mkdir() [function.mkdir]: Permission denied in /home/admin/domains/pasidomek.lt/public_html/Ip/Lib/less.php/Cache.php:154file_put_contents(/home/admin/domains/pasidomek.lt/public_html/Theme/ZTA/assets/theme.css) [function.file-put-contents]: failed to open stream: Permission denied in /home/admin/domains/pasidomek.lt/public_html/Ip/Internal/Design/LessCompiler.php:180 III. Rights of Persons Addicted to Psychotropic Agents

Rights of Stigmatized Groups

III. Rights of Persons Addicted to Psychotropic Agents

Pharmacotherapy using medical opioids[1] to treat opioid addiction was first introduced in 1964, with Lithuania adopting it in 1995. In Lithuania, this sort of treatment is referred to as substitution maintenance therapy. The main purpose of such therapy is to improve and normalize the mental and physical condition, social adaptation and integration into society of people suffering from opioid dependence, as well as reduce the harm associated with drug use. This treatment usually offered by centres for addictive disorders as well as some mental health centres. 

After serving their prison sentence, persons will return to society, which is why terminating treatment or not offering it on time results in a variety of threats to both the individuals concerned and to society at large – from health problems to criminal recidivism.

Opioids are the most widespread of narcotic drugs; they can be natural (such as morphine and codeine, which are obtained from poppies), synthetic (some painkillers) and semi-synthetic (for example, heroin). 

According to the State Mental Health Centre, there were 4619 persons registered in Lithuania with mental or behavioural disorders because of opioid abuse in 2013,[2] of which only 539 were undergoing substitution maintenance therapy.[3]

According to the National Audit Office, compared to other European countries, the availability of substitution treatment in Lithuania is limited, since only specialized treatment centres are able to offer it – that is, centres for addictive disorders and primary mental health care centres.[4] Furthermore, not all centres for addictive disorders and primary mental health care centres offer substitution treatment – for example, in 2014 these services were offered by 4 out of 5 centres for addictive disorders and 15 out of 89 primary mental health care centres.

In Lithuania, the use of substitution therapy kept spreading up until 2010-2011. The activities of the UN Office on Drugs and Crime had a hand in this development – in 2006, substitution therapy was offered in 6 municipalities, whereas this number rose to 13 by 2010.[5] Following the withdrawal of support from the UN Drug and Crime Office in 2011, the spread of the availability of this therapy stopped. Nowadays, only 12 out of 60 municipalities offer substitution therapy; in addition, the centres offering these services are not distributed evenly, which is why some individuals have no access to them at all. 

The Law on the Rights of Patients and Compensation of the Damage to Their Health provides that persons have a right to access to health care.[6] This means that persons must be ensured access to these services with respect to their location, and that the continuity of their treatment must be guaranteed in the event of their incarceration. 

Opioids are the most widespread of narcotic drugs; they can be natural (such as morphine and codeine, which are obtained from poppies), synthetic (some painkillers) and semi-synthetic (for example, heroin).

Even though Lithuania was one of the first post-Soviet countries to employ harm reduction programmes with respect to drugs (also known as low-threshold treatment), very little attention is paid to this problem today: there were only 10 needle and syringe exchange offices operating in the country in 2014 (12 in 2010); most offices offer only a very limited range of services, are open for just a few hours a day, often run out of tools or even money for wages due to the fact that they have no regular funding. The visits to those offices and the range of available services have been steadily declining since 2010, when the UN Office on Drugs and Crime withdrew its support from Lithuania. With reference to the World Health Organization's recommendations, HIV prevention is only effective when these services reach at least 60% of the injecting drug users. This actual figure in Lithuania is almost three times lower.

Rapid HIV screening tests used in low-threshold offices to test for HIV in persons that are at the highest risk of infection are funded solely through contributions from a foreign donor; furthermore, the funds are procured and testing is organized solely through the efforts of NGOs. Only three or four municipalities regularly allocates funding to these services. Since 2013, the state has allocated 146 thousand LTL (around 42 thousand Euro) each year to low-threshold services, which is realistically enough to ensure the minimal maintenance of two offices at most. Furthermore, the reality of the situation is that only a small proportion of these funds are actually made use of due to unfavourable conditions of the tendering process. This way, the state is deliberately risking an HIV/AIDS epidemic and playing with national security, despite the fact that back in 2002 Parliament had adopted resolution titled "On the Prevention of Drug Addiction in Lithuania", declaring drug addiction and AIDS to be factors that threaten national security.[7]

 One of the main challenges in the fight against HIV is the transmission of HIV related to the use of injection drugs: the prevalence of HIV infection in Lithuania is now approaching 0.01% of the population. Syringe and needle exchange programmes, addiction therapy using medical opioids and HIV testing are in practice the most important and necessary means to effectively prevent HIV in injecting drug users. These measures are included in the World Health Organization package of the most important interventions based on science and must be used together to effectively reduce the spread of HIV.[8] This package is approved by all major international organizations that are active in the field of HIV prevention: UNAIDS, the UN Office on Drugs and Crime, the UN General Assembly, the UN Commission on Narcotic Drugs, the European Economic and Social Committee (EU) as well as the Global Fund to Fight AIDS, Tuberculosis and Malaria.

