The Galician Monitoring Centre for Drugs and Drug Addiction General

COLECCIÓN DROGODEPENDENCIAS ESTUDIOS

The Galician Monitoring Centre for Drugs and Drug Addiction General Report 2002 28 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT 2002 PROJECT CONSULTANTS CONSULTORÍA, ESTUDIOS Y GESTIÓN DE PROYECTOS, S.L. AUTHORS JOSÉ NAVARRO BOTELLA LORENZO SÁNCHEZ PARDO

THECNICAL CONSULTING AND COORDINATION MANUEL ARAÚJO GALLEGO

COLLABORATORS INDALECIO CARRERA MACHADO JESÚS MORÁN IGLESIAS EDUARDO PICÓN PRADO JESÚS VARELA MALLOU

TRANSLATION MARÍA JESÚS RABUÑAL CORGO

Edita: Xunta de Galicia Consellería de Sanidade Comisionado do Plan de Galicia sobre Drogas

ISBN: Depósito legal: Índex

1 FOREWORD AND PRESENTATION ...... 5

2 CURRENT SITUATION AND TENDENCIES OF DRUG USE AND DRUG DEPENDENCY IN GALICIA ...... 11 2.1 TENDENCIES OF DRUG USE ...... 14 2.2 EVOLUTION OF DRUG USE-RELATED PROBLEMS ...... 17 2.3 FUTURE PERSPECTIVES ...... 19

3 SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE ...... 21 3.1 OBJECTIVES AND METHODOLOGY OF THE PROGRAMME OF SURVEYS ON “DRUG USE IN GALICIA” 1988-2000 ...... 23 3.2 PREVALENCE AND PATTERNS OF USE ...... 28 3.3 REASONS, RISK FACTORS AND PROTECTIVE FACTORS IN DRUG USE ...... 54 3.4 DRUG USE-RELATED PROBLEMS ...... 60 3.5 PUBLIC OPINION AND ATTITUDES TOWARDS DRUGS ...... 63 3.6 CONCLUSIONS ...... 70

4 PREVENTION INDICATORS ...... 73 4.1 LEVELS OF IMPLEMENTATION AND TYPOLOGY OF PREVENTION PROGRAMMES ...... 77 4.2 SCHOOL PREVENTION PROGRAMME AGAINST DRUG USE (SPPDU) ...... 79 4.3 FAMILY PREVENTION PROGRAMME ...... 83 4.4 ENHANCEMENT OF VALUES-EDUCATIONAL PROGRAMME ...... 84 4.5 CONCLUSIONS ...... 85

5 SOCIAL REINTEGRATION INDICATORS ...... 87 5.1 LEVELS OF IMPLEMENTATION AND TYPOLOGY OF SOCIAL REINTEGRATION PROGRAMMES ...... 90 5.2 SOCIO-LEGAL ADVICE PROGRAMMES ...... 92 5.3 CONCLUSIONS ...... 93

6 TREATMENT INDICATORS ...... 95 6.1 ADMISSIONS TO TREATMENT FOR THE USE OF PSYCHOACTIVE SUBSTANCES ...... 97 6.2 PATIENTS ADMITTED TO THE DIFFERENT TREATMENT PROGRAMMES ...... 100 6.3 PROFILES OF THE GPD TREATMENT NETWORK USERS ...... 104 6.4 EVALUATION OF THE TREATMENT SERVICES ...... 119 6.5 CONCLUSIONS ...... 125

7 HEALTH-CARE INDICATORS ...... 127 7.1 INFECTIOUS DISEASES ASSOCIATED WITH THE USE OF DRUGS ...... 129 7.2 HOSPITAL INDICATORS ...... 136 7.3 CONCLUSIONS ...... 138 8 MORTALITY INDICATORS ...... 139 8.1 MORTALITY FFROM ACUTE REACTION TO THE USE OF DRUGS ...... 141 8.2 DEATHS IN ROAD ACCIDENTS ASSOSCIATED WITH THE USE OF DRUGS ...... 147 8.3 MORTALITY RATE FROM AIDS AMONG DRUG USERS ...... 149 8.4 CONCLUSIONS ...... 150

9 DRUG SUPPLY INDICATORS ...... 151 9.1 SUBSTANCES SEIZED ...... 153 9.2 PURITY AND PRICES OF SUBSTANCES ...... 159 9.3 CONCLUSIONS ...... 163

10 LEGAL-PENAL INDICATORS ...... 165 10.1 ARRESTS AND REPORTS FOR DRUG TRAFFICKING ...... 167 10.2 LEGAL PROCEEDINGS FOR DRUG TRAFFICKING ...... 169 10.3 REPORTS FOR DRIVING WITH BLOOD ALCOHOL CONCENTRATION LEVELS OVER THE LEGAL LIMIT ...... 171 10.4 ADMINISTRATIVE SANCTIONS FOR THE USE OF DRUGS ON THE PUBLIC HIGHWAY ...... 173 10.5 CONCLUSIONS ...... 174

11 GENERAL PROPOSALS OF INTERVENTION ...... 175 11.1 PROPOSALS OF INTERVENTION IN THE FIELD OF PREVENTION ...... 177 11.2 PROPOSALS OF INTERVENTION IN THE FIELD OF TREATMENT ...... 179 11.3 PROPOSALS OF INTERVENTION IN THE FIELD OF SOCIAL REINTEGRATION ...... 180

12 BIBLIOGRAPHY ...... 181 1. FOREWORD AND PRESENTATION Foreword

The different agencies involved in the fight against drug dependency have available today a series of data systems aimed at studying in detail the situation of drug use and abuse in all its complexity, evaluating the effectiveness and impact of the measures taken in this area, as well as planning new strategies of intervention.

These systems are based on the use of several indicators, not always coinciding, and often insufficiently contrasted, with the purpose of bringing to light a reality so polycausal and dynamic as is that of drug dependency; consequently generating serious distortions in the understanding of this problem and with the possibility of causing major disagreements in the planning of the measures to be taken. Therefore there is a need to unify the data, obtained from different sources through the various systems of data gathering, which undoubtedly will enable us to have a more realistic global view.

Due to the dynamism and constant evolution of drug dependency, and the need to have up-to-date, reliable and comparable information that can provide us with a detailed pic- ture of the problem, we have found it necessary to set up a work team of experts on the subject. The main objective of this team is to provide feedback on the current situation of drug dependency and to predict its likely evolution, monitoring all the data related to the topic, which come from the different sources that exist today, processing and analysing them with the purpose of evaluating the tendencies of this phenomenon in the Autonomous Community of Galicia.

This need was already present among the recommendations included in the “Report of the Non-Permanent Commission for the Study of the Socio-Economic and Health-Care Repercussions of Drug-Dealing in Galicia”, passed by a plenary session of the Galician Par- liament on July 1st, 1992. This same need led the European Parliament to create the “Euro- pean Monitoring Centre for Drugs and Drug Addiction” in February 1993, which specifically recommended the development of similar mechanisms in the European Union member states, aimed towards fulfilling similar functions in their jurisdictions.

Taking these considerations into account, the Ministry of Health and Social Services of the Galician Government (DOG n. 188, August 29th, 1995) sets up the Galician Monitoring Centre for Drugs and Drug Addiction in 1995. Its goal is to offer a global view on the problem of drug addiction in its different aspects, thus contributing to a more suitable planning of the strategies and measures conducted by the Autonomous Administration and which, as stated in the Galician Plan on Drugs (GPD), are carried out through the Commissioner’s Office for the Galician Plan on Drugs (CGPD). 8 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

I wish to express my most sincere thanks to all the people participants in the elaboration of the present report. This task would not have been possible without the cooperation of different institutions, both from the state and autonomic administrations, as well as the university and the judicial system. My special acknowledgement to all the professionals working for these institutions that have made possible this cooperation.

I wish the present book to be of great help to all the people who intervene in the field of drug dependencies. Knowledge is one of the premises of action. Now we can say that we have a better understanding of the issue of drug dependencies in Galicia. To improve our knowledge in order to improve our intervention is principal that, I am sure, we all share. Therefore, the more adequate our action, the greater our contribution to increase the level of health and social well–being of our fellow citizens.

José Mª Hernández Cochón Minister of Health Government of Galicia Presentation

So far the GMCDDA has produced several reports on drug use in our Community, although they have always focused on specific areas. Consequently every two years a report on drug use is published, as a result of the epidemiological study of the population carried out with the same periodicity. The Report on the Treatment Evaluation System, the Indica- tor of Mortality, etc. are published every year.

Each of these reports offers a partial view on the complex and multifactorial problem of drug abuse. However there was a need for a report, which encompassing them all, would go beyond the mere description of each aspect of the problem and which would provide a comprehensive global view.

Therefore, the fundamental objective of this report is to offer a global perspective on the problem of drug addiction in Galicia from 1986, when the then so-called Autonomous Plan on Drug Addiction was created (now renamed Galician Plan on Drugs) up to 2001, based on a series of indicators that constitute the Healthcare Information System of the Galician Plan on Drugs (HCISGPD).

The contents of the “General Report of the Galician Monitoring Centre for Drugs and Drug Addiction 2002” are divided into ten broad sections:

■ The first section includes a diagnosis of the present situation, of past tendencies and of possible future ones with reference to drug use and dependency, based on which we try to identify the main challenges the Galician society must face.

■ The following eight sections are concerned with each one of the different groups of indicators that make up the Information System of the GMCDDA (sociological and epidemiological, prevention, social reintegration, treatment, health-care, mortality, supply control and legal-penal indicators), where all the data provided by the different public and private organisations that collaborate with the GMCDDA are synthesized and analysed.

In each of these sections we shall start by analysing the current situation and continue to describe its evolution up to December 31st, 2001, pointing out the likely future tendencies. Finally, whenever the available data should allow, we shall carry out a comparative analysis of the data concerning Galicia, the whole of Spain and the European Union.

■ In the last section we synthesize a series of proposals and technical recommendations derived from the analysis of all feedback provided by the Information System of the GMCDDA, through which we try to orientate the decision making processes in order to adapt the intervention programmes and strategies to the present situation of the drug problem. 10 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

The present report, product of the participation of many professionals, is the culmination of a laborious process of gathering and analysing data. Using this report as a basis we try to present, in an orderly way, all the information available on a series of relevant aspects related to drug use and its consequences and to the intervention strategies developed to deal with them. This report is used to provide all political and institutional bodies, and all the professionals who work in the field of drug addiction, with a tool to assist them in their tasks.

Improving and amplifying the information available is a constant challenge that the GMCDDA should confront in the following years, by means of purging and improving the existing indicators and, possibly, by incorporating new ones, as well as new sources of data. The success of this task should be reflected in the improvement of the contents of the future reports of the Galician Monitoring Centre.

I wish to thank all the institutions and professionals that have collaborated with us in the elaboration of this report, wich, I am sure, will be of great help to us all.

Manuel Araújo Gallego Commissioner of the Galician Plan on Drugs 2. CURRENT SITUATION AND TENDENCIES OF DRUG USE AND DRUG DEPENDENCIES IN GALICIA 2. CURRENT SITUATION AND TENDENCIES OF DRUG USE AND DRUG DEPENDENCIES IN GALICIA

The deep social, political, economical and cultural changes that took place in the Spanish society in the seventies, meant the incorporation of Galicia to the dominant social and cultural trends of that decade in Europe, which brought about, among other phenomena, the appearance of new substances and new patterns of drug use in certain sectors of society, especially among the juvenile population. The democratisation and the economic and cultural liberalization processes brought about a change in the pattern of traditional drug use, characterised by the use of substances, such as, tobacco and alcohol among adult males and of tranquillizers and hypnotics among women. The appearance of new substances in the market and the incorporation of new groups of drug users, such as teenagers and women, who had so far kept out from drug use, meant a radical transformation in the relationship, which the Galician society in particular, and the Spanish one in general, maintained with these substances. From this moment on the use of illicit drugs among young people would play completely different roles from the ones it traditionally played, (linked to gastronomic habits and to certain social events), becoming at first an element of cultural identification, through which they tried to express a type of rejection towards certain values and forms of social organisation. This process would reach its apex with the rapid spread of the use of the various illicit drugs and with the emergence of a number of serious related problems producing a highly negative impact on public health and the collective welfare (delinquency, contagious diseases, social exclusion, etc), which turned what was called “the drug problem” into one of the main social preoccupations. The social alarm generated by the effects associated to the use of heroin, was unable to prevent the generalization of the use of drugs, legal and illegal ones, among the Galician juvenile population and their increasingly greater social acceptance. The greater presence of drugs and the association of their use to recreational contexts have favoured the normalization of their use, detecting a high social tolerance towards substances like alcohol or cannabis derivatives, and to a lesser extent, towards the occasional use of the rest of the illicit drugs. The consolidation of a pattern of juvenile drug use, clearly differentiated from the adult one, has not meant the substitution of the traditional pattern; the fact is that both patterns co-exist nowadays. Therefore the Galician society faces a double challenge: to confront tobacco and alcohol-abuse related problems, which have been widely widespread among the adult population for decades, and to tend to the new demands that drug use and abuse among young people creates. As is described in the following sections of the present report, the changes in the relationship of the Galician society with drugs have been numerous and important in the last two decades, changes that have to do with the substances taken, the patterns of use, the profile of drug users and the effects derived from them with respect to the users themselves and to society in general. Some of the main milestones that characterize the evolution of drugs and drug addiction in Galicia in the last years will be described next. 14 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

2.1 TENDENCIES OF DRUG USE

The incorporation of teenagers and young adults to the use of drugs, which brought about the constant reduction in the average age in the introduction to the use of drugs, together with the increasing similarity of use habits between sexes, has resulted in a rapid increase in the presence of drugs in the Galician society. This expanding tendency that drug use had been registering since the 80s, would have been reversed in the last years, registering a general decline in the prevalence of the use of legal and illegal drugs in Galicia, coherent with the evolution observed in the whole of Spain, favoured by the delay in ages with relation to the initiation of the use of all kinds of substances (except for amphetamines and inhalants) and by the reduction of the levels of experimentation with many other drugs. The tendency followed by the use of the different substances in Galicia for the period 1988-2000 could be synthesized as follows: 1 During the whole period the levels of tobacco addiction have diminished sharply among the adult male population, who have traditionally been the group with the highest prevalence of tobacco use. Nevertheless, the progressive decrease that everyday smokers had demonstrated would have been reversed since 1996. The rebound of tobacco addiction observed from then onwards is due to the increase in the numbers of everyday smokers among teenagers and young adults, and especially among women, who in some age intervals show a higher prevalence of use than their male counterparts. It must be taken into account that tobacco is a substance that registers a high level of continuity and fidelity in its use, therefore the increase in its use among young people implies a high probability that this habit will last and consolidate itself in the future. This trend threatens the positive evolution, which despite the rebound observed in the past years, tobacco addiction has had in Galicia in the 1988-2000 period. The fact that women’s tobacco addiction is catching up with men’s (a trend noticeable as well in the case of alcohol and other drugs) make foreseeable, unless important social changes take place or the administrations take specific steps, the continuity of the rebound of the prevalence of tobacco addiction observed since 1996. 2 In the last years the use of alcohol, which had been increasing since the 80s, has diminished. Together with the fall in the general prevalence of use observed in Galicia since 1988, reflected in an increase in the number of teetotallers, and in the reduction of everyday drinkers, a highly positive trend has taken place; that is: an important drop in the number of abusive drinkers. However, this positive evolution of alcohol use in the previous years has reversed from 1998 onwards, with a decrease in the number of teetotallers and a rebound in the number of abusive drinkers. This rebound in alcohol consumption is the result of a marked increase in the prevalence of abusive drinkers among women, who between 1998 and 2000 would have gone up from 2.2 to 3.7%, and among young people (from 3.7 to 5.4% in the 12 to 18 age group). The intensification of alcohol abuse among young people implies that abusive drinkers are younger now, being the 19 to 24 age group that which concentrates the highest percentage of abusive drinkers in Galicia (13%) and threatens to produce a general increase in alcohol abuse in the short term, just as has occurred with everyday smokers since 1996. 3 The evolution of the use of cannabis in Galicia, following the trend nationwide, is characterized by a sharp increase registered since 1988, both in its occasional users (those who have taken it on some occasion), and in its habitual ones, consolidating itself as the most commonly used illicit drug. This rising tendency has been especially reinforced in the period between 1998 and 2000. CURRENT SITUATION AND TENDENCIES OF DRUG USE AND DRUG DEPENDENCIES IN GALICIA 15

