2013 NATIONAL REPORT (2012 data) TO THE EMCDDA by the Reitox National Focal Point „LATVIA’’ New developments, trends and in- depth information on selected issues Reitox 2013 FOREWORD 2013 National Report, new developments, trends and in–depth information on selected issues is one of the national annual reports compiled by the National Focal Points in the European Information Network on Drugs and Drug Addiction (REITOX) which is co-ordinated by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). The national reports form the basis for the EMCDDA’s annual report The state of the drugs problem in Europe. The national reports are compiled in accordance with the guidelines provided by the EMCDDA. The Latvian National Report discusses recent developments and research data from 2012 and early 2013. The sections that describe the drug situation during the past year (drug experimentation, problem drug use, health and social correlates and consequences, availability and supply of drugs) are linked with discussion on related societal interventions (prevention, treatment, harm reduction, social reintegration and control). Each section begins with background information on the subject and the latest data is discussed in the subsections. The length of the sections in the report depends on the amount of data available on each subject area. Head of Addiction Monitoring Division Aija Pelne (Centre for Disease Prevention and Control of Latvia) wrote Section 3 and Subsections 5.1. and 5.2. Anda Karnite (Riga Stradins University) wrote Subsection 6.1 and 7.2. Agnese Zīle- Veisberga (Ministry of the Interior of Republic of Latvia) wrote Section 9 and 10. We thank them warmly. The report was compiled and the remaining sections written by Ieva Pūgule, Mārcis Trapencieris, Linda Sīle and Ildze Redoviča at the Latvian Reitox National Focal Point, which operates at the Centre for Disease Prevention and Control of Latvia. Research data and comments from experts on different areas of the drug issue were used in drafting the report. We thank all the experts for their contribution and comments. The report has been approved by the deputy director of Centre for Disease Prevention and Control of Latvia/ EMCDDA Management Board member Dr. Dzintars Mozgis and the director of Centre Mrs. Inga Šmate. Riga, November 2013 Centre for Disease Prevention and Control of Latvia* 22 Duntes Street, Riga LV-1005, Latvia Tel.: +371 67043700 Fax.: +371 67043701 e-mail: [email protected] www.spkc.gov.lv *Centre for Disease Prevention and Control of Latvia was established on 1 April 2012. Centre is supervised by Ministry of Health and is aimed at strengthening Latvia’s public health system, preventing diseases, including infectious and rare diseases. 2 This report was written by: Ieva Pūgule Head of Latvian NFP, Centre for Disease Prevention and Control of Latvia Ildze Redoviča Researcher, Centre for Centre for Disease Prevention and Control of Latvia Linda Sīle Public Health Analyst, Centre for Disease Prevention and Control of Latvia Aija Pelne Head of Addiction Monitoring Division, Centre for Disease Prevention and Control of Latvia Agnese Zīle- Veisberga Ministry of the Interior of Republic of Latvia Anda Karnīte Department of Public Health and Epidemiology, Riga Stradins University Mārcis Trapencieris University of Latvia Philosophy and Sociology Institute We would specially like to thank the following: Astrīda Stirna Riga Psychiatry and Addiction Centre Jānis Bekmanis Ministry of the Interior of Republic of Latvia, National Drug coordinator Santa Pildava Centre for Disease Prevention and Control of Latvia Diāna Vanaga Centre for Disease Prevention and Control of Latvia Sniedze Karlsone Centre for Disease Prevention and Control of Latvia Agnese Freimane Centre for Disease Prevention and Control of Latvia Raina Ņikiforova Centre for Disease Prevention and Control of Latvia Inga Martinova Latvia State Centre for Forensic Medical Examination Inga Vovere The State Police Angelīna Gribova The State Police Please use the following citation: Centre for Disease Prevention and Control of Latvia (2013), 2013 National Report (2012 data) to the EMCDDA by the Reitox National Focal Point. Latvia: new developments, trends and in-depth information on selected issues. Riga: Centre for Disease Prevention and Control of Latvia 3 List of Abbreviations AIDS Acquired Immune Deficiency Syndrome ART Antiretroviral treatment BST Buprenorphine Substitution Treatment CA Court Administration CDPC Centre for Disease Prevention and Control of Latvia CHE The Centre of Health Economics CM Latvian Cabinet of Ministers CRPI Children's Rights Protection Inspectorate DHPP Department of Health Promotion and Prevention DRD Drug related deaths DRID Drug-related Infectious Diseases EC European