Country overview: Latvia
- Drug use among the general population and young people
- Problem drug use
- Treatment demand
- Drug-related infectious diseases
- Drug-related deaths
- Treatment responses
- Harm reduction responses
- Drug markets and drug-law offences
- National drug laws
- National drug strategy
- Coordination mechanism in the field of drugs
- Public expenditure
- Drug-related research
|Year||EU (27 countries)||Source|
|Population||2012||2 041 763 p ||503 663 601 b p||Eurostat|
|Population by age classes||15–24||2012||12.6 % p||11.7 % b p||Eurostat|
|25–49||34.4 % p||35.4 % b p|
|50–64||20.1 % p||19.5 % b p|
|GDP per capita in PPS (Purchasing Power Standards) 1||2011||58||100||Eurostat|
|Total expenditure on social protection (% of GDP) 2||2010||17.8 % p||29.54 % p||Eurostat|
|Unemployment rate 3||2012||14.9 %||10.5 %||Eurostat|
|Unemployment rate of population aged under 25 years||2012||28.4 %||22.8 %||Eurostat|
|Prison population rate (per 100 000 of national population) 4||2011||316.0||:||Council of Europe, SPACE I-2011|
|At risk of poverty rate 5||2012||19.1 % b||16.9 % e||SILC |
p Eurostat provisional value.
b Break in series.
1 Gross domestic product (GDP) is a measure of economic activity. It is defined as the value of all goods and services produced less the value of any goods or services used in their creation. The volume index of GDP per capita in Purchasing Power Standards (PPS) is expressed in relation to the European Union (EU-27) average set to equal 100. If the index of a country is higher than 100, this country's level of GDP per head is higher than the EU average and vice versa.
2 Expenditure on social protection contains: benefits, which consist of transfers, in cash or in kind to households and individuals to relieve them of the burden of a defined set of risks or needs.
3 Unemployment rates represent unemployed persons as a percentage of the labour force. Unemployed persons comprise persons aged 15 to 74 who were: (a) without work during the reference week; (b) currently available for work; (c) actively seeking work.
4 Situation of penal institutions on 1 September, 2011.
5 Share of persons aged 0+ with an equivalent disposable income below the at-risk-of-poverty threshold, which is set at 60 % of the national median equivalised disposable income (after social transfers).
The national general population surveys on drug use in Latvia have been conducted every four years since 2003, and the most recent data are available for 2011. All three surveys used the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) recommended data collection methods and a target population of people aged 15–64, with an average sample of 4 500 respondents. This allows comparison with similar studies in other countries as well as comparability of results between the three studies over time. In 2011 lifetime use of cannabis was reported by 12.5 % of respondents (12.1 % in 2007 and 10.6 % in 2003). The lifetime prevalence rate for ecstasy was 2.7 % (4.7 % in 2007 and 2.4 % in 2003), 2.2 % for amphetamines (3.3 % in 2007 and 2.6 % in 2003), and 1.5 % for cocaine (2.3 % in 2007; 1.2 % in 2003). Although there was a small increase in the lifetime prevalence of cannabis use, use of other substances has reduced and returned to the levels of 2003. The data indicate a slight decline in the most recent use of cannabis. Thus, last year prevalence of cannabis use was reported by 4.0 % of the sample and last month prevalence by 1.5 %, compared to 4.9 % and 1.8 % respectively in the 2007 study. Drug use remains more prevalent in large cities, and particularly in the capital, where every second male respondent reported having used drugs at least once in their lifetime. Although drug use remains more prevalent among males than females, the most recent study indicates a narrowing in the gender gap, largely due to a reduction in drug use prevalence among males since 2007, while prevalence rates have remained unchanged among females. Use of all illicit substances, including new psychoactive drugs, was higher in younger age groups than among those aged 35 and older. Available data for younger adults (15–34 years old) also indicated that use of traditional illicit substances declined in 2011when compared to 2007. Thus, the lifetime prevalence for cannabis use dropped from 21.7 % to 20.4 %; for ecstasy from 8.5 % to 4.4 %; for amphetamines from 6.1 % to 3.5 %; and for cocaine from 2.4 % to 2.2 %
The data on substance use among 15- to 16-year-old school children are available from the regular European School Survey Project on Alcohol and Other Drugs (ESPAD) studies that have been carried out in Latvia since 1999. According to the data from surveys, cannabis is the most popular illicit drug among students aged 15–16. Lifetime prevalence of cannabis was reported by 17 % of students in 1999, 16 % in 2003, 18 % in 2007 and 24 % in 2011. Although experimenting with cannabis in Latvia remains at an average level when compared to other European countries, the increase of lifetime prevalence rates reported between 2007 and 2011 is one of the highest among all ESPAD countries. Lifetime use of ecstasy, amphetamines, hallucinogens and cocaine was reported by 4 % of the sample. The reported lifetime prevalence levels for ecstasy and amphetamines were lower in 2011 than in 2007, while a higher proportion of respondents reported past use of cocaine in 2011 than those in 2007. Last year prevalence of cannabis use was 16 % (11 % in 2007; 9 % in 2003; 11 % in 1999), and last month prevalence of cannabis use was 6 % (4 % in 2007 and 2003; 5 % in 1999). In addition, the reported lifetime prevalence of cannabis use was 29 % among males and 19 % among females.