The increase in the use of cannabis in Galicia is the result of the high increase in its use among the lower age groups (the prevalence of use among 12 to 18-year-olds has multiplied by 7.5 times in the latter months of the 1992-2000 period), as it has also increased among women (whose prevalence for the same indicator and period has doubled). The increase in the use of cannabis among teenagers and young adults has been boosted by the perception of low levels of risk associated with it, which makes foreseeable the continuity of the growing tendency of its use for the following years, unless the opinions and attitudes towards the use of this substance change. 4 The regular use of tranquillizers has registered slight increases, a tendency which has been favoured by the rise in their use among males, although their use is still clearly higher among women. Since 1998 a decrease in the use of these substances has been noted. The use of hypnotics has had a similar evolution, although in this case, their use is more frequent among men. 5 Heroin use has been progressively declining since the beginning of the 90s, registering nowadays very low prevalence of use. Despite this fact, it still plays an important role, from the epidemiological point of view. The social alarm caused by the effects associated to heroin use has played a decisive role in limiting the incorporation of new users; that is why the profile of heroin users corresponds basically with that of middle-aged people, who show a polyuse pattern, here the use of heroin alternates with the use of other opiates, cocaine and cannabis. A relevant aspect in the evolution of heroin use (apart from the lower use prevalence already mentioned), is the significant decline of certain risk practices associated with it (a decrease in injecting drug use). The fact that heroin users are older now, together with the fact that people start taking heroin later, allows us to be optimistic about the future evolution of the use of this substance, which will presumably continue decreasing in the following years. 6 The use of psycho-stimulants shows a tendency towards stabilization, with slight decreases in the general prevalence of the use of cocaine and stability in the use of amphetamines. Cocaine use has increased among the youngest age group (12 to 18-year-olds), whereas it continues stable or declines slightly among the older age groups. It must be noted that, as has happened with some other of the analysed drugs, its use has increased among women, whereas it has decreased among men. We must point out the existence of a certain cyclical movement in the use of psycho- stimulants, induced by the shift in users’ preferences from one substance to another depending on occasional trends and on whether they are available in the market. The- refore the evolution of the prevalence of the use of substances such as cocaine or synthetic drugs would show peaks and valleys, with continuous risings and fallings. 7 The use of substances, such as inhalants or crack, is still a minority trend of a marginal nature; its current prevalence (very scarce) will remain steady or slightly decline in the foreseeable future. 8 Despite the progress made as far as opinions and attitudes towards drugs are concerned, there is still an important social tolerance towards the use of certain substances, mainly those, which, such as alcohol and cannabis, have a high number of users. This circumstance has fomented the growing use of drugs and their social acceptance, mainly among young people. A particularly relevant fact is that the percentage of people who include the most commonly used substances (tobacco, alcohol and cannabis) among the most dangerous drugs has fallen sharply between 1988 and 2000. 16 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

9 Although, as a whole, the problem of drug use has improved in Galicia, the reinforcement of certain phenomena, such as the increasing use of drugs among adolescents and women (both groups that were historically the origin of the fast spread of their use in Spain) might mean the reversal of the positive evolution reflected in the past years. In fact, the increase in the prevalence of substances, such as tobacco, alcohol or cannabis among teenagers and women, would explain the general rebound that the use of these three substances has been registering in Galicia since 1998. It is therefore crucial to control the emergent use of these substances among teenagers and women by designing specific strategies for these groups, if we wish to prevent the beginning of an expansive cycle in the use of drugs in Galicia. CURRENT SITUATION AND TENDENCIES OF DRUG USE AND DRUG DEPENDENCIES IN GALICIA 17

2.2 EVOLUTION OF DRUG USE-RELATED PROBLEMS

The existence of certain problems associated to drug use does not always run parallel to the social awareness of these problems, or to the existence of people’s demands to overcome them, as a consequence of the interceding effect that social perception (opinions and attitudes dominant at every moment) exerts on them. This phenomenon would explain, to a great extent, the reason why addiction to tobacco and alcohol, substances that have traditionally had a very negative effect on public health, have not generated an important volume of demands for treatment or have not made available well-developed systems of information, capable of adequately monitoring the evolution of the many health and social effects related to their use. Despite the deficiencies of the currently available information systems, focused primarily on the analysis and observation of the effects derived from illegal drug use, we are able to provide a global perspective of the general evolution of the main effects related to drug use in Galicia, which might be synthesized in the following processes: 1 After long years of continued increase, since 1997 a decline has been observed in the number of admissions for treatment for abuse or dependency on certain drugs in the treatment centres integrated in the GPD. This decrease is due both to the decline observed in the use of heroin (substance which has traditionally caused most of these episodes) and to the larger numbers of long-term treatment programmes, which, as in the case of methadone maintenance programmes, are allowing the stabilization of drug users in therapeutic processes, avoiding their constant admissions and discharges from treatment centres. 2 Despite the decline in the number of admissions for treatment, the number of patients treated in the treatment centres integrated in the GPD has increased slightly in the past years, reaching its peak in 2001, with 11,815 people treated. This trend in the volume of treatment reflects the efforts made in the past years by the Commissioner’s Office of the Galician Plan on Drugs to consolidate its treatment network, which has meant the increase of therapeutic supply and the improvement of the quality standards of the services, which have managed to reduce the levels of treatment drop-out and to increase therapeutic discharges. 3 The intensification of treatment also applies to the inmate prison population in Gali- cia, as is shown by the 48% increase in the number of inmates treated on-site since 1998 totalling 1,640 inmates in 2001. At the same time some intense work has been done with those drug dependents, which do not make formal demands for treatment, offering them harm-reducing programmes directed at preventing the appearance or the reinforcement of certain health and social drug abuse-related problems. 4 Despite the betterment of health care and the consolidation and improvement of the services provided by treatment centres, we observe that the number of patients treated in health-care centres for abuse or dependency on drugs such as alcohol and tobacco is far from the number of people, who according to the results of epidemiological studies, show patterns of abusive use of these substances (great distance between the real and potential demands due to tobacco and alcohol abuse problems). 5 The problematic use of cocaine is increasing, which has resulted in a larger number of demands for treatment attributable to this substance up to 1999, and the growing presence of its metabolites in persons who died of an acute adverse reaction after taking drugs. 6 The prevalence of certain infectious-contagious diseases is still very high among drug users, with infection rates that, in the case of people admitted for treatment in 2001, are around 18% in the case of hepatitis C, and around 12% for VIH/AIDS. However, in the past years we have seen a significant decrease in the prevalence of these diseases among drug users, as a result of greater health-care control over this group of 18 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

people (such as the setting up of prevention programmes, hepatitis B control programmes, tuberculosis and VIH/AIDS) and the reinforcement of harm-reducing strategies, which have enabled drug users to give up certain risk practices (injecting drug use has been reduced to 31% among the subjects admitted for treatment in 2001). Although there are no precise data on the incidence of tuberculosis among Galician drug users, it is known that drug addiction, and especially alcohol use, appears as one of the main risk factors in cases where tuberculosis has been diagnosed. 7 In the past years there has been a sharp decline in the number of AIDS cases diagnosed in Galicia with a rate of 36.6 per million inhabitants in 2001 (slightly lower than the national average). Injecting drug use continues to be the principal means of AIDS transmission, although it is progressively becoming less frequent. 8 Deaths related to the use of certain drugs have dramatically decreased in the past years, especially those related to the use of illicit drugs, which have seen a notable decrease in the number of deaths from acute adverse reaction after taking drugs or those caused by AIDS among injecting drug users. On the other hand the mortality rate attributable to alcohol abuse has stabilized, although we have noted the high incidence that the abuse of this substance has in road accidents’ deaths, as is confirmed by the fact that 36% of Galician drivers who died in road accidents in 2001 had exceeded the maximum blood alcohol concentration level permitted by law. CURRENT SITUATION AND TENDENCIES OF DRUG USE AND DRUG DEPENDENCIES IN GALICIA 19

2.3 FUTURE PERSPECTIVES

The study of the situation of drug use and drug dependency in Galicia enables us to predict a relatively stable future for the following years, not expecting dramatic changes in the tendencies described above. 1 Predictions for the following years include increases in tobacco, alcohol and cannabis addiction among youths and women, which may imply that the prevalence of the use of these substances may grow globally in Galicia. 2 It is expected that heroin use will continue to fall, whereas the use of psycho-stimulants will remain stable, though occasional rebounds in the use of certain substances contained in this group cannot be discarded. With the current data available it cannot be ruled out that slight increases in cocaine use may take place, whereas the use of synthetic drugs and amphetamines will most likely remain stable. 3 The health-care programmes, following the tendencies shown by drug use, will be presumably characterized by the reinforcement of the processes of therapeutic control already described. The foreseeable deceleration of the number of users will result in the progressive improvement of services offered to them. 4 In this context of stability, it is advisable to focus attention on a series of emergent trends, specially those concerning the use of tobacco, alcohol and cannabis among teenagers and women, which will require an intensification of the strategies that are already being processed to tackle these problems, both from a purely preventive perspective and as well as from a treatment perspective. There exists an evident necessity to offer some kind of support to young people with problems of substance addiction, who, so far, have not found access to treatment centres. The peculiarities of their profiles, make it necessary to design intervention strategies orientated to give socioeducative and therapeutic support to a group of people, that could be defined as teenagers and young adults in high risk situations. 3. SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE 3. SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE

3.1 OBJECTIVES AND METHODOLOGY OF THE PROGRAMME OF SURVEYS ON “DRUG USE IN GALICIA” 1988-2000

At the end of the 70s and beginning of the 80s, drug use becomes an important social problem. Along with the traditional substances, tobacco and alcohol, the use of other illegal drugs, such as cannabis, cocaine and heroin, increase. The latter one, although very limited in use, about 1%, soon has serious repercussions on health, family and insecurity on the streets. All these problems create an atmosphere of social alarm and cause great concern among public authorities; thus three specific studies have been commissioned by three different bodies; one on drug use among the Spanish population in general aged 12 and over (Navarro, J. et al., 1984), another one on the habits of alcohol use (Alvira, F. et al., 1985) and a third one on drug use among youths. (Comas, D., 1985). Although these three studies show some differences in content and methodology, the then recently created National Plan on Drugs (NPD, 1985) uses them as a reference in its presentation report and from their data it draws the following conclusions:

■ The considerable social potentiality of heroin in relation to a series of factors and effects, which contributes to their appearance and reproduction through social contagion, and eventually converts them into a stereotype of great impact and effectiveness.

■ Increase in cocaine use, whose consequences are masked, due to the fact that cocaine has a period of “clinical silence” that lasts from three to five years, and from this point on health problems appear.

■ Controversy about how dangerous the effects of cannabis are on health and its acceptance among young people as a less dangerous substance, becoming, together with alcohol, a multiplying risk factor for the use of other drugs among teenagers and young adults.

■ Relation of the use of illegal drugs to an increasing lack of security on the streets, identifying the drug addict as a criminal and drugs as a factor of criminality in a more ideological than scientific approach, since, drugs usually end up reinforcing already existing processes of social exclusion.

■ Tendency to identify or restrict drug use, especially illegal drug use, among young people. The drug addiction problem currently affects, all social groups and all geographical areas in Spain, and although it is true that young people are at considerably greater risk, it is also true that society has two standards when evaluating certain behaviours, depending on whether a young person or an adult is involved. According to this the main questions on drug use problems would then be: the promi- nent role of heroin, the growing but masked increase of cocaine use, the controversy about the danger of cannabis on health, the ideologized association of illegal drugs with the lack of security on streets and that drug addiction affects not only youth, but all social groups. These three studies had a national scope and although they provided us with highly interesting and useful information, there was a serious limitation: many of their data, particularly those that had to do with the use of the least commonly used substances, were not at all significant as far as the different Autonomous Communities were concerned. 24 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

This limitation, together with the need to study in depth the peculiarities found in the different parts of Galicia, led the then so-called Autonomous Plan on Drug Addiction to set up a Programme of Surveys on “Drug Use in Galicia” in 1988. This research project, the first of its kind, was intended to have time continuity so that some historical series could be compiled, which would allow for the analysis of the evolution of certain factors: prevalence, polyuse, motivation, risk factors, public opinion, demands for intervention, etc. Therefore, it became necessary to design a wide corpus of hypotheses as research objectives so that this Programme of Surveys could have a theoretical consistency in time, which would allow us to measure and explain, as far as possible, the changes that were taking place and the likely evolution tendencies. The initial hypotheses contained in the first of these investigations (GPD-EDIS, 1988)), were the following: 1st Drug use in Galicia would have two main characteristics: the first one being the wide extent of the use of certain drugs, such as tobacco, alcohol, psychotherapeutic drugs and cannabis; the second one: the serious epidemiological consequences of the use of heroin and cocaine, less commonly used drugs at the time. 2nd The most commonly used drugs, cannabis among them, might have reached their peak, or a certain degree of stabilization, whereas less commonly used drugs, mainly heroin and cocaine would be in a period of expansion; cocaine use being in a state of greater expansion among the population and the drug that could pose the main problem within a few years’ time. 3rd The age span of the users of various drugs would present two distinct patterns: first- contact drugs used by young people, such as inhalants, cannabis, heroin, cocaine and amphetamines, and drugs used by adults, such as tranquillizers, hypnotics and analgesics. Tobacco and alcohol would be two drugs that, due to their generalized use, would affect large sectors of society of all ages, even though their initiation of drug use would begin at a very early age. 4th A distinct sex division is also profiled: men would probably use mainly tobacco, alcohol, hallucinogens, cannabis, cocaine and heroin; women would be the most likely users of tranquillizers, hypnotics and common analgesics. Finally, a certain balance between sexes in the use of inhalants, amphetamines and morphine analgesics could be established. 5th Nevertheless, according to recent studies, this structurization based on gender and age is somewhat dynamic and in constant change. Women would be approaching men as far as tobacco and alcohol addictions are concerned. 6th Except for tobacco and alcohol, which are drugs present in most of the population, the rest of drugs can be divided into two categories based on habits of use: monouse, or use of only one drug and polyuse, or use of two or more drugs. Among the latter group we find those presenting a high polydrug use pattern. These users are most likely to present the most acute problems and to require more intense care and treatment. 7th Regarding cannabis two different patterns of use are established: one of monouse, and the other one as a drug alternating with other stronger drugs, such as heroin, cocaine, amphetamines, etc. 8th In the case of heroin, we would find a generalized polyuse pattern, associated, as we already know, with cannabis, tranquillizers and morphine analgesics and with cocaine, which until recently was not very common, but is becoming more and more frequent. 9th As far as the regularity of the use of the various drugs is concerned, we would probably find three different degrees: the first one, the most regular use would be that of tobacco, alcohol, morphine analgesics/opiate derivatives, tranquillizers and hypnotics; a second group would include amphetamines, cannabis and probably common analgesics, too; finally the least frequent ones would be inhalants and hallucinogens; even though the spread of cocaine would eventually show a higher degree of regular use. SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE 25