 The consumption of psychotropic agents in Lithuanian prisons presents a two-fold problem. On the one hand, it is in places of detention that a lot of people get their first taste of drugs, where high levels of stress and lack of positive mental stimulation facilitate addiction. On the other hand, prisons focus on finding and controlling drugs, with limited success, but completely fail to understand the need for and benefits of addiction therapy, together with the potential harm to the person (and to society, once said person is free) caused by refusing or terminating treatment. In 2009, records show that there were 740 persons in places of detention with mental or behavioural disorders caused by opioid abuse.[9] Therapy using medicinal opioid agents that persons receive outside of places of detention is not continued upon imprisonment – that is, the continuity of treatment is not ensured. The abrupt termination of treatment causes serious harm to a person's health. This practice is incompatible with the aforementioned provision of the Law on the Rights of Patients and Compensation of the Damage to Their Health, which states that free state health care encompasses the health care of individuals detained by the courts or law enforcement authorities, of persons held in pre-trial detention and of convicted persons; as well as the health care of persons with a dependence on alcohol or drugs.[10] Attention is also drawn to the Code of the Enforcement of Punishments, which states that imprisoned convicts suffering from addiction to alcohol, narcotics or psychotropic substances may, upon submitting a written request, be treated for these addictions while serving their prison sentence.[11]

In 2010, implementing the UN Office on Drugs and Crime Office project, therapy using medical opioids was, for the first time ever in Lithuania, continued for people in police custody of Vilnius City Commissariat. As such, today persons who have begun their substitution therapy prior to their arrest can only continue it while they are still in police custody. Persons who are addicted to opioids and imprisoned in places of detention managed by the Prison Department are not given access to substitution therapy, without ensuring the continuity of any prior substitution treatment and providing the same level of health care as is available to people outside of prison. The availability of substitution therapy in all the places of detention would reduce the risks associated with the consumption and proliferation of drugs, as well as the transmission of dangerous infectious diseases in prison.[12] Furthermore, after serving their prison sentence, persons will return to society, which is why terminating treatment or not offering it on time results in a variety of threats to both the individuals concerned and to society at large – from health problems to criminal recidivism.

Findings and Recommendations 

  • The state and municipalities should increase the level of regular funding of offices offering low-threshold services to injecting drug users, ensuring that these services reach at least 60% of all injecting drug users and enabling as many people as possible to access therapy using medical opioids.
  • Lithuania does not ensure that people serving time in places of detention managed by the Prison Department have equal access to health care as people outside of prison. We recommend ensuring that pharmacotherapy using medical opioids is available to persons in places of detention.

[1] Opioids are the most widespread of narcotic drugs; they can be natural (such as morphine and codeine, which are obtained from poppies), synthetic (some painkillers) and semi-synthetic (for example, heroin)

[2] State Mental Health Centre, End-of-year distribution of mental and behavioural disorders when using drugs (F11-F19) according to drug group, 30 October 2014, http://www.vpsc.lt/index.php?option=com_content&view=article&id=36%3Aligotumo-narkomanija-dinamika-lietuvos-respublikoje-1999-2009-m-100-000-gyv&catid=11%3Apriklausomybs-lig-statistika&Itemid=22&lang=lt

[3] Drug, Tobacco and Alcohol Control Department, Annual Report 2014, published in 2014, p. 59, http://www.ntakd.lt/files/informacine_medzega/0-NTAKD_medziaga/1-MP/2014_LT.pdf

[4] National Audit Office, "Report on the study of the consumption of methadone in Lithuania in 2009-2010", 30 November 2011, No. VA-P-10-10-19, https://vkontrole.lt/failas.aspx?id=2476

[5] Project of the UN Office on Drugs and Crime titled "Prevention of HIV/AIDS among the users of injecting drugs and their care in Estonian, Latvian and Lithuanian places of detention, http://www.unodc.org/documents/balticstates/GrantDocuments/Seminar_20080619.pdf

[6] Law on the Rights of Patients and Compensation of the Damage to Their Health, 3 October 1996, No. I-1562, http://www3.lrs.lt/pls/inter3/dokpaieska.showdoc_l?p_id=477161

[7] Resolution of the Seimas "On the Prevention of Drug Addiction in Lithuania", 24 January 2002, https://www.e-tar.lt/portal/lt/legalAct/TAR.259607F3B43A

[8] World Health Organization, UN Office on Drugs and Crime, UNAIDS, “Technical guide for countries to set targets for universal access to HIV prevention, treatment and care injecting drug users", 2012, p. 10-21, http://www.who.int/hiv/pub/idu/targets_universal_access/en/

[9] Drug Control Department, Annual Report, published in 2010, p.112-114, http://www.ntakd.lt/files/informacine_medzega/0-NTAKD_medziaga/1-MP/2012_LT.pdf

[10] Law on the Health System, 19 July 1994, No. I-55247, Article 47, http://www3.lrs.lt/pls/inter3/dokpaieska.showdoc_l?p_id=454090

[11] Law on the Enforcement of Punishments, 27 June 2002, No. IX-994, Article 175, http://www3.lrs.lt/pls/inter3/dokpaieska.showdoc_l?p_id=494004

[12] National Audit Office, "Report on the study of the consumption of methadone in Lithuania in 2009-2010", 30 November 2011, No. VA-P-10-10-19, https://vkontrole.lt/failas.aspx?id=2476  


Cannot modify header information - headers already sent by (output started at /home/admin/domains/pasidomek.lt/public_html/Ip/Internal/ErrorHandler.php:62) in /home/admin/domains/pasidomek.lt/public_html/Plugin/ZTABase/Model.php:8 II. Rights of Migrants IV. Rights of HIV-positive Individuals