Opioids in Lithuania

In 2016, it was estimated that there were around 7 500 high-risk opioid users, that is 3.92 per 1 000 of the population aged 15-64 years. The estimated number of people who inject drugs (opioids and stimulants) was around 8 900 (4.63 per 1 000 aged 15-64 years).


Data from specialised treatment centres indicate that opioids, mainly heroin, were the most commonly reported primary substance for all and first-time clients entering treatment in 2017. Between 2015 and 2017, a decrease was observed among the number of first-time treatment clients reporting primary use of opioids or of amphetamine/methamphetamine; the increase in the number of cannabis users seeking treatment for the first time reported up until 2016 did not continue in 2017.

 

Injection remains the main route of drug administration among heroin and amphetamines users entering treatment. Approximately one fifth of clients entering treatment are female; however, the proportion varies by primary drug used.

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The vast majority of the victims in 2017 were male. The mean age at death was 36 years; this figure has increased in recent years. Opioids remained the primary substances involved in 9 out of 10 deaths with known toxicology results (mainly heroin, but also methadone, fentanyl and carfentanil). Almost half of the fatalities occurred in the capital, Vilnius.

 

The drug-induced mortality rate among adults (15-64 years) was 44 deaths per million in 2017, double the European average of 22 deaths per
million.

Treatment provision
In 2017, a total of 1 697 people entered treatment, the majority of whom were treated in outpatient settings. Regardless of treatment setting, the majority of clients sought treatment as a result of the use of opioids, mainly heroin.


On 31 December 2017, a total of 1 136 clients were receiving OST in Lithuania, about 100 fewer than in 2016. The majority of OST clients were treated with methadone. Methadone maintenance is continued for clients in police custody.

Among the new psychoactive substances, the most commonly seized drugs are synthetic cathinones and synthetic cannabinoids.

 

Furthermore, the number of trafficking cases linked to carfentanil, a potent synthetic opioid, and the quantities seized have sharply increased in recent years.

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Prevalence of high-risk drug use and coverage of opioid substitution treatment and needle and syringe programs in Lithuania in 2015–2016

Journal of Substance Abuse Treatment, March 2021

In Lithuania, injecting heroin and other illicit opioids has dominated high-risk drug use since about 2000. More recently, patients have reported a high-risk use of amphetamines. Newly diagnosed HIV cases among people who inject drugs peaked in 2002 and 2009 and drug-related deaths have been on the increase. Yet research has reported a limited number of available harm-reduction programs. This study aimed to estimate the size of high-risk drug using populations in Lithuania and to apply these estimates in assessing the coverage of opioid substitution treatment (OST) and needle and syringe programs (NSP).

There were between 4854 and 12,444 high-risk opioid users (HROU) and between 8371 and 10,474 people who inject drugs (PWID) in Lithuania in 2015/2016. In addition, study authors obtained a preliminary estimate of 4742–7000 high-risk amphetamine users. This constitutes around 2.5–6.5 HROU and 4.4–5.3 PWID per 1000 inhabitants aged 15–64. On average, 9.9–25.5% of HROUs were in opioid substitution treatment (OST) and an average PWID in Lithuania obtained 19–29 syringes via NSPs during the study period.

While the current prevalence of high-risk drug use in Lithuania is comparable to other European countries and for PWID, it is above the average; and the coverage of OST and NSP services in this population is markedly lower than in most countries of the European Union and warrants further investment.

Toxicologist explains the nature of drug use in Lithuania

Technologijos, May 2020

Doctor of Vilnius Republic University Hospital (RVUL) toxicologist Dr. Robertas Badaras explains the nature of drug use among Lithuanians.

 

"European Union research has shown that one-fifth of people have used prescription drugs without a prescription. In Lithuania, adolescents aged 15-16 lag behind all other EU countries regarding over-the-counter medication use, except for one position. Compared to other EU countries, teenage girls are almost three times more likely to use non-prescription sedatives," said the toxicologist.

Drug dependence is most commonly acquired by people using painkillers. The main problem with these medications is that they cannot be stopped abruptly because of the immediate withdrawal symptoms. Opioid doses then increase, and the pain threshold lowers.

"The first question to ask a patient who may be addicted to opioids is how many times a week or a month do you defecate? These drugs affect the peristalsis of the gastrointestinal tract and, even if they are not stopped, but the dose can be reduced, the intestinal function can be improved," said Dr R. Badaras.

Another phenomenon is "drunk medicine". These are patients who consume alcohol all day and medication in the evening, and so on daily, the doctor says. And while it's a deadly combination, there are a lot of people doing it.

Comparing Lithuania with the Baltic and Scandinavian countries, we consume three times more benzodiazepines.


"Abrupt discontinuation of benzodiazepines results in severe abstinence. It is a psychoactive substance that cannot be stopped quickly. It should be stopped by gradually reducing the dose. If it succeeds in half a year, the result is very good, "said the toxicologist.

 

But why does it happen that a person becomes addicted to benzodiazepines? The answer is not simple - they are not used according to the doctor's prescription and medication instructions, but according to what the patient feels best.

“The first thing a Lithuanian does after buying medicines is to open the box and throw away the instructions. I have an acquaintance who takes 20 tablets of sleeping pills a day. He has been taking those medicines for many years, and the fact that the instructions say that they cannot be used for more than four weeks is not even known to a person because he has not read, ”said Dr R. Badaras.

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