10th The means of obtaining drugs would be numerous, although they would be structured in three different groups: via personal relations (peer groups, family...), via wider environmental relations (social groups, street selling and in specific places) and finally via medical prescription, the latter referring to prescribed and over-the- counter psychotherapeutic drugs. 11th With regard to the reasons expressed for taking drugs, we would find a large number of them, with the possibility of essentially reducing them to three broad categories: social response, personal experimentation and symptomatologies associated to a disease or syndrome. 12th Apart from the reasons made explicit by drug users, there would be a series of objective risk factors related to drug use. These would be numerous and diverse, however reducible to a series of common factors: family conflicts, unemployment, basic existential attitudes, social and institutional values, psychological situation, etc. 13th Drug use would pose serious problems for a number of people with grave consequences on health, work, family life, money matters and especially for the users of highly-priced illegal drugs, it would cause financial strain and trouble with the law. 14th The position of drug users with respect to the possibility of giving up the drug would be diverse depending on the drug used: the greater the addictive potentiality of each drug, the greater degree of difficulty. 15th Among drug users presenting a certain degree of regular use, we would find a proportion of cases, where some kind of detoxification and rehabilitation treatment was being or had been carried out; but our hypothesis is that, that proportion would be low even in the cases concerning highly addictive drugs, as occurs with heroin, in which case we do not expect to find more than three or four cases out of every ten. 16th The variables related to status and social class have less and less influence on drug use, finding a more generalized pattern in the use of some drugs, as occurs with tobacco, alcohol, psycho-stimulants and cannabis. The possible differences might be found in heroin, whose use tends to be more limited, and with cocaine, which is well established among the affluent classes, although it is becoming increasingly popular. 17th Among the non-users there are conscious and unconscious reasons for not taking drugs. Their analysis could help us formulate certain protective factors on which, together with the deactivation of risk factors, a programme of preventive strategies could be based. 18th The existence, among the population in general, and drug addicts in particular, of certain attitudes towards the fight against drugs, the treatment of drug users and their reintegration into society has also been mentioned. These attitudes would probably be structured around the following axes: repression, information-education, treatment and the improvement of life quality and environmental conditions that are basically the origin of drug addiction. 19th However, some kind of resistance is likely to appear when the rehabilitation process affects people more directly (the inauguration of a rehabilitation centre in their dis- trict), which would be convenient to know in order to develop some persuasion ad collaboration strategies. 20th The lack of public awareness regarding its implication in the problem as users of potentially harmful legal drugs is predictable. The knowledge of these facts would facilitate the development of prevention strategies and others to promote awareness. Given the fact that we intended to establish some historical series, these initial hypotheses and the indicators derived from them have remained practically unchanged. However, the appearance of new problems and the substantial changes that some of them have registered, made it necessary to incorporate new hypotheses in the successive studies on Drug Use in Galicia carried out in 1992, 1994, 1996, 1998 and 2000 and in the specific study on the Use of Synthetic Drugs (GPD-EDIS, 2001). Those hypotheses would be the following: 26 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

21st After an expansive phase, heroin would enter a phase of stagnation and likely descent. 22nd Methadone substitution treatments for heroin users would probably bring about a certain increase in the use of other opiates. 23rd As heroin users also take other substances, the decrease in the use of heroin would imply a decrease in the levels of polydrug use. 24th New synthetic drugs would experiment a certain expansion, which would tend to stabilize in a few years’ time. 25th The combined effect of a decrease in the use of heroin, an increase of synthetic drugs and the stabilization of cocaine, would cause the previously prevalent polyuse, the use of narcotics, to be displaced by the use of psycho-stimulants. 26th Although alcohol abuse might decrease slightly in its general prevalence among the population, the youngest age groups would increase its use, mostly over the weekend. 27th Together with risk factors of a personal, family and social nature, work conditions (stress, precariousness, insatisfaction, etc.) might also have an influence on the abuse of alcohol and other drugs. 28th In the intervention strategies developed to deal with drug problems, we ought to take into consideration a series of relevant protective factors (values, education, prevention at school, etc.). 29th In order to adequately plan for the interventions and resources to tackle drug problems, we should bear in mind the indexes of risk in each health-care area: high, medium-high and low. 30th The more intense the interventions to deal with drug problems become, the higher the level of knowledge and appreciation of the work carried out. These thirty hypotheses permit us, through their empiric comparison with the results of the different existing studies, to confirm some tendencies with a certain predictive value, which will be described in the following sections and summarized in the final conclusions. But first we shall have a concise look at the methodology used in the Programme of Surveys. As for the questionnaire applied to the survey in the first study carried out in Galicia in 1988 we cite the following: “The model of survey on drugs epidemiology, first introduced by Smart in an inves- tigation project for the World Health Organisation, which we have used slightly modified here, has been subjected to several reliability and validity controls, with basic criteria, established firmly enough, in our opinion, by several authors. We are referring to the works by Whitehead and Smart (1972), those by Single and cols. (1975), those by Smart (1975), Jonhston’s revision (1980) and studies similar to the one by O’Malley and cols. (1983). These studies have synthesized the different tests to apply, such as: checking the validity and reliability of this type of survey, establishing its effectiveness to analyse people’s behaviour in relation to drugs, provided accurate methodological controls are applied. The model of data gathering that we use in this study has been checked in several samples from different geographical areas. It has also been evaluated from the point of view of its validity and reliability in relatively difficult samples, in Spanish (Medina Mora and cols. 1981), apart from the first studies carried out on this instrument in English by Smart (1980). It has been also applied by EDIS in a wide national study “Drug use in Spain” (1984) and in other regional studies “Drug use in Aragón” (1986), “ Andalusians before Drugs” (1987), “Risk profiles in drug use in Madrid” (1988).” Subsequently, the basic structure of this questionnaire has been applied in studies in Galicia (1992 to 2000), Andalusia (1989 to 2000), The Community of Valencia (1996 to 2000), SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE 27

and slightly adapted to studies on drugs at the workplace in Spain (1987, 1996 and 2001), in Madrid (1996), Andalusia (1997) and the Community of Valencia (1999). The survey has been conducted on a probabilistic, personal basis and at the interviewees’ places of residence, as is stated in the methodology, and we have taken into consideration many of the observations derived from the methodological revision of the survey carried out in the USA, (GFROERER, J., 1991), (TURNER, CH. F. et al, 1992), regarding the structuring and level of understanding of the questions, the privacy and anonymity of the interview, seman- tic contaminations, and the treatment and analysis of the data obtained. Finally, the different methodological aspects of the studies carried out in Galicia can be summarised in the following technical specifications (Table 3.1):

Table 3.1 Technical specifications of the studies on drugs in Galicia, 1988-2000

Universe Over 12-year-olds, both sexes, residents in Galicia Geographic Area Galicia

Sample Size 1988: 3,700 Interviews conducted at 1992: 2,000 the interviewer´s place of residence 1994: 2,300 1996: 2,300 1998: 2,300 2000: 2,300 Sample Error 1988: ± 1.64% (p=q=50) 1992: ± 2.20% 1994: ± 2.04% 1996: ± 2.04% 1998: ± 2.04% 2000: ± 2.04% Level of Reliability 95.5% (k=2 sigma) Sample Design Random stratified with simple non-proportional distribution per health areas and age groups, with sample balance to recover the proportionality in relation to the real population in each health area and age group. Proportional per habitats. Random distribution in each sample unit through random routes and the drawing of the last sample unit: the person to be interviewed. Sample Control 20% of the interviews were confirmed by phone Dates 1988: October-November 1992: November-December 1994: December 1996: June 1998: November 2000: November

The first study from 1988, due to its exploratory nature, was based on a sample of 3,700 interviews. From then onwards we were able to optimise the sample distribution in the different health areas, which enabled us to apply a sample of 2,000 elements in the second study, which happened to be slightly scarce in the disintegrations of certain variables; therefore from the third study onwards we raised the sample size to 2,300. 28 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

3.2 PREVALENCE AND PATTERNS OF USE

3.2.1 TOBACCO AND ALCOHOL TOBACCO

Tobacco is, after alcohol, the second psychoactive substance, which Spanish people have most commonly used some time in their lifetimes, but it is the first one in daily use. From the data of the last Household Survey on Drug Use from the year 1999 (SMCDDA, 2001), 32.6% of Spanish population aged 15 to 65, would smoke on a daily basis. Based on the data of the last survey carried out in Galicia, we see that in the year 2000 among the over 12-year-old age group, the prevalence of daily tobacco smokers represented 32% of the total. Similar to the percentage rates prevalent for the whole country, the rate of daily smokers varies considerably depending on gender and age. In Galicia there are also, in general, more male smokers than females, with percentages of 41.3% and 23.4%. However, if we take into account the age factor, we see that there is an age group, that of the 19 to 24 year-olds, where the proportion is reversed, with more women as daily smokers than men, with percentages of 49.6% and 41.9%, respectively (Table 3.2).

Table 3.2 Daily smokers by gender and age (percentages)

Total 12–18 19–24 25–39 40–54 55 and over

Males 41.3 34.2 41.9 50.4 44.3 39.4 Females 23.4 30.3 49.6 37.5 23.6 4.5 Total 32.0 32.2 45.7 44.0 33.8 17.7 Males: x2 = 173, 12 g.l., P<.00000 Females: x2 = 253, 12 g.l., P<.00000

The data representing the use of tobacco reflected in the six studies carried out between 1988 and 2000 is included in Table 3.3.

Table 3.3 Evolution of the use of tobacco, 1988-2000 (percentages)

Year Have never Used to, but Smoke Smoke smoked currently don´t occasionally dailly

1988 54.4 5.0 5.0 33.7 1992 60.4 5.0 5.0 29.6 1994 61.9 4.6 4.5 28.6 1996 56.2 7.7 7.2 28.9 1998 51.6 10.0 6.1 32.2 2000 50.1 14.0 3.9 32.0

It might be estimated that in Galicia in 2000, there would be, in absolute terms, 755,000 daily smokers and another 92,000 occasional ones. The evolution of the daily use of tobacco in Galicia, over the thirteen year-period the series covers is the following (Graph 3.1): SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE 29

Graph 3.1 Evolution of dialy tobacco use (%). Galicia, 1988-2000

EVOLUTION OF USE

Up to 1994 we observe a progressive decrease in tobacco addiction among the over 12- year-old group, the highest prevalence of regular daily smokers. This same tendency has also been observed in the studies carried out nationwide in the past decade, both among the general population (NAVARRO, J., et al, 1984), (NPD-EDIS, 1995), and the working population (EDIS-UGT, 1987) (FAD-EDIS, 1996), who are usually the major users of this substance. Nevertheless, in 1996 we observe a slight increase, which in 1998 approaches that of 1988, and stabilises in the year 2000. The rebound of daily tobacco use is mainly due to the increase of daily smokers among teenagers and young people, and especially women. This trend is rather generalised, being the cause of the increase in the global prevalence, as it is observed in the following chart:

CHART A Daily smokers’ rates in different recent studies1

Geographic area and age Year % Daily smokers

National (15 and over) 1995 30.5 National (15-65) 1997 32.9 National (15-65) 1999 32.6 Canarias (15-65) 1997 36.2 Madrid (15-65) 1997 36.0 C. Valenciana (15 and over) 1996 35.0 C. Valenciana (15 and over) 1998 36.5 C. Valenciana (15 and over) 2000 40.0 Andalucía (12 and over) 1996 29.5 Andalucía (12and over) 1998 31.0

1 PNSD-EDIS “National Household Survey on Andalucía (12 and over) 2000 33.2 Drug Use” (1995) and PNSD-SIGMA DOS “National Household Survey “ (1997). Home Galicia (12 and over) 1996 28.9 Office. Madrid. EDIS “Drug use on the Canary Islands” (1997). Canarian Plan on Drugs. EDIS “Drug use and related factors in the Galicia (12 and over) 1998 32.2 Municipality of Madrid” (1997). City Council of Madrid. FAD-EDIS “Drug use and related Galicia (12 and over) 2000 32.0 factors in the Community of Valencia” (1996) (1998) (2000). The Drug Dependency Directorate. Generalitat Valenciana. EDIS “Andalusians before Drugs” (1996) (1998) (2000). Commissioner’s Office for Drugs. Junta de Andalucía. Sevilla. (This note also applies to the rest of the charts) 30 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

In Galicia this evolution of the prevalence of daily smokers has also had a correlate in the average number of cigarettes smoked per day, in 1988 they were 18.9 and in 1996 they were 16.6, rising to 18.0 in the year 2000. Thus we have established that both the rate of daily smokers and the average number of daily cigarettes rose in 2000, but they did not reach the levels observed in 1988. Finally, in reference to the ages when people start smoking, in 1998 the average was 15.7 and in 2000 it was 16.6. The initiation age has increased in almost a year. However, the greatest prevalence of daily smokers, that in 1988 was found in subjects aged between 25 and 39 years (47.1%), in 2000 it was between the aged 19 to 24 years (45.7%). That is to say, even though people start smoking when they are a bit older, daily smokers take up the habit at an earlier age. Based on all the data we conclude that, in the years between the first and the second Galician studies, the established hypotheses regarding tobacco use have been confirmed: tobacco is a commonly used drug among the whole population, mainly men (1st and 4th hypotheses), but it is in a process of change in which women’s addiction to tobacco is approaching that of men’s (5th hypotheses), and where there is an earlier initiation age (3rd hypotheses). The latter is corroborated by the greater prevalence of daily smokers among teenagers and young people. The foreseeable tendency for the following years would be then that, unless important changes take place (abolition of tobacco advertising, increase of public awareness to the fact that tobacco is an addictive substance, changes in young people’s lifestyles, etc.), tobacco will continue being a commonly used substance with daily smokers rates not under 30%; and between 40% and 50% among young adults and middle-aged people. The progressive incorporation of women to work and social life, a highly positive fact in itself, will result in equalizing their roles to those of men’s, an effect of the imitation of certain behaviours and habits, such as the addiction to tobacco, alcohol and other substances.

ALCOHOL

Alcohol is the most commonly used psychoactive substance in Spain. According to the data from the 1999 Household Survey on Drugs, 87.1% of the population aged between 15 and 65 have taken alcohol at some time, and 74.6% did so in the past twelve months. In the thirty days prior to the interview the prevalence of alcohol consumption was still quite high, at 61.7%. In Galicia, during the same period, 58.7% of the population aged over 12 had consumed alcohol. The different age groups analysed explain this difference in percentages. In the evolution of alcohol use nationwide, in Galicia and in the other Autonomous Communities, a certain decrease was observed up to 1999 (nationwide), and up to 1998 (Galicia), both in the prevalence of general use, as well as in that of abusive drinkers. However, in the analysis of the data of the 1998 Galician study, the possibility of this decrease being reversed, and of a rebound in alcohol consumption had already been considered, due to the progressive incorporation of adolescents and women to the abusive2 use of alcohol. In the 2000 study this prediction seems to have come true, observing an increase of 1.6% in the prevalence of alcohol abuse, mainly due to the fact that the prevalence of abusive drinkers in the youngest age groups has gone up: in the 12-18 age group the increase was from 3.7% in 1998 to 5.4% in the year 2000, and in the 19-24 age group

the percentage rose from 9% to 13% in 2000. The same has occurred with females, who 2 Abusive consumption (heavy+excessive+high- risk drinkers) would be when it exceeds 75ml went from a prevalence of 2.2% in 1998 to one of 3.7% in 2000. per day for males and 50 ml for females. Their equivalence in grammes and standard basic The data about abusive drinkers in Galicia can be seen in the following table 3.4. units would be: over 60 grs. or 6 SBU for males and 40 grs. or 4 SBU for females, according to the criteria of the Director- General’s Office for Public Health. Report number 2 (page 23) of the Spanish Monitoring Centre for Drugs and Drug Addiction (1999) SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE 31

Table 3.4 Abusive drinkers by gender and age (percentages)

Total 12-18 19-24 25-39 40-54 55 and over

Males 13.6 6.6 15.1 15.2 17.0 12.6 Females 3.7 4.9 11.5 7.5 1.7 0.6 Total 8.5 5.4 13.0 11.3 9.2 5.5 Males: x2 = 153, 20 g.l. P<.00000 Females: x2 = 89, 20 g.l. P<.00000

According to these data 8.5% of the Galician population aged over 12 were abusive drinkers, the highest rate was found among the 19 to 24 age group at 13%. From a general point of view the different types of alcohol use observed in Galicia in the six studies are shown in the table (Table 3.5):

Table 3.5 Evolution of the types of drinkers. Galicia, 1988-2000.

