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LITHUANIA: NATIONAL PROGRAMME 2018-2028

LITHUANIA

NATIONAL DRUG, TOBACCO AND ALCOHOL CONTROL

AND USE PREVENTION PROGRAMME 2018-2028

The national Drug, Tobacco and Alcohol Control and use Prevention Programme 2018–2028 is a strategic document that provides long-term national goals, priorities and commitment to apply a health-based approach to the use of psychoactive substances (drugs, tobacco and alcohol) and to help people protect or recover their health, well-being and the quality of life. This long-term document is the result of a joint work by officially formed interinstitutional and intersectoral working groups, based on the evaluation of external experts and the inclusion of public opinion survey.


Strategic goal A healthier and safer country where every person is able to receive help while avoiding or reducing alcohol, tobacco or drugs related harm and where opportunities to take care of the health, social and economic well-being of one's own, family or community members are provided.

Mission Human-centred, integral, contextual policy development based on validated scientific and factual data and coordinated solutions that create prerequisites and enable people to address the health, rights, education, social and other issues related to the use of psychoactive substances by them or their close ones.


Core principles

Fostering of human rights Respect for human dignity, liberty, democracy, equality, right to education, health care, social security and equal access to services.

Individual approach Assessment of the personal, social, cultural, situational risk factors, measures applied on its basis in the immediate environment; proportionate and effective measures for person's criminal behaviour related to the use of psychoactive substances.

Service quality

Purposeful funding and provision of services (prevention, treatment, rehabilitation, social integration, harm reduction) that meets national and international quality standards and different society needs.

Balanced policy and responsible management Coordinated, cost-effective, innovative, evidence-based solutions for problems involving legal, illicit psychoactive substances and their cross-sectoral implementation, while maintaining the balance between supply and demand.

Comprehensiveness and continuity Integrated and systematic approach to human security and risk management, consistent implementation and review of policy related to the use of psychoactive substances and openness in applying the international experience.

Partnership and unified vision Promotion of partnership between public and non-governmental sectors, local communities, regions in the integrated and coordinated manner at

the national and international levels.


Prevention Intervention Treatment

Rehabilitation Reintegration

DEMAND REDUCTION SUPPLY REDUCTION

Alcohol, tobacco and tobacco related

products Narcotic and

psychotropic substances Criminal policy

HARM

REDUCTION

Infectious diseases Overdose

Community Prisons

Nightlife settings

MONITORING

Policy cornerstones

Reducing demand, which is understood as equally important and complementary prevention, intervention, treatment, psychological and social rehabilitation and reintegration measures aimed at preventing or delaying the onset of use of psychoactive substances among young people, motivating the people to change their behaviour, helping the addicts of psychoactive substances for their return and successful integration into the society. Reducing supply, which is understood as the instruments of state regulation, instrumental, methodological, motivational, international cooperation aimed at managing legal substances and imposing physical and economical limitations on availability of illicit psychoactive substances by effectively using the control and criminal justice systems.

Reducing harm, which is seen as an effective risk management tools and support for addicts aimed at reduction of direct and indirect damage related to the use of drugs and psychotropic substances to the individual or society.

Monitoring, which is understood as the collection and evaluation of reliable, high-quality and comparable information, aiming at improving data-based decision making, recognizing the scientific evaluation of policies and interventions, strengthening the information exchange at national and international levels, supporting and enhancing the research on psychoactive substances.


Goals, objectives and tasks of the Programme

Prevention

The first goal of the Programme is prevention based on different needs, contextual and scientific data, accessible to everyone, focused on the development and protection of a healthy and safe society.

1. Consistent application of prevention tools for the use of psychoactive substances for different age groups, and other social factors that address the interests and needs of children and young people, and responds to the new challenges. Areas for implementation of this task:

extended offer of programmes for general prevention of the use of psychoactive substances based on children's age and topics, their implementation and introduction in educational, health, social services institutions and NGOs;

development and implementation of preventive measures for the use of psychoactive substances were for students at higher education institutions;

increased supply and availability of non-formal and informal education and training programmes and content for children and young people;

newly designed or adapted, implemented precautionary measures for the prevention of use of psychoactive substances for children of addictive parents, gambling, drug abuse, new psychoactive substances;

the variety of early intervention services, their forms and provision, and availability for irregular users, experimenting children and young people.

2. Responsible parents and other close relatives of children with knowledge and skills actively involved in the process of the prevention of the use of psychoactive substances. Areas for implementation of this task:

development of effective parenting skills to help children understand the peculiarities of children's development, to choose effective parenting strategies, to build positive family relationships and to enhance self-confidence;

creation of a system for helping parents having children irregularly using psychoactive substances, to help them understand their role, develop their ability to respond adequately to life challenges and motivating them to participate in decision-making;


systematic provision of information, counselling and motivation services to risk

groups of parents (relatives of addicts, pregnant women) in order to secure the mental, social and physical well-being of them and their children.

3. Creation of legal, financial and organizational prerequisites for the

implementation and evaluation of qualitative (effective) preventive activities at all levels (institutional or organizational, municipal and national). Areas for implementation of this task:

development of accreditation system of preventive programmes and implementation at the national level;

legalisation and implementation of common standards of preventive action quality, improvement of competences of education, social and health care institutions, NGOs representatives;

real co-operation and collaboration of institutions, bodies and NGOs working in the field of prevention in each municipality's territory, working with different target groups.

4. Conscious and sustainable members of society concerned about their health, creating and sustaining their welfare and the welfare of others. Areas for implementation of this task:

wide and varied application of the range of public education tools geared towards awareness among its members and appropriate provisions on the use of psychoactive substances and the associated risks and consequences;

newly created and applied prevention measures that meet the latest challenges: development of gambling addiction, the use of new tobacco products, consequences and risk of mixing of several psychoactive substances, prevention of drinking and driving, and other relevant aspects;

a coherent strategy for the education of employers, organisers of amusement, leisure and mass events aimed at raising awareness and responsibility for the prevention of the use of psychoactive substances;

developed and practically applied programmes and tools for the prevention of the use of psychoactive substances for work, recreation, leisure activities, and mass events.

5. Performance of reliable monitoring of the implementation of prevention of the use of psychoactive substances, on the basis of which changes and the measures necessary for them are planned. Areas for implementation of this task:


development of a system-bank for monitoring the implementation of

preventive programmes and measures;

initiating and conduct periodic studies on the use of the Internet by children

and young people, the scale of gambling, their interactions with the use of

psychoactive substances, and other factors related to the development of

addiction;

creation and introduction of new quantitative and qualitative indicators for

measuring the quality, diversity and accessibility of non-formal education of

children;

introduction of new criteria for the measurement of content and scope of

complex services for families, and consistent recording of information

according to them;

consistent research carried out to measure changes, to assess the

effectiveness of preventive measures, the quality of their implementation and

their impact on different target groups.

Treatment, rehabilitation, social integration The second goal of the Programme is the availability of quality, tailor made, economically sustainable and scientifically based system of treatment, rehabilitation and reintegration services for people who harmfully use and/or are dependent on psychoactive substances.

1. Development of effective, individualized, tailor-made, early detection and referral system, as a system and continuous process of receiving treatment and other necessary services or assistance, due to dependence on the use of psychoactive substances or risky behaviour associated with the use of psychoactive substances. Areas for implementation of this task:

revised and adjusted legal regulation for the treatment of diseases caused by an addiction of psychoactive substances, including the reduction of legal and formal barriers and stigma associated with the use of psychoactive substances;

a network of health and social services (and/or tools) has been developed to ensure timely identification, information, advice, motivation, helping people who are harmfully using and/or addicted to psychoactive substances to receive the necessary and high quality assistance;


throughout the aid system, the science-based, accredited and cost-effective

methods and tools are applied to enable professionals in diverse areas to identify persons who are harmfully using and/or dependent on psychoactive substances as early as possible and to help receive the necessary assistance and/or treatment;

ensuring adequate coverage of specialists in various fields of expertise (health, education, social affairs), able to suspect, motivate and help obtain assistance.

2. Accessible, high-quality, cost-effective, accredited treatment, rehabilitation and reintegration services tailored to personal needs. Areas for implementation of this task:

an increasing number of people who seek help against problems related with the use of psychoactive substances and an increasing number of people who complete a full-term abstinence treatment programme and continue to receive treatment for medical rehabilitation, psychosocial treatment (Minnesota programme) and/or social and psychosocial rehabilitation programmes and successfully complete them;

developed specialist services for addicted patients with various diseases, thereby ensuring less stigma and discrimination against these people;

ensuring effective and high quality service standards (including, service standards for vulnerable groups of population such as women, children, etc.) and the introduction of a system of professional development and support for treatment, rehabilitation and reintegration;

developed and implemented programme for the provision of training and refresher training for social workers in order to help people who are harmfully using and/or addicted to psychoactive substances, and their family members;

developed provision of reintegration services in the country, ensuring the functioning of the connection between treatment and social services;

guaranteed treatment options for addictions (including opioid substitution treatment) in places of detention.

3. A legal environment has been created to ensure availability of services, monitoring and stigma reduction. Areas for implementation of this task:

an effective case transfer system based on human rights and economic sustainability, ensuring the coordination of health and social services;


a set of procedures at the municipal level that ensures the necessary assistance

to people who are harmfully using and/or dependent on psychoactive substances after returning after treatment and (or) rehabilitation, in terms of motivation, integration into the labour market, relapse prevention, and development of safe, continuous care in the living environment;

effective and coordinated system for financing the tools for availability of help to target group and stigma reduction measures implemented by community and volunteer groups;

effective and flexible procurement of services from the non-governmental and private sectors;

ensuring the payment of dependency disease treatment services from the PSDF's budget, taking into account the state's financial capabilities and the quotas established;

elimination of legal, medical diagnosis-based barriers to work, driving, receiving health and social services and ensuring that there is no discrimination in respect of the person receiving treatment services for the use and/or dependence of psychoactive substances;

measures and resources provided for persons dependent on psychoactive substances to support them in the labour market, motivating employers to preserve the work place while the person is being treated for addiction on psychoactive substances and/or participates in the programme of social psychological rehabilitation.

4. Collection of reliable, comparable, objective information on the prevalence of

psychoactive substance use, its consequences and the extent of addiction.

Areas for implementation of this task:

development of systems for data collection, improvement of data quality,

carrying out the research and organising pilot projects;

development of a low-threshold service monitoring system;

development of a system for the monitoring of addictive disease services,

integrated into the general monitoring system for medical services;

ensuring consistent monitoring of applied and proposed methods of

treatment, rehabilitation and reintegration, integrated into the overall system

for evaluating health technologies and social services.


Reducing the supply of alcohol, tobacco and tobacco related products

The third goal of the Programme is reduced the availability (physical and economic) of products related to alcohol, tobacco and tobacco products, in order to protect public and individual health.

1. The following tasks are raised to achieve the third goal of the Programme:

ensuring the continuity and impact assessment of measures restricting the availability of alcohol, tobacco and tobacco products;

excise policy that reduces the availability of alcohol and tobacco;

the licensing mechanism for activities with alcohol products and tobacco products is continuously improved, taking into account the practices applied by the EU, and ensuring the development of operators engaged in licensed activities in order to raise awareness of the development of socially responsible business;

regulated licensing mechanism of tobacco raw materials, tobacco-related products, and these products as an excise object;

implemented labelling of alcoholic beverages with warning signs or texts on alcohol damage, conditional number of units of alcohol;

implemented prohibition of direct display of tobacco products and related products at the points of sale, as well as the general packaging of tobacco products as unattractive to consumers;

efficient and unified monitoring mechanism is being implemented by the Drug, Tobacco and Alcohol Control Department at the national level;

improved border inspection procedures and other border control measures to strengthen the protection of the state border;

coordinated measures for the prevention of illicit tobacco and alcohol are constantly being implemented;

consistent education to the society, promoting intolerance of law abuses related to illicit tobacco and alcohol turnover;

methods and tools for increasing the efficiency of the investigation of crimes on the Internet in the area of illicit tobacco and alcohol turnover;

ongoing education of local government representatives encouraging municipalities to actively use their rights to restrict the availability of alcohol and tobacco.


Reducing the supply of narcotic and psychotropic substances

The fourth goal of the Programme is enhanced public safety and health through modern and innovative solutions in order to reduce the availability of narcotic and psychotropic substances.

1. Strengthened state border control. Areas for implementation of this task:

integrated risk profiling systems developed and installed;

efficient interinstitutional and cross-border exchange of information insert;

inspection bodies equipped with the necessary personnel, equipment and technique;

legal and organizational conditions for the effective control of goods and vehicles crossing the frontier provided.

2. Effective drug control implemented in places of imprisonment. Areas for implementation of this task:

increased human resources and staff motivation;

modern equipment is used to identify prohibited substances.

3. Ongoing effective fight against the phenomenon of drug supply. Areas for implementation of this task:

enhancing the ability of officials in the fields of criminal intelligence, detection of unlawful laboratories and disclosure of cannabis growing sites and the profiling of persons involved in smuggling, introduction and application of good practice of other countries;

introduced procedure for reimbursement of damages caused by legal actions of officials;

in the work of law enforcement agencies, priority is given to the disclosure and investigation of crimes related to the illicit possession of narcotic drugs or psychotropic substances with the aim of distributing them, i.e. organized criminal groups;

legal arrangements introduced for the confiscation of crypto currencies;

developed and strengthened cooperation between law enforcement agencies, competent state and municipal institutions, associations and communities in the field of illicit trafficking in narcotic and psychotropic substances and their precursors, related to organized crime.


Criminal policy review The fifth goal of the Programme is the humanistic, public health-based and evidence-based criminal policy against the users of psychoactive substances.

1. The following tasks were raised to achieve the fifth goal:

decriminalized less dangerous offenses related to the use of narcotic and psychotropic substances, providing administrative responsibility for them, ensuring the application of social, health care system interventions on instead of criminal measures;

penalties provided for in the Criminal Code of the Republic of Lithuania were reviewed and depenalization measures provided in order to limit the excessive use of the custodial sentenced and their excessive duration when the punishment goals can be attained by applying more lenient or alternative sanctions, and alternatives focused on assistance to person;

substantially revised regulation of small, high and very high quantities of narcotic and psychotropic substances, based on common and scientifically based criteria, and abolition of the determination of pure substance mass in criminal proceedings.

Harm reduction The sixth goal of the Programme – reduced health, social and economic

consequences of the use of narcotic and psychotropic substances on individuals,

communities and the society.

1. Ensuring access to low-threshold services for people who use narcotic and

psychotropic substances. Areas for implementation of this task:

increasing public funding is ensured by an equal contribution of municipalities

to providing harm mitigation services in low-threshold cabinets through the

implementation of an optimal package of harm reduction services;

providing general methodological guidance to harm reduction services in low-

threshold cabinets and at custodial institutions;

provision of various harm reduction services in low-threshold cabinets and in

places of imprisonment;


a system integrating the low-threshold cabinets, imprisonment institutions, health

care institutions and social services was developed; it’s purpose is to apply the case

management for the users of narcotic and psychotropic substances, mediation

services, referral for treatment and service integration.

2. Reduced number of the spread of infectious diseases, poisonings and fatal

poisonings, ensuring the optimal coverage of the low-threshold package of services.

Areas for implementation of this task:

increasing the availability of syringes and needles and other single-use injectables in

all areas of the low-threshold cabinets and increasing the use of evidence-based and

WHO-recommended harm-reduction measures in prison settings, to curb the

spread of infectious diseases;

ensured availability of preventive measures for the deaths from overdose in low-

threshold cabinets and for persons leaving places of imprisonment;

increasing the scope of rapid random screening for infectious diseases, the

distribution of condoms in low-threshold cabinets, in places of imprisonment, and

places of entertainment;

development of work programmes on the street as one of the low-threshold

services to provide addicts with useful information and refer them to healthcare

facilities.

3. Ensuring effective response to current and emerging trends in the use of narcotic

and psychotropic substances. Areas for implementation of this task:

introducing measures to respond to new risks associated with the use of narcotic

and psychotropic substances (e.g. testing of the composition of drug and

psychotropic substances at the user initiative and for their safety purposes);

A system for monitoring the provision of services to persons who have been

subjected to addiction on mentally active substances, incarcerated, or leaving

prison.

