The National Drug Policy Coordinator Has Unveiled the Strategy for the Upcoming Years and Expects a Lively Debate

Not only illegal drugs, but also alcohol, tobacco, and gambling are the areas that the new National Strategy for Drug Policies for the next nine years focuses on. Prescription drug addiction is also a new addition. The National Drug Policy Coordinator, Jindřich Vobořil, explained the aims of the strategy to Zdravotnický deník (Healthcare Daily). He is currently preparing the first draft, which should be sent to the Inter-ministerial commentary procedure at the end of May. The underlying principle that permeates all areas of addiction should be harm reduction. However, Vobořil expects that he will hit a wall with his ideas with those incompetent government officials that have yet to understand that a drug-free world is a mere illusion. “The headline of our entire strategy is the minimisation of damages and risks. Nothing else. I do not think that any other philosophy or national strategy concept is realistic,” says Jindřich Vobořil.

 

Why was this new strategy created?

If I ignore the fact that the previous nine-year period strategy is coming to an end, then I would have to say that I cannot imagine that any preventive policies would not be planned ahead. My experience is that if strategies are made each year for the coming period, then nothing is achieved. If the government decides to not adopt any long-term conception and does not set a specific goal, like lowering the number of children who abuse tobacco or who get drunk, then it does not need to evaluate or change anything. A business plan for the longer term must be created, or a timetable, or however you wish to label it.

Were the goals of the previous strategy met, some that can be expressed with real, verifiable numbers, and what, on the other hand, was unsuccessful?

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When we speak of illegal drugs, our policy has paid off for a long time, albeit that in the past few years, little money has gone to fund it. It is no longer a relevant problem, and so finances have been greatly curtailed there. Currently, the situation is improving. Our problematic indicators are below the average of the world and the EU.

What pains us is tobacco and alcohol, where for a long time, there was no strategy planned. During the course of the last nine years, we have been quite vocal that it is necessary to do something, that all of these areas are interconnected and that there is no plan, so what should we do with them. Although we have an action plan for tobacco and alcohol for the past three years, but nothing much has happened, the situation has not improved. No finances remained to carry out the tasks of the plan. Although we have been successful in convincing those concerned that the necessary amounts of finances must be defined, it remains the responsibility of the Ministry of Healthcare, and in the end, it was not able to find the resources needed.

Increase Taxes on Both Tobacco and Alcohol

Will tobacco and alcohol remain a part of the new strategy even after this experience? Where do you find the faith that if until now, no money has been found for this purpose, funds will be found in the upcoming period?

I cannot imagine that we will go back to old solutions that we know do not work independently. We are the eleventh country in the EU that has chosen the complex, so-called integrated approach. We are not alone, nor are we the first. My philosophy is – I am an expert who the government pays so that I tell what we need to do. And the government then decides, whether it will provide the funds and for what. I will not, however, suggest a compromise in advance. Even past governments came to understand that they cannot require that I come up with something that is toothless.

And how sharp will your “teeth” be when it comes to alcohol and tobacco for the next period?

The entire national strategy should be funded by resources amounting to about 1 % of the excise duties on alcohol and tobacco, as well as of the gambling tax, which equals to an amount of something between 500-700 million crowns for prevention and treatment. If I disregard repression, then it is necessary to focus on all other – soft – areas, whether it be prevention, treatment, education of experts, engaging general practitioners as well as the public.

Are the costs of health insurance included in this money?

No. The costs of health insurance are, however, approximately calculated. The paradox is that health insurance companies spend around 1.5 billion per year on this matter, but only 200 million of this sum are costs for the specific actions of targeted intervention. Other costs are either one-time visits to a psychiatrist or other physician, prescribing medicine, laboratory examinations, etc. A large percentage of people flow through psychiatric clinics without greater effect. This represents another tidy sum of money. If well-managed, the approach of this area would be functional and cheaper.

Perhaps it would be good to remind the public another – much larger – sum of money that health insurance companies must spend for the treatment of the consequences of alcoholism and smoking.

Exactly. We need to lead a bigger campaign in the Czech Republic, even though this is rather a vulgar term evoking television spots and billboards in the minds of people. What I mean is a systematic pressure applied by all possible means, which would, for example, alter the first age of alcohol experience. The Germans have focused on this and led a ten-year-long campaign, shifting the age when one first gets inebriated by three years. For us, it is somewhere around 13 years of age for 25% of children.

