2011 NATIONAL REPORT (2010 data) TO THE EMCDDA by the Reitox National Focal Point BULGARIA New Development, Trends and in-depth information on selected issues REITOX 1 Table of content of the report # Chapters Page Summary 4 Part A: New Developments and Trends 1. Drug policy: legislation, strategies and economic analysis 9 2. Drug use in the general population and specific targeted-groups 18 3. Prevention 25 4. Problem drug use 38 5. Drug-related treatment: treatment demand and treatment availability 42 6. Health correlates and consequences 55 7. Responses to health correlates and consequences 80 8. Social correlates and social reintegration 84 9. Drug-related crime, prevention of drug related crime and prison 87 10. Drug markets 102 Part B: Selected Issues 11. Drug-related health policies and services in prison 113 12. Drug users with children 122 Part C: Bibliography Alphabetic list of all bibliographic references used 127 Alphabetic list of relevant Internet addresses 128 Annexes List of tables and graphs used in the text 130 2 Summary 3 In 2010, in SG No. 22/19 March 2010 an amendment to the Narcotic Drugs and Precursors Control Act (NDPCA) was published. This Act is the main legislative instrument regulating public relations in the sphere of organization, powers and tasks of the public authorities exercising control over production, processing, trade, use, storage import, export, transit, transfer, transport and accountability of narcotic drugs as well as marketing, import and export of precursors. The amendment was prepared in the second half of 2009. The amendments have laid the foundations of a better legal framework to underlie the regulations – the ordinances that will be issued under the Act. Working groups have been set up to carry out this task, which complete their work this year. In connection with the amendments to the Act, modifications have been made in the regulatory acts for its implementation. By the end of 2010 26 Municipal Drug Councils (MDC) were set up in the municipalities, which are administrative regional centres, operating in line with the adopted community programmes and strategies for prevention, treatment and rehabilitation of drug addiction. There are 26 Prevention and Information Centres (PIC) to the MDC in those cities. MDC and PIC are financed by the Government budget through the municipal budgets as activities delegated by the state. Allocations for 2010 were used to pay the salaries for 27 staff positions of chairmen and 27 staff positions of secretaries of MDC and 65 staff positions for PIC teams, and provide means of maintenance. * * * During November-December 2010, the National Focal Point for Drugs and Drug Addictions conducted a national representative survey among university students in Bulgaria. It was conducted among 3705 students from 29 universities in 12 cities across the country. According to the survey 38.9% of students in the country have tried a drug at least once in their lifetime (in 2006 - 35.2%). At the same time 14.1% of the students have used some narcotic drug in the last 30 days before the survey (in 2006 - 9.2%). The data show quite clearly that cannabis (and particularly marijuana) is the most widely used illegal substance. At least once in their lives it was used by 37.4 percent of the respondents (in 2006 - 32.9%), or about 105,000 students (in 2006 - 70, 000). As second in size in terms of illicit drugs can be determined the group of users of synthetic stimulants - mainly amphetamines and substances such as ecstasy. Those who had used at least once in their lifetime amphetamines were 14.6% (in 2006 - 8.4%) and in the case of ecstasy the shares were 8.7% and 6.5%. It is evident that the use of cocaine is increasing. A survey among young people in Sofia in 1999, having as object almost the same age group, showed use at some time in their life in 2.6% and in the last 30 days - 0.7% of respondents. A survey conducted in 2006, already showed respectively 4.9% and 1.2%, and in 2010 - 9.0% and 1.8%. The Fifth wave of ESPAD took place in the spring and summer this year in over 35 countries in Europe. Each participating country provided the funding for the study; the National Focal Point for Drugs and Drug Addiction provided the funding for Bulgaria with funds from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), the responsible institutions being the National Centre for Public Health and Analysis (NCPHA) and the National Centre for Addictions (NCA). In Bulgaria in 2011 a total of 2217 schoolchildren (1132 boys and 1085 girls) in grade 9 and 10 in 192 classes were surveyed. In 2011, 27% (about 15-17,000) 15-16-year-olds have used at least once in their lifetime any illicit drug. About 23% (about 12-15,000) have used at least once in their lifetime marijuana or hashish, and 7% (4-5,000) have