The data from the Health Behaviour in School-aged Children (HBSC) study conducted in 2002 and 2010 among 15-year-old students corroborates the results of ESPAD, indicating an increase in cannabis use among school-age adolescents. These studies found that the lifetime prevalence rate for cannabis increased from 12 % in 2002 to 25 % in 2010.
Prevention of dependence and drug use is one of the four pillars of the new drug programme for 2011–17 adopted by the Cabinet of Ministers, and is also an integral part of the public health strategy for 2011–17. In general, drug prevention activities are integrated into broader health promotion activities and are implemented in a decentralised manner. Districts and municipalities play a central role in planning and funding prevention activities implemented outside the school curricula.
Following the financial downturn in 2009, national structural reforms were instigated that further influenced the extent and quality of existing prevention measures. Several agencies working in the field of health prevention and promotion were closed and funding for programmes implemented by non-governmental organisations (NGOs) was limited.
The Ministry of Health and the Ministry of Education and Science are responsible for introducing drug prevention into school programmes. Health classes that also address substance use are integrated into the basic national curriculum within the subjects of ‘social sciences’ for the grades 1–9 curricula and ‘health education’ for secondary schools. These classes aim to strengthen pupils’ decision-making capabilities and their ability to overcome peer pressure. However, the health education classes are not mandatory for all secondary schools and are among nine subjects from which educational institutions choose to implement three. The Ministry of Health is trying to encourage change and to make the subject compulsory for all secondary schools. Many schools involve medical doctors or other health promotion staff, police officers and non-governmental organisations in their informational and educational activities, primarily in relation to significant events such as the World AIDS Day, to organise competitions, exhibitions, etc. Peer education and life skills based methodologies are mainly used in extracurricular activities.
At the community level, universal prevention activities primarily focus on the provision of alternative leisure activities, and organising security services and video surveillance in schools.
The implementation of selective prevention is generally weak and sporadic. If available, it mainly targets pupils who miss school, adolescents exhibiting high-risk behaviour or juvenile offenders. Indicated prevention is non-existent, while ‘early intervention programmes’ are regarded as treatment. Although there are no specific national prevention guidelines on drugs, in 2011 Guidelines for Local Governments in Promoting Health were developed by the Ministry of Health that also cover measures relevant for the promotion of mental health and dependency reduction. Outcome evaluations of prevention activities remain rare.
In 2010–11 the EU-funded project Youth against Drugs was implemented in Latvia. It mainly focused on media campaigns and supports alternative leisure activities for young people.
View ‘Prevention profile’ for additional information.
In 2011 estimates of problem drug use were obtained based on the treatment multiplier method. The estimate indicated a prevalence of problem drug use between 7.8 and 12.1 cases per 1 000 inhabitants aged 15–64 years. This means that there were about 13 141 problem drug users (between 10 849 and 16 811) in Latvia in 2011.
In 2010, there were an estimated 10 169 opioid users, and 6 540 problem users of amphetamines in Latvia.
Up to 2012 the EMCDDA defined problem drug use as injecting drug use (IDU) or long duration/regular use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis were not included in this category. Details are available here.
From 2008 the Centre of Health Economics (restructured on 1 April 2012 as the Centre for Disease Prevention and Control) put into practice the new treatment recording system, Patient Register Data (PREDA). The PREDA system collects data about drug use and is directly linked to the General Mortality Register. In 2011 treatment demand data were gathered from 34 of the 60 outpatient centres across Latvia. No treatment demand indicator (TDI) data were collected from inpatient treatment centres for the reporting period.