Can a campaign of any sort truly change the behaviour of people so significantly?

Yes. I am not speaking of a media campaign, but of a systematised pressure. When I told the current prime minister, Mr. Babiš, that I want to do a campaign, he immediately said: Do not even say that, a campaign! However, he, himself, has experienced that a political campaign works when the right measures are used. A so-called social campaign is already being led against tobacco. Using various means, we create an environment in which smoking is increasingly considered to not be the norm, i.e. smoking is banished from public spaces. Today, we no longer smoke in restaurants or in offices, and most people no longer light up at home in front of their children. The way we view smoking has begun to change; the media reflect this shift, knowledge is spreading, there is education in schools, and so on.

One of the more effective measures that has worked all over the world is pricing.

When it comes to alcohol, where should such a campaign or pressure or a certain common approach be aimed?

One of the more effective measures that has worked all over the world is pricing. The World Health Organisation has repeatedly commented this and has provided the numbers. Another tool is also excise duties. I have heard liberal economists say that during booms we should lower direct and increase indirect taxes, such as excise duties. Since direct taxes effect everyone, including all employees, but alcohol and tobacco are a sort of premium. We are one of the three countries with the cheapest tobacco in the EU. All we need is the will to, as a government, collect more money through these taxes, because at the moment, we have 8 percent of tax revenues from tobacco and 3 percent of all government revenues. If excise duties on tobacco are increased only a little, nothing will happen. However, it has been proven that an increase in duties lowers the frequency of use, lowers the number of young smokers, as well as the length of the period they smoke.

Will the strategy say by how much taxes should be lowered?

This is the subject of discussion. Personally, I do not think that it should be elaborated just like a business plan.

So a specific number should be included in it?

Yes, because if we do not have a number, then I do not expect such a great effect. Increasing excise duties is not the only measure, however. We always must consider a whole complex of measures, from a campaign of some sort to, perhaps, how one can control that the government administration enforces the law on limiting the availability of alcohol and tobacco to minors. According to surveys, 86% of minors say that they can purchase tobacco and alcohol without any problems. We, ourselves, have carried out control purchases, where we sent out fifteen-year-olds in five cities to all large store chains, and except for Lidl, all of them failed. We asked Lidl, where we did a control purchase repeatedly two years later, why they always have good results. We discovered that this is what the management wants; it simply does not allow the sale of alcohol and cigarettes to minors.

These inspections are otherwise the responsibility of the Czech Trade Inspection Authority?

The new law that is known as the Tobacco Act (or also the Anti-Smoking Act, but it also treats alcohol and other addictions – eds. note), gives the right to the CTIA to enter stores in cooperation with the police. This is a novelty, in effect for only several months. The inspection should check adherence to the law and to dictate preventive measures, such as shutting down a pub for up to two days. It can also carry out control purchases.

Suggesting an increase in excise duties on alcohol goes somewhat against the grain of the thought of Czech politicians. Across the spectrum, they would prefer to offer voters a lower tax on this commodity.

Politicians speak of lowering VAT. When I recently spoke with both the minister of health and the prime minister in resignation, both said that when it comes to excise duties, they are not against them. Another story is VAT, and another is the tax on profits. If you write that I hope to increase excise duties on alcohol, then, as always, I will receive tens of unpleasant emails from angry fellow citizens, saying what sort of self-professed expert am I, as well as worse expressions or even threats of the like of someone will lie in wait for me to beat me up. Once I was even challenged to go meet someone in a pub. So, I asked them, which pub? I’ll go. But they took it back. But I truly do think that the result must be an increase in the price of alcohol.

Expensive rum will be drunk at the rate of one shot per hour, at which the alcohol will be metabolised.

Do you have any examples of treating alcohol addiction through pricing from abroad?

