Facts and Numbers
Drug use among the general population and young people
Three national general population surveys on drug use in Lithuania were carried out in 2004, 2008 and 2012. The 2008 and 2012 surveys were carried out in line with the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) guidelines, and were conducted among 4 777 and 4 831 randomly selected people aged 15–64 respectively.
The results indicate that cannabis remains the most frequently used illicit substance in Lithuania. Among younger adults (aged 15–34) the lifetime prevalence of cannabis use fell from 21.2 % in 2008 to 17.1 % in 2012. Last year prevalence of cannabis use also declined, from 5.6 % in 2008 to 2.3 % in 2012 for all respondents, and among younger adults from 9.9 % in 2008 to 5.1 % in 2012. Last month prevalence of cannabis use was reported by 1.2 % of all respondents in 2008, and fell to 0.7 % in 2012; among younger adults it was 2.6 % in 2008 and 1.6 % in 2012. Males were four times more likely to report lifetime use of cannabis; however, the gender gap narrowed in younger age groups. In both surveys, ecstasy and amphetamines were respectively the second and the third most prevalent drugs. Similarly to cannabis, reported prevalence for these substances was also lower in 2012 compared to 2008.
Lithuania has participated in the European School Survey Project on Alcohol and Other Drugs (ESPAD) since 1995. With the exception of lifetime prevalence rates of inhalants use and heroin, experimentation with illicit drugs increased among students in Lithuania between 1995 and 2007, and the most recent (2011) survey found a further increase in lifetime prevalence rates for cannabis and inhalants use. Data from the 2011 ESPAD survey showed lifetime prevalence of cannabis use, the illicit drug 15- to 16-year-olds most frequently experimented with, was 20 % (18 % in 2007; 13 % in 2003; 12 % in 1999). Results also showed 13 % for last year prevalence of cannabis use (12 % in 2007; 11 % in 2003; 10 % in 1999), and 5 % for last month prevalence (5 % in 2007; 6 % in 2003; 4 % in 1999. Inhalants were the second most frequently reported substance, with lifetime prevalence rates at 7 % (3 % in 2007; 5 % in 2003; 10 % in 1999), followed by amphetamines at 3 % (3 % in 2007; 5 % in 2003; 2 % in 1999). With regard to ecstasy, hallucinogens, cocaine and heroin, results of the most recent survey indicated a lifetime prevalence of 2 %. Males were almost twice as likely to report lifetime use of cannabis as females.
A study in nightclub settings from 2008 indicates that use of illicit substances among clubbers is higher than among the general population. Nearly a third of clubbers have used an illicit substance in the past, with cannabis, ecstasy and amphetamines being the most popular substances used.
The Lithuanian Drug Strategy prioritises the prevention of drug use in the family, among children and youths. In 2011 the Resolution of the Parliament of the Republic of Lithuania, On Targeted Policy of Prevention and Control of Drugs, Tobacco and Alcohol Consumption, prioritised the development of mature values and building of skills for a healthy life among children and young people through integrated and evidence based prevention programmes. Drug prevention projects are focused mainly on universal prevention in local communities and schools, aiming to protect young people from drug use.
The Ministry of Education and Sciences implements the universal prevention programme Prevention of Use of Alcohol, Tobacco and Psychoactive Substances, which was instigated in more than 950 schools in 2012. The programme is adapted to each age group, and covers pre-school, primary, basic and secondary education. More than ten different life skills-based drug prevention activities are used across all educational settings, and a number of methodological materials and training activities for teachers on this topic are also available. The Zip’s Friends programme, an early prevention and socio-emotional development course targeting pre-school and first-year schoolchildren, was implemented in 12 educational settings throughout the country in 2012. None of them are evaluated. The internationally recognised Unplugged programme, which increases children’s social communication skills and critical thinking, continued to be implemented in 40 schools. A number of schools offer a special programme to children whose parents use psychoactive substances. Universal prevention activities are carried out in youth centres or youth spaces, mainly through providing alternative leisure activities and engaging young people in educational programmes. Several programmes for parents are available through school settings, and these mainly focus on improving parenting and communication skills.
Selective and indicated prevention activities in Lithuania have been targeted mainly at recreational settings, such as nightclubs and children from at-risk families. In recreational settings prevention activities are primarily initiated by the police, while nightclubs tend to apply measures such as safety checks at the entrance, limiting the entry of under aged young people, and maintaining a safe physical environment.
Mass media campaigns and informative approaches (leaflets, etc.) play a significant role in prevention activities.
In 2012 the methodological recommendations ‘Development of psychoactive substance control and prevention programmes in the municipalities of Lithuania’ were issued to promote evidence-based development and the evaluation of municipality-based prevention programmes.