In 2011, a total of 2 010 clients were admitted to drug treatment, of whom 386 were new treatment clients. Opioids were reported as the primary drug among all clients entering treatment, at 52.9 %, followed by 19.3 % for amphetamines and 11.8 % for cannabis. Data regarding new treatment clients entering treatment indicate that 34.1 % reported that opioids were the primary drug (heroin or home based opioid prepared from poppy seeds called hanka), followed by 28.2 % for amphetamines and 19.8 % for cannabis.
In 2011, some 29 % of all treatment clients were under age 25. Among new treatment clients, the proportion of those under the age of 25 was higher and represented 45 % of all new clients entering treatment. In terms of gender distribution, 79.3 % of all treatment clients were male and 20.7 % were female, while among new treatment clients 76.9 % were male and 23.1 % were female.
In Latvia, as in other Baltic countries, there is a high proportion of injecting drug users (IDUs) among all reported HIV cases. There was an increase in the number of HIV cases diagnosed annually in Latvia in the late 1990s, and this reached a peak in 2001. In 2011 there were 299 newly reported HIV positive cases in Latvia (274 in 2010 and 275 in 2009). Since 2001, the proportion of IDUs among newly diagnosed HIV cases has decreased gradually and in 2011 some 90 cases (30.1 %) were transmitted through injecting drug use. The largest proportion of HIV cases registered in 2011 had been infected through heterosexual contact (48.2 %), with 6.7 % through homosexual contact and 0.7 % through maternal transmission. In 14.4 % of cases the mode of transmission remained unreported. However, the overall prevalence of HIV among injecting drug users remained high; in 2011, about 11.2 % of the clients of 18 needle and syringe programmes were tested HIV positive, which is significantly more than in 2010. This is attributed mainly to a drop in the total number of HIV tests administered by the programmes. The last seroprevalence study, conducted in 2007, suggested that the HIV prevalence rate among IDUs was 22.6 %.
Eleven of the 49 cases of acute hepatitis B virus (HBV) and one of the 19 cases of chronic HBV infection with a known transmission route were linked to injecting drug use in 2011. For the hepatitis C virus (HCV), 16 of the 56 acute HCV cases and 187 of the 485 cases of chronic HCV infection with a known transmission route were linked to IDU. The 2007 seroprevalence study suggests HBV and HCV prevalence rates among IDUs were 55.9 % and 74.4 % respectively. In 2010–11 testing of various sub-groups of IDUs corroborated the findings of the 2007 study and indicated HCV prevalence rates of 50.0–81.5 %.
Although the rate of tuberculosis has decreased by half since 2000, it remains a significant public health issue in Latvia. In particular, the number of cases with dual HIV and tuberculosis infection is steadily growing and more than half of all those co-infections are diagnosed in injecting drug users.
The Centre for Disease Prevention and Control (which assumed the responsibility from the Centre of Health Economics after its reorganisation in April 2012) maintains a General Mortality Register (GMR), and it regularly exchange data with the State Centre for Forensic Medical Examinations, which maintains a special register of deceased persons. The special register records the results of forensic tests and toxicological analyses. According to the GMR, in 2011 there were 11 acute deaths directly related to drug consumption or overdoses for which the definition was in line with the drug-related deaths standards (7 in 2010; 19 in 2009; 24 in 2008; 21 in 2007; 17 in 2006; and 14 in 2005), the EMCDDA standard protocol for extracting data on drug-related deaths from Member States’ registers (which includes acute deaths directly related to drug consumption or overdoses). Opiates were a main substance involved in 45.5 % of cases, and was combined with other substances in a large proportion of other cases. Of these 11 cases, nine were male and two were female, and the mean age was 30. There is, however, an assumption that a significant number of drug-related deaths are underreported due to a reduction in the number of autopsies that are performed, lack of technical capacity and misclassification of a cause of death. Mortality cohort studies indicate that the standardised mortality ratio among opioid users is nine times higher compared with the general population of the same age.
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 are funded by the state budget of the National Health Service. Long-term inpatient drug treatment (rehabilitation) for children is provided through funds from the Ministry of Welfare. Drug treatment is also delivered by private, profit-making organisations.
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 to receive state-funded services from the addiction treatment specialists. In 2011, state-funded outpatient services are provided by addiction specialists in 41 treatment institution, while inpatient treatment is provided in specialised psychiatric hospitals, regional multi-profile hospitals and other medical institutions, which are either publicly or privately funded. In recent years, 10 treatment institutions have provided beds for the inpatient treatment of drug users. The outpatient services provide mainly psychosocial intervention, cognitive behavioural therapy, motivational interventions and long-term maintenance programmes, while inpatient facilities offer detoxification, psychosocial interventions and therapeutic communities. Two specialised psychiatric centres provide long-term medical rehabilitation based on the principle of ‘therapeutic community’.
