• Drug use among the general population and young people
• Prevention
• Problem drug use
• Treatment demand
• Drug-related infectious diseases
• Drug-related deaths
• Treatment responses
• Harm reduction responses
• Drug markets and drug-related offences
• National drug laws
• National drug strategy
• Coordination mechanism in the field of drugs
• Public expenditure
• Drug-related research

Drug use among the general population and young people

The first national general population survey on drug use in Latvia was conducted in 2003 and repeated in 2007. The target population comprised persons aged 15–64. In 2007, lifetime use of cannabis was reported by 12.1 % of respondents (10.6 % in 2003). Lifetime prevalence rates for other drugs were 3.3 % for amphetamines (2.6 % in 2003), 4.7 % for ecstasy (2.4 %), and 2.3 % for cocaine (1.2 % in 2003). Available data for younger adults (15–34 years old) showed that 21.7 % reported lifetime experience with cannabis and 8.5 % reported to have used ecstasy and 4 % with cocaine, 6.1 % amphetamines at least once in their life. Last-year prevalence of cannabis use was reported by 9.7 % of the sample and last-month prevalence by 3.6 %.

Cannabis is the most popular illicit drug among students aged 15–16 years, as demonstrated by the ESPAD survey conducted in the last years. Lifetime prevalence of cannabis was reported by 17 % of students in 1999, 16 % in 2003, 18 % in 2007 and 24 % in 2011. In 2011, results showed that inhalants lifetime prevalence was reported by 23 % of the students. Lifetime use of ecstasy, amphetamines, hallucinogens and cocaine is reported by 4 % of the sample. Concerning ecstasy and amphetamines, the reported lifetime prevalence levels are lower in 2011 when compared to 2007 results, while past experience in cocaine use is reported by a higher proportion of respondents in 2011 than those in 2007. Results indicated 16 % for last-year prevalence of cannabis use (11 % in 2007, 9 % in 2003, 11 % in 1999), 6 % for the last-month prevalence of cannabis (4 % in 2007 and 2003, 5 % in 1999). In addition, the reported lifetime prevalence of cannabis use among males was 29 % and 19 % among females.

The data from the Health Behaviour among School-aged Children study conducted in 2002 and 2010 among 15-year-old students corroborates the results of ESPAD indicating increase in the cannabis use among school-age adolescents. According to the results of the studies, the lifetime prevalence rate for cannabis has increased from 12 % in 2002 to 25 % in 2010.

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Prevention

Prevention of dependence and drug use is recognised as one of 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, the drug prevention activities are integrated into broader health promotion activities and implemented in a decentralised manner. Districts and municipalities play a central role in planning and funding of prevention activities implemented beyond the school curricula.

Following the financial downturn in 2009, national structural reforms were implemented which further influenced the extent and quality of implemented prevention measures. Several agencies working in the field of health prevention and promotion were closed and funding for programmes implemented by the non-governmental organisations was limited.

The Ministry of Health and the Ministry of Education and Science is responsible for introducing drug prevention in school programmes. Health classes that also address substance use are integrated into the basic national curriculum under subjects of ‘Social sciences’ for 1–9 grades curricula and ‘Health education’ for secondary schools. These classes aim to strengthen pupils’ decision-making capabilities and overcome peer pressure. In many schools, the practice of organising informational and educational activities involving medical doctors or other health promotion staff, police officers and non-governmental organisations exists, and is used mainly to commemorate significant events, such as the World AIDS Day, organise competitions, exhibitions, etc. Peer education and life-skills based methodologies are used mainly in extracurricular activities.

At community level, universal prevention activities mainly focus on the provision of alternative leisure activities and organisation of 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 or adolescents exhibiting high risk behaviour. Indicated prevention is non-existent while ‘early intervention programmes’ are regarded as treatment. There are no national prevention guidelines which would unify the implementation drug prevention activities and outcome evaluations out of prevention activities are rare.

In 2010, a two-year long EU-funded project ‘Youth against Drugs’ was started and will mainly produce media campaigns and support alternative leisure activities for young people. 

View ‘Prevention profile’ for additional information.

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Problem drug use

In 2010, estimates of problem drug use, problem opioid use and problem amphetamine use populations were obtained based on the treatment multiplier method. The estimate indicated a prevalence of problem drug use between 9.8 and 16.4 cases per 1 000 inhabitants aged 15–64 years. This means that there are about 18 888 problem drug users (between 15 029 to 25 234) from whom 10 169 were users of heroin or other opioids and 6 540 were problem users of amphetamines.

The EMCDDA defines problem drug use as injecting drug use (IDU) and/or long duration/regular drug use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis are not included in this category.