One of the measures that we could adopt is interesting, not yet much applied, Scotland has taken these measures and Ireland is considering them – the mandatory purchase price per gram of alcohol. This is, of course, a very strict measure, but it should lead to a situation where the producer does not lose profits. The principle is a flexibility of the degree where price regulations still have the effect of causing a decrease in drinking. I’ll mention an example from my life: not long ago, I went with some friends to a rum bar – I do not get drunk, and I even abstained for several years, – perhaps about 15 of us sat there for four hours.  That evening, each of us drank 3 to 4 shots of expensive rum. Rum in a bottle can sometimes cost about three hundred crowns, and these shots come to 120 crowns each. People still buy them, and everyone has a good time. The only person who got drunk was a person that drank, say, twelve shots of Fernet because they were cheap. The rest of us drank expensive rum at the rate of one shot per hour, at which the alcohol was metabolised.  We need to discover the extent of the measures, because if we overdo the repressions, they have the opposite effect and the black market develops, etc. I want to convince my colleagues that we should work not only with experts on public health, but also with economists during the whole course of the strategy. Economists could carry out a relevant analysis of buying power, of the Czech mentality, and of other factors that could influence the effect of the suggested measures. It has been repeatedly seen in developed countries that a change in the availability and in pricing had a significant effect on both tobacco and on alcohol, and that in the form of reducing problematic use, as well as the frequency of overall use. It is simply a large difference if I drink 10 beers or two a day, or if I have five shots or one.

Harm reduction is promoted by experts, but some officials do not understand

When we spoke together last time, you emphasised that the overriding approach to addictions, including alcohol and tobacco, is risk reduction, or harm reduction. I assume that the new strategy will also be informed by this principle?

In this aspect, I continue in the work of my predecessor, who created the current strategy right before my arrival. Of course, especially when it comes to tobacco, I cannot imagine a more modern approach than steering towards the minimisation of damages and risks. The fantasy of a drug-free and tobacco-free society is unrealistic. Today, there are policies that favour less harmful products, and it has been proven that most of the population has reacted to them, thus significantly reducing health consequences, especially. An example is the Swedish and Norwegian situation, where they fell to single-digit percentages. The occurrence of cardiovascular disease, heart attacks, and pulmonary diseases dramatically decreased. This is the way we want to go, we even have the opinions of expert organisations on it – e.g. for the treatment of tobacco addiction, for diseases of addiction, even of the association of pulmonary specialists. Part of the solution must include the industry, because it is the party that has been developing less risky products. The government should make the more harmful products less favourable. It will be a great battle, since absolute incompetence tends to be victorious in the government administration. Although the entire community of experts says that we must choose the path of harm reduction, there is an effort to ban less harmful products.  Thus, the products that present the greatest risks are being supported. I cannot explain to these officials that people do not die because of addiction. They tell me that nicotine is the problem. No, nicotine causes addiction, but people die rather because of the tar, i.e. because the cigarette burns, it combusts. The headline of our strategy is the minimisation of damages and risks. Nothing else. I do not consider any other philosophy or national strategy conception to be realistic. The naive and the unrealistic idea of a drug-free society stands against this.

The strategies of legal and of illegal drugs both have something to teach the other.

The principle of harm reduction is nothing new in Europe. When I consider Britain, for example, harm reduction is the preferred national policy that is promoted by health bureaus there.

Great Britain has always been a pioneer in the principle of harm reduction. The first policy material in the world – the so-called white paper – was created in 1988 under Margaret Thatcher, who then declared that “harm reduction is more important than abstinence, because we are dealing with the consequences”.

How is it that Ms. Thatcher was so prophetic?

She invited experts, not officials, to the table. With all due respect, I, too, am an official. She invited experts who did not work for the government, who produced numbers that were not affected by the government’s need to maintain the status quo. This is their tradition. Whereas the United States declared prohibition in the 1920s, Britain sought out substitution therapy. The Czech Republic is one of the countries that promotes the approach of harm reduction. When I joined the horizontal drug policy group in Brussels in 2010 as the representative of the Czech Republic, this was practically a vulgar expression. We led the debate about it for such a long time that today, harm reduction is part of the European strategy for drug policies. The strategies of legal and of illegal drugs both have something to teach the other. On one hand, there is the strict regulation of the market, which has been shown to be effective for tobacco and alcohol. On the other hand, there is the approach of harm reduction, integrating into it a low threshold approach expecting the addictive elements encoded in human behaviour. One cannot expect that people will not exhibit signs of addictive behaviour. It is therefore necessary to anticipate this reality and to primarily find ways of reducing damage.

Who, then, is creating obstacles to the adoption of the principle of harm reduction in today’s Czech Republic? Where is it that they ignore the experts?