Year Teetotallers Low Moderate Heavy Excessive High risk use use use use use

1988 52.3 19.8 17.0 4.0 3.2 3.5 1992 53.5 18.6 17.2 4.3 3.4 3.1 1994 54.8 17.8 16.9 4.9 3.2 2.4 1996 56.3 19.0 16.3 3.5 2.9 2.0 1998 59.9 15.6 17.6 3.5 2.2 1.2 2000 57.3 15.2 19.1 3.4 2.8 2.3

If we now take into consideration abusive drinkers (heavy+excessive+high risk), we reach the conclusion that there would be, in absolute terms, about 200,800 people in this situation in 2000, out of which 96,000 would present high-risk abuse. The evolution of abusive drinkers between 1988 and 2000 can be seen in Graph 3.2.

Graph 3.2 Evolution of alcohol abuse in Galicia (%), 1988-2000

EVOLUCIÓN DO CONSUMO

According to the data we observe that the falling tendency of abusive alcohol use in Gali- cia, registered between 1992 and 1998 is reversed in 2000 demonstrating an increase of over 1.5%. The reasons for this increase are those stated above, which refer to a higher abusive 32 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

consumption among teenagers, young adults and women. We must add that, whereas among middle-aged and elderly people the alcohol use pattern is prevalent on working days, among young adults it is prevalent over the weekend, with maximum average daily consumptions of 48.76 ml. and 63.59 ml., respectively. Average quantities consumed in each age group, on working days and over the weekend can be seen in the following chart 3.3.

Chart 3.3 Average alcohol consumed in ml, by weekdays and age. Galicia, 2000

Ml alcohol on working days

Ml alcohol on weekends

As for the types of alcoholic beverages, we have to point out that, although in general, wine, beer and spirits in this order, are the most commonly drunk in Galicia, these preferences change among abusive drinkers, with spirits in the first place (specially cocktails) followed by beer and wine. These differences have to do with the important presence of young people among abusive drinkers, whose drinking preferences differ from those of adults. The evolution of alcohol abuse registered in several national and regional studies can be seen in the following chart B.

Chart B Evolution of the rates of abusive drinkers in different studies Geographic area and age Year % Abusive drinkers

National (working population) (15-65)3 1987 19.5 National (working population) (15-65) 1996 14.0 National (general population) (15-65) 1997 working days 9.9 weekend 10.1 National (general population) (15-65) 1999 Working days 6.0 Weekends 7.7 Andalucía (12 and over) 1994 9.5 Galicia (12 and over) 1994 10.5 Andalucía (12 and over) 1996 7.8 Galicia (12 and over) 1996 8.4 C. Valenciana (15 and over) 1996 7.0

Andalucía (12 and over) 1998 6.5 3 UGT-EDIS (1987). “Drug dependencies at the workplace”. Unión General de Trabajadores. Galicia (12 and over) 1998 6.9 Madrid. FAD-EDIS (1996). “The effects of drugs at work”. Fundación de Ayuda Contra C. Valenciana (15 and over) 1998 6.1 la Drogadicción. Madrid. EDIS (1994) (1996) (1998) “Andalusians before drugs”. Commissioner’s Office for Drugs. Junta de Andalucía (12 and over) 2000 7.8 Andalucía. Sevilla. FAD-EDIS (1996) (1998) “Drug use and related factors in the Galicia (12 and over) 2000 8.5 Community of Valencia”. Drug Dependency Directorate. Generalitat Valenciana. Valencia. SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE 33

Up to 1998-99 we observe a general decline in alcohol abuse, but in 2000 a rise takes place not only in Galicia, but also in Andalusia, where consumption grows by 1.3%. In the (EDIS, 2000) study on Andalusia, we find the same reasons apply for the increase. As for the initiation ages to drinking alcohol in Galicia, they were 16.1 in 1998 and 16.7 in 2000, that is to say, there is a delay of 0.6 years in the age at which drinking starts. On the contrary, and just as occurred with tobacco, the most prevalent age group of abusive drinkers was that of 25-39-year-olds (13.9%) in 1998, on the other hand in 2000 it was the 19-24 -year-old age group (13%). This parallelism between daily smoking and drinking is due to the fact that they are two substances that are usually mixed and, as we shall see later, they constitute one of the four basic patterns of polyuse, with coefficient rates in the same factor of 0.670 and 0.618, respectively. With all these data on alcohol use we see that between 1988 and 2000, all the stated hypotheses have come true: regarding the extension of its use (1st and 4th hypotheses), the progressive incorporation of women and young adults to alcohol abuse (5th and 3rd hypotheses), and the consolidation of its use among young people over the weekend. Finally, besides the single use of each substance, we also observe- even more than predicted- a quite widely extended polyuse of tobacco and alcohol (6th hypothesis). The tendencies or predictions related to alcohol use are very similar to those regarding tobacco: a rebound of the general prevalence of abusive consumption, provoked mainly by the higher abuse observed among women and the younger age groups. At the same time, a polyuse pattern of daily smoking and alcohol abuse is consolidated, associated, although in a lesser degree, with cannabis. In order to reverse this tendency a series of changes and strategies, similar to those mentioned in tobacco addiction, should be implemented and particularly some preventive work should be done at home and at school, which, as we shall later see, are very important protective factors.

3.2.2 ILLEGAL AND PSYCHOTHERAPEUTIC DRUGS Among the group of illegal drugs we find the following substances: in the first place, cannabis, which is of relatively common use and is present in two polydrug use patterns: with tobacco and alcohol on the one hand, and with psycho-stimulants on the other. In the latter pattern we find the following substances: cocaine, synthetic drugs, hallucinogens and amphetamines. In another polydrug use pattern, that of narcotics, we have heroin and other opiates. Finally, we shall see two other substances of a very limited use, but which appear in both patterns mentioned above: inhalants, in the polydrug use pattern of psycho-stimulants and crack among narcotics. There is a fourth polydrug use pattern, that of psychotherapeutic drugs, which include tranquillizers and hypnotics, but because of its particularity, it will be discussed later. The indicators of use reflected in the six studies conducted in Galicia from 1988 to 2000 have been the following ones: lifetime (ever used), the past six months, the past 30 days and the frequency of use within these thirty days. We shall see the prevalence in each indicator and its evolution for each substance and within the indicator of the past thirty days we shall see the frequency of use (from 2 to 6 times per week and on a daily basis). We also include the prevalent use by gender and age, the average initiation age and comparisons with similar national or regional studies. As for the hypotheses and likely tendencies, the analysis will be applied on all the substances together.

CANNABIS

As it has been reflected in the various studies, cannabis is the most commonly used illegal drug in Spain (1999) in general (7.5% in the past twelve months), and in Galicia (2000) in 34 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

particular (6.1% in the past six months). Its role in the polydrug use pattern of tobacco-alcohol-cannabis has a saturation coefficient of 0.535, and of 0.461 in the pattern of psycho- stimulants. It is, therefore, quite a versatile substance. The prevalence in the different indicators in Galicia, between 1988 and 2000, is shown in Table 3.6:

Table 3.6 Evolution of the use of cannabis. Galicia, 1988-2000

Year Lifetime Past 6 Past month Regular (ever used) months

1988 * 5.6 5.0 1.2 1992 * 2.4 2.0 0.6 1994 * 2.7 2.4 0.5 1996 8.5 3.7 2.7 0.3 1998 7.6 4.0 3.2 0.6 2000 13.1 6.1 5.3 0.9

*The lifetime indicator has not been included in these studies.

In absolute terms, we estimate that in Galicia in 2000 approximately 125,000 people would have taken cannabis in the past six months, out of which from 42,000 to 46,000 would do it on a regular basis (from 2 to 6 times per week or daily). The evolution recorded in each study and the global tendencies of the prevalence for the indicator of use in the past six months can be seen in Graph 3.4:

Graph 3.4 Evolution of the use of cannabis in the past six months (%), 1988-2000

Evolution of use of Cannabis

As can be observed, after a significant decrease in the use of cannabis between 1988 and 1992, a slow but progressive increase of its prevalence is observed in the successive studies. Therefore, the global tendency would be one of net use increase: 5.6% in 1988 and 6.1% in 2000; that is, 0.5% higher. In general, the increase in the prevalence of cannabis is fundamentally due to the high increase in use observed among the two lowest age groups between 1992 and 2000 (Table 3.7). SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE 35

Table 3.7 Evolution of the use of cannabis in the past six months by age (%)*. Galicia 1992-2000 1992 1994 1996 1998 2000 From 12 to 18 2.3 5.0 9.4 9.1 17.4 From 19 to 24 9.3 10.9 10.9 8.9 14.6 From 25 to 39 3.7 3.0 5.6 6.9 6.9 From 40 to 54 0.9 0.4 0.0 1.3 1.9 Over 54 0.0 0.0 0.0 0.0 0.7 Total 2.4 2.7 3.7 4.0 6.1

In the 12 to 18 and the 19 to 24 age groups, the use increases from 2.3% and 9.3%, respectively, in 1992, to 17.4% and 14.6% in 2000. The prevalence of cannabis by gender in the different studies was the following:

Table 3.8 Evolution of the use of cannabis in the past six months by gender*. Galicia, 1992-2000 1992 1994 1996 1998 2000 Females 1.1 1.1 2.1 1.7 2.1 Males 3.8 4.4 5.5 6.5 10.4 Total 2.4 2.7 3.7 4.0 6.1

As can be observed, in the year 2000 women almost double their use of cannabis in relation to 1992, whereas men- the most frequent users in all the studies- almost treble it. The ratio between men and women goes from 3.5 to 1 in 1992 to 4.9 in 2000. That means that even though there is an increase among both sexes, it is slightly more intense among men than women. This rising tendency in the use of cannabis has been also observed in other similar studies, except in the Community of Valencia, where the 1998 prevalence was very high, but went down in 2000, as we can see in the next chart C:

Chart C Evolution of the use of cannabis in different studies Geographic area Year Past Past 6 or and age month 12 months

Spain (15-65) 1995 2.7 5.8* 1997 4.0 7.5* 1999 4.2 7.5* Andalucía (12 and over) 1994 3.9 5.6 1996 4.1 5.8 1998 4.3 5.3 2000 5.8 7.5 Galicia (12 and over) 1994 2.4 2.7 1996 2.7 3.7 1998 3.2 4.0 2000 5.3 6.1 Comunidad Valenciana 1996 6.3 8.3* (15 and over) 1998 6.8 10.4* 2000 6.3 7.8

* The division of use by age groups and gender * Past twelve months has been applied from the 1992 study onwards. In the 1988 study only the most As for the initiation ages of use of cannabis, we see that they remain fairly stable. In prevalent uses were pointed out. (This note also applies to the other substances) 1998 the average age was 16.9; in 1992 it rose slightly to 17.6, and in 2000 it was 17.5. 36 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

COCAINE Even though cocaine is not as commonly used as cannabis, it is a substance, which is quite present in society, especially among young people. In Spain (1999) the use of cocaine was at 1.5% in the past twelve months, and in Galicia (2000) at 1.3% in the past six months. On the other hand, it is a leading drug in the polydrug use pattern of psycho-stimulants, with a saturation coefficient of 0.687. The prevalence in the different indicators in Galicia, between 1988 and 2000, is found in Table 3.9.

Table 3.9 Evolution of the use of cocaine in Galicia, 1988-2000 Year Lifetime Past 6 Past Regular months month 1988 * 1.7 1.5 0.1 1992 * 1.5 1.3 0.1 1994 * 2.0 1.6 0.2 1996 2.7 1.8 1.3 0.1 1998 2.3 1.2 0.6 0.1 2000 2.9 1.3 1.1 0.0

These estimates mean that in 2000, in absolute terms, approximately between 25,000 and 27,000 people would have taken cocaine in the past six months, out of which between 2,000 and 3,000 would do it on a regular basis. (from 2 to 6 times per week or daily). Taking the indicator of the past six months as a reference, we can see the evolution of the use of cocaine between 1988 and 2000 (Graph 3.5):

Graph 3.5 Evolution of the use of cocaine in the past six months (%), 1988-2000

Evolution of use of Cocaine

If we carefully observe the differences in prevalence year after year, we see that the use of cocaine is somewhat irregular, producing peaks and valleys, with a maximum of 2% in 1994 and a minimum of 1.2% in 1998. Nevertheless, the tendency of the global evolution would be a decreasing one, dropping from 1.7% in 1988 to 1.3% in 2000. Regular use is fairly stable, oscillating between 0.2% and 0.1%. As for the use of cocaine by age, in table 3.10 we can see that the age groups with the highest prevalence are the 19 to 24 age group, rising from 1992 (3.3%) to 2000 (4%), and the 25 to 39 age group, but this percentage falls from 1992 (4.5%) to 2000 (2.2%). These data highlight the fact that cocaine users tend to be younger now. SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE 37

Table 3.10 Evolution of the use of cocaine in the past six months (%) by age, 1992-2000

1992 1994 1996 1998 2000

From 12 to 18 0.4 1.3 1.3 1.7 1.3 From 19 to 24 3.3 4.9 5.3 3.2 4.0 From 25 to 39 4.5 3.7 4.0 2.2 2.2 From 40 to 54 0.0 2.4 0.0 0.4 0.9 Over 54 0.0 0.0 0.0 0.0 0.0 Total 1.5 2.0 1.8 1.2 1.3

The prevalence of cocaine use by gender was the following (Table 3.11):

Table 3.11 Evolution of the use of cocaine in the past six months (%) by gender, 1992-2000

1992 1994 1996 1998 2000

Females 0.3 0.8 0.7 0.5 0.4 Males 2.7 3.3 3.2 1.9 2.2 Total 1.5 2.0 1.8 1.2 1.3

Males are, in all the studies, the most frequent cocaine users, even though the ratio between males and females, which in 1992 was 9 to 1, falls in 2000 to 5.5 to 1. Besides the fact that cocaine users tend to be younger now, we also observe that women’s use is approaching that of men (in 1998 the ratio was just 3.8 to 1). The prevalence in the use of cocaine in Spain in general and in other Autonomous Com- munities in particular can be seen in chart D:

Chart D Evolution of the use of cocaine in different studies

Geographic area Year Past Past 6 or and age month 12 months

Spain (15-65) 1995 0.4 1.6* 1997 0.8 1.6* 1999 0.6 1.5* Andalucía (12 and over) 1994 2.4 3.1 1996 1.4 2.0 1998 1.4 1.9 2000 1.5 2.2 Galicia (12 and over) 1994 1.6 2.0 1996 1.3 1.8 1998 0.6 1.2 2000 1.1 1.3 C. Valenciana (15 and over) 1996 2.3 3.2* 1998 2.3 4.7* 2000 2.7 3.6*

* Past twelve months

In general we observe the same irregular behaviour of cocaine registered in Galicia, rising and falling, but within a slight downward tendency with respect to the first studies. Specifically in Galicia and with a perspective from 1988 (graph 3.5) the highest prevalence 38 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

is reached in 1994 and 1996, followed by a certain decline. This irregularity might be related to its mixed use with other psycho-stimulants (synthetic drugs, amphetamines) and the fact that users change from one substance to another. Finally, concerning the age of initiation to cocaine use, we observe, parallel to the highest prevalence at earlier ages, a slight decrease in the initiation age, dropping from an average of 19.9 in 1988 to 19.4 in 2000.

SYNTHETIC DRUGS, AMPHETAMINES AND HALLUCINOGENS

Even though each of these substances is specific, we include them all in the same category since along with cocaine (which has a slightly more diversified use) they constitute the primary pattern of polydrug use: that of psycho-stimulants, with rather high saturation coef- ficients: hallucinogens with 0.692, synthetic drugs with 0.682 and amphetamines with 0.670. On the other hand, their profiles are rather similar, since they have in common a wide spectrum of regular users. The prevalence of use of each of these three substances, in the different studies conducted in Galicia is the following:

Table 3.12 Evolution of the use of synthetic drugs, amphetamines and hallucinogens, 1988-2000

Year Lifetime Past 6 Past Regular months month Synthetic drugs* 1988 * * * * 1992 * * * * 1994 - 0.8 0.8 0.0 1996 1.4 1.0 0.9 0.0 1998 1.1 0.7 0.6 0.0 2000 1.7 0.7 0.5 0.0 Amphetamines 1988 - 1.9 1.4 0.2 1992 - 0.4 0.4 0.1 1994 - 0.6 0.4 0.0 1996 1.1 0.6 0.4 0.0 1998 1.1 0.6 0.4 0.0 2000 1.4 0.7 0.6 0.0 Hallucinogens 1988 - 0.6 0.3 0.0 1992 - 0.2 0.1 0.0 1994 - 0.3 0.2 0.0 1996 1.1 0.4 0.3 0.0 1998 1.0 0.4 0.3 0.0 2000 1.3 0.5 0.3 0.0

* Synthetic drugs were included for the first time in the survey in 1994

As we can see the prevalence of use of each of these three drugs is very similar. In 2000, the use of synthetic drugs in the past six months is 0.7%, of amphetamines 0.7%, also, and of hallucinogens 0.5%. Their use is occasional, with no daily use at all or with a very limited daily or high frequency use; but with 0.1% or 0.2% use once a week, basically at the weekend. In the whole of Spain in the past twelve months, the use was calculated at 1% for synthetic drugs, 0.7% for amphetamines and 0.6 % for hallucinogens. It could be estimated that the use of these substances, in absolute terms, would be approximately as follows: for synthetic drugs between 16,000 and 18,000 people would have used them in the past six months, out of which from 2,000 to 3,000 would use them SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE 39

once a week. For amphetamines, from 16,000 to 18,000 in the past six months, and from 2,000 to 3,000 once a week. And for hallucinogens there would be from 10,000 to 12,000 users in the past six months, out of which from 2,000 to 3,000 were once a week users. It must be pointed out that due to the mixed use of these substances, about half of the formerly mentioned users would use two or three of those drugs, with a nucleus of polydrug users of these substances from 20,000 to 25.000 people in the past six months and from 3,000 to 5,000 on a regular basis. The evolution of the use of these drugs in the past six months would be the one in graphs 3.6, 3.7 and 3.8.

Graph 3.6 Evolution of the use of synthetic drugs in the past six months (%), 1994-2000

1,2%

1,0%

0,8%

0,6%

0,4%

0,2%

0,0% 1994 1996 1998 2000 Evolution of use of Sinthetic Drugs 0,8% 1,0% 0,7% 0,7%

Graph 3.7 Evolution of the use of amphetamines in the past six months (%), 1988-2000

2,0%

1,8%

1,6%

1,4%

1,2%

1,0%

0,8%

0,6%

0,4%

0,2%

0,0% 1988 1992 1994 1996 1998 2000 Evolution of use of Amphetamines 1,9% 0,4% 0,6% 0,6% 0,6% 0,7%

In the evolution of the use of these three substances we observe, as a common denomin- ator, a certain downward tendency, especially significant in the case of amphetamines, and insignificant in synthetic drugs and hallucinogens. The sharp decline of amphetamine use between 1988 and 1992 might be due to the fact that the introduction of synthetic drugs could partially substitute their use. And the same might be true, although more moderately, for the decrease experimented by hallucinogens in 1994, 1996 and 1998; nevertheless, these substances seem to have a more stable use, since in 2000 they reach the same levels of 1988 and 1992. 40 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Graph 3.8 Evolution of the use of hallucinogens in the past six months (%), 1988-2000

0,7%

0,6%

0,5%

0,4%

0,3%

0,2%

0,1%

0,0% 1988 1992 1994 1996 1998 2000 Evolution of use of Hallucinogens 0,6% 0,2% 0,3% 0,4% 0,4% 0,5%

The evolution of the use of these three substances by age can be seen in Table 3.13:

Table 3.13 Evolution of the use of synthetic drugs, amphetamines and hallucinogens in the past six months (%) by age, 1992-2000.

1992 1994 1996 1998 2000

Synthetic drugs From 12 to 18 * 1.0 1.3 2.0 1.0 From 19 to 24 * 5.7 4.4 2.8 2.0 From 25 to 39 * 0.4 1.7 0.6 1.5 From 40 to 54 * 0.0 0.0 0.2 0.0 Over 54 * 0.0 0.0 0.0 0.0 Total * 0.8 1.0 0.7 0.7 Amphetamines From 12 to 18 0.0 0.0 1.0 1.7 0.3 From 19 to 24 1.4 4.0 1.2 1.6 0.8 From 25 to 39 1.0 0.9 1.9 0.7 1.7 From 40 to 54 0.0 0.0 0.0 0.4 0.9 Over 54 0.0 0.0 0.0 0.0 0.0 Total 0.4 0.6 0.6 0.6 0.7 Hallucinogens From 12 to 18 0.0 0.3 1.0 1.0 0.7 From 19 to 24 0.6 1.6 1.6 1.6 1.6 From 25 to 39 0.2 0.2 0.6 0.4 1.1 From 40 to 54 0.0 0.0 0.0 0.0 0.0 Over 54 0.0 0.0 0.0 0.0 Total 0.2 0.3 0.4 0.4 0.5

As for synthetic drugs and hallucinogens, the prevalent age group is always the 19 to 24-year-olds, and although the use of amphetamines was also prevalent in this age group in 1992, 1994 and 1998; the 25 to 39 age group was more prevalent in 1996 and 2000. This shows that some of their initial users have moved to synthetic drugs, whereas others remain faithful to amphetamines. We must highlight the fact that those aged from 12 to 18 diminished their use of synthetic drugs significantly between 1988 and 2000 and the use of hallucinogens more moderately. This may be the result of prevention strategies implemented at school, as we shall later see in the section about risk and protective factors. The evolution of the use of these three substances by gender is reflected in Table 3.14: SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE 41

Table 3.14 Evolution of the use of synthetic drugs, amphetamines and hallucinogens in the past six months (%) by gender, 1992-2000

1992 1994 1996 1998 2000

Synthetic drugs Females * 0.8 0.6 0.3 0.3 Males * 0.9 1.5 1.2 1.2 Total * 0.8 1.0 0.7 0.7 Amphetamines Females 0.3 0.4 0.2 0.2 0.3 Males 0.7 0.9 0.9 1.2 1.1 Total 0.4 0.6 0.6 0.6 0.7 Hallucinogens Females 0.1 0.1 0.3 0.3 0.2 Males 0.3 0.5 0.5 0.5 0.7 Total 0.2 0.3 0.4 0.4 0.5

As we can see, in 2000, the uses of these three substances are always more prevalent among men than among women, in the following ratios: synthetic drugs 4 to 1, amphetamines 3.7 to 1, and hallucinogens 3.5 to 1; that is, the ratios are quite similar for the three substances. If we take the main indicator, the use in the past six or twelve months, as a reference, we can see that the evolution in the whole of Spain and in other Autonomous Communi- ties has been the following:

Chart E Evolution of the use of synthetic drugs, amphetamines and hallucinogens in different studies in the past six or twelve months

Geographic Year Synthetic Amphetamines Hallucinogens area and age drugs

Spain 1995 1.1* 0.9* 0.7* (15-65) 1997 1.0* 0.9* 0.9* 1999 1.0* 0.7* 0.6* Andalucía 1994 1.3 1.3 0.6 (12 and over) 1996 1.6 1.3 0.8 1998 0.9 0.8 0.7 2000 1.5 0.6 0.4 Galicia 1994 0.8 0.6 0.3 (12 and over) 1996 1.0 0.6 0.4 1998 0.7 0.6 0.4 2000 0.7 0.7 0.5 C. Valenciana 1996 1.8* 1.3* 1.0* (15 and over) 1998 1.8* 2.5* 1.3* 2000 1.3* 0.6* 0.7*

* Past twelve months

In the period of time that these studies cover (1994-95 to 2000) we observe a moderate downward tendency, in general, with the exception of a slight increase in synthetic drugs in Andalusia and hallucinogens in Galicia. As for the average ages of initiation to use of these three substances in Galicia we see that: for the three drugs the initiation ages remain, in general, quite stable; for synthetic drugs the average age was 20.1 in 1994 and 19.8 in 2000; for amphetamines it was 20.2 in 1988 and 20.3 in 2000; and for hallucinogens it was 18.1 in 1988 and 18.9 in 2000. 42 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

HEROIN

Heroin was the drug that caused most social alarm among Spanish society in the 80s. Despite the fact that its use never exceeded 1%, it produced serious personal, family and social problems. In Galicia, in the first study from 1988, a prevalence of 1% was detected in the interval of the past six months, but from the early 90s onwards, it was reversed, resulting in 0.5% in the same interval in 2000; at the time regular use descended from 0.2% to 0.1%. The prevalence of use observed in Galicia in the period 1988-2000 would be the following (Table 3.15):

Table 3.15 Evolution of the use of heroin in Galicia (%). 1988-2000

Year Lifetime Past 6 Past Regular months month

1988 * 1.0 0.9 0.2 1992 * 1.0 0.7 0.2 1994 * 1.0 0.7 0.2 1996 1.2 0.7 0.6 0.1 1998 1.1 0.5 0.4 0.1 2000 0.9 0.5 0.4 0.1

In absolute terms, we could estimate that in Galicia, between 10,000 and 12,000 people would have used heroin in the past six months, with 5,000 to 7,000 regular users (from 2 to 6 times per week or daily). The users of other opiates in those same intervals would be from 25,000 to 27,000 people and from 10,000 to 12,000, respectively. If we take the indicator of use in the past six months as a reference, we can follow the evolution of heroin use in the period 1988-2000 (Graph 3.9).

Graph 3.9 Evolution of the indicator of “use of heroin in the past six months” (%). Galicia, 1988-2000

Evolution of use of Heroine SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE 43

The evolution of heroin use by age groups would be the following (Table 3.16):

Table 3.16 Evolution of the use of heroin in the past six months by age (%). 1992-2000.

1992 1994 1996 1998 2000

From 12 to 18 0.0 0.7 0.3 0.7 0.2 From 19 to 24 3.3 3.5 2.4 0.8 0.4 From 25 to 39 2.5 2.7 1.7 1.5 1.1 From 40 to 54 0.0 0.4 0.0 0.0 0.9 Over 54 0.0 0.0 0.0 0.0 0.0 Total 1.0 1.0 0.7 0.5 0.5

In the 1992-94-96 studies, the most prevalent age group was the 19 to 24, but in 1998- 2000, the most prevalent was the 25 to 39, as a combined effect of the aging of chronic users and the increase of new users. As for the use of heroin by gender, we observe the following evolution (Table 3.17):

Table 3.17 Evolution of the use of heroin in the past six months by gender (%). 1992-2000

1992 1994 1996 1998 2000

Heroin Females 0.6 0.5 0.2 0.2 0.2 Males 1.5 1.6 1.2 0.9 0.9 Total 1.0 1.0 0.7 0.5 0.5

As we can observe there are always more male heroin users than female, with a ratio of 2.5 to 1 in 1992 and of 4.5 to 1 in 2000. In the next chart we also include the compared data from other studies based on the indicator of the past twelve or six months.

Chart F Evolution of the use of heroin in the past twelve or six months in different studies

Geographic area Year Heroin and age

Spain (15-65) 1985 1.1* 1995 0.5* 1997 0.3* Andalucía (12 and over) 1994 1.6 1996 0.7 1998 0.6 2000 0.6 Galicia (12 and over) 1994 1.0 1996 0.7 1998 0.5 2000 0.5 C. Valenciana (15 and over) 1996 0.7* 1998 0.5* 2000 0.5*

* Past twelve months 44 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Despite the difficulty that the detection of heroin use through the method of home interviews, has always posed, there is a general coincidence in a distinct downward tendency. As for the ages of initiation of both substances, we observe a delay process in both of them: the average age to start using heroin was 18.4 in 1988 and 21.6 in 2000.

INHALANTS AND CRACK

The use of inhalants and crack in Galicia is so extremely limited and marginal that we are unable to carry out a detailed analysis such as the one we have conducted on the above mentioned substances. However, we are able to offer some relatively significant data on each of them. As for inhalants, the use reflected in the first study from 1988 was 0.2% in the past six months and 0.1% in the past thirty days; regular use was undetected. These percentages have remained stable in the different studies, observing in 2000 a use of 0.3% and of 0.2%, respectively. The age of initiation was 18, as an average, in 2000 (17.4 in 1988) and their highest rates were 1% among the 12 to 18 age group, 0.4% among males and 0.2% among females. Nationwide, in Spain, the use of inhalants has been calculated to be of about 0.2%, the same as in other Autonomous Communities, such as Andalusia, Madrid or the Community of Valencia. As for crack, we must point out that this substance first appeared in a study in Galicia in 1998, where we observed a 0.1% use in the past six months, without detecting any use in the past thirty days. The same was found in the 2000 study. Its highest percentage rate is found among men and among the 25 to 39 age group, in both cases at 0.2% in the past six months. The average starting age would be 25.41. The use of crack registered in Spain has oscillated between 0.1% and 0.2%, just as it occurs in the Autonomous Communities that have been mentioned above. The use of these two substances is extremely limited and, in fact, they are used together with other substances; with inhalants integrated in the polydrug use pattern of psycho- stimulants, with a coefficient of 0.462. As for crack, it is found in the polydrug use of narcotics, with a use mixed with the use of heroin; its coefficient factor is 0.704.

PSYCOTHERAPEUTICS

In this group we include two types of substances, which have been analysed in all the surveys carried out in Galicia between 1988 and 2000. These substances are: tranquillizers and hypnotics. Both of them make up a fourth pattern of polydrug use, with fairly high coefficient factors: 0.781 for tranquillizers and 0.704 for hypnotics. The use for each of these substances in 2000 was the following: the use of tranquillizers was at 3.9% in the past six months, with regular use at 2.1%; the percentages of use of hypnotics were: 1.7% and 1.4%, respectively. The percentages for these uses in the different studies conducted in Galicia have been the following: SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE 45

Table 3.18 Evolution of the use of tranquillizers and hypnotics (%). 1988-2000

Year Lifetime Past six Past Regular months month

Tranquillizers 1988 * 4.1 3.6 1.8 1992 * 3.7 3.4 1.2 1994 * 3.1 2.7 1.0 1996 9.2 5.6 4.4 2.0 1998 7.2 4.8 4.3 2.2 2000 7.5 3.9 3.3 2.1 Hypnotics 1988 * 1.8 1.8 0.8 1992 * 1.9 1.8 0.6 1994 * 1.2 1.2 0.8 1996 4.1 2.9 2.7 0.5 1998 2.8 2.4 2.2 0.4 2000 2.3 1.7 1.6 1.4

In absolute terms, we could estimate that the users of these substances in Galicia in 2000 are approximately the following: as for tranquillizers we have 92,000 people in the past six months, out of which 50,000 would be regular users. On the other hand, 38,000 people would have used hypnotics in the past six months, with 33,000 regular users. Taking the indicator of use in the past six months as a reference, we are able to see the evolution of these substances between 1988 and 2000:

Graph 3.10 Evolution of the use of tranquillizers in the past six months (%). 1988-2000

Evolution of use of Tranquillizers 46 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Graph 3.11 Evolution of the use of hypnotics in the past six months (%). 1988-2000

Evolution of use of Hypnotics

As is evident, the evolution of the use of tranquillizers and hypnotics is very similar: a significant decrease in 1994, followed by an important rebound in 1996, and a clear decline in 1998 and 2000. The evolution of the use of these substances, according to age, in the different studies has been the following one (Table 3.19):

Table 3.19 Evolution of the use of tranquillizers and hypnotics in the past six months by age (%). 1992-2000

1992 1994 1996 1998 2000

Tranquillizers From 12 to 18 1.1 0.7 0.7 0.3 0.7 From 19 to 24 1.9 2.4 1.2 2.0 1.6 From 25 to 39 3.9 3.3 4.3 3.0 3.1 From 40 to 54 2.6 3.9 2.2 6.0 1.7 Over 54 6.1 3.6 12.0 8.0 8.0 Total 3.7 3.1 5.6 4.8 3.9 Hypnotics From 12 to 18 0.0 0.0 0.3 0.0 0.3 From 19 to 24 0.9 0.8 0.4 0.4 0.4 From 25 to 39 1.0 1.5 1.3 0.9 0.4 From 40 to 54 2.6 2.4 1.7 1.7 1.1 Over 54 3.1 0.9 6.6 5.5 3.9 Total 1.9 1.2 2.9 2.4 1.7

The most predominant age group in both substances is the over 54 group, which in 2000 reaches 8% for tranquillizers and 3.9% for hypnotics. As for the evolution of use according to gender we have the following data (Table 3.20): SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE 47

Table 3.20 Evolution of the use of tranquillisers and hypnotics in the past six months by gender (%). 1992-2000

1992 1994 1996 1998 2000

Tranquillizers Females 2.4 2.4 2.4 3.6 2.5 Males 4.8 3.8 8.5 5.8 5.2 Total 3.7 3.1 5.6 4.8 3.9 Hypnotics Females 1.2 2.0 2.4 2.2 1.2 Males 2.4 0.4 3.4 2.6 2.1 Total 1.9 1.2 2.9 2.4 1.7

In all the studies we observe that the use of these two substances reaches higher percentage rates among females, prevalence, which, both in the 1992 and 2000 studies, double those of males. As for the use of psychotherapeutic drugs in different studies, in the indicator for the past twelve or six months, we can see the following results:

Chart G Evolution of the use of tranquillizers and hypnotics in the past twelve or six months, in different studies

Geographic area Year Tranquillizers Hypnotics and age

Andalucía (12 and over) 1994 7.0 2.8 1996 6.2 2.2 1998 4.8 1.4 2000 5.3 2.8 Galicia (12 and over) 1994 3.1 1.2 1996 5.6 2.9 1998 4.8 2.4 2000 3.9 1.7 C. Valenciana 1996 5.7* 3.9* (15 and over) 1998 6.5* 2.8* 2000 4.2* 3.2*

* Past twelve months

As can be seen, the use of tranquillizers and hypnotics registered in the studies of the three Communities are somewhat irregular, rising and falling, without the possibility of establishing a distinct tendency in either direction. As for the ages when people are initiated into the use of these substances in Galicia (and also in the other Communities), we find that in both substances the average age is high, getting even higher between 1988 and 2000: in tranquillizers from the age of 36.8 in 1988 to the age of 39.5 in 2000 and in hypnotics from the age of 40.1 to 44.4.

SUMMARY

Summarizing, based on the recorded data referent to the different illegal drugs and psychotherapeutic drugs -just as has been done with tobacco and alcohol- and considering the initial hypotheses from the 1988 study and the new hypotheses added in the consecutive studies we see that:

■ The 1st hypothesis that there exists a substantially common use of cannabis principally among young people and of psychotherapeutic drugs among middle-aged people, has been verified. While the use of the rest of substances would be more limited. 48 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

■ As for the growing use of the different substances, we see that the use of cannabis has risen slightly more than predicted in the 2nd hypothesis, whereas the use of cocaine and heroin has increased in a lesser degree, with heroin showing a declining tendency from 1994, as it is stated in the 21st hypothesis.

■ Synthetic drugs, after a period of expansion, stabilize their use and even slightly decrease, as was predicted in the 24th hypothesis.

■ As for the uses of the different substances, the 4th hypothesis has proven correct in all the studies: males would mainly use (besides tobacco and alcohol) hallucinogens, synthetic drugs, cocaine and heroin, and females would be more frequent users of tranquillizers and hypnotics.

■ As for the age structure of the different substances, the 3rd hypothesis has been confirmed; first contact drugs and their prevalence of use among teenagers and young adults (inhalants, cannabis, amphetamines, cocaine and heroin); initiation substances and adult uses (tranquillizers, hypnotics and morphine analgesics); and substances of an early but prolonged use, such as tobacco and alcohol.

■ As for the polydrug use (6th, 7th and 8th hypotheses) we observe that part of the users mix several substances, making up four basic patterns of polydrug use. Consi- dering this an important point we shall analyse it in depth further on.

■ Concerning the regularity of use of each substance, the findings in all the studies confirm (9th hypothesis) a pattern of very frequent use for heroin, tobacco (daily), alcohol (abusive), the other opiates, tranquillizers and hypnotics; and another pattern of a more irregular or occasional use, in the case of inhalants, cocaine, hallucinogens, amphetamines and synthetic drugs. As for cannabis, we came upon a double pattern, one of regular use and the other of more intermittent use.

■ Finally, in the 29th hypothesis, it was stated that for the correct planning of strategies, we should consider the possibility that in the different health-care areas different risk rates might exist. In fact so, it has been proven in all the studies underta- ken, that according to the percentages and the potentially affected population, there are three risk levels: in the highest risk level, we would find A Coruña, Vigo and Santiago; in the medium-high level would find Lugo, Ourense, O Ferrol and Ponte- vedra; and in the lower risk level, we would have O Salnes, Cervo-Burela, O Barco and Monforte. This set of hypotheses about drug use, the majority of which have been confirmed, study after study, establish reliable results and conclusions. This well-focused approach to the reality of drug use and abuse allows us to establish a series of possible tendencies of the drug trends in Galicia. However, before going into it, we shall have a more detailed look at the polydrug use, and the evolution of the use/abuse of different substances in the short and long term.

3.2.3 POLYDRUG USE, EVOLUTION AND POSSIBLE TENDENCIES

A POLYDRUG USE

According to the data obtained in the 2000 survey, we can see that 58.7% do not smoke every day, do not abuse alcohol, or have not taken other substances in the past six months. 30.4% have taken only one substance in the same periods of time. Finally 10.9% have taken several substances. In the latter group, we have 2.9% (7% of users) who are mixing three or more substances. This would be the most specifically polydrug user group, in absolute terms, from 65,000 to 70,000 people. However, if we take into account that in regard to tobacco and SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE 49

alcohol, we have only included everyday smokers and abusive drinkers, the group that mix- es two substances is also very important from an epidemiological point of view, since there we would find another 180,000 to 190,000 people. Both groups, which would make up a total of about 230,000 people, would be the highest risk population sector. The evolution of these groups of polydrug users through all the studies can be found in the following table:

Table 3.21 Evolution of polydrug use in Galicia. 1988-2000

Number of 1988 1992 1994 1996 1998 2000 Drugs used

None 53.3 59.4 59.6 60.1 60.2 58.7 One 32.0 29.1 27.6 27.8 30.6 30.4 Two 10.7 8.4 8.6 8.5 6.6 8.0 Three or more 4.0 3.1 4.3 3.6 2.6 2.9 Total 100.0 100.0 100.0 100.0 100.0 100.0

Summarizing the data in the previous table and taking those who mix two or more drugs, we get Table 3.22:

Table 3.22 Evolution of polydrug use rates in Galicia, 1988-2000 (percentages)

1998 1992 1994 1996 1998 2000

14.7% 11.5% 12.9% 12.1% 9.2% 10.9%

After an evident decrease in 1992 compared to 1988, there is a certain rebound in 1994, however without reaching the 1988 rates. In 1996 there is a slight fall, which becomes more pronounced in 1998. But in 2000 we observe, once again, a slight increase of 1.7 points. Due to the discreet level of continuity in the rates of polydrug users, a good method to visual- ize the possible evolution of users would be by calculating the average rate in the three first studies (1988, 1992 and 1994) and the three following ones (1996, 1998 and 2000). According to this, we would find percentages of 12.96% between 1988 and 1994 and 10.73 between 1996 and 2000. This would mean a general declining tendency of 2.23 points between both periods. On the other hand, and applying the same methodology used in all the Galician studies, in 2000 we carried out a factorial analysis of the main components in order to find the basic types or patterns of polydrug use that would explain most of these polydrug uses. On this occasion we also obtained four factors or basic patterns of polydrug use, with a vari- ance of 54%. To summarize, the factors or patterns of polydrug use obtained would be the following (Table 3.23): 50 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Table 3.23 Patterns of polydrug use. Galicia, 2000

Pattern 1: PSYCHO-STIMULANTS Hallucinogens .692 Cocaine .687 Synthetic drugs .682 Amphetamines .670 Inhalants .462 Cannabis .461 Pattern 2: NARCOTICS Heroin .752 Crack .704 Other Opiates .620 Amphetamines .504 Pattern 3: TOBACCO-ALCOHOL-CANNABIS Daily Tobacco .670 Abusive Alcohol .618 Cannabis .535 Pattern 4: PSYCHOTHERAPEUTIC DRUGS Tranquillizers .781 Hypnotics .704

Thus, the main patterns of polydrug use would be the ones found in Graph 3.12:

Graph 3. 12 Patterns of polydrug use. Galicia, 2000

1ST PSYCO-STIMULANTS Hallucinogens Cocaine Synthetic Drugs Amphetamines 2ND Inhalalants 3RD NARCOTICS Cannabis TOBACCO Heroin ALCOHOL Other Opiates CANNABIS Crack Amphetamines

4TH PSYCHOTHERAPEUTIC DRUGS Tranquillizers Hypnotics

The same four patterns of polydrug use found in 1998 are present again in 2000; psycho-stimulants become consolidated in the first pattern and the pattern of narcotics has occupied second place in the past years. At present the tobacco-alcohol-cannabis pattern is situated in third place, causing the pattern of psychotherapeutic drugs to descend to fourth place. Cannabis and amphetamines appear in two of these patterns. On the other hand we also see two important changes within the first and second patterns: SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE 51

■ In the first pattern: that of psycho-stimulants, cocaine rises from 5th place in 1998 to second place in 2000, that is, it is already a leading drug within the pattern.

■ In the second pattern: that of narcotics, we find crack, following heroin, which didn’t occur in 1998. According to these data, we see that the hypotheses referring to polydrug use hold true. As we have anticipated, basically the 6th, 7th and 8th hypotheses are confirmed. These hypotheses predicted the use as well as some peculiarities of polydrug use: the fact that cannabis was a drug “that was mixed with other stronger drugs”, and the existence of a group of polydrug users that mixed an important number of drugs (cocaine, synthetic drugs, heroin, other opiates...). The 25th hypothesis, in reference to narcotics’ displacement to the second pattern and psycho-stimulants rising to the first place, is also confirmed, just as the fall in the overall rate of polydrug users induced by the decrease in heroin use, as stated in the 23rd hypothesis.

B EVOLUTION OF USE OF DIFFERENT DRUGS IN THE SHORT AND LONG TERM, AND POSSIBLE TENDENCIES

Based on the information contained in graphs 3.13 and 3.14 we can reach a series of conclusions concerning the evolution and possible trends in use in a short period of time (1998 to 2000) and in a longer one (1988 to 2000), as well as their possible future evolution.

1 Evolution in the short term: 1998 to 2000

Graph 3.13 Evolution of the use of drugs in the recent short term. Galicia, 1998-2000. (daily smoking, abusive alcohol, and rest of drugs: use in the preceding six-month period)

2.5 CANNABIS 2.1 2.0 ALCOHOL -1,6 1.5 TES

1.0 OTHER OPIA 0.6 0.5 AMINES 0.1 HALLUCINOGENS 0.1 AMPHET COCAINE 0.1 0.0 0.0 0.0 0.0 0.0 CRACK HEROIN -0.5 -0.2 INHALANTS TOBACCO

-1.0 SYNTHETIC DRUGS -0.7 -0.9 LLIZERS HYPNOTICS -1.5 TRANQUI-

If from Graph 3.13 we consider the differences that exceed two tenths (which would be within the possible sample error), between 1998 and 2000, we find that the possible evolution of the recent use of these substances would be: 52 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

■ Increase: quite significant for cannabis (over two per cent) and slight for other opiates (about 0.5%).

■ Decrease: moderate for tranquillizers and hypnotics (the first descend almost one per cent, and a somewhat lower rate for the second substances).

■ Remain: either because no differences can be detected or because they are insignificant and uncertain: inhalants, cocaine, synthetic drugs, hallucinogens, amphetamines, heroin and crack.

2 Evolution in the long term: 1988 to 2000

Graph 3.14 Tendencies in the evolution of drug use in the long term, 1988-2000 (daily smoking, abusive alcohol, rest of drugs: use in the preceding six-month period)

1.0 TES OTHER OPIA 0.7

0.5 CANNABIS 0.5 INHALANTS 0,1 0.0 0.0 0.4 -0.1 -0.1 CRACK

-0.5 -0.2 -0.4 -0.5 HYPNOTICS COCAINE -1.0 HEROIN HALLUCINOGENS SYNTHETIC DRUGS TRANQUILLIZERS

-1.5 -1.2 AMINES

-2.0 -1.7 AMPHET TOBACCO

-2.5 -2.2 ALCOHOL

Taking into account the deviations higher or lower than one tenth, and given the span of time, in Graph 3.14, we see that the overall tendencies in the evolution for the past thirteen years would be as follows:

■ Increase: moderately, with a rise of about 0.5, we find cannabis, the other opiates and hypnotics; and more moderately, 0.2, for tranquillizers.

■ Decrease: with certain intensity, between 2 and 1.2, we find alcohol abuse, daily smoking and amphetamines; and more moderately, heroin (-0.5) and cocaine (-0.4).

■ Remain: 0.1 or -0.1 for inhalants, hallucinogens and synthetic drugs. In general this evolution over the past thirteen years represents a historical sequence between the first data gathering in 1988 and 2000. These data most certainly reflect the extent of the use of these substances; however, with regard to the possible evolution in the near future, we have to take into account how certain uses have come to develop in the present and have developed in the recent past (1998 to 2000), especially as far as gender is concerned (females) and the youngest age groups (aged 12-18 and 19-24- years), as it has already been indicated for each substance. SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE 53

Bearing all this in mind, although tobacco, alcohol, and possibly also cocaine, have experienced a distinct overall decline, a possible rebound in the following years, cannot be ruled out, depending on the evolution of use among women and young adults. Cannabis, hypnotic-sedatives, and the rest of opiates seem to be in a slow and maybe discontinuous rising phase; the latter ones probably as a result of their double use as pain relievers (among the elderly) and substitutes for heroin. Heroin seems to continue to fall steadily although the rate of habitual users only slightly diminishes. As for synthetic drugs and others related to them, there exists the likelihood of no overall increase, but a significant use will persist among young adults. Finally, polydrug use is likely to fall, but within the first pattern, that of psycho-stimulants, which are very trendy and quite consolidated among young adults, we still find a heavy polydrug use. There is another pattern, in which -although the polydrug use is not as intense as the previous one- there exists an important number of users and it is presumably on the rise, this is the pattern of daily smoking, alcohol abuse and cannabis. These tendencies are, in general, similar to the ones observed by the EMCDDA in the whole of the European Union. In its 1999 and 2000 Reports (EMCDDA, 1999-2000) we see that the use of cannabis is growing, especially among young people. Heroin has suffered a fall with rates under 1%. Synthetic drugs and amphetamines increased in the 90s, although, at present, their use has fallen in some countries. The same occurs with cocaine. The main risk these substances and synthetic drugs might pose would be their introduction among the youngest age groups. These reports also highlight the “mixed use” (polydrug use), of both illegal and legal drugs, especially of alcohol and tranquillizers. 54 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

3.3 REASONS, RISK FACTORS AND PROTECTIVE FACTORS IN DRUG USE

3.3.1. REASONS FOR DRUG USE AND RELATED RISK FACTORS The possible reasons for using drugs have been analysed in the different studies carried out in Galicia from two perspectives: the subjective perspective, based on the reasons admitted by the users themselves and the objective perspective, based on the different risk factors related to use. See the results obtained from each of these two perspectives.