The Riga Centre of Psychiatry and Addiction Disorders has been providing methadone maintenance treatment since 1996, and from 2005 maintenance treatment has been offered using buprenorphine. In recent years, however, the availability of treatment has expanded beyond the capital city. Since 2010, in addition to the centre in Riga, eight opioid maintenance treatment offices operated by multidisciplinary rehabilitation teams have provided methadone maintenance treatment, while buprenorphine programmes are now available in five cities. 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 opioid substitution treatment via general physicians who have completed a special training programme. The regulation also stipulated continuity of opioid substitution treatment in prison (free of charge for methadone, and at the patient’s own cost for buprenorphine). On 31 December 2011 the total number of clients in substitution treatment was 277, of whom 218 were on methadone and 59 on buprenorphine. An increase in the total number of clients compared to previous years was noted, due to the expansion of the methadone maintenance programme beyond Riga, although two-thirds of treated patients are still reported in Riga.
View ‘Treatment profile’ for additional information.
Two major harm reduction responses are carried out in Latvia — opiate substitution programmes (described in detail in the section ‘Treatment responses’) and a network of low-threshold centres (LTCs) for IDUs. The first needle exchange programme (later an LTC) was opened in 1997. In 1999, street outreach activities were introduced. By the end of 2009 a network of 18 LTCs were operational — three in the capital city region and 15 in other local municipalities. Mobile needle and syringe programmes are offered at three sites. The network of LTCs is financed by the state and municipalities, and by additional resources such as fundraising projects. Early in 2011, however, the large project funded by United Nations Office on Drugs and Crime (UNODC) ended, which has led to a reduction in the number of street workers operating in LTCs.
LTCs provide a wide range of low-threshold services: needle exchange, outreach, voluntary HIV counselling and testing (VCT), HCV testing, disinfectants, condoms, group and individual risk reduction information, education, etc. In 2011 approximately 338 000 syringes were distributed through the programme, an increase on previous years, although coverage, judged by the number of syringes distributed per injecting drug user, is assessed as insufficient by many international experts.
Latvia also participates in transnational projects aiming to reduce the spread of HIV/AIDS, STDs, hepatitis and tuberculosis across the Baltic States.
Latvia is mainly used as a transit country for transporting drugs and precursors to its neighbouring countries, Scandinavian countries and the Russian Federation. In recent years the number of Latvian citizens involved in drug smuggling activities internationally has also increased, while an international drug cartel that actively recruited Latvian citizens as drug mules was dismantled in 2011. Data from law enforcement institutions show a number of import routes for illicit drugs: methamphetamine is brought into Latvia from Lithuania, Belgium, the Netherlands and Germany; herbal cannabis and cannabis resin are imported from the Netherlands, Belgium, Lithuania and Poland en route to Scandinavian countries, or for cannabis resin to the Russian Federation. Latvia is also used for cocaine transit from South America to Russia via sea or air. Heroin enters Latvia from countries in Central Asia and the Russian Federation mainly by air and land, and is transported on to the Scandinavian countries. In 2011, nine cannabis-growing sites and two methadone production laboratories were seized in Latvia. New psychotropic substances available in Latvia are mainly produced in Asian countries.
Data on drug seizures, which combine data from all law-enforcement agencies, are provided by the Forensic Service Department of the State Police. In 2011 a record amount of seized methamphetamine (52 kg) was reported, while amphetamine seizures continued on a declining trend from 2007, indicating that methamphetamine has replaced amphetamine in the market. The majority of seizures in 2011 were linked to cannabis products, and the amount of cannabis resin and cannabis plants seized in 2011 increased, while the amount of herbal cannabis halved. In 2011, the national authorities reported a continuing reduction in the amount of heroin seized (0.4 kg in 2011; 1 kg in 2010; and 2 kg per year in 2007–09). The amount of cocaine seized hit a record high of 206 kg in 2010, but the following year this fell to 81 kg, almost all of which was recovered in a single seizure. The emerging market of new substances might be responsible for the declining proportion of synthetic drugs such as ecstasy in the market.
According to the Ministry of the Interior, 9 240 drug-law offences were reported in 2011. Most of these were use-related offences. With regards to the substances involved, the registered offences were linked mainly to methamphetamine, cannabis and heroin.