This is caused by the misunderstanding of several people in the government administration. If I speak about it with politicians, with the media, or with the public, then they usually understand me. Only several individuals will continue to block harm reduction, and I sometimes suspect that they are parroting someone else who stands behind them.

Who tells them what to say?

I am not exactly sure, but who currently wants to maintain the status quo?

Should products that are, let us say, healthier, be subject to a different tax policy than of those products whose riskiness are proven to be greater?

Yes. The government should have a clear imperative. My suggested strategy will lead to the government making products that burn less favourable and to make their less harmful alternatives more favourable. Not vice versa, as is the current state of the matter.

New strategic focus: prescription drugs

We have touched upon illegal drugs, alcohol, tobacco, but what are the other areas that the strategy will deal with? Are there any new areas that the current strategy does not deal with?

Today, already, gambling is one such topic. What is new and that has to be incorporated into the strategy is the huge problem of prescription drug abuse, which are legally produced and supplied through pharmacies. I feel that it is a highly sensitive issue that I did not want to deal with for a long time. A whole range of measures has to be adopted, beginning with how to work with the doctors writing the prescriptions, to educating the public and the final consumers, to create a support network that would timely indicate those people from whom the drugs are no longer therapeutic, but rather can be diagnosed with addiction.

Which drugs should we be wary of?

These are traditional drugs – sleeping pills, or opioids, so-called anxiety medicine, and a whole range of others.

Women are prescribed anxiolytics three times more often than men.

Prescription drug abuse is sometimes amplified by the prescription of unsuitable drugs by doctors. For instance, some neurologists are capable of needlessly stuffing children with benzodiazepines because they are slightly agitated, or because their parents cannot handle them. Thus, children get used to solving problems by using drugs. A recent study even showed that adolescents even steal them from their parents. The borders between a pill taken at a dance club and a pill found at home is then blurred for youth.

Already in 1975, Dr. Urban wrote a publication in which he warned that the largest group of what used to called “toxicomans” in Czechoslovakia is made up of women about 45 years of age, who carry pills in their purses and use tens of them daily because they were prescribed by their doctors. This phenomenon is practically ignored. I do not wish to genderise the issue, but there are situations where doctors prescribe women anxiolytics three times more often than men. Women are expected to maintain a household and be functional. If a man has a problem, he goes to a pub.

Can the principle of harm reduction also work when it comes to pharmaceuticals, e.g. you give a person in danger a tablet rather than they begin abusing a worse substance?

Of course, I claim that any sort of addiction need not be the primary problem that must be a priori solved in the first place. This is where I get into disputes with those people who do not really understand the situation, and who are influenced by the myth that addiction is the greatest evil. Sometimes, though, a certain type of addiction can even be part of the therapeutic process. It also took me many years of working with addicts to understand that abstinence can lead someone into a worse situation than they were already in, and that it can also cause harm to their surroundings and to society. Managed sobriety, or the managed administration of drugs that cause addiction can be a better solution for some people than – and here I could think of 100 situations – domestic violence, depression, and other situations in which they no longer manage their regular life. Finding the right degree is not easy. This is what is difficult to explain to technocrats in the government administration and in health insurance companies, that it is sometimes better to have an addict to a less harmful substance who is still able to manage their life.

Euphoria from game playing is 93% the same as a heroin high.

Addictions to various substances have a tendency to exchange places with each other. We often cure someone of illegal drugs, and then they switch to pharmaceuticals, or they switch to drinking or playing gambling machines. Gambling machines are also about a changed consciousness that the addict experiences; they also get a high, a feeling of bliss, or euphoria. There are even studies that examine receptor activity, and they show that 93% of the activity from game playing is the same as a heroin high.

That is, indeed, a high correlation!

This is how various addictions overlap each other, and the idea that we must primarily convince people to abstain is not right. Especially when we know that a large percentage of chronic users suffer from a mental disorder, and they have either never consulted their doctor about it, or they have somehow fallen out of the network of care. A person who is battling homelessness, the police, addiction – psychiatrists often are not at all able to deal with them. They leave therapy within several days or weeks, and end up at the Salvation Army. Maybe they are offered treatment for their alcoholism, but they drink alcohol or take the drugs because they actually help them.

Health insurance companies should cover substitutional therapies such as buprenorphine

What else about the overlapping of illegal drugs and prescription drugs makes you worry?

