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Drug treatment overview for Latvia

Map of Latvia

1. National context

The national coordination body for drug treatment in Latvia is the Riga Centre of Psychiatry and Addiction Disorders, which is responsible for the delivery, accreditation, monitoring and evaluation of drug treatments. Drug treatment is mainly delivered by institutions that operate under the supervision of the Ministry of Health and is funded by the state budget of the National Health Service. Long-term social rehabilitation is also provided through funds from the Ministry of Welfare. Drug treatment is also delivered by private, profit-making organisations, and is regulated by the Medical Treatment Law.

Drug treatment services are available in outpatient and inpatient clinics. Addiction treatment specialists are direct access specialists, which means that potential clients do not need to have referrals from family physicians in order to receive state-funded services from the addiction treatment specialists. In 2013 state-funded outpatient services were provided by 69 addiction specialists in 44 treatment institution. Outpatient addiction treatment services were also provided by addiction specialists working in private organisations. Inpatient treatment was provided in specialised psychiatric hospitals and in regional and local multi-profile hospitals, which are either publicly or privately funded. In recent years the number of inpatient service providers has decreased, and in total nine treatment institutions provide beds for the inpatient treatment of drug users. If treatment is provided by private institutions or practices, a client must fully cover all the costs of the service. The outpatient services provide mainly psychosocial intervention, cognitive behavioural therapy, motivational interventions and long-term maintenance programmes, while inpatient facilities offer emergency care for overdose cases, detoxification and short-term psychosocial interventions. Two specialised psychiatric centres provide long-term medical rehabilitation based on the principle of the ‘therapeutic community’.

The Riga Centre of Psychiatry and Addiction Disorders has provided methadone maintenance treatment (MMT) since 1996, and opioid substitution treatment (OST) using buprenorphine since 2005. In recent years the availability of treatment has expanded beyond the capital city. Since 2010, in addition to the centre in Riga, nine OST offices operated by multidisciplinary rehabilitation teams provide MMT, while buprenorphine programmes are now available from eight providers. The treatment can also be prescribed at any inpatient clinic, provided that it has a Council of Physicians with at least two drug addiction specialists. In 2012 a new regulation came into force stipulating broader provision of OST via general physicians who have completed a special training programme. The regulation also stipulated continuity of OST in prison. Methadone is provided free of charge by the state, while buprenorphine is available at the patient’s expense. The geographical expansion of MMT and changes in the legal framework contributed to a threefold increase in the number of OST clients between 2006 and 2012; however, the OST coverage rate still remains the lowest of all European Union (EU) Member States. On 31 December 2013 the total number of clients in substitution treatment was 424, of whom 328 were on methadone and 96 on buprenorphine.

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2. Treatment registries and monitoring systems

Individual client records from inpatient and outpatient treatment facilities are traditionally kept by the State Addiction Agency (SAA). Treatment agencies are required by law to provide client data in the standardised format of patient registration cards to this centralised national register where they are entered and processed. Private sector facilities provide their records in aggregated form.

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3. Treatment demand

Table 1: Number of clients entering treatment in Latvia by year
Clients in treatment 2010 2011 2012 2013
Number of all clients entering treatment N. Av. 2010 2187 1543
Number of all clients entering treatment with known primary drug 1699 1972 2148 1504
% of which for opioid use   52.9 50 52.1
% of which for cocaine use   0.4 0 0.3
% of which for cannabis use   11.8 15 27.3
% of which for stimulants use (other than cocaine)   19.4 20 16.0
Number of new clients entering treatment 455 386 402 555
Number of new clients entering treatment with known primary drug 278 369 395 529
% of which for opioid use 40.3 34.1 26 19.7
% of which for cocaine use 0 0.3 1 0.8
% of which for cannabis use 16.5 19.8 27 51.4
% of which for stimulants use (other than cocaine) 24.8 28.2 27 21.9
Notes:
The variation across time, in particular with regard to the absolute numbers of clients in treatment, should be interpreted with caution as coverage data may have changed over time. For further information on coverage details please refer to the relevant EMCDDA Statistical Bulletin.
‘N. Av.’ stands for ‘No information available’.
For an explanation of terms used, see the definitions of terms.
Sources:

Reitox national reports 2014 and TDI tables.
EMCDDA Statistical Bulletin 2015.

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4. Treatment provision

Table 2: Opioid substitution treatment provision in Latvia
Opioid substitution treatment 2010 2011 2012 2013
Number of clients in opioid substitution treatment 237 277 355 424
of which with methadone 193 218 278 328
of which with buprenorphine 44 59 77 96
Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HSR section).
For an explanation of terms used, see the definitions of terms.
Sources:
Standard Table 24 (ST24) on 'Treatment availability' submitted in 2014.
Table 3: Year of official introduction of opioid substitution treatment substances in Latvia
Applied substances in opioid substitution treatment Officially introduced in
Methadone (MMT) 1996
Buprenorphine (HDBT) 2005
Heroin assisted treatment,including as trials N.App.
Slow-release morphine N.App.
Buprenorphine/naloxone combination N. Av.
Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HSR section).
‘N. App.’ stands for ‘Not applicable’.
For an explanation of terms used, see the definitions of terms.
Sources:
Reitox national reports.
Table 4: Legal framework of opioid substitution treatment in Latvia
Legal framework of opioid substitution treatment Methadone Buprenorphine
Do office-based medical doctors have the right to initiate the prescription of substitution treatment? N.App. N.App.
Do specialised medical doctors have the right to initiate the prescription of substitution treatment? N.App. N.App.
Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HSR section).
For an explanation of terms used, see the definitions of terms.
'Specialised medical doctors' refers to specifically trained or accredited office-based medical doctors.
Sources:
Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2014.

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5. References and links

Related EMCDDA resources

External links

Please note that the EMCDDA is not responsible for the content of external sites.

Treatment inventories

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About the EMCDDA

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the reference point on drugs and drug addiction information in Europe. Inaugurated in Lisbon in 1995, it is one of the EU's decentralised agencies. Read more >>

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Page last updated: Thursday, 28 May 2015