The development of new treatment options and increasing the quality of, and expanding the provision of, existing treatment services are among the priorities of the current national drug strategy. The national coordination body for drug treatment in Latvia is the Riga Centre of Psychiatry and Dependencies, which is responsible for the delivery, accreditation, monitoring and evaluation of drug treatment. 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 social rehabilitation is also provided through funds from the Ministry of Welfare. Drug treatment may also be delivered by private profit-making organisations, and is regulated by the Medical Treatment Law.
Drug treatment is available in outpatient and inpatient clinics. Outpatient drug treatment services are provided by narcologists in specialised public or private treatment centres and the services usually address all forms of dependencies. Several low-threshold services provide some psychosocial interventions and counselling to drug users; however, these are not classified as drug treatment facilities in Latvia. Inpatient treatment is provided by specialised psychiatric hospitals and by regional and local multi-profile hospitals, which are either publicly or privately funded. If treatment is provided by private institutions or practices, the client must fully cover the costs of the service. Outpatient services provide mainly psychosocial intervention, cognitive-behavioural therapy, motivational interventions and opioid substitution treatment (OST). Inpatient facilities offer emergency care in the event of an overdose, detoxification and short-term psychosocial interventions. Long-term rehabilitation based on the principle of the ‘therapeutic community’ is also offered.
OST with methadone has been available since 1996, and treatment with buprenorphine was introduced in 2005. In recent years, the availability of OST has expanded beyond the capital city, and it can be prescribed at any inpatient clinic provided that it has a Council of Physicians including at least two narcologists. Methadone is provided free of charge by the state, while buprenorphine is available at the patient’s expense.
In 2017, 2 590 clients received drug treatment in Latvia, most of whom were treated in outpatient settings.
In 2017, the primary use of opioids, mainly heroin, remained the principal reason for treatment entry among all clients admitted to treatment, followed by the primary use of cannabis, which was reported by nearly 3 out of 10 people entering treatment. The increase in opioid clients entering public specialised treatment observed up to 2016 did not continue in 2017. However, there are indications of an increase in the number of drug clients receiving treatment for the use of different types of fentanyl.
The geographical expansion of OST, combined with changes in the legal framework, contributed to a substantial increase in the number of OST clients between 2006 and 2017, although OST coverage in Latvia remains among the lowest in the European Union. In 2017, almost 700 clients received OST, mainly with methadone.