Administrative sanctions (a fine of about EUR 130 or administrative detention of up to 15 days) are applied for unauthorised acquisition and storage of small amounts of illicit drugs. Larger amounts for personal use (precisely determined in the law On the Procedures for the Coming into Force and Application of the Criminal Law) can lead to a criminal penalty of up to seven years in prison. Drug use without medical prescription is also an administrative offence, but for repeated illegal drug use within 12 months a person may be sentenced to imprisonment of up to two years. Since 2004 the court has been able to impose treatment with a suspended sentence, or to release an addict from detention if he or she has agreed to undergo treatment, but no underlying control mechanism has been established.
Traffickers of any quantity may be sentenced to up to 10 years’ imprisonment, or eight to 13 years if large amounts, or especially dangerous substances, are involved.
In 2009–11 a number of new substances were added to Schedule I or II of the Narcotic and Psychotropic Substances and Precursors to be Controlled in Latvia. This has led to further amendment of the guidelines On the Procedures for the Coming into Force and Application of the Criminal Law, which now define small and large quantities of mephedrone, and also lists tapentadol.
View ‘Legal profile’ for additional information.
Latvia’s State Programme on Drug Control and Drug Addiction Restriction 2005–08 was evaluated in 2009. In 2010, the National Programme on Drug Control and Drug Addiction Restriction for 2011–17 was completed and subsequently approved by the Cabinet of Ministers on 14 March 2011. It was developed in accordance with the Regulation for Development of Planning Documents and Impact Assessment, and the Latvian Strategic Development Plan 2010–13. The new programme also reflects the principles of EU drug policy. It sets out three main goals: 1) to reduce the acceptance of illicit drug use in society; 2) to reduce the harm caused to society through illicit drug use by making effective healthcare services available for drug users; and 3) to reduce the availability of illicit drugs. The strategy is built around four pillars: 1) prevention; 2) health care; 3) reducing availability; and 4) policy coordination and information analysis. It foresees four main actions, namely: prevention, treatment, drug supply reduction, and policy coordination and analysis of information.
View ‘National drug strategies’ for additional information.
The Drug Control and Drug Addiction Restriction Coordination Council is chaired by the Prime Minister and comprises seven ministers and several national experts. It is responsible for coordinating government agencies, municipalities and non-government organisations tasked with implementing the national drug strategy. Alongside supervising four ad hoc groups, which work on supply reduction, demand reduction, legal turnover and information analysis, the Council is tasked with developing drug programmes and their implementation and evaluation.
The Council Secretariat is responsible for the day-to-day coordination of activities related to the Programme on Drug Control and Drug Addiction Restriction. Appointed by the Minister of Interior, the Head of the Council Secretariat functions as the National Drug Coordinator and is responsible for coordinating the work of the Council Secretariat and the Council’s working groups. The Centre for Disease Prevention and Control (formerly located at the Centre of Health Economics), which houses the national focal point in the Reitox network, coordinates day-to-day monitoring work, as well as the collection and dissemination of information on illicit and licit drugs.
Latvian drug policy documents do not have associated budgets and there is no review of executed expenditures. However, the evaluation of the national action plan (2005–08) provided the first overview of central government expenditures. This was later used in commissioned research. (1)
In 2008, the total drug-related public expenditure (2) was estimated at 0.01 % of GDP, with 35.5 % for public order and safety activities, 32.2 % for social protection and 29.1 % for health initiatives. The remaining expenditures contributed to general public services and education activities.
The available information does not allow the trends of drug-related public expenditures in Latvia to be reported.
(1) Vanags, A. and Zasova, A. (2010), Budget and non-budget social costs of drug abuse in Latvia in 2008, Analytical report by BICEPS, Centre of Health Economics, March 2010, Latvia.
(2) 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.
View ‘Public expenditure profile’ for additional information.
The State budget funds most drug-related research in Latvia, particularly as the main studies at national level are included in the State Programme on Drug Control and Drug Addiction Restriction. The Centre of Health Economics, where the Latvian national focal point is located, funds studies on drug prevalence among the general population, and the municipality of Riga is also a significant actor in funding, with the objective of improving prevention activities at city level. Social and youth research are the main types of research currently conducted by university departments, while basic and applied research are conducted by the Latvian Institute of Organic Chemistry. The Latvian national focal point, meanwhile, plays a significant role in monitoring and analysing the public health situation in the country, and in disseminating drug-related research findings. Recent drug-related studies mentioned in the 2012 Latvian National report mainly focused on aspects related to the health-related consequences of drug use, but research on the prevalence of drug use was also highlighted.
View ‘Drug-related research’ for additional information.