High-risk drug use
Up to 2012 the EMCDDA defined problem drug use as injecting drug use (IDU) or long duration/regular drug use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis were not included in this category. However, in 2012 a new concept of ‘high-risk drug use’ was adapted. The new concept includes ‘problem drug use’, but is broader (mainly in its inclusion of high-risk use of more substances). Details are available here.
In 2010 a capture–recapture study based on data from the Ministry of Health, Ministry of Justice and Ministry of Interior was implemented to estimate the number of problem opiate users between 2005–07. According to the study, in 2007 there were around 5 458 problem opiate users in Lithuania (range: 5 314 to 5 605), a rate of 2.4 per 1 000 population aged 15–64.
The data collection system for treatment demand in Lithuania is currently being developed. In 2012 all 144 treatment units submitted treatment demand data.
On 31 December 2012 healthcare institutions reported 5 935 individuals registered with a diagnosis of dependence disorders caused by drugs and psychotropic substances. According to the treatment demand indicator, 212 individuals entered treatment for the first time in their life in 2012.
Data indicate that most (66 %) new clients entered treatment because of primary use of opioids through injection; other substances have a minor role in the primary problems reported by new clients. In 2012 a total of 24 % of new treatment clients were aged 35 and over, while 27 % were under 25. With regard to gender distribution, 79 % of new treatment clients were male and 21 % were female.
Drug-related infectious diseases
In Lithuania the Centre for Communicable Diseases and AIDS at the Ministry of Health (CCDA) collects aggregated nationwide diagnostic data on human immunodeficiency virus (HIV), acquired immune deficiency syndrome (AIDS), acute hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. The most recent bio-behavioural seroprevalence study of HIV, HBV and HCV among people who inject drugs (PWID) was carried out in 2007–08.
HIV prevalence rates among subgroups of PWID increased to more than 1 % in 1997, yet remained consistently below 5 % until 2001. Testing of clients of harm reduction programmes in 2010 indicated significant geographical variations in HIV prevalence rates, ranging from 0.0 % to 21.4 %, while in 2012 HIV prevalence among 598 tested clients in Vilnius harm reduction programme was 2.7 %. In 2012 the number of newly reported HIV positive cases increased to 160. Of these, 62 were PWID.
In 2012 the CCDA registered 24 people with acute HBV; however, only 12 notified cases included a known transmission route, two of which were linked to injecting drug use. In 2012 some 40 people with acute HCV were registered and, as with HBV, the transmission route for a significant proportion of cases remained unknown. All six registered acute HCV cases with a known transmission route were PWID. Due to the high proportion of cases with unknown causality, the data on HBV and HCV transmission among PWID in Lithuania should be treated with caution.
Drug-induced death and mortality among drug users
Since 2010 data on drug-induced deaths have been submitted by the General Mortality Register (GMR) of the Institute of Hygiene. Drug-induced deaths are those lethal cases where the direct cause of death recorded on the death certificate is the use of narcotic and psychotropic substances. The national focal point receives full data from the GMR and is able to extract and report data according to the EMCDDA definitions and recommendations.
In 2012 some 70 drug-induced deaths were recorded, which indicates an increase in the number of registered deaths after a period between 2007 and 2011when a decreasing trend in deaths was registered. Most cases were male (66 out of 70 cases) and the mean age at death was 33.2 years. The largest group of deceased were aged 25 to 29 years. Toxicological analyses were reported for 64 cases in 2012. Opioids were the primary substances involved in 44 cases (one of which reported methadone) with known toxicology results, while 23 of deaths were due to mixed or unknown substances.
The drug-induced mortality rates among adults (15–64) was 34.7 deaths per million in 2012, about twice the European average of 17.1 deaths per million.
Data are also collected on deaths among persons registered in the Lithuanian health care institutions due to mental and behavioural disorders who used drugs and psychotropic substances, to record mortality trends among this population. In most of these cases the cause of death is unknown, as the State Mental Health Centre does not have permission to access this information through the GMR.
Drug treatment in Lithuania is provided mostly by public and private agencies. Coordination, implementation and provision of drug treatment are conducted at the local level. The main funding bodies of the different treatment services are the national budget, national health insurance and municipal budgets. Four regional counties and one municipality finance specialised treatment centres at the regional level.
Outpatient drug treatment is provided by 107 public mental health centres, primary health care institutions and through private medical institutions that have obtained a special licence. Outpatient drug treatment is also provided in Centres for Addictive Disorders. There are five regional public specialised Centres for Addictive Disorders, which are located across the country. These centres offer treatment of one to three months by group psychotherapy, acupuncture and counselling, and they also provide methadone treatment. Inpatient treatment, such as withdrawal treatment and residential treatment, is delivered by the specialised Centres for Addictive Disorders, while detoxification services are available through toxicological units in general hospitals or in private toxicology centres. Special treatment programmes are available for children dependent on psychoactive substances, including two long-term rehabilitation communities.