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Treatment demand

Since 2008, the Centre of Health Economics has put into practice the new treatment recording system PREDA (Patient REgister DAta). Within the PREDA system, data about drug use is collected. The PREDA system is directly linked to the General Mortality Register. In 2010, treatment demand data was gathered from 34 outpatient centres out of the 60 centres across Latvia. No TDI data were collected from inpatient treatment centres for the reporting period.

In 2010, a total of 1 738 clients were admitted to the drug treatment of whom 287 were first-time treatment clients. Opioids were reported as the primary drug among all clients entering treatment, at 56.2 %, followed by 19.4 % for amphetamines and cannabis at 11.7 %. Data regarding first-time treatment clients entering treatment indicate that 40.3 % reported that opioids were the primary drug, followed by 24.8 % for amphetamines and 16.5 % for cannabis.

In 2010, 34 % of all treatment clients were under the age of 25 years. While among new treatment clients the proportion of those under the age of 25 years was higher and represented 45 % of all new clients entering treatment. As far as gender distribution is concerned among all treatment clients 79.2 % were males and 20.8 % were females, while among first time treatment clients, 73.9 % were males and 26.1 % were females.

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Drug-related infectious diseases

In Latvia, likewise to other Baltic countries, there is a high proportion of injecting drug users (IDUs) among all reported HIV cases. An increase in annually diagnosed HIV cases was observed in Latvia in the late 1990s and reached the peak in 2001. In 2010, newly-reported HIV positive cases in Latvia reached 274 cases (275 cases in 2009). Since 2001, the proportion of IDUs among newly diagnosed HIV cases has decreased gradually and in 2010, 86 cases (31.3 %) were transmitted through injecting drug use. The largest part of cases registered in 2010, 47.8 % (131), were transmitted through heterosexual contacts, 6.5 % (18) through homosexual contacts and in 1.5 % (18) of the cases, a mother had infected her child. For 12.8 % (35) of the cases, the mode of transmission remained unreported. However, the overall prevalence of HIV among injecting drug users remains high, in 2010, about 6.3 % of the clients of 18 needle and syringe programmes were tested HIV positive. The seroprevalence study study conducted in 2007 suggests HIV prevalence rate among IDUs at 22.6 %.

In terms of notification of data, the Infectology Center of Latvia provides data on HCV and HBV infections. In 2010, 22 out of 71 cases of acute HBV and 3 out of 15 cases of chronic HBV infection with known transmission route were linked to injecting drug use. What regards HCV,  9 out of 53 acute HCV cases  and 113 out of 387 cases of chronic HCV infection with known transmission route were linked to IDU. The 2007 seroprevalence study suggests HCV and HBV prevalence rates among IDUs were 74.4 % and 55.9 %, respectively. In 2010, testing of various sub-groups of IDUs corroborate the findings of the 2007 study and indicate HCV prevalence rates 50.0–58.9 %.

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Drug-related deaths

The centre for Health economics maintains a General Mortality Register (GMR), however, it regularly exchange data with the Centre for Forensic Medical Examinations which maintain a special register of deceased persons.  The special register contains the results of forensic tests and toxicological analyses. According to the GMR, in 2010, there were 7 acute direct drug-related deaths for which the definition was in line with the drug-related deaths standards (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 registers in the Member States of the European Union (which includes acute deaths directly related to drug consumption or overdoses). Opiates were involved in 71.4 % cases. Of these 7 cases, 6 were males and one was female and the mean age was 25.7 years. While the significant drop in the number of drug-related registered death cases in 2009–10 is partly attributed to the decrease in the number of performed autopsies and due to misclassification of a cause of death. Mortality cohort studies indicate that standardised mortality ratio among opioid users is nine times higher as compared with same age general population.

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Treatment responses

In Latvia, the national coordination body for drug treatment is the Riga Centre of Psychiatry and Addiction Disorders, which is responsible for delivery, accreditation, monitoring and evaluation of drug treatment. Drug treatment is mainly delivered by institutions which operate under the supervision of the Ministry of Health and are funded by the state budget of the Health Payment Centre. 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. State funded outpatient services are provided by addiction specialists in 38 treatment institutions, 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 2010, 10 treatment institutions provided beds for inpatient treatment of drug users. The outpatient services provide mainly psychosocial interventions and long-term maintenance programmes, while inpatient facilities offer detoxification, psychosocial interventions and therapeutic communes. Long-term medical rehabilitation based on a principle of ‘therapeutic community’ is provided by two specialised psychiatric centres.

