Abstract
This article presents a literature review of published and grey literature focused on problem opioid use (POU) on the territory of the CR. The development of POU in the CR can be divided into 4 periods, all characterised by injecting opioid use.
The period before 1989 was typified by misuse of opioid analgesics and home-made drugs (braun). The first half of the 1990s was significant for the emergence of the so-called heroin epidemic as illegally transported heroin gained a dominant position on the drug scene.
Subutex has been available in the CR since 2000 and its leakage on the illicit drug market has been observed since 2002, characterised by the sale and purchase of small surplus quantities of buprenorphine obtained through doctor shopping. The increase in the illicit problem use of buprenorphine is associated with consequent decrease in heroin use and the heroin market.
Buprenorphine is currently the most used opioid among POU in the CR. There has been reemerging increase in the use of opioid analgesics for the past 5 years, esp. in the regions with typically high prevalence of POU.
The misuse of both buprenorphine and opioid analgesics is related to the limited affordability and local availability of opiate substitution treatment (OST) in the CR. The prevalence of POU in the CR was estimated at 12,700 users in 2015, i.e. 27.1% of all the 46,900 estimated problem drug users.
The development of POU went through periods of misuse of opioid analgesics and later of substitution products characterised by a great amount of self-supplying and an unorganised market, in comparison to the highly organised commercial market with heroin. POU in the CR is characteristic of a high level of injecting which represents a considerable public health issue.
It is therefore necessary to scale-up specific therapeutic and harm reduction interventions for POU, esp. OST.