In addition, 19 long-term rehabilitation centres and seven day centres are operating across the country.
Substitution treatment with methadone has been implemented since 1995, and treatment commenced in three cities in 1996. Buprenorphine treatment has been available since late 2002 throughout specialised mental healthcare institutions, and Suboxon is also registered in the country. The provision of opioid substitution treatment (OST) is guided by Order No. 702 of the Ministry of Health, which restricts the implementation of methadone and buprenorphine treatment to treatment centres. In 2011 the Order from the Ministry of Health further amended Order No 702, clarifying criteria and procedures for the application of OST and proposed a procedure for an annual assessment of OST’s effectiveness for clients. As of 1 January 2013 there were 19 health care institutions in 12 cities providing the treatment. In 2012 some 687 clients received OST, and 636 of them were in methadone maintenance treatment. Methadone maintenance is continued for clients in police custody; however, it is discontinued if a client is transferred to prison. OST is not available in Lithuanian prisons.
Harm reduction responses
In 1997 the Vilnius Centre for Dependence Diseases, in cooperation with the Open Society Foundation in Lithuania, was the first to commence low-threshold programmes for injecting drug users. A special decree of the Ministry of Health, adopted in 2006, provided a background for the expansion of the programmes and also sets the minimum criteria for services. In 2012 there were 11 low-threshold units, including three mobile outreach needle/syringe exchange points, operating in seven cities in Lithuania. These programmes are funded through local budgets; two of the programmes closed during 2010–11 due to financial constraints, but have subsequently re-opened. Injecting drug users may exchange needles and syringes, and obtain condoms, disinfectant tissues, bandages and educational/informational material. They may also have a short consultation with a social worker and obtain information about the availability of healthcare and social assistance. However, information and counselling remain the primary foci of the services, which is reflected in a decline in the number of needles and syringes distributed through the centres — in 2012 more than 196 000 syringes were provided, markedly fewer than the 238 745 syringes distributed in 2008. Pharmacies are a significant source of sterile injecting equipment. A 2008 study showed high levels of intolerance among pharmacy staff toward IDUs; and no special harm-reduction programmes have been implemented in cooperation with them as yet.
Drug markets and drug-law offences
Lithuania is considered a transit country for the trafficking of illicit substances between west European and east European countries, mainly by land. Cannabis products arrive in Lithuania from the Netherlands or Spain, mainly in transit. Small quantities of cannabis are also cultivated within the country under artificial conditions. In 2012 a total of nine small to medium-size cannabis cultivation sites were detected in Lithuania. Amphetamine-type stimulants (ATS), predominately methamphetamine, are smuggled mainly from the Netherlands, Belgium and Poland en route to Scandinavian countries, Belarus, Russia and Ukraine. Three ATS production sites were detected in 2012.
Heroin is smuggled from Central Asian countries through Russia and Belarus. Testing indicates deteriorating purity in the heroin seized in the past few years. Klaipeda, a sea port, remains one of the main entry points for cocaine, although other ways of smuggling the substance by land, postal service and air are increasingly exploited. Most of the cocaine seized in Lithuania is destined to Russia or other European countries. New psychoactive substances arrive from eastern or southern Asian countries mainly by air.
The number of offences related to illicit drug trafficking increased from 959 in 2003, when harsher laws were adopted, to 3 006 in 2012. According to the Lithuanian Ministry of Interior, more than half of all drug-law offences were linked to the possession of and dealing in illegal substances. In 2012 around 37 % of drug law offences were related to cannabis, followed by heroin at 24.8 % and methamphetamine at 17.1 %.
In 2012 there were 242 herbal cannabis seizures, followed by 112 heroin seizures. Although the number of cannabis resin seizures remained below record levels, the record amount of 424 kg of cannabis resin was seized in 2012. The amount of herbal cannabis seized in 2012 was twice that seized in 2011 (43 kg in 2011 and 96 kg in 2012). A record low amount of heroin of 0.5 kg was seized in 2012, and in the vast majority of single seizures amounts did not exceed 1 g. In 2012 there were 36 seizures of amphetamine and 83 seizures of methamphetamine. As a result, 26 kg of amphetamine and 54 kg of methamphetamine were seized. In 2012 a total of 120 kg of cocaine was seized. Ecstasy was involved in a small number of seizures, and the amounts seized have significantly declined to 54 tablets compared to 2008, when 76 808 tablets were seized.
National drug laws
A new penal code entered into force in May 2003, with further changes in 2010 to tighten custodial sentences. Possession of even a small amount of illicit drugs with no intent to distribute is a criminal offence, with a sentence of up to two years’ imprisonment. (This is also listed as an administrative offence, but the penal code takes priority.) Drug traffickers may be sentenced to between two and eight years’ imprisonment, which increases to 8–10 and then 10–15 years, depending on the quantities involved and aggravating circumstances (e.g. involvement of minors or an organised group).
Quantities of all drugs are set out in a Ministry Regulation that defines small, large and very large quantities.
In 2009 an administrative penalty was introduced for offences related to the presence of intoxicated workers at workplaces.
New psychoactive substances in Lithuania are regulated through amendments of the List of Drugs and Psychotropic Substances Prohibited to Use For Medical Purposes. In 2010–12, for example, 18 new substances or substance groups were added to the List.
National drug strategy
The National Programme on Drug Control and Prevention of Drug Addiction, 2010–16 was endorsed by the Lithuanian Parliament on 10 November 2010. The overarching goal of the programme is to reduce the supply and demand for illicit drugs and psychotropic substances and their precursors, as well as the spread of drug addiction, by strengthening individual and public education, health and safety. Several priorities are included in the national programme addressing: drug demand reduction among children and youth in particular; drug supply reduction; drug use monitoring; information; and coordination and international cooperation. The programme is constructed around two pillars covering the areas of supply and demand reduction and two cross-cutting themes focus on coordination and cooperation, and information and research. It is primarily concerned with illicit drugs.
Coordination mechanism in the field of drugs
On 1 April 2011 the Drug Control Department under the Government of the Republic of Lithuania (originally established on 1 January 2004) was absorbed into the new Drug, Tobacco and Alcohol Control Department. Among the central tasks of the Drug, Tobacco and Alcohol Control Department are: participate in formulating public policy on drugs, tobacco and alcohol control and organise its implementation; coordinate and monitor the activities of national authorities involved in precursor chemical, tobacco and alcohol control; prepare national alcohol, tobacco, drug control and prevention programmes and coordinate their implementation; organise and coordinate the risk assessment of new psychoactive substances; perform the licensing of the wholesale production of tobacco and alcohol and the licensing of precursors; and function as the Reitox national focal point in the EMCDDA’s Reitox network.
As a result of the merger of the Drug Control Department and the State Tobacco and Alcohol Control Service, the functions of the latter institution also became the responsibility of the Drug, Tobacco and Alcohol Control Department.
In 2008 the Seimas (Parliament) of the Republic of Lithuania formed a Parliamentary Commission for the Prevention of Drug and Alcohol Addiction, consisting of 14 parliamentarians. The objectives of the commission are, inter alia, to safeguard the interests of the government and to provide favourable conditions for the implementation of national policies on drug and alcohol prevention and control. It is tasked with formulating national policies and strategies in the areas of drug and alcohol prevention and control and drafting drug control laws. Drugs and drug addiction are also discussed by parliamentary committees and commissions, such as the Committee for Health Affairs and the Commission for Prevention of Drug and Alcohol Addiction.
The National Health Council, which operated under the Statute of the Parliament, is one of several bodies that coordinates drug control policy formulation and the implementation process.
Each of the 60 municipalities has a Municipality Drug Control Commission. These usually consist of representatives of local institutions (police, education institutions, doctors, social workers, etc.), and the chairman is usually the mayor or vice-mayor. These municipal commissions coordinate different actions, such as prevention, treatment and harm reduction.
A multi-annual budget was associated to Lithuania’s action plan for 1999–2003. The action plan for 2004–08 had no such budget. However, in that period, the government defined a detailed budget each year. Between 2008 and 2010 information on drug-related public expenditures was fragmented, but in 2011 the government started to associate an annual budget to the Lithuanian Interagency Activity Plan (2011–13).
In 2008 labelled drug-related expenditures (1) were estimated to represent 0.02 % of GDP. Most planned expenditures were allocated to treatment and rehabilitation (50.9 %), followed by prevention (18.4 %), law enforcement (17.7 %) and coordination and research activities (13.0 %). After 2011 the overall annual budget approved at the beginning of every fiscal year for drug-related expenditure declined as a proportion of GDP, from 0.013 % GDP in 2011 to an estimated 0.002 % in 2013. There is no information concerning the allocation of funds within different drug-related initiatives.
Some of the funds allocated by governments for expenditure on tasks related to drugs are identified as such in the budget (‘labelled’). Often, however, the bulk of drug-related expenditure is not identified (‘unlabelled’) and must be estimated by modelling approaches. The total budget is the sum of labelled and unlabelled drug-related expenditures.
Scientific research and the development of information systems and training on research are two priorities within the national programme on drug addiction, prevention and control. Research is mainly funded by relevant ministries and public authorities. The Lithuanian national focal point has a mandate to develop methodological recommendations in the drugs area. It also conducts population surveys and collects information from several governmental, academic and NGO sources on drug-related research, which is disseminated through its annual National report and website. Recent drug-related studies mentioned in the 2013 Lithuanian National report mainly focused on prevalence, incidence and patterns of drug use, responses to the drug situation and consequences of drug use
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