A REASONS FOR DRUG USE

In Table 3.24 we find the reasons admitted for alcohol use in the different studies:

Table 3.24 Reasons for alcohol use. 1988-2000

Reasons 1988 1992 1994 1996 1998 2000

Because I like it 58.3 39.8 78.1 57.6 56.2 68.9 Socializing 13.9 30.1 13.9 17.6 21.8 16.9 Social influence 3.9 14.7 2.8 5.4 11.9 5.2 Family problems 0.8 5.0 0.3 13.0 0.7 4.0 Don’t know 3.6 2.7 2.4 3.3 4.1 3.6 Health problems 1.6 1.9 0.8 0.8 1.5 0.5 Other reasons 6.5 1.9 1.3 1.2 1.1 0.3 Money problems 0.7 0.1 0.1 0.8 2.2 0.2 Work problems 0.4 0.1 0.0 0.1 0.5 0.2 Unable to give it up 1.0 0.1 0.0 0.1 0.1 0.2 Undecided/Uninterested 9.3 3.1 0.4 0.0 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0

As is reflected in all the studies the primary reason for drinking alcohol is “because I like it”, rising from 58.3% in 1988 to 68.9% in 2000. In second place, we find “socializing and social influence”, which totalled 17.8% in 1988 and 22.1% in 2000. Both motives would reflect the extent of the presence of alcohol in personal and social habits. This would seem a non- problematic perception of alcohol use. As for the other motives admitted, there is a group, which establish a direct link between taking alcohol and problematic situations (family, work and health problems). This group reached a peak of 5% in 1988, and remained so in 2000. As for the motives for using illegal drugs or psychotherapeutic drugs, they can be divided into three categories, in order to make the comparison of the data obtained during the past decade easier and more practical. Thus, the three types of reasons considered are the following ones:

■ Symptomatological reasons, related to health problems: diseases, pain, stress, etc.

■ Pleasure and experimental reasons: to seek pleasure, to cheer up, to try out new experiences, to overcome boredom, etc.

■ Social response reasons, which refer to the use of drugs as a solution to difficult or frustrating personal and social situations (personal, family, work problems or social exclusion), or on the other hand, as a desire to improve or attain social integration (to improve one’s performance at work or at school, to belong to a group, etc). SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE 55

The evolution of the rate for these reasons can be found in Table 3.25:

Table 3.25 Reasons for the use of illegal drugs and psychotherapeutic drugs. 1988-2000

Reasons 1988 1992 1994 1996 1998 2000

Symptomatological 57.0 36.0 36.5 32.5 43.2 32.1 Social response 19.3 11.5 28.3 34.1 28.9 12.0 Pleasure and experimental 11.1 10.0 28.2 21.1 22.1 48.6 Undecided/Uninterested 12.6 42.5 7.0 12.3 5.7 7.3 Total 100.0 100.0 100.0 100.0 100.0 100.0

The evolution of the different motives admitted for the use of other drugs has been the following: decrease of symptomatological reasons (from 57% in 1988 to 32.1% in 2000), also a decline in social response motives (from 19.3% in 1988 to 12% in 2000); on the other hand, pleasure and experimental reasons have risen considerably from 11.1% in 1988 to 48.6% in 2000. This progressive change of the reasons probably means that they are not being masked under justifications such as: feeling down, frustrated, socially excluded..., while seize-the- day and hedonistic motives are more openly admitted. However, this does not mean that there are no objective situations, which -apart from the way they are interpreted- predis- pose people to use drugs. These situations have been referred to as risk factors, which we shall analyse next.

B RISK FACTORS IN DRUG USE Since the first Galician study in 1988, a series of variables have been included to detect the existing link between drug use and certain situations that could function as related risk factors. In the first studies the method used was to calculate the average rates by using the risk variables that represented the different factors: family, social and personal, in addition to the work factor from the 1998 study onwards. And in all these studies, it has been proved that family and social factors were the primary link to drug use, followed by personal factors and work-related factors. In the 2000 study we used a more accurate methodology - the analysis of logistic regression- which was applied not only to risk factors, but also to a new set of protective factors. This set of factors was studied after a bibliographical revision included in the 2000 report. As for risk factors, a total of 25 variables were included; 17 out of which were highly related to the abuse of alcohol and other drugs. In Graph 3.15 we include the variables, whose existence has a probability of use (odds ratio) over 1.80 in relation to their non-existence and are highly significant (from P<.01 to P<.000). Concerning these variables we should point out that:

■ In the family factor the highest odds ratio is found especially in parents’ alcohol and drug abuse (3.42) and in poor family relationships (couple: 2.85 and parents-children: 2.75).

■ In the personal factor we have five significant variables, but with lower odds ratios. The most significant ones are: stress and personal tension (2.41), low performance at school (2.20) and lack of self-confidence (2.19).

■ In the social factor we have four quite significant variables, especially the likelihood of obtaining drugs easily (2.81), knowing drug users (2.27), and a negative social perception (2.10).

■ Finally, in the work factor we have five significant variables, mainly those referring to a bad contractual situation or work instability (2.40), uneasiness about work prospects (2.21), or bad working conditions (long hours: 1.99, and exhaustion: 2.12). 56 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Therefore, when these situations and risk factors are present, the rates of use observed are always higher than when they are not.

Graph 3.15 Risk factors in drug use. (Logistic regression odds ratio. P<.01 to P<.000)

0 1 2 3 4

FAMILY factor POOR RELATIONSHIPS PARENTS-CHILDREN 2.75

PARENTS ALCOHOL DRUG ABUSE 3.42

POOR RELATIONSHIPS BETWEEN COUPLE 2.85

PERSONAL Factor STRESS AND TENSION 2.41

LOW PERFORMANCE AT SCHOOL 2.20

LACK OF SELF-CONFIDENCE 2.19

PERSONAL DISSATISFACTION 2.10

THOUGHTS OF SUICIDE 1.81

SOCIAL factor KNOWING DRUG USERS 2.27

AVAILABILITY OF DRUGS 2.81

DISSATISFACTION WITH LEISURE ACTIVITIES 1.91

NEGATIVE SOCIAL PERCEPTION 2.10

WORK factor BAD WORKING CONDITIONS 2.40

LONG WORKING HOURS 1.99

DISSATISFIED WITH RELATIONSHIPS AT WORKPLACE 1.82

EXHAUSTION AT WORK 2.12

UNEASINESS ABOUT WORK PROSPECTS 2.21

NO DRUG USE DRUG USE

3.3.2 REASONS FOR NOT USING DRUGS AND PROTECTIVE FACTORS AGAINST DRUGS As for reduction or moderation in drug use, we shall see here, just as we have done in the previous section, the subjective perspective represented by the reasons admitted for not using drugs, and the objective one, based on protective factors against drug use.

A REASONS FOR NOT USING DRUGS

In all the studies the respondents were asked about their reasons for not using drugs in general, alcohol included. The evolution observed from 1988 to 1998 is as seen in Table 3.26: SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE 57

Table 3.26 Evolution of the reasons for not using drugs, 1988-1998*

Reasons 1988 1992 1994 1996 1998

Moral personal convictions 8.9 15.7 22.1 12.7 13.8 Because they are 29.3 37.6 37.6 41.2 23.1 health damaging Because they are 2.5 1.7 0.6 0.7 3.0 harmful to society I feel fine and 39.5 25.0 34.2 26.6 41.1 I don’t need them They are illegal 0.7 0.7 0.7 0.3 1.7 They cause personal, 2.9 1.7 1.8 7.7 9.0 family and work problems My family wouldn’t accept it 0.3 0.1 0.1 0.2 1.1 I am afraid of them 1.3 0.3 0.6 0.6 1.6 Because I don’t trust myself and 0.4 0.3 0.3 0.3 0.4 I don’t know whether I could have control over them I don’t want to say why 9.6 14.6 1.3 0.0 - Other reasons 2.7 1.1 1.0 0.9 1.6 Undecided/uninterested 1.8 1.5 1.0 8.7 3.5 Total 100.0 100.0 100.0 100.0 100.0

* In order to leave space for the variables for protective factors in the questionnaire, this indicator was not included in the 2000 survey.

The three most important reasons for not using drugs in the last survey were the same as those stated all through the 90s. However, in 1998 physical and psychological well-being becomes the primary motive, even before the perception that these substances are health- damaging. On the other hand, moral and personal convictions continue at the 1996 (and 1992) percentage levels, whereas the awareness of the problems drug use causes has been increasing since 1996. In any case, the personal reasons -self-identity and well-being- outweigh the external and legal motives, as well as fear. Therefore, personal conviction, well-being and personal fulfilment are the subjective protective factors that should be encouraged as a preventive strategy, since the basic structure of these reasons has remained quite stable since 1988. This becomes even more evident and will be seen in detail by analysing the indicators of protective factors, further on in the study.

B PROTECTIVE FACTORS AGAINST DRUG USE

Using the same methodology as for risk factors, in the 2000 survey we included another 25 variables based on significant protective factors; eighteen out of which had a moderating or reducing effect on drug use (odds ratio from 1.80 onwards and P<.01 to P<.000). As we can see in Graph 3.16 (contrary to what happened with risk factors) the presence of certain protective factors reduce drug use more than when they are not present. We should point out the following about protective factors:

■ Included in the factor for alternative values (to enjoying the present and hedonism) we find five significant variables, the following appearing as particularly relevant: cooperation values (2.25), body and health-care (2.19) and keeping away from friends’ drug use (2.13).

■ Included in the factor for alternative activities (to discos, drinking, etc.) we have five significant variables. The most relevant ones are: social (2.31) and humanitarian activities (2.01), and doing sport (2.04). 58 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

■ Within the factor for family integration there are four significant variables associated with a lower drug use. The most important ones are: communication between parents and children in general (2.23), parents’ warning children about drug risks (2.20) and family stability (1.96).

■ Finally, within the factor for environment and prevention we also find four significant variables. The most important ones are: having received information about drug use prevention at school (3.15), which is the most important protection variable for preventing drug use. Having participated in some activity against drugs (2.23), and knowing some prevention message (2.19) are also very significant variables. Therefore, when these protective factors are present, the use of drugs is lower than when they are not present. In the face of all these risk and protective factors, it seems crucial to promote prevention, as an essential response to this current problem. In the presentation of the National Strategy on Drugs 2000-2008 (GDNPD, 2000 a) we can read the following: “But, without any doubt, the key strategy is prevention. Prevention, which, as we have been repeating all along these years, must be based on education and should encourage certain attitudes and values. It should be orientated especially to children and youths and should take into consideration the recreational weekend use. It should also be included in a broader frame, in the so-called “Health Education”. Pre- vention strategies should focus on family and school environments. School programmes have already gone a long way and have aroused public interest lately, but we are obliged to place emphasis on the process of intervention in this area. We must also continue working in other environments, where, although we have carried out interesting experiences, there is still a long way to go: that is the case of prevention at the workplace or the projects of cooperation with the media.” These prevention strategies in Galicia are reinforced by the influence of protective factors -whose relevance has been empirically demonstrated- such as health and body-care, family, prevention at school, alternative values and activities, or intervention at the workplace. In view of the information compiled in the two former sections, we can see that several hypotheses have been proved true: those referring to the three basic reasons for using drugs: pleasure and experimentation, social response and symptomatological reasons (11th hypothesis); those referring to the link between risk factors and drug use (12th and 27th hypotheses), the one concerning the reasons for not taking drugs (17th hypothesis) and the relationship between protective factors and the moderation or decrease in drug use ( 29th hypothesis). According to all this, we may conclude that -due to the predictive potential of the reasons for using drugs and of risk factors particularly- all the strategies aimed at reducing or deactivating these reasons and factors, would bring about a decrease in drug use. Being particularly important the following: parents’ non-use of drugs, the improvement of family relationships, reduction of stress, personal tension, and poor academic performance, reduction of drug supply and social presence of drugs; and among workers, the elimination of precarious work and the improvement of certain work conditions. In the same way, the reinforcement of the reasons for not using drugs, and above all, the emphasis on protective factors would also help to moderate or reduce drug use. In this regard, it would be very important to promote alternative models to enjoying the present and hedonism (solidarity, health-care, drug rejection...) among youths; communication among family members and family stability (helping parents in the education of their children against drugs), the encouragement of certain activities as alternatives to consumist leisure (social and humanitarian activities, sport..) and above all drug prevention strategies conducted at school and any other type of prevention strategy in general. SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE 59

Chart 3.16 Protective factors against drug use. (Logistic regression odds ratio. P<.01 a P<.000)

0 1 2 3 4

ALTERNATIVE values COOPERATION 2.26

KEEPING OUT FROM DRUG USE 2,13

NOT IMMEDIATE SATISFACTION 1.83

BODY AND HEALTH-CARE 2.19

DEFINED OBJECTIVES IN LIFE 1.95

ALTERNATIVE activities HUMANITARIAN ACTIVITIES 2.01

SOCIAL ACTIVITIES 2.31

RELIGIOUS ACTIVITIES 1.80

DOING SPORT 2.04

KEEN ON READING 1.83

FAMILY integration FAMILY STABILITY 1.96

DIALOGUE PARENTS-CHILDREN 2.23

PARENTS TALK TO CHILDREN ABOUT DRUGS 2.20

TELL PROBLEMS AT HOME 1.87

ENVIRONMENT AND PREVENTION INTEGRATED IN THE COMMUNITY 1.72

KNOW PREVENTIVE MESSAGES AGAINST DRUGS 2.19

PRTICIPATION IN ACTIVITIES AGAINST DRUGS 2.23

HAVE RECEIVED DRUG PREVENTION AT SCHOOL 3.15

DRUG USE NO DRUG USE 60 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

3.4 DRUG USE-RELATED PROBLEMS

It is well-known that the use of drugs produces negative consequences for their users; the more regular and/or abusive the use, the more negative the consequences. These consequences can be multiple, and at the same time, the user may find himself/herself affected by several of them at a time: health, personal, family and social problems. Other indicators of the negative consequences of drugs are the degree of subjective dependency and the need for help and treatment. Therefore, in this section we shall see how these three types of indicators have evolved from 1988 to 2000.

A NEGATIVE CONSEQUENCES OF DRUG USE

In the 2000 study 15.5% of drug users claimed to have suffered some negative consequence related to drug use. The consequences mentioned were the following:

■ 4.2% of illegal drug users and/or users of psychotherapeutic drugs have suffered health problems, as a consequence of this use.

■ 6.0% have had money problems.

■ 4.2% of these users have experienced family or social problems.

■ 0.5% have had problems at school or at work.

■ 0.6% have had legal problems. The evolution of these problems between 1988 and 2000 is reflected in Table 3.27:

Table 3.27 Evolution of drug use- related problems. 1988-2000

Sorts of problems 1988 1992 1994 1996 1998 2000

Health 14.9 29.9 20.0 45.9 6.5 4.2 Money 19.2 4.9 20.7 12.5 6.1 6.0 Family and relationships 8.1 8.6 13.8 9.4 8.7 4.2 Legal 3.6 0.4 2.1 3.1 - 0.6 Work or academic 2.6 0.8 2.1 2.7 2.2 0.5 None 51.6 54.9 41.3 26.5 76.5 84.5 Total 100.0 100.0 100.0 100.0 100.0 100.0

Before commenting the evolution of the negative consequences, we find it necessary to point out that the users of tranquillizers and hypnotics (the largest group, on the other hand) clearly constitute the highest percentage of those who claim the absence of negative consequences from drug use. Only one out of ten psychotherapeutic users claim to have been affected by problems related to the use of these substances. However, the situation changes when we observe the users of illegal drugs: the proportion of users not affected by negative consequences drops significantly, especially among heroin users (almost all of them claim to have suffered problems related to the use of this substance on some occasion), among users of amphetamines (87.5% had been affected) and among users of synthetic drugs (70.6%). On the contrary, the users of cannabis make up the group, who, among the users of illegal drugs, claim to have been less affected by drug use-related problems (23.5%). The solid link between the use of heroin and the resulting negative consequences would explain the significant drop in these consequences observed in the previous table dating from 1996, since it is then (Graph 3.9) when a sharp fall in the use of this substance takes place. In 1998 and 2000 heroin use is half of what it used to be in 1988 and 1994. On SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE 61

the other hand, the decrease of the negative consequences should also be attributed, to a certain extent, to the expansion in Galicia of certain harm-reducing programmes, such as the methadone-substitution programme, the exchange of syringes and the distribution of preventive packets among heroin users.