4. Effectiveness evaluation, development and ensured continuity of measures

introduced at custody institutions. Areas for implementation of this task:

regular studies (according to the approved methodology) conducted on changes in

the number of drug users in all custody institutions;

periodic studies of offenders conducted to assess the effectiveness of rehabilitation,

re-socialization programmes (measures) used (dynamics of personal

criminogenic factors, recidivism, behavioural changes, etc.).


Implementation of the programme

The parliamentary control of the implementation of the Programme is carried out by the Seimas of the Republic of Lithuania. The implementation of the Programme is organized and coordinated by the Government of the Republic of Lithuania, the Drugs, Tobacco and Alcohol Control Department responsible for monitoring and analysing the changes in indicators of the criteria specified in the Programme. The Government of the Republic of Lithuania provides funds for the implementation of the Programme and its action plans when preparing the draft law on approval of financial indicators of the state budget and municipal budgets for the respective year for the implementation of the Programme, as well as the funds received from the PSDF budget, the EU, international organizations and other legal acts may be used.


Targeted results

Current situation (years)

2023 2028

Reduced alcohol consumption among the residents of 15+ years (abs. alc.) (WHO)1

15,2 (2016)

10,2 8

Reduced percentage of population smoking in the last 30 days, aged 15-64 (GPS)2

33,9 (2016)

21 19

Preserved stability in the conception of drug and psychotropic substances (percentage) (GPS)

3,1 (2016)

3,1 3,1

Extended age (≤ 13 years of age, percentage) of schoolchildren who smoke the first cigarette (ESPAD)3

45 (2015)

40 35

Increased the number of schoolchildren who did not use alcohol at all (percentage) (ESPAD)

13 (2015)

15 20

Increased proportion of inhabitants with successful smoking cessation among those who attempt to quit smoking (percentage)

26 (2016)

36 46

Decreased number of deaths caused by diseases directly related to the alcohol consumption (number per 100 000 inhabitants)

20,4 (2017)

15,8 11,6

Increased coverage of opioid substitution treatment financed through state and compulsory health insurance fund budgets (percentage)

12,4 (2016)

40 60

Increased availability of short-term social care services for addicts (places per 100 000 inhabitants)

1,27 (2016)

1,3 1,4

1 WHO – World Health Organisation information 2 GPS – General population survey information 3 ESPAD – European School Survey Project on Alcohol and Other Drugs information


Created availability of social reintegration services for dependent persons (places per 100 000 inhabitants)

0 (2016)

0,42 0,5

Reduced availability of cigarettes among schoolchildren (percentage) (ESPAD)

64 (2015)

56 50

Reduced availability of alcohol among schoolchildren (percentage) (ESPAD)

70 (2015)

60 50

Reduced incidence of alcohol-related psychosis (number per 100 000 inhabitants)

28,2 (2017)

21,9 16,2

Reduced number of deaths due to smoking-induced malignant neoplasms (number per 100 000 inhabitants)

58,3 (2017)

45,1 33,2

Reduced availability of cannabis among schoolchildren (percentage) (ESPAD)

25 (2015)

20 15

Reduced number of schoolchildren using drugs at least once (percentage) (ESPAD)

19,2 (2015)

18 17

Increased number of investigated crime related to the unlawful possession of narcotic or psychotropic substances for the purpose of distribution (percentage)

82 (2016)

86 90

Increased coverage of low threshold services (percentage) (ULAC4, HRDU5)

24 (2016)

40 60

Reduced number of persons who used drugs or psychotropic substances during imprisonment (percentage) (EMCDDA)6

16,9 (2017)

14 9

Reduced HIV incidence related the use of injecting drugs (cases per 1 million population) (EMCDDA)

28,7 (2016)

10 2

Eliminated number of deaths related to the use of narcotic and psychotropic substances (cases per 1 million population aged 15-64) (EMCDDA)

58 (2016)

20 0

4 ULAC – Communicable diseases and AIDS Centre information 5 HRDU – Number of high risk drug users 6 EMCDDA – European Monitoring Centre for Drugs and Drug Addiction

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