used at least once in their lifetime amphetamines. In 2011, 11% (about 6500-7000) 15-16-year-olds have used at least once in the last 30 days marijuana or hashish. * * * 4 As in the previous year (2009), the activities conducted and coordinated at the national level for 2010 have been mostly within the field of universal prevention. The target group of reported prevention activities consisted mainly of children and youth. In 2010, the share of universal prevention in Bulgaria was smaller than in 2008 and 2009, but the share of selective prevention was considerably larger than that in 2009. At the national level, activities aimed at school-based drug addiction prevention are coordinated and conducted mainly by the Ministry of Education, Youth and Science. According to data from the MDC and PIC reports the total number of activities by type of prevention for 2010 is 162, which is twice as small as their number for 2009. And again, most of the initiatives accomplished in 2010 were aimed at universal prevention – 130. * * * At the end of 2009, under the leadership of the National Focal Point for Drugs and Drug Addiction the collection of primary data on study-evaluation of problem drug use in Bulgaria by means of the Capture-recapture method was completed. The aim of the study was the formulation of an evaluation of the number and profile of problem drug users in the country. A central evaluation of 31,316 persons who are problem drug users in Bulgaria was formed. Applying the confidence interval of 95%, we can outline a broader range of the evaluation - between 23,050 and 42,920 persons. Given that at 31 December 2009 the total population of Bulgaria was 7,563,710 people (National Statistical Institute, 2010) the evaluation of the proportion of problem drug users in the country is 4 persons per 1000. The broad range of this evaluation (with confidence interval of 95%) is between 3 and 6 persons per 1,000. Relative to the population aged 15-64, which at 31 December 2009 was 5 211 619 this evaluation would be 6 per 1000, in a broad range between 4 and 8 persons per 1,000. According to the Ministry of the Interior, drug users are 3519, and of these 495 (or 14.1%) were minors or underage. Cannabis is used by 2266 persons (64.4%), heroin – by 769 persons (21.9%), cocaine – by 61 persons (1.7%), synthetic drugs (ecstasy, amphetamines, barbiturates) – by 981 persons (27.9%). * * * The analysis of the situation in Bulgaria shows that at the end of 2010 the country had a network of treatment centres and treatment programmes, which was in a process of development and expansion. Treatment of patients abusing or addicted to psychoactive substances includes both programmes based on medically assisted treatment (detoxification, substitution, maintenance treatment) and psychosocial rehabilitation programmes (of the type of “Therapeutic community”, day-care centres, programmes for employed persons / students). The analysis of data related to treatment demand shows that as to 31/12/2010 mainly government institutions carried out inpatient detoxification in Bulgaria, while outpatient detoxification was arranged mainly in private clinics. In 2010 in the country 30 substitution and maintenance programmes with a total capacity of 5,210 medical seats operated (of which a total of 3012 seats were occupied), of which about 4425 for Methadone treatment and 785 for treatment with Substitol. 73% of the patients undergoing treatment in substitution / maintenance programmes were treated in private programmes, and 27% - in state or municipal programmes as of 12/31/2010. The seats occupied in programmes funded by the government budget (state and municipal programmes) were 1009 (82% of their capacity), and in the programmes without state or municipal participation - 1797 (45% of their capacity). The main source of information about the basic characteristics of the treated clients is data collected by the National monitoring system for seeking treatment in relation to drug use (TDI system). In 2010 she covered practically 1573 persons starting treatment during the year in 6 hospitals, 7 outpatient units and centres and 15 substitution maintenance programmes in 11 5 Bulgarian cities. The generalized image of the persons who started treatment for drug use in 2010 can be described as follows: Gender - predominantly male (81.1%) Ethnic group - predominantly Bulgarians (89.1%) Overall average age - 29 Education - predominantly secondary (64.4%) Basic problem substance - predominantly heroin (84.8%) Frequency of use - predominantly daily (69.4%) Pattern of use - predominantly injecting (72.1%) * * * The level of the HIV infection in Bulgaria is still low among the general population, but over the period 2004 - 2009 it marked a lasting tendency of increasing among the injecting drug users.