Commission ECAD European Cities against Drugs EMCDDA European Monitoring Centre for Drugs and Drug Addiction ESPAD European school survey project on alcohol and other drugs EU European Union GMR General Mortality Register GPS General Population Survey HBV Hepatitis B virus HCV Hepatitis C virus HIV Human Immuno-deficiency Virus HSD Health Statistics Department IDU Injecting drug use ICD-10 International Classification of Diseases (10th revision) INCB International Narcotics Control Board LaSPAD National School Survey on Alcohol and other Drugs LNFP Latvian National Focal Point LPA Latvian Prison Administration LSCFME Latvian State Centre for Forensic Medical Examination MCA Monitoring Centre for Addiction MI Ministry of the Interior MMT Methadone maintenance therapy NAF National Armed Forces NFP National Focal Point NGO Non-Governmental Organisation PDU Problem Drug use PLHIV People living with HIV/AIDS PREDA Patient REgister DAta RPAC Riga Psychiatry and Addiction Centre SEA State Employment Agency SPS State Probation Service STD Sexually transmitted diseases STSDA Sexually Transmitted and Skin Diseases State Agency TDI Treatment Demand Indicator UNODC United Nations Office on Drugs and Crime WHO World Health Organization 4 Table of contents SUMMARY ......................................................................................................................................................... 6 PART A: NEW DEVELOPMENTS AND TRENDS .......................................................................................... 10 1. DRUG POLICY: LEGISLATION, STRATEGIES AND ECONOMIC ANALYSIS…………………………………………… 10 1.1. Legal framework………………………………………………………………………………………………………….. 10 1.2 National action plan, strategy, evaluation and coordination............................................................................. 12 2. DRUG USE IN THE GENERAL POPULATION AND SPECIFIC TARGETED GROUPS…………………………………… 14 2.1. Drug use in the general population……………………………………………………………………………………. 14 2.2. Drug Use in the school and youth population………………………………………………………………………… 20 3. PREVENTION………………………………………………………………………………………………………. 24 3.1. Environmental prevention……………………………………………………………………………………………….. 25 3.2. Universal prevention……………………………………………………………………………………………………...26 3.3. Selective prevention in at-risks groups and settings…………………………………………………………………. 32 3.4. Indicated prevention……………………………………………………………………………………………………… 33 3.5. National and local media campaigns.................................................................................................................34 4. PROBLEM DRUG USE………………………………………………………………………………………………36 4.1. Prevelence and incidence estimates of PDU………………………………………………………………………….. 36 4.2. Data on PDUs from non-treatment sources…………………………………………………………………………... 37 5. DRUG-RELATED TREATMENT: TREATMENT DEMAND AND TREATMENT AVAILABILITY…………………………….. 40 5.1. Strategy and policy……………………………………………………………………………………………………….. 40 5.2. Treatment systems………………………………………………………………………………………………………… 41 5.3. Access to treatment………………………………………………………………………………………………………..43 6. HEALTH CORRELATES AND CONSEQUENCES……………………………………………………………………... 60 6.1. Drug-related infectious diseases……………………………………………………………………………………….. 60 6.2. Other drug-related health correlates and consequences……………………………………………………………. 73 6.3. Drug related deaths and mortality of drug users…………………………………………………………………….. 74 7. RESPONSES TO HEALTH CORRELATES AND CONSEQUENCES……………………………………………………. 78 7.1. Prevention of drug related emergencies and reduction of drug-related deaths…………………………………. 78 7.2. Prevention and treatment of drug-related infectious diseases……………………………………………………… 78 8. SOCIAL CORRELATES AND SOCIAL REINTEGRATION……………………………………………………………… 81 8.1. Social exclusion and drug use………………………………………………………………………………………….. 81 8.2. Social reintegration……………………………………………………………………………………………………… 83 9. DRUG-RELATED CRIME, PREVENTION OF DRUG RELATED CRIME AND, PRISON………………………………….. 84 9.1. Drug- related crime………………………………………………………………………………………………………. 85 9.2. Drug law offences………………………………………………………………………………………………………… 86 9.3. Other drug- related crime……………………………………………………………………………………………….. 91 9.4. Prevention of drug- related crime……………………………………………………………………………………… 91 9.5. Interventions in the criminal justice system…………………………………………………………………………… 92 9.6. Drug use and problem drug use in prisons…………………………………………………………………………….93 9.7. Respnses to drug- related health issues in prisons…………………………………………………………………… 95 9.8. Reintegration of drug users after release form prison………………………………………………………………. 97 10. DRUG MARKETS…………………………………………………………………………………………………. 99 10.1. Availability and Supply..................................................................................................................................