increased income inequality among the general population (measured by the Gini index, aOR = 1.34, 95% CI = 1.18-1.51) were associated with a higher odds of HIV infection. Older age (per 8 years aOR = 0.84, 95% CI = 0.76-0.94), male sex (aOR = 0.77, 95% CI = 0.65-0.91) and reporting pharmacies as the main source of clean syringes (aOR = 0.72, 95% CI = 0.59-0.88) were associated with lower odds of HIV positivity. CONCLUSIONS: A history of incarceration appears to be independently associated with HIV infection among people who inject drugs (PWID) in Europe, with a stronger effect among PWID with lower probability of incarceration.

• MeSH
• HIV infekce * epidemiologie   MeSH
• HIV séropozitivita * MeSH
• intravenózní abúzus drog * epidemiologie   MeSH
• lidé MeSH
• průřezové studie MeSH
• tendenční skóre MeSH
• uživatelé drog * MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH

INTRODUCTION: Among people receiving current or previous opioid maintenance treatment (OMT), the leading cause of premature death is an opioid overdose. However, other causes of mortality remain high in this group. An understanding of causes of deaths across multiple settings can be useful in informing more comprehensive prevention responses. The aim of this study was to describe all non-overdose causes of death in three national cohorts (Czechia, Denmark, and Norway) among OMT patients and to explore associations of non-overdose mortality with age and gender. METHODS: This prospective comparative cohort study used national mortality registry databases for OMT patients from Czechia (2000-2019), Denmark (2000-2018), and Norway (2010-2019). Crude mortality rates and age-standardized mortality rates (ASMRs) were calculated as deaths per 1,000 person years for cause-specific mortality. RESULTS: In total, 29,486 patients were included, with 5,322 deaths recorded (18%). We found variations in causes of death among the cohorts and within gender and age groups. The leading non-overdose causes of death were accidents in Czechia and Denmark, and neoplasms in Norway. Cardiovascular deaths were highest in Czechia, particularly for women in OMT (ASMR 3.59 vs. 1.24 in Norway and 1.87 in Denmark). CONCLUSION: This study found high rates of preventable death among both genders and all age groups. Different demographic structures, variations in risk exposure, as well as variations in coding practices can explain the differences. The findings support increased efforts towards screening and preventative health initiatives among OMT patients specific to the demographic characteristics in different settings.

• MeSH
• kohortové studie MeSH
• lidé MeSH
• poruchy spojené s užíváním opiátů * MeSH
• předávkování léky * MeSH
• příčina smrti MeSH
• prospektivní studie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH