Zeskanowane obrazy 1. Introduction Around 96 million adults in the European Union are estimated to have used illicit drugs at least once in their lifetime. The global COVID-19 pandemic has dramatically altered different aspects of modern life, including drug use, the drug market, and the ability of European countries to provide help and support to people with drug problems (EMCDDA, 2020a). As there are great differences across European coun- tries in their drug policy, drug availability, demand and response services, and also in the management of the COVID-19 pandemic, the aim of this study was to investigate how the COVID-19 pandemic might Journal of Geography, Politics and Society 2022, 12(1), 28–41 https://doi.org/10.26881/jpgs.2022.1.05 COVID-19 AND THE DRUG SITUATION IN LITHUANIA Evelina Pridotkienė (1), Rūta Gedminienė (2), Rasa Povilanskienė (3), Brigita Rašimaitė (4), Viktorija Stifanovičiūtė (5) (1) Drug, Tobacco and Alcohol Control Department, REITOX network national focal point, Šv. Stepono 27A, LT-01312 Vilnius, Lithuania e-mail: evelina.pridotkiene@ntakd.lt (corresponding author) (2) Drug, Tobacco and Alcohol Control Department, REITOX network national focal point, Šv. Stepono 27A, LT-01312 Vilnius, Lithuania e-mail: ruta.gedminiene@ntakd.lt (3) Drug, Tobacco and Alcohol Control Department, REITOX network national focal point, Šv. Stepono 27A, LT-01312 Vilnius, Lithuania e-mail: rasa.povilanskiene@ntakd.lt (4) Drug, Tobacco and Alcohol Control Department, REITOX network national focal point, Šv. Stepono 27A, LT-01312 Vilnius, Lithuania e-mail: brigita.rasimaite@ntakd.lt (5) Drug, Tobacco and Alcohol Control Department, REITOX network national focal point, Šv. Stepono 27A, LT-01312 Vilnius, Lithuania e-mail: viktorija.stifanoviciute@ntakd.lt Citation Pridotkienė E., Gedminienė R., Povilanskienė R., Rašimaitė B., Stifanovičiūtė V., 2022, COVID-19 and the drug situation in Lithu- ania, Journal of Geography, Politics and Society, 12(1), 28–41. Abstract The application of restrictive public health measures because of COVID-19 has affected all areas of life, including drug use, drug market, and the response of law enforcement and health, education, and social care institutions to the drug phenomenon. In Lithuania students who used psychoactive substances irregularly were more likely to reduce the use of these substances or ab- stained during quarantine. However, those who used these substances regularly increased the use during quarantine. The pro- vision of harm reduction services was not interrupted, but the package of health services was reduced. There were disruptions in the number of clients entering treatment. Participation in the Early Intervention Programme in Lithuania for young people who are experimenting with alcohol or drugs increased but did not reach the pre-pandemic level. The pandemic also affected workplace-based prevention. The drug market situation remained stable, although the number of the quantities seized indi- cated some annual variations, caused by changes in supply and demand during the COVID-19 pandemic. Key words COVID-19 pandemic, psychoactive substance use, drug prevention, drug treatment, drug supply, Lithuania. Received: 08 April 2022 Accepted: 07 May 2022 Published: 27 May 2022 COVID-19 and the drug situation in Lithuania 29 have affected patterns of drug use, drug market, coverage, and implementation forms of prevention measures, treatment and harm reduction services in Lithuania. In this article, we discuss a hypothesis that the COVID-19 pandemic may have impacted different aspects of the drug phenomenon in Lithu- ania: not only drug supply and demand, but also the response measures, and that these changes were greatest at the beginning of the pandemic, when COVID-19 management restrictions were introduced and during lockdown periods or COVID-19 waves. We have reviewed the results of surveys conducted by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and Drug, Tobacco and Alcohol Control Department, as well as data collect- ed from other institutions of the Republic of Lithu- ania and other national data sources. 2. Prevalence of psychoactive substance use 2.1. The Mini-European web survey on drugs – impact of COVID-19 on patterns of drug use in Lithuania In order to investigate and rapidly document the current impact of the COVID-19 epidemic and na- tional responses in the EU Member States on chang- es in patterns of drug use, harms and service provi- sion, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) conducted a study using an adapted version of the trendspotter methodol- ogy across the EU Member States, whose part is the survey on Impact of COVID-19 on patterns of drug use, harms and drug services in the European Union. The Mini European Web Survey on Drugs: COVID-19 is part of this snapshot and it was conducted across Europe. The aim is to gather information about how patterns of drug use may have changed in Europe due to COVID-19 (EMCDDA, 2020b). The standardised online questionnaire European Web Survey on Drugs: COVID-19, as developed by the EMCDDA, was made available online in 21 lan- guages between the 17th of April and the 3rd of June 2020. The study specifically targeted adults aged 18 years old or above with experience of illicit drug use over the past 12 months. In Lithuania, the survey questionnaire was dis- tributed through social networks and operated for 5 weeks. During this period, 568 respondents from Lithuania participated in the survey. The mean age of the subjects was 24.7 years old, ranging from 18 to 46 years old. The majority of the survey participants were men (55.1%). It is observed that the consumption rates of some substances in Lithuania were higher compared to the overall rate of all countries participating in the study. Seven out of ten respondents had used cannabis in the previous year, almost half had used MDMA, and one third had used cocaine, amphetamine or LSD. More than half of those surveyed reported having used cannabis in the past 30 days; one in six had used amphetamine, one in seven –MDMA, one in eight – cocaine and LSD (Fig. 1). Meanwhile, the results of European countries show that more than half of the respondents (60%) had used cannabis in the previous 30 days, one in ten – ecstasy, cocaine, LSD and opioids; 5% had used amphetamine, 4% – heroin and synthetic cannabinoids. The study assessed various changes in the use of psychoactive substances during the COVID-19 pan- demic. One-fifth of the respondents reported using more drugs (22.4%) during COVID-19, and one in six (17.8%) using less during that period. 15.5% of the respondents indicated that they used the same amount. Meanwhile, the results of European coun- tries show that almost half of the respondents did not use or used less drugs, 30% of respondents re- ported using more drugs and 23% – using less. The biggest changes were among cannabis users. The majority of the respondents who used cannabis started using more (16.2%) and in higher quantities (8.6%) during the COVID-19 pandemic. 7.7% of the respondents started using more alcohol instead of cannabis, and 5.3% completely stopped using can- nabis (Fig. 2). Assessing European participation in the study highlights that regular (weekly) cannabis users were twice as likely to report an increased fre- quency of use compared with non-regular users dur- ing the confinement period. The use of MDMA was not significantly altered during COVID-19. About a quarter of the respond- ents said there was no change; 8.5% of the respond- ents indicated that they had stopped using these substances, and 4.8% used less often. About 16.5% of the respondents reported that their cocaine use patterns did not change, 6% – stopped using it, and about 3% – used less. About 16% of the respondents reported no change in their amphetamine use hab- its; 5.1% started using more, and the same number stopped using amphetamine altogether. One-fifth of the subjects reported that their LSD use did not change during the COVID-19 pandemic; 4.9% had stopped using the substance, and 2.3% started us- ing more. The study also looked at the reasons for lower or higher drug use. The majority of the respondents, both in Europe and in Lithuania, reported using less drugs due to reduced access and availability. In Lith- uania, a smaller proportion of respondents reported 30 Evelina Pridotkienė, Rūta Gedminienė, Rasa Povilanskienė, Brigita Rašimaitė, Viktorija Stifanovičiūtė 3 .5 % 5 .3 % 8 .5 % 9 .0 % 3 2 .9 % 3 3 .1 % 4 6 .1 % 3 4 .7 % 7 5 .9 % 2 .6 % 4 .0 % 7 .7 % 6 .9 % 1 7 .5 % 1 4 .6 % 1 6 .7 % 1 9 .5 % 5 7 .8 % 0 10 20 30 40 50 60 70 80 90 C a n n a b is E c s ta s y /M D M A L S D C o c a in e A m p h e ta m in e s S y n th e ti c c a n n a b in o id s O th e r o p io id s O th e r s y s n th e ti c s ti m u la n ts H e ro in Last year prevalence Last month prevalence