B DEGREE OF SUBJECTIVE DEPENDENCY

Another important indicator used to evaluate the negative consequences of drug use would be the degree of subjective dependency admitted by the users themselves. In the 2000 survey 15.6% of users admit being “hooked”, to some extent, by the use of these substances, so 8.1% claim that they would find it somewhat difficult to give up drugs, and 7.5% admit that they would find it very difficult or impossible. The global percentage of the users who admit some degree of subjective dependency is identical to the percentage of those who claimed having suffered some negative consequence (15.5%), and when we cross the figures they coincide in over 90% of cases. The evolution of this degree of subjective dependency on drug use throughout the series can be seen in Table 3.28.

Table 3.28 Evolution of the degree of subjective drug dependency. 1988-2000

Would you be able 1988 1992 1994 1996 1998 2000 to give up drugs?

I would find it impossible 2.5 2.4 12.4 4.3 9.7 2.4 I would find it very difficult 4.3 5.3 18.6 12.9 12.7 5.1 I would find it 15.7 15.0 15.2 35.5 9.7 8.1 somewhat difficult I could do it easily 53.9 26.1 43.4 38.3 25.7 34.1 Undecided/uninterested 23.6 51.2 10.4 9.0 42.2 50.3 Total 100.0 100.0 100.0 100.0 100.0 100.0

As we can see, following the increase in the degree of subjective dependency between 1988 (22.5) and 1996 (52.7), from this point on the intensity of this indicator has dropped to 32.1 in 1998 and to 15.6 in 2000. This is also due to the fall in heroin use, since the degree of subjective dependency among heroin users is at 77.5%, whereas for all the rest of substances the degree of subjective dependency ranges from 10 to 15 %.

C NEED FOR HELP AND TREATMENT

Another group of indicators closely related to the former ones are those referring to the need for help and treatment, specifically the three following: advice to seek treatment (Graph 3.17), consulting experts (Graph 3.18) and undergoing treatment (Graph 3.19). The evolution of these indicators between 1988 and 2000 can be seen in the following charts: As we can see in the previous charts between 1988 and 1996 there was an increase in the group advised to seek treatment and in consulting experts, and after 1996 onwards there has a fall in both indicators, registered in the 1998 and 2000 studies. In the indicator of undergoing or having undergone treatment the fall starts in 1996, after an increase in 1992 and 1994. All these indicators respond to the 13th, 14th and 15th hypotheses, although in 1988 the inflection experienced from 1994 and 1996 in the group of negative consequences related to drug use, the degree of subjective dependency and the need for help was not predicted. This fall is due, as we have already said, to the decrease in heroin use and in the polydrug use associated with it, and also to the expansion and extension of harm- reducing programmes. 62 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Chart 3.17 Proportion of users advised to undergo treatment. 1988-2000

Chart 3.18 Proportion of users who have consulted experts, 1988-2000

Chart 3.19 Proportion of users who are undergoing or have undergone treatment, 1988-2000 SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE 63

3.5 PUBLIC OPINION AND ATTITUDES TOWARDS DRUGS

The presence and use of drugs form part of the social reality existent in Galicia and there is public opinion related to them. For this reason a series of indicators have been included in all the studies carried out in Galicia to evaluate this public opinion. The most relevant of these indicators would be the following ones: the most important measures taken to fight drug use and assistance offered, the use of drugs in public and private places, opinions about methadone and syringe exchange programmes, and the degree of knowledge and opinion of the work conducted by the Galician Plan on Drugs. The results and evolution of these indicators would be the following:

3.5.1 HELP AGAINST DRUGS

A TYPES OF ASSISTANCE AVAILABLE AGAINST DRUG USE

This question was posed to the users of the different substances in the studies carried out from 1992 to 2000 and their answers were as follows (Table 3.29):

Table 3.29 Most important types of assistance to give up drugs, according to users. 1992-2000

Types of assistance 1992 1994 1996 1998 2000

Detoxification from drugs 15.9 27.6 18.2 35.0 25.4 Health- and medical-care in general 11.4 26.9 13.6 8.8 13.8 Psychological support and psychotherapy 8.6 23.4 26.7 14.4 18.5 Vocational training 0.4 0.7 1.2 2.1 4.1 Assistance in finding job 2.9 4.1 6.2 3.5 6.9 Assistance with paperwork 0.0 0.0 0.4 0.0 0.4 Family counsel 1.2 2.8 1.6 13.8 1.0 Assistance with social reintegration 2.4 2.1 7.0 4.7 10.4 Assistance with legal problems 0.4 0.7 1.2 0.3 0.6 Undecided/uninterested 56.7 11.7 23.9 17.4 18.9 Total 100.0 100.0 100.0 100.0 100.0

From the data obtained in the whole series, we distinguish the following tendencies:

■ All along the years the types of assistance concerning users’ health are considered the most important ones and remain in first place: detoxification from drugs, health- and medical- care, psychological support and psychotherapy.

■ Currently, we can also point out the types of support geared to achieving social and work rehabilitation, (training and looking for jobs), with a distinct rising tendency throughout the series. Summarizing all these types of assistance in four basic groups, their distribution in 2000 in demonstrated in the Chart 3.20: 64 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Chart 3.20 Proportion of drug users who consider the different types of assistance as the most important to give up drugs. Galicia, 2000

B MEASURES AGAINST DRUGS When the Galician population aged 12 or over are asked which would be the most effective measures to fight drug use, the answers would have evolved in this way from 1988 to 2000 (Table 3.30):

Table 3.30 Most effective measures to fight drugs. 1988-2000

Measures 1988 1992 1994 1996 1998 2000 Repression of drug dealers 52.8 72.2 59.6 47.0 37.6 39.2 Repression of drug users 1.9 2.3 2.6 4.2 9.3 7.0 Campaigns about the 9.6 4.2 4.9 7.2 14.5 11.3 consequences of drug use Legalization of drugs 3.7 7.5 10.7 9.5 18.1 14.7 Improvement life conditions 15.0 4.2 9.5 9.4 4.8 7.7 (work, leisure) Create stimuli and motivation 5.6 2.1 2.0 6.6 2.6 3.2 Education on drugs at school 7.5 4.7 8.0 10.2 9.0 13.8 More assistance and 2.6 1.5 1.9 3.6 2.8 1.5 treatment centres Family advice and 0.4 1.5 0.9 2.3 1.3 1.6 support programmes Total 100.0 100.0 100.0 100.0 100.0 100.0

The repression of drug dealers is still considered the most efficient measure by most people, although at present it is still below the levels detected from 1988 to 1996. The repression of users decreases slightly in relation to the previous year, following the increase observed in 1998; the same occurs with the campaigns about the consequences of drug use and the legalization of drugs. On the other hand, education on drugs at school is the variable that under- goes a higher increase; currently this measure reflects the highest percentage of people who mention it in the whole series (13.8%). The improvement of life conditions rises and falls several times throughout the series, settling now in an intermediate position (7.7%). People’s motivation, the opening of assistance and treatment centres and family advice and support programmes still show very low percentages, as occurred in the previous studies. SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE 65

If we ignore the intermediate studies and compare the data from 1988 and 2000, group- ing the repressive measures, those for legalizing drugs and the educative, informative and assistance measures, in Graph 3.21 we can see the evolution experienced in the long term:

Graph 3.21 Evolution of the three basic types of measures against drugs between 1988 and 2000

According to these data we see that essentially the tendencies are the following: decrease in repressive measures, stabilization of educative-informative-assistance measures and increase in legalising measures. Although each one of them has not varied its order of priority claimed by people throughout these years.

3.5.2 DRUG USE IN PUBLIC AND PRIVATE PLACES When the respondents were asked if drug use should be allowed or penalized in public and private places, these were their answers: As far as public places are concerned, 4.1% did not respond, and 95.9% did answer; 13.1% out of the latter believe that it shouldn’t be penalized and 82.8% think that it should. Consequently the percentages would be these: 13.6% believe it shouldn’t be penalized and 86.4% are in favour of penalizing it. As for the penalization of drug use in private places, 14.4% did not respond, 85.6% did answer. 34% out of the latter believe this use should be permitted and shouldn’t be penalized, whereas 51.6% think that it should be punished (34.4% with a light sanction and 17.2% with a severe sanction). The corresponding percentages would be: 39.7% against sanction and 60.3% in favour of it. The evolution of these opinions from 1994 to 2000 can be seen in graphs 3.22 and 3.23: As reflected in the previous graphs, public opinion is very stable. As for the use of drugs in public places most people are in favour of penalizing it, though showing a slight decrease, of 4.2% between 1994 and 2000. As for the use of drugs in private, most people are also in favour of penalizing it, although people here show greater tolerance (39.7% in 2000), which, on the other hand, is quite similar to the percentage of 1994. 66 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Graph 3.22 Attitudes towards drug use in public places 1994-2000

Graph 3.23 Attitudes towards drug use in private places. 1994-2000

3.5.3 IMPLEMENTATION OF THE GALICIAN PLAN ON DRUGS Galicia was one of the first Autonomous Communities which tried to offer an adequate solution to drug use and abuse, capable of covering all possible areas: assistance and treatment of drug dependents, harm-reduction programmes, school prevention, etc. In all the different epidemiological studies carried out in Galicia several indicators have been included with the purpose of finding out the degree of acceptance of these programmes. In the 1996, 1998 and 2000 studies harm-reduction programmes were included: such as methadone administration and the distribution of sterilized syringes. And in the 1994, 1996, 1998 and 2000 studies those concerning the level of knowledge and assessment of the Galician Plan on Drugs. We shall have a look at the evolution of these indicators. SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE 67

A METHADONE AND SYRINGES

1 The Administration of methadone

When asked, 15.4% of the interviewees did not respond in 2000, whereas 84.6% did give a response; and 10.8% of those who answered believe methadone should not be adminis- tered, 73.7% think it should. If we take as a reference group those who have an opinion about the topic, the percentages of pros and cons would be the following ones: against 12.8%, in favour 87.2%. And if we compare the percentages of those who at present are in favour with the ones that were in favour in 1996 and 1998, we can see the following:

Table 3.31 Evolution of the opinions in favour of the administration of methadone (%). 1996-2000

1996 1998 2000

81.6 84.2 87.2

As we can see there is a progressive increase in the percentage of people who are in favour, in fact a 5.6% increase between 1996 and 2000.

2 The distribution of syringes

Those who, in 2000, do not respond to this question are a minority, just 3.1%, against 96.9% who do respond. 5.9% of the latter are against the distribution of syringes and 91% are in favour. The percentage of pros and cons would be as follows: against, 6.1%, in favour 93.9%. And, comparatively, those in favour in 1996, 1998 and 2000 would be the following ones:

Table 3.32 Evolution of the opinions in favour of the distribution of syringes (%). 1996-2000

1996 1998 2000

92.0 89.4 93.9

The public approval received by this programme represents a very high and steady rate, 2% higher than in 1996.

B KNOWLEDGE AND EVALUATION OF THE GALICIAN PLAN ON DRUGS

1 Knowledge

In 2000 only 0.1% do not respond to the question about their awareness of the existence of the Galician Plan on Drugs and 99.9% do respond. 39.5% from them state they have knowledge of it (Table 3.33):

Table 3.33 Evolution of the percentage of people who have heard of the Galician Plan on Drugs (%)*. 1994-2000

Have you ever 1994 1996 1998 2000 heard of it?

No 69.6 63.7 67.9 60.5 Yes 30.4 36.3 32.1 39.5 Total 100.0 100.0 100.0 100.0

* In 1994, 1996 and 1998 it was called the Autonomous Plan on Drug Dependency. 68 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

As we can see the level of knowledge of the Galician Plan on Drugs has increased in 7.4 % in relation to 1998 and in 9.1% in relation to 1996 (Graph 3.24).

Graph 3.24 Evolution of the public knowledge of the Galician Plan on Drugs, 1994-2000

2 Evaluation

The evaluation of the GPD by those who admit having knowledge about it, on a one to ten scale, is the following:

Table 3.34 Evaluation of the work done by the Galician Plan on Drugs. 2000

Evaluation %

Negative (1 to 4) 9.4 Low positive (5 and 6) 32.0 Highly positive (7 to 10) 58.6 Total 100.0 Base (807) Average mark 7.00

The results of these data show that only 9.4% of the respondents make a negative assessment, whereas 90.6% have a very positive opinion about it -over 5- and 58.6% out of them evaluate it from 7 to 10. The average mark is 7. The evolution of the average mark in all the previous studies is the following (Table 3.35):

Table 3.35 Evolution of the evaluation of the Galician Plan on Drugs (1994-2000)

Years Average mark

1994 6.25 1996 6.91 1998 6.98 2000 7.0

As we can see there is a progressive increase in the positive evaluation of the Galician Plan on Drugs, although between 1998 and 2000 it is so slight that it approximates the maximum possible (Graph 3.25). SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE 69

Graph 3.25 Evolution of the evaluation of the Galician Plan on Drugs, 1994-2000

Thus, we see that there is a rather high level of approval and support in the indicators for the programmes implemented by the Galician Plan on Drugs, both for harm- reducing programmes, and for those concerning the knowledge and assessment of the Plan. The same holds true for the protective effectiveness of school prevention, which we have previously mentioned, (section 3.3.2) as far as the main protective factors against drug use are concerned. In all the data in the present section 3.5 about public opinion and attitudes about drugs in Galicia, we see that the hypotheses proposed have been proved true: the 18th, concerning public attitudes about drugs (help and intervention measures) and the 30th, referring to a progressive increase in the knowledge and positive assessment of the work being done to deal with drugs and drug problems. 70 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

3.6 CONCLUSIONS

At the beginning of this chapter it was stated that in the early 80s Spanish people were deeply concerned about heroin use and its related negative consequences; at the same time, the lack of safety in cities and towns associated with the use of this substance provoked an intense social alarm. This paradigm was known as “heroin crisis” (GAMELLA, J., 1997). The same occurred in Galicia, and the solutions given, both nationwide and region- ally, to deal with this situation were mainly characterized by the assistance and treatment of heroin users, with drug-free treatments at first and later with the introduction of methadone and harm-reducing programmes, among others. However, probably due to the combined effect of the series of measures taken to tackle the problems generated by this situation, in addition to the severity of the problems themselves, heroin use diminished in the early 90s. This fact, together with the introduction of synthetic drugs and the change in the use pattern of other substances, such as alcohol and cocaine among young people and their progressive increase among women, as well as the association of drug use with ludic and recreational contexts, gave way to the consolidation of a new pattern (NAVARRO, J., 2002), characterized by a certain standardi- sation and tolerance towards the use of certain substances, such as alcohol, cannabis and the occasional use of psycho-stimulants. After the increase in the use of cocaine, synthetic drugs, amphetamines and hallucinogens that took place in the early 90s, in Galicia a period of certain stability set in, and declined afterwards, probably the peak of the use of these substances in our Community. Nevertheless, their main potential risk is their introduction among the youngest age groups and the polydrug use that it leads to. These facts, together with the increase in the use of cannabis, and the abuse of alcohol and cocaine among young people - especially over the weekend- would be the most important epidemiological features to bear in mind in the following years. Obviously, without neglecting the problems generated by the use of heroin and other opiates, which although less common, are still very significant. And we must not ignore the abuse of tranquillizers, hypnotics or opiate-based analgesics, especially among adults and older people. The most negative consequences of drug use are health and money problems, family and social problems, academic and work problems and although, much more limited, problems with the law, too. Although the number of people that have suffered these problems has diminished parallel to the decline in heroin use, 15.5% of abusive drinkers or abusive users of other substances still have problems. This group coincides 90% of the times with 15.6% of those who admit being hooked to these substances. As for the reasons given for using drugs, the most prevalent ones are pleasure and experimental reasons, followed by symptomatological and social reasons. However, under- lying these subjective reasons admitted by users, we also find a series of objective risk factors highly related to the abuse of alcohol and other drugs; the most significant ones are parents’ drug abuse, family conflicts, social presence of drugs and their availability, personal instability, poor performance at school, certain hedonistic and seize-the-day values, and among those who work, negative and precarious working conditions, (stress, long hours, exhaustion, etc). In contrast we also find a series of reasons for not using drugs, together with some objective protective factors that moderate or reduce drug use. Personal well-being, health and moