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.
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
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.
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.
Republican Centre for Addictive Disorders: Overdose deaths in Lithuania and what is being one about it
Republican Centre for Addictive Disorders, August 2020
The number of overdose deaths in Lithuania, which has long been among the highest in Europe, in 2016 began to decline. The most significant contributor to the change was the service of naloxone, an opioid antidote, at the Republican Center for Addiction.
Almost 10,000 Europeans die from overdoses every year, compared to about 100 a year in Lithuania. In many cases in our country, this has to do with opioid drugs, including fentanyl, a heroin substitute that is now very popular and flooding the drug market, and, in particular, injecting drug use. "Injecting is the most dangerous due to the spread of HIV and viral hepatitis, venous and circulatory disorders, and the likelihood of sepsis. However, this is also one reason why the number of overdose deaths in Lithuania has always been high - compared to, e.g. The Netherlands, where only about 2% inject. In Lithuania, the situation for people using opioid drugs remains the opposite - 93 per cent of users are injecting opioids," says Morgana Daniele, RPLC's public relations specialist.
"Naloxone is a safe drug that can save lives. If there is a person using opioids in the immediate vicinity, there is a good chance that this medicine may be needed. The service is free, works in all our branches all year round, and the consultation lasts only 15 minutes". The centre's specialist regrets that the cheap and effective service is still difficult to access in Lithuania - the Addiction Center reaches only those who are already seeking treatment. "The risk of an overdose in a person taking heroin and especially fentanyl is very high, and by the day he seeks treatment, sometimes ten or more years pass. Many young people die in this way without even reaching specialists. Therefore, this service should be provided in low-threshold offices, and naloxone could be discussed more widely by family doctors and psychiatrists," says M. Danielė.
During 2019, RPLC affiliates distributed over 2,000 naloxone kits. Since 2016 the service has been implemented by the RPLC in five Lithuanian cities. It has significantly contributed to the decrease in the number of deaths - it dropped by almost half (in 2015, 115 such deaths were recorded, in 2018 - 59). "Despite all our efforts, the scope of the service is currently critically low - since February, the RPLC branch in Vilnius no longer provides low-threshold services, the component of which was overdose prevention. Due to legal barriers, people who use drugs and their families in the capital are left without life-threatening help without the low-threshold offices taking over this service," the specialist lamented.
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.