A drug that is meant to work as a substitute is being sold on the black market. The heroin market has shrunk from an estimated 11 thousand daily users to 4 thousand in the last ten years. A great result, actually. Many of the six thousand people who use buprenorphine are able to go to work, do not overdose, and live a higher quality life; they are a smaller risk factor for society. On the black market, buprenorphine comes to about eight thousand crowns a month compared to the approximately thirty thousand and more a month paid for heroin; people are able to save this amount from their pay cheques. Despite of this, the police are pressuring us to be stricter, so that this substance disappears from the black market. We also require, however, that the users of buprenorphine do not relapse back to heroin use. We need to pay attention to this and ensure that the substance containing buprenorphine or one of its alternatives is available.

Health insurance companies should play a much greater role in the treatment of addiction. I have the feeling that they lack the courage to do so. Or perhaps the will.

Is this a challenge for health insurance companies: to cover the costs of buprenorphine so that it legally gets to those people who will use it instead of heroin?

Yes, health insurance companies should be a part of the strategy as a whole. They should play a much greater role in the treatment of addiction, in the coverage of substitutional therapy, etc. I have the feeling, however, that they lack the courage to do so. Or the will.

Is it a mental problem of the way we define who is ill and needy in the Czech Republic? If, perhaps, health insurance companies do not suffer from a bias that addicts are not sick people?

There is a prejudice, one hundred percent, but institutes of public administration are just like the insurance companies, they should begin thinking economically. We have all of the numbers from around the world; I do not see why all of the results of studies and effectiveness analyses could not be applied here, as well. They show that finances invested into prevention and treatment are a quarter of the costs of the long-term consequences of ignoring this problem.

Can you give insurance companies examples from abroad where buprenorphine or similar substances are covered by the government or health insurance companies?

Great Britain, Germany and other countries. I have heard the Ministry of Health use a quite short-sighted argument that these are rich countries who are able to afford the coverage of such substances. I feel that they are rich because they do not allow some things, because in the end, they would just be throwing money out the window. It is the same principle as if I said that I do not have money to change the oil in my car. My motor will then wear down. I have never understood this logic of the government administration. As if a completely different logic from the logic of the regular world – common sense – worked there.

The time for marijuana legalisation is approaching

The approach to some illegal drugs in the world is being reassessed; we see, for instance, that marijuana is being legalised more often. Should the Czech Republic also take this path?

The worldwide trend is quite obvious that the prohibition of marijuana, hashish, and other cannabis drugs will end. The prohibition of coca leaves will certainly also end, which is not risky; it will become a normal commodity like green tea or coffee. Many countries also have a lenient view of MDMA, or ecstasy, and some even of opioid tinctures. We should be ready for such changes, so that we do not completely deviate, going from absolute prohibition to an absolutely open market. Just as with alcohol and tobacco, we should remain somewhere in between. We should also think through how we can get substances presenting a higher risk, such as opioids, to consumers in a way that presents a lower risk. This means providing them with buprenorphine or even the aforementioned opioid tinctures. The question of how to regulate the market. For instance, in Uruguay, you can buy cannabis legally in pharmacies, just as formerly, one could purchase cocaine in the pharmacies of Central Europe.

Do you mean therapeutic cannabis, or cannabis in general?

In general. The goal should be to ensure greater control with the help of regulated availability, but also with much better monitoring. Today, cannabis is available on the black market, and we are not able to monitor nor control it.

Many people would rather undergo the temporary discomfort of withdrawal symptoms in order to be able to switch to less harmful substances.

How would users get to the substances that should substitute the more dangerous opioids?

Buprenorphine is a good example; a user gets access to it through their general practitioner. They need not undergo any complex examinations. Sadly, physicians do not know how to prescribe this drug and let it be covered by the insurance company. However, this could be the way to go with those substances that we know are less risky. People used them until they were taken away from them, forcing them to use the riskier substances. When opium no longer became available, people started to use morphine, then heroin, and then heroin was no longer available, so they use fentanyl. The risk is much greater. The fentanyl epidemic is rampant worldwide, and the death of tens of thousands of people is caused to a great degree by the unavailability of less risky substances. Sometimes, it is hard to explain our approach and the statistics backing it even to doctors. They see the strength of the dose and say that if someone uses up to 3 grams of heroin a day, then the buprenorphine will not be enough for them. This is not good reasoning. It has been shown that many people would rather undergo the temporary discomfort of withdrawal symptoms in order to be able to switch to less harmful substances. These people then commit fewer thefts, they go to work, and they do not overdose.