Fig. 1. Last year and last month prevalence of drug use (%) in Lithuania, 2020. Source: Narkotikų…, 2020b. Fig. 2. Change in cannabis use since the outbreak of COVID-19 (%), 2020. Source: Narkotikų…, 2020b. 0.45% 1.1% 1.4% 1.6% 1.6% 1.9% 2.1% 2.3% 5.3% 7.7% 8.6% 10.0% 16.2% 0 2 4 6 8 10 12 14 16 18 No charge Used psychoactive medicines instead Used a new psychoactive substance instead Used a different form of cannabis Used in a different way Used other illicit drugs instead Used less quantity in a session Started using since COVID-19 restriction Stopped using since COVID-19 restriction Used more alcohol instead Used grater quantity in a session Used less frequently Use more frequently COVID-19 and the drug situation in Lithuania 31 using less drugs due to financial instability or a de- crease in income. Only about 3.9% of the respond- ents indicated that they were concerned about the drug use impact on their health (Fig. 3). One in seven subjects reported using drugs dur- ing COVID-19, mainly due to boredom, about 6.9% – because of pandemic concerns (Fig. 4). A quarter of the respondents said they did not attempt to purchase illicit drugs during COVID-19, with one in ten receiving illicit drugs from another dealer. 8% reported buying in larger quantities than usual. For one-third of the respondents, drug acqui- sition remained unchanged. 40% of the European respondents said that restrictive measures did not change their drug-buying habits, with 24% saying that they did not try to buy drugs, and 5% stopped buying illegal drugs (Fig. 5). The study sample is predominantly character- ised as young recreational drug users: young adults with a greater experience of drug use than reported by the general population. General Population Sur- veys can provide valuable information on drug use prevalence in Europe, but insufficient sample sizes can prevent them from yielding robust information on patterns of use. This is where web-based surveys can help. They are a useful tool for collecting infor- mation on patterns of drug use from a larger sample of people who use illicit drugs and can complement and overcome some of their limitations of other data sources. While not being representative of the general population, carefully conducted web sur- veys may nevertheless provide valuable additional information about variations in use among different groups of people who use drugs. 2.2. Changes in psychoactive substance use during the COVID-19 pandemic among university and college students Substance abuse is common among university/col- lege students and can result in a range of academic, physical, mental, and social problems. Lack of skills, necessary to cope with pressure and manage stress in their lives, which became particularly relevant during the pandemic, can lead to substance abuse. In autumn 2020, the Drug, Tobacco and Alcohol Con- trol Department conducted an online survey among university/college students to assess their substance use patterns, well-being, attitudes towards preven- tion measures and policy, and explore the relation- ship between psychological well-being and sub- stance abuse. The sample size was 2,412 students, studying in Lithuania’s higher education institutions (universities and colleges) (Narkotikų…, 2020a). Survey results showed that 37.2% of the stu- dents smoked or used other nicotine containing products daily (tobacco cigarettes – 15%, heated tobacco products – 15.9%, e-cigarettes with nico- tine-containing liquid – 12%). 71.4% of the students consumed alcohol at least once in the last month, and 2.6% – daily. 11.8% of the students used drugs 16.0% 15.7% 9.2% 8.1% 6.0% 5.8% 3.9% 0 2 4 6 8 10 12 14 16 18 Reduced ability to obtain drugs Reduced ability of drugs to buy Decreased income Saving money due to financial instability Reduced availability of going out Fewer opportunities to use drugs Anxiety about drug effects on health Fig. 3. Most frequent reasons for decreased drug use as a result of the COVID-19 restrictions (%), 2020. Source: Narkotikų…, 2020b. 32 Evelina Pridotkienė, Rūta Gedminienė, Rasa Povilanskienė, Brigita Rašimaitė, Viktorija Stifanovičiūtė 0.9% 2.1%2.3% 6.9% 13.4% 0 2 4 6 8 10 12 14 16 Boredom Anxiety/to cope with COVID-19 Increased income Because I stockpiled drugs Increased availability of drugs Fig. 4. Most frequent reasons for increased drug use as a result of the COVID-19 restrictions (%), 2020. Source: Narkotikų…, 2020b. Fig. 5. Methods of acquiring illicit drugs during COVID-19 (%), 2020. Source: Narkotikų…, 2020b. COVID-19 and the drug situation in Lithuania 33 (cannabis, ecstasy, LSD etc.) at least once in the last month (2.2% – daily). Survey results showed that students who used alcohol, nicotine or drugs ir- regularly were more likely to reduce the use of these substances or abstained during quarantine. How- ever, those who use these substances regularly were more likely to increase their use (use more often or in larger amounts) during quarantine. Among students who were drinking daily, 41.3% answered that dur- ing quarantine their alcohol consumption increased (they used more often or in larger amounts than be- fore quarantine), 22.2% consumed alcohol less fre- quently or in smaller amounts, and 34.9% reported that there were no changes in their drinking habits (compared to the pre-quarantine period). 40.4% of daily users of drugs, new psychoactive substances or inhalants replied that during quarantine their drug use increased, and 19.2% answered that their drug use decreased. Among daily smokers (or other nic- otine-containing products users, vapers), 26.4% of them were smoking/consuming nicotine more often or in larger amounts during quarantine, and 23.5% consumed less nicotine than before quarantine. To reduce the stress of studying, to relax or fall asleep, as many as a third of the students used nico- tine-containing products and alcohol in the last year, with a smaller proportion choosing prescription medications (13%) or drugs (8%). In order to improve study achievements, increase work productivity and performance, in the last year, almost half of the stu- dents consumed energy drinks and other caffein- ated products. 23% of the students used nicotine- containing products for this purpose, 11% – alcohol, 8% – prescription medications, and 4% – drugs. Study results also showed that during quarantine the well-being of as many as 23% of the students worsened. More than a quarter of the respond- ents were not satisfied with their health. More than a third of them often felt anxiety and had difficulty concentrating. Nearly a third of the respondents of- ten had sleep problems or did not want to do any- thing. 28% of the students often felt depressed, and the same percentage had been thinking about sui- cide at some point in their lives. Students who used psychoactive substances rated some of their health and well-being indicators significantly worse than non-users, especially those who used psychoactive substances to reduce the stress of studying, relax, or fall asleep. 3. The impact of COVID-19 on harm reduction and substance use treatment In order to investigate the effects and implications of this pandemic for people who use drugs in Europe, the EMCDDA instigated a mixed-method trends- potter study: Impact of COVID-19 on drug services and help-seeking in Europe. Results highlighted that COVID-19 and national lockdowns have led to reduced availability and provision of treatment and harm-reduction services in most European countries. Emerging evidence suggests that, like other healthcare providers, drug services are facing a range of challenges including: staffing shortages, access to personal protective equipment, and man- aging infected clients and staff vulnerability to infec- tion (EMCDDA…, 2020b). Lithuania also participated in this study, and the national results showed that provision of harm re- duction services was not interrupted but the pack- age of services was reduced: HIV testing was sus- pended. Instead of HIV testing, HIV self-tests were shared in small numbers. In order to reduce the fre- quency of visits, more syringes were issued per time. At the beginning of quarantine, there was a lack of protection measures, but the municipality supplied them. According to harm reduction services providers, the frequency of consumption and the quantity of one dosage decreased among high risk drug users due to the fact that it has become much more dif- ficult to earn or get money. Prices and quantity did not change. The availability did not decrease but, be- cause of less income, drugs became less available to high risk drug users (low threshold cabinets clients). A significant proportion of individuals mix alcohol, methadone, and carfentanil. The healthcare sector faced many challenges during the COVID-19 pandemic. Substance use treatment services were not an exception. The first lockdown in Lithuania was declared on 16 March, 2020. Since then some drug treatment services were entirely suspended (e.g. inpatient treatment for new clients was closed, outpatient consulta- tions were replaced by telemedicine). Phased re- sumption of healthcare services started on 18 May, 2020, the resumption of inpatient services with COVID-19 pre-testing requirements was reached on 8 June, 2020. Despite the partial resumption of healthcare provision, difficulties such as COVID-19 outbreaks and the isolation of patients continued to be challenging. As there were no conditions in healthcare facilities to isolate patients who were in- fected with COVID-19 or had been in close contact with COVID-19, they were discharged for outpatient 34 Evelina Pridotkienė, Rūta Gedminienė, Rasa Povilanskienė, Brigita Rašimaitė, Viktorija Stifanovičiūtė treatment. Complicated requirements for patients to access treatment, changes in types of interventions and disruptions in service activity and capacity dur- ing the pandemic may have severely affected the re- ported numbers of clients entering drug treatment. The National Mental Health Centre’s data on monthly drug treatment demands showed a de- crease in both new and overall clients entering treat- ment during the pandemic (Fig. 6). A particularly sharp decline in the number of patients entering treatment occurred during the first lockdown, which in Lithuania preceded the first wave of COVID-19 as some treatment services were entirely suspended. In 2020, inpatient and outpatient treatment centres in Lithuania provided treatment in total for 555 persons, which is about 31% lower in compari- son with 2019. The sharp decline in clients entering treatment is especially evident among opioid us- ers (Fig. 7). The disruptions in the number of clients entering treatment strongly correlates with the lockdowns, mandatory testing and COVID-19 waves, which not only impaired the treatment accessibility but data collection as well. Other issues, such as the changes in clients’ behaviours which would be unrelated to COVID-19 pandemic, are also possible but are less likely due to the lack of evidence. 4. Prevention in the context of COVID-19 4.1. School-based prevention, family-based prevention, and non-formal education For children and adolescents, the two prime sites for substance use prevention are school and family (EMCDDA, 2019). Study of the Psychotraumatology Centre of Vilnius University showed that the number of adolescents (aged 13–18) facing psychosocial dif- ficulties increased from 13% in 2019 to 18% in 2020. In 2020, more than half of adolescents had difficul- ty communicating with peers, and 1 in 4 said they had problems in their family (Psichotraumatologi- jos…, 2020). Although the quarantine and closing of schools had a significant impact on the psychologi- cal and social well-being of schoolchildren, the edu- cational community made every effort to continue their activities. Based on the Education Management Information System data, in 2020 schools continued to give priority to social emotional education pro- grammes and, less frequently, to psychoactive sub- stance use prevention programmes, but there were changes in the popularity of these programmes com- pared to 2019. The coverage of some programmes decreased (mostly in the number of schools imple- menting the programme) and increased in other cases (mostly in the number of schoolchildren who participated in the programme) despite the quaran- tine (Table 1) (Narkotikų…, 2021a). Fig. 6. Preliminary data on the number of all and new clients entering treatment between January, 2019 and August, 2021 in Lithuania Source: Several sources were used to prepare this figure – Valstybinis…, 2019; Valstybinis…, 2020; Valstybinis…, 2021. COVID-19 and the drug situation in Lithuania 35 Engagement of children and planning their after- school leisure time is an integral part of non-formal and prevention education. In 2020, 60.2% of school- children participated in non-formal education pro- grammes or attended activities in schools (62.6% in 2019). Participation in non-formal educational ac- tivities was limited by distance learning introduced due to the COVID-19 pandemic. Seeking to adapt to the pandemic situation and restrictions, 62% of pre-quarantine activities were performed remote- ly. But the goal of the State Education Strategy for 2013–2022 that all schoolchildren would use the opportunities of non-formal education by 2020 was not achieved (Švietimo…, 2021). According to data provided by the Centre for Health Education and Disease Prevention, in 2020, Fig. 7. Preliminary data on all clients entering treatment by primary drug between January, 2019 and August, 2021 in Lithuania. Source: Several sources were used to prepare this figure – Valstybinis…, 2019; Valstybinis…, 2020; Valstybinis…, 2021. Tab. 1. Implementation and participation in the social emotional education programmes in 2019 and 2020 (number of schools and schoolchildren). Title of the Programme Number of schools implementing the programme Number of schoolchildren participat- ing in the programme 2019 2020 2019 2020 LIONS QUEST ‚Crossroads of Teens’ 226 300 34 835 49 211 LIONS QUEST ‚Keys to Success’ 125 208 18 229 35 415 ‘Second Step’ 290 265 29 914 31 412 LIONS QUEST ‘Time Together’ 104 190 14 805 26 301 ‚My way’ 49 79 12 970 18 511 ‘Apple Friends’ 228 184 10 687 8 173 ‘Zippy‘s Friends’ 316 291 7 661 7 132 ‚Unplugged’ 90 75 3 974 3 964 ‚Snowball’ 40 33 2 296 2011 VEIK education programme 42 51 1 121 1 295 ‚Mentor’ 7 4 75 63 Source: Narkotikų…, 2021a. 36 Evelina Pridotkienė, Rūta Gedminienė, Rasa Povilanskienė, Brigita Rašimaitė, Viktorija Stifanovičiūtė the number of school-age children and children at social risk who participated in health education and training on smoking, alcohol and drug use preven- tion topics, organised by public health care and per- sonal health care institutions, was almost 3 times lower than in 2019 (Fig. 8) (Narkotikų …, 2021a). Family is generally the context in which children learn their group’s norms, values, attitudes and be- haviours (EMCDDA, 2019). The psychological well- being of children significantly depends on the well- being of parents and carers and the situation in the family, which could be unstable and vulnerable dur- ing the pandemic. Unfortunately, in 2020, compared to 2019, the number of parents participating in all 4 parenting skills training programmes, recommend- ed by the Ministry of Education, Science and Sports, significantly decreased (Fig. 9) (Narkotikų…, 2021a). Based on data provided by the State Child Rights Protection and Adoption Service under the Ministry of Social Security and Labour, complex services were provided to families in all municipalities in 2020, but fewer people received these services than in 2019. In 2020, 76% of cases when it was necessary to en- sure a safe environment for the child (prior to the assessment of the child’s situation) were due to in- toxication of the child’s representatives from alcohol or other psychoactive substances and inability to take proper care of their child. But there were some positive trends: the duration of mobile teams’ work with the family was extended to 30 days in 2020, the number of applications to form mobile teams in- creased by 49% in comparison to 2019, the average number of mobile team meetings with family more than doubled (Narkotikų…, 2021a), the number of children’s day care centres providing day social care and education services and the number of children participating in children’s day care centre projects increased, also more NGO projects to develop inde- pendent and constructive families were selected for funding (Lietuvos…, 2021). 4.2. Early intervention measures for young people One of the effective support measures for young people aged 14–21 who are experimenting with or irregularly using alcohol and/or drugs implemented in Lithuania is the Early Intervention Programme (based on the international programme ‘Fred goes net’). The aim of this programme is to motivate young people to stop using these substances be- fore they become addicted. Participation in this Pro- gramme can be voluntary or compulsory (as a means of administrative impact or minimal childcare). Since 2018, the Programme has been implemented na- tionally in the form of live group sessions. Such ac- tivities could not be implemented or were restricted during the COVID-19 lockdowns. Data, provided every year by the regional Pub- lic Health Bureaus shows that in 2020 the availabil- ity of early intervention services decreased by 35% Fig. 8. Number of children who participated in health education and training on smoking, alcohol and drug use preven- tion topics, organised by public health care and personal health care institutions in 2019 and 2020. Source: Narkotikų…, 2021a. COVID-19 and the drug situation in Lithuania 37 compared to 2019. Although, in 2021, the number of municipalities implementing the Programme was lower than before the pandemic, there are positive trends compared to 2020 – 10 more municipalities implemented the Programme than a year ago (in 2019 – 48 out of 60 municipalities, in 2020 – 31, in 2021 – 41) but still far from being implemented in all 60 municipalities. The number of young people who participated in the Programme and successfully com- pleted it also decreased in 2020 compared to 2019. In 2021 the numbers increased but did not reach the pre-pandemic level (Fig. 10) (Narkotikų…, 2022). 4.3. Workplace-based prevention The COVID-19 pandemic and quarantine created new challenges for governments, employers, em- ployees and whole society. Changes in work condi- tions and stress could create potential risks to em- ployees’ safety and health, e.g., uncontrolled use of psychoactive substances, lack of communication, need for support, uncontrolled workplace safety. In February–April 2021, 551 workplace representa- tives were interviewed using an online survey by the Drug, Tobacco and Alcohol Control Department in order to assess the need and availability of sub- stance use prevention measures in the workplaces of Lithuania, and the changes in activities caused by the pandemic. Half of the respondents were employ- ers themselves (Narkotikų..., 2021b). Survey results showed that 20.5% of workplac- es no longer carried out substance use prevention measures they had taken before the quarantine or limited them. Only 2% of workplaces implemented more measures, including new ones, and in 7% of workplaces the scale of prevention measures re- mained the same, but their nature and methods of implementation changed. During the quarantine, implementation of all assessed substance use pre- vention and control measures decreased in at least some of the workplaces (Fig. 11). About a third of the workplaces that implemented measures such as improving employee mental health, education, counselling on psychoactive substance use prob- lems, and assistance to employees with such prob- lems stopped these activities during the quarantine. A quarter of workplaces that tested employees for alcohol use, and more than half of the workplaces that tested employees for drug use stopped testing during the quarantine. 5. Drug supply in the context of COVID-19 According to the Lithuanian Criminal Police Bu- reau, the drug market situation is regarded as stable in Lithuania, although the number of the quantities seized indicates some annual variations, which could be affected by lockdowns because of COVID-19 – increasing cocaine, amphetamine and 39 237 218 1 101 4 676 2 50 177 638 3 421 0 500 1 000 1 500 2 000 2 500 3 000 3 500 4 000 4 500 5 000 'Gordon Training International programme' 'Stairs. It’s easier together' 'School for Parents and Teachers' 'STEP' Other parenting skills training programme 2019 2020 Fig. 9. Number of parents participating in parental skills training programmes in 2019 and 2020. Source: Narkotikų…, 2021a. 38 Evelina Pridotkienė, Rūta Gedminienė, Rasa Povilanskienė, Brigita Rašimaitė, Viktorija Stifanovičiūtė 490 386 661 403 325 532 0 100 200 300 400 500 600 700 2019 2020 2021 Participated in the Programme Successfully completed the Programme 3% 12% 16% 17% 18% 20% 26% 30% 31% 5% 7% 4% 7% 10% 11% 11% 9% 14% 0 10 20 30 40 50 Drug testing in the workplace Surveying employees on substance use Allowing employees with substance use disorders to get addiction treatment, keeping their job Support, help for employees who have substance abuse problems Assessment of employee psycho-emotional wellbeing Counseling employees on the problems caused by substance use Improving mental health of employees, increasing psycho-emotional competencies Alcohol testing in the workplace Providing information, education, trainings to employees on substance use prevention Implement Currently do not, but implemented until the lockdown Fig. 10. Number of the Early Intervention Programme participants in 2019–2021. Source: Narkotikų…, 2022. Fig. 11. Implementation of different substance use prevention and control measures in the workplaces (2021, N=551 workplace representatives, %). Source: Narkotikų..., 2021b. COVID-19 and the drug situation in Lithuania 39 methamphetamine quantities seized and a signifi- cant decrease in MDMA. In Lithuania, as in previous years, new psychoactive substances market can be assessed as small. No significant changes were no- ticed during COVID-19 period. In 2020, there was a sharp increase in the quan- tities of cocaine, amphetamine and methampheta- mine seizures compared with previous years (Fig. 12). Since 2019, the new trend has been observed – the amount of amphetamine seized exceeded the amount of methamphetamine. The same trend con- tinued in 2020. The decrease in MDMA amounts seized are mostly affected by COVID-19 due to re- strictions for all entertainment places (night clubs, pubs, bars, etc.). Moreover, in 2020 the amount of hashish with- drawn from illicit circulation in Lithuania decreased sharply – from 1775 kg in 2019 to 3.8 kg in 2020, as well as amounts of cannabis (220 kg in 2019, 41 kg in 2020), presumably due to lockdowns because of COVID-19. According to studies, changes in the cannabis market were observed due to shortages of cannabis in the wholesale market. This may have been triggered by the closure of borders for indi- viduals who smuggled cannabis in private vehicles. During the quarantine period, the closure of recrea- tional places may have led to a decline in drug use, which did not result in a shortage in the retail market (EMCDDA, 2020b). Following new psychoactive substances (NPS) trends, no significant changes were observed in previous years. Since 2016 up to now, in the illicit drug market heroin has been replaced by carfenta- nil and mixtures with carfentanil, and still no signs of heroin coming back to the Lithuanian market. Despite the changes in amounts seized, average retail prices of almost all ‘traditional’ drugs remained stable. Only the price of amphetamine has increased, while the price of MDMA has decreased – as a result of reduced MDMA demand because of COVID-19. 6. Conclusions In Lithuania the health and social consequences of COVID-19 are still in research, but during the pan- demic period these trends were observed: • Changes in psychoactive substance use preven- tion varied to different degrees depending on the setting and activity. School-based preven- tion programmes and after-school activities were most often continued and/or performed remote- ly. After a significant decrease in the availabil- ity of the Early Intervention Programme in 2020, there were positive trends in 2021, but participa- tion in this Programme still did not reach the pre- pandemic level. Also, in 1 out of 5 workplaces, less preventive action was taken than before the pandemic. • During the pandemic, parts of both prevention and monitoring activities moved online. Web sur- veys are a useful tool for collecting information 112.4 23.6 6.5 90.8 4.4 36.9 50.0 283.0 17.4 43.4 16.1 13.8 0 50 100 150 200 250 300 2018 2019 2020 Amphetamine Methamphetamine MDMA Cocaine Fig. 12. Quantities of seized cocaine, amphetamine, methamphetamine and MDMA, 2018–2020 (kg). Source: Narkotikų…, 2021a. 40 Evelina Pridotkienė, Rūta Gedminienė, Rasa Povilanskienė, Brigita Rašimaitė, Viktorija Stifanovičiūtė on patterns of drug use from a larger sample of people who use illicit drugs and can complement and overcome some of their limitations of other data sources. While not being representative of the general population, carefully conducted web surveys may, nevertheless, provide valuable addi- tional information about variations in use among different groups of people who use drugs. • It may be assumed that the period of the lock- down changed the habits of the drug users and this made an impact on the seizures of drugs: the amount of amphetamine seized exceeded the amount of methamphetamine, and the amount of MDMA significantly decreased. • The disruptions in the number of clients enter- ing treatment strongly correlates with the lock- downs, mandatory testing and COVID-19 waves, which not only impaired the treatment acces- sibility but data collection as well. Other issues, such as the changes in clients’ behaviour which would be unrelated to COVID-19 pandemic, are also possible but are less likely due to the lack of evidence. • Due to the COVID-19 lockdown, treatment ser- vice provision had to be changed and adapted to the restrictions – limited availability to some treatment services. Harm reduction services pro- vision was not interrupted but the package of services was reduced. references EMCDDA, 2019, European Prevention Curriculum (EUPC). 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