Since 1996, the Riga Centre of Psychiatry and Addiction Disorders has been providing methadone maintenance treatment, and since 2005, maintenance treatment has been offered using buprenorphine. In the last years, however, the availability of treatment is expanding beyond the capital city. In 2010, eight opioid maintenance treatment offices operated by multidisciplinary rehabilitation teams, in addition to the Centre in Riga, were providing methadone maintenance treatment. The treatment can be also prescribed at any inpatient clinic, provided that it has a Council of Physicians with at least two drug addiction specialists. Moreover, provisions are drafted to make a treatment available through general physicians who have completed special training programme. On 31 December 2010, the total number of clients in substitution treatment was 237, of whom 193 were on methadone and 44 on buprenorphine. An increase in the total number of clients compared to previous years is noted, due to the expansion of the methadone maintenance programme beyond the Centre in Riga.

View ‘Treatment profile’ for additional information.

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Harm reduction responses

There are two major harm reduction responses carried out in Latvia — opiate substitution programmes and a network of Low threshold centres (LTCs) for IDUs. The first needle-exchange programme (later LTC) was started in 1997. In 1999, street outreach activities were introduced. By the end of 2009, the network of 18 LTCs has been operational in the capital city area (3) and other local municipalities (15). In three sites, mobile needle and syringe programmes are offered. The network of LTCs is financed by the state and municipalities, as well as additional resources, such as projects which raise funds. Early in 2011, however, the large UNODC-funded project ended which has led to a sharp reduction in a 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), viral hepatitis C testing, disinfectants, condoms, group and individual risk reduction information, education, etc. In 2010, approximately 311 000 syringes were distributed through the programme.

Latvia also participates in transnational projects, aiming to reduce the spread of HIV/AIDS, STDs, hepatitis and tuberculosis across the Baltic States.

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Drug markets and drug-related offences

Latvia is often used as a transit country for transporting drugs and precursors to its neighbouring countries, and in recent year number of Latvian citizens involved in ‘drug smuggling’ activities internationally has also increased. Data from law enforcement institutions shows a number of import routes for illicit drugs: synthetic drugs are brought into Latvia from the neighbouring Baltic countries, Poland, Belgium, the Netherlands and Germany; herbal cannabis and cannabis resin are imported from the Netherlands, UK, Spain, Germany, Lithuania, Poland and also from the south of the Russian Federation. Latvia is also used for cocaine transit from South America to Russia and the Scandinavian countries via sea or air. Heroin enters the country from countries in Central Asia and the Russian Federation mainly by air and land, and is further transported to western Europe, Lithuania, Poland and the Scandinavian countries. In 2010, eight cannabis plants growing sites and a methadone production laboratory were seized in Latvia. New psychotropic substances available in Latvia are mainly produced in China.

Data on drug seizures, which combine data from all law-enforcement agencies, are provided by the Forensic Service Department of the State Police. In 2010, the record amount of seized cocaine at 206 kg was reported, and most of it was transiting through Latvia to its destination countries. Also, quantities of all cannabis products seized in 2010 increased, which is mainly attributed to discovery of the domestic production sites. Quantities of seized amphetamines have declined sharply in 2007–10, following a record amount of 11 kg seized in 2006. At the same time, a steady increase in the seized amounts of methamphetamine was noted between 2003 and 2008, when 32 kg of the substance was seized, while in 2009 and 2010 the quantities of seized methamphetamine dropped to 8 kg. In 2010, the national authorities reported seizing 1 kg of heroin; which is less than in 2007 and 2008 (2 kg).  The emerging market of new substances might be responsible for the declining proportion of some synthetic drugs in the market.

According to information from the Ministry of the Interior, in 2010, there were a total of 4 817 drug-related offences reported. About 73.15 % of reports were use-related offences. With regards to the substances involved, the registered offences were linked mainly to cannabis, heroin, methamphetamine and ecstasy-type substances. 

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National drug laws

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 for up to two years. Since 2004, the court may impose treatment with a suspended sentence, or release an addict from detention if he or she has agreed to undergo treatment, but there is no underlying control mechanism 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 2009–10, 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.

View ‘Legal profile’ for additional information.

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National drug strategy

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. The new programme is consistent with the EU drug policy and also with several national planning documents. 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.

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Coordination mechanism in the field of drugs

The Drug Control and Drug Addiction Restriction Coordination Council, chaired by the Prime Minister and comprised of seven ministers and several national experts, is responsible for coordinating and reviewing national actions. It supervises four ad-hoc groups, which work on supply reduction, demand reduction, legal turnover and information analysis. 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.

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Public expenditure

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 Latvian total drug-related labelled public expenditure (²) was estimated at representing 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 reporting on the trends of drug-related public expenditures in Latvia.

(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.

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Drug-related research

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 2011 Latvian National report mainly focused on aspects related to the prevalence of drug use, but research on responses to drug use and on consequences and determinants of drug use was also highlighted.

View ‘Drug-related research’ for additional information.

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