Should we seek out a sort of Golden mean for the drug policies of the Czech Republic?

In the introductory propositions of the strategy, we write that the worst scenario is a free market. It presents a huge risk and causes giant damage. However, complete prohibition seems to also not be adequate. The example of buprenorphine has shown that if a less harmful substance is available, then it is from the standpoint of public health and economics, as well as from the consequences on the individual, much better. We should venture in this direction. We should also give self-governments much greater competencies. Although it is not exactly common in our country, it should be normal that Prague has its own strategy and should have a sufficiently strong position to write its own ordinances.

Should each city have such competencies?

Of course, this should primarily apply to large cities, where there is the greatest problem with illegal drugs. If Prague feels that it needs to establish application rooms where heroin users can come and apply buprenorphine, it should have this opportunity. Other parts of the country do not have the need to do so. Prague should have such competencies that national legislation should not be able to stop it from taking such actions.

I would like to return to cannabis. Do you think that the legalisation of cannabis without attributes will lower the need for therapeutic cannabis?

I think not; these are two separate things.

Many people satisfy themselves with common cannabis. They already grow it on their balconies, and although the contents of therapeutic substances is surely not reliable and varies, their symptoms are relieved, whether by real or by placebo effects.

I guess so, but if they need a prescription from a doctor, nota bene if insurance could partially cover its costs, why would they not do so, if they are truly ill.

If cannabis were to be legal, it would be cheap and available. People could choose – either they could legally grow the cannabis at home, or they could for a higher price purchase it in pharmacies, since it is not yet covered by insurance.

It has been observed that cannabis can serve as substitutional therapy for people with an alcohol problem. A Swiss experiment shows that intensive smokers of cannabis with high potency can switch to low potency of cannabis, with a THC content of 1%, which is legal there. The results are not yet available, but it seems that a large percentage of the smokers who smoked high potency cannabis that they grew themselves at home under a lamp has switched to the legal, low potency forms.

So when you speak of legalisation, you mean low potency cannabis, not just any type of cannabis?

I mean harm reduction. The whole time. To have less risky possibilities available. There will always be a certain group of people who chooses more risky behaviour than is necessary.

Insurance companies cannot treat addictive substances in the same way as other medicines.

I mention it because in principle, cannabis is a natural combination of substances whose effectiveness will never be the subject for a consensus of the scientific, medical community, and thus might never be covered by insurance. That is why I ask if such a double track – to legalise low potency cannabis and to maintain therapeutic cannabis – is not the answer?

I am convinced that when it comes to addictive substances, insurance companies cannot treat them in the same way as other medicines. If we have an estimated 800 thousand people on the black market who take cannabis at least once a year with faith in its therapeutic properties, and if we also know that we can greatly curtail the black market using controlled availability, then we must do so. This is impossible to do without health insurance. This is exactly the reason why they have applied this approach in Germany.

 Our approach to gambling is differentiated

You have also mentioned gambling. What does the concept of harm reduction look like there, e.g. with slot machines? In other words, what sort of form can a socially less dangerous format of gambling with a lower social pathology have?

This is the subject of examination. There are certain examples from abroad. For instance, the Australians, who were invited to the Czech Republic by a NGO from Brno, presented us with a model where one half of all slot machines, i.e. those boxes with the worst and most addictive games, are operated by a type of non-profit social clubs. All profits go to socially responsible activities, including the treatment of addiction. They have also introduced all measures such as prolonging the period between winning, losing, and a game. They offer help, the staff has been trained and is motivated, and when they observe that someone has been playing for a long time, they strike up a conversation with them. They take their mind off the game, stop them, bring them a coffee, etc.

Last year, you published a report that shows that the regulation of gambling is circumvented by two area – international internet sites and quizomats. Will the strategy deal with such semi-legal ways that some subjects use to try to avoid regulation, taxation, etc.?

Certainly, it will be one of the priorities of the strategy and of creating action plans. Gambling and on-line gaming is a phenomenon that has greatly increased. In our point of view, illegal casinos are those that offer quizomats; several measures have begun to be successfully applied here. It is always the same story. The moment that the majority of the government administration comes to understand that it has to cooperate, when business bureaus, the police, the CTIA, hygiene bureaus, customs authorities, and others become involved and apply pressure together, then the regulations written on paper begin to work. In the case that one person in some department, division, or ministry begins to deal with it, and then leaves, nothing of their work remains.

