Drug use among the general population and young people
The first national general population survey on drug use in Lithuania was carried out in 2004 and the second in 2008. The survey was carried out in line with the EMCDDA guidelines, and was conducted among persons aged 15–64. According to the results, lifetime use of cannabis was reported by 11.9 %; among younger adults (15–34 years), the prevalence was 21.2 %. Last year prevalence of cannabis use for the whole sample was reported to be 5.6 %.
Lifetime experience with illegal drugs increased significantly during the 1990s, as shown by the ESPAD surveys conducted in 1995 and 1999. Except for lifetime prevalence rates of inhalants use and heroin, experimentation with illegal drugs increased among students in Lithuania between 1995 and 2007. Data from the ESPAD survey conducted in 2007 show lifetime experience for cannabis, the most frequently illicit drug experimented with among this age group, with 18 % having used cannabis at least once during their lifetime in 2007 (13 % in 2003 and 12 % in 1999). With regard to amphetamines and ecstasy and inhalants, results of the survey indicated a lifetime prevalence of 3 %. Results also showed 12 % for the last year prevalence of cannabis use (11 % in 2003, 10 % in 1999), 5 % for the last month prevalence of cannabis (6 % in 2003, 4 % in 1999). In addition, the reported lifetime prevalence of cannabis use among males was 24 % and 13 % among females.
Prevention
The Lithuanian strategy prioritises prevention of drug use in the family, among children and youths.
Drug prevention projects executed in Lithuania are focused mainly on universal prevention in local communities and schools, aiming at protecting young people against drug use. The universal prevention programme ‘Prevention of use of alcohol, tobacco and psychoactive substances’ was adapted to each age group, and covers pre-school, primary, basic and secondary education. Furthermore, teachers received training on the delivery of this programme. There is now a better overview on projects financed and those projects also have a better implementation and design. Selective and indicated prevention projects in Lithuania were targeted mainly at recreational settings, such as nightclubs, at-risk groups and families. In 2005, the project ‘Clubbing without drugs’, a prevention programme on drug distribution and use in nightclubs, engaged several stakeholders such as managers of nightclubs, representatives of nightclubs, police officers and nightclub personnel.
This programme proved to be very effective for all stakeholders involved. Mass media campaigns and informative approaches (leaflets, etc.) play a key role.
Problem drug use
Using the capture–recapture method, there were estimated to be around 2 167 problem drug users (1 663–2 934) in Vilnius in 2007 (a rate of 4.1–7.3 per 1 000 inhabitants aged 15–64). A provisional estimate of around 4 300 problem drug users and around 3 200 injecting drug users was constructed for the whole country.
The EMCDDA defines problem drug use as intravenous drug use (IDU) or long duration/regular drug use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis are not included in this category.
Treatment demand
In Lithuania, the data collection system for treatment demand is under development. In Lithuania, in 2008, a total of 95 outpatient treatment centres submitted treatment demand data out of the 95 centres.
As of 31 December 2008, the healthcare institutions have records of approximately 5 808 individuals registered with dependence disorders caused by drugs and psychotropic substances, out of which 272 were first-time treatment clients, registered during 2008. Data indicate that 80.0 % of all registered clients reported opioids as the primary drug, followed by 2.6 % for amphetamines and 0.6 % for cannabis. A similar distribution was identified among new treatment clients: 67.6 % reported that opioids were the primary drug, followed by 4.8 % for amphetamines and 0.4 % for cannabis.
In 2008, 30 % of all clients entering treatment were aged more than 35 years. Among new treatment clients, 40 % were less than 25 years of age. As far as gender distribution is concerned, 81 % of all clients entering treatment were male, whereas a smaller proportion of 19 % were female. The same pattern in gender distribution was reported among new treatment clients, with 76 % for male and 24 % for female.
Drug-related infectious diseases
In Lithuania, HIV prevalence rates among subgroups of IDUs increased to more than 1 % in 1997, yet remained consistently below 5 % until 2001. In 2008, newly-reported HIV positive cases in Lithuania reached 95 cases (106 cases in 2007). In 2008, out of the 95 cases, 44.2 % (42) were injecting drug users (IDUs). In 2004, users of intravenous drugs comprised 74.8 % of newly-diagnosed HIV cases, compared to 75.5 % in 2003. In Lithuania, regional public health centres, and Centres for Emergency Health (n= 54) send aggregated data on HBV and HCV infection from each territory, to the National Centre for Communicable Diseases Prevention and Control (CCDPC). In 2008, the CCDPC registered 90 persons with acute viral hepatitis B. Among notified cases with known transmission route, 8.9 % (8) were IDUs in 2008 (13 % in 2007). For acute HCV infections in 2008, 43 persons with acute viral hepatitis C were registered. Out of the 43 registered acute HCV cases, 13.9 % (6) were IDUs (43 % in 2002; 59 % in 2001). The 51.2 % of cases implied an unidentified contraction factor causing HCV.
Drug-related deaths
Data on drug-related deaths are submitted by the General Mortality Register of the Statistics Department of the Republic of Lithuania. DRD cases are those lethal cases where the direct cause of death recorded on the death certificate is due to use of narcotic and psychotropic substances. The data from the registry are compliant with drug-related deaths standards, a standard protocol for extracting data on drug-related deaths from registers in the Member States of the European Union (which includes acute deaths directly related to drug consumption or overdoses). In 2008, 60 direct drug-related deaths were recorded, while in 2007, this number was 72. As regards the distribution by age and sex, the majority of them were males (93.3 %) and the mean age was 31.8 years.
Treatment responses
Drug treatment in Lithuania is provided mostly by public agencies, followed by private agencies and NGOs. Coordination, implementation and provision of drug treatment is conducted at the local level. The main funding bodies of the different treatment services are the national health insurance, county budgets and Vilnius municipality. Four regional counties and one municipality finance specialised treatment centres at regional level.
In Lithuania, outpatient drug treatment is provided by public mental health centres or by psychiatric clinics, and through private medical institutions that have obtained a special licence. Furthermore, 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.
Substitution treatment with methadone was implemented in 1995, and treatment commenced in three cities in 1996. Buprenorphine treatment has been available since late 2002, throughout the specialised mental healthcare institutions. According to Order No 702 of the Ministry of Health, methadone and buprenorphine treatment can only be initiated by treatment centres. In 2008, the total number of clients in substitution treatment was 838, 640 of whom were on methadone and 198 on buprenorphine.
Harm reduction responses
In 1997, the Vilnius Centre for Dependence Diseases, in cooperation with the Open Society Fund in Lithuania, were the first to commence low-threshold programmes for injecting drug users. In 2008, 14 low-threshold units offering needle-exchange, information on behavioural consequences and treatment options operated in ten cities in Lithuania. Since 2001, a mobile outreach needle/syringe exchange point implemented by the Vilnius Centre for Addictive Disorders began to reach the main places where drug users gather. Injecting drug users may exchange needles and syringes, obtain condoms, disinfectant tissues, bandages, educational-informational materials, as well as a short consultation by a social worker and information about the availability of healthcare and social assistance. In 2008, a total of 238 745 syringes were provided in Lithuania, showing a marked increase from the previous year (187 000 syringes distributed in 2007). More than half of these were distributed and collected in Vilnius alone. In Klaipeda, the third largest city in Lithuania and the principal seaport of the country, with a high prevalence of HIV/AIDS, two drop-in rooms are run by the Klaipeda Centre for Dependence Disorders, which reach a major proportion of IDUs outside the treatment sphere. Lithuania also participates in transnational projects aiming at reducing the spread of HIV/AIDS, STDs, hepatitis and tuberculosis across the Baltic States.
Drug markets and drug-related offences
Lithuania is located on the Silk route, along which heroin is smuggled from central Asian states through Russia, Ukraine, Poland and the Baltic states. The number of crimes related to illicit drug trafficking has increased from 959 in 2003, during which harsher laws were adopted, to 1 839 in 2008. According to the Lithuanian Criminal Police Bureau, the majority of drug-related crimes concerned the illegal production, acquisition, possession, transportation and dealing with illegal drugs. The largest share of drug-related offences in 2008 were related to heroin, with 26.4 % of all drug-related offences reported, followed by cannabis with 22.6 % and methamphetamine with 19.8 %.
In 2008, there were 249 herbal cannabis seizures, followed by 282 heroin seizures, similar figures as in the previous year. The quantity of cocaine and ecstasy seized increased in 2008 compared to 2007 (from 2 kg in 2007 to 41 kg in 2008 and from 17 583 tablets in 2007 to 76 808 tablets in 2008, respectively). The amounts of other drugs followed a downward trend compared to the preceding years.
National drug laws
Since May 2003, a new penal code entered into force, under which possession of even a small amount of illicit drugs with no intent to distribute is a criminal offence, sentenced to up to two years' imprisonment or arrest. This remains also an administrative offence and may be judged to be a misdemeanour, but the penal code takes priority.
Quantities of all drugs are set out in a Ministry Regulation that defines small, large and very large quantities.
Traffickers may be sentenced for five to eight years, which rises to 10 and then 15 years, depending on the quantities involved and aggravating circumstances (e.g. involvement of minors or an organised group).
National drug strategy
Lithuania has a ‘National strategy on drug addiction prevention and control 2004–08’ and a ‘National programme for control of drugs and the prevention of drug addiction 2004–08’. The strategy is comprehensive, and has the goal to reduce and curb the spread of drug addiction, thus ensuring state and public security. It focuses on illicit drugs and covers four areas: primary prevention; healthcare/rehabilitation/social reintegration; supply reduction; and research and information. The national programme, which supports the implementation of the strategy, contains a list of measures on drug demand reduction, drug supply reduction, drug use monitoring, information, coordination and international cooperation.
Coordination mechanism in the field of drugs
The Drug, tobacco and alcohol control department started its activities on 1 April 2011. The most important tasks of the Department are: to implement drug prevention and drug control policy, after identifying the principal directions of the implementation of the policy; to organise implementation of drug prevention and drug control measures; and to coordinate other activities of the state and municipal institutions and organisations in the sphere of drug prevention and drug control.
In 2004, the Seimas (Parliament) of the Republic of Lithuania formed a permanent Drug Addiction Prevention Commission, consisting of 11 parliamentarians. The objectives of the Commission are to safeguard the interests of the government and to provide favourable conditions for the implementation of national drug policy.
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.
Drug-related research
Scientific research is a priority within the national programme on drug addiction, prevention and control, together with the development of information systems and training on research. The Lithuanian national focal point has a mandate to develop methodological recommendations in this 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 2009 Lithuanian National report mainly focused on aspects related to prevalence, incidence and patterns of drug use.