So your role is not to conceive everything by yourself?

I am a coordinator. The current prime minister in resignation, Mr. Babiš, says that he does not understand the word coordination, that he wants to manage matters. I did not have the chance to explain it to him. I certainly cannot direct the Ministry of Justice and of Agriculture, but what I can do is initiate their cooperation, which is what we call coordination. Coordination throughout the government administration and self-governments, but also throughout industries. For instance, I attempted to come to an agreement with the operators and owners or large grocery store chains. We tried to meet with them and explain that selling tobacco to minors is a problem, even though it is located behind the counter. However, it seems that if the police and the CTIA are not involved, than we have no say with most of these chains. Their reasoning is pragmatic – they do not wish to have queues at checkouts. So they let salespersons sell whatever they want.

Apparently there is a range of social hazards of each gambling game. We begin on the level of lotteries, which pose practically no social danger, since they do not cause pathological states, and I do not know if they have any social impacts…

Exceptionally, only a small percentage, perhaps 0.05 % of the population.

Land-based slot machines have an algorithm that detects when a player begins to exhibit risky behaviour and sends them messages – stop playing, have a coffee.

And then there is the question of hard gambling, where the risks are great. Should the government have a differentiated approach to various types of gambling, according to the principle of social risks and harm reduction?

I have already mentioned the example of hard gambling, it is possible. What is more complex is the issue of taxation. Of course gambling should be subject to tax and should be less accessible, but it is also necessary to adopt measures that anticipate that people will play, but will offer them a model of timely detection and help. All gambling companies that function online, and today even the so-called land-based slot machines found in casinos are all online, have a mathematical algorithm that is able to anticipate the behaviour of the player. This is the approach used in Australia, for instance. The player must register themselves, and if the algorithm detects that they have begun to exhibit risky behaviour, it sends them a message – stop playing, have a coffee, or stop to consider whether you need help that we can provide.

Do we have a tax differentiation on gambling in the Czech Republic?

Yes, the new Gambling Act differentiates taxation. The greatest tax burden has been placed on slot machines.

And the smallest?

Betting has a lesser burden, and the smallest are lotteries, of course.

Do you count on this principle in the new strategy?

Yes. We carried out the first analysis of the consequences of gambling in the Czech Republic even before we began publishing annual reports. In the conclusion of the analysis, we recommended what should be included in the new legislation. The new legislation adopted about half of our recommendations. From what I know, the operators of gambling facilities have already taken the brunt of the consequences. They complain that they have higher taxes and that their profits are lower, that they are being sent into liquidation. I translate their complaints into the fact that the legislation is effective.

Abandon the convention on drugs?

What will be the fate of your draft of the new strategy?

Once the draft will be finished, I will put it through the reflection process.

Do you have any idea of when?

I would like to meet with the working group at the end of April and beginning of May, and I would like to present the first draft at the end of May. Then, a great uproar about the new strategy will emerge, and it will be torn to tatters, so we shall see if anything of it will remain. Of course, I will wait until we have a government with a confidence vote.

We cannot sit at one table with a president who has executed 15 thousand people without trial in the past year.

Hopefully, you will live to see the day…

The approval of the national drug policy strategy is a fundamental matter. In it, I will also suggest that the Czech Republic be active on the international scene. Even though many might raise their eyebrows, I think that it is necessary to change our perception or even re-evaluate international conventions. I think it is a crime to sit with some countries at the same table. I will suggest that we should rather withdraw from the basic international convention on drugs from 1961 and with its ensuing pacts. We cannot sit at the same table as Rodrigo Duterte from the Philippines, who has executed 15 thousand people with trial in the past year just because someone anonymously turned them in for supposed drug possession. When we organised meetings during UN negotiations last year and this year, Filipinos described how crazy the situation in their country is. Many other countries behave just as irresponsibly, and the experiences we have from prohibition have shown that this insanity only leads to much worse situations. In my opinion, the only realistic policy is not a sort of War on Drugs, but a policy that is focused on the concept of harm reduction. Only such a policy has hope for success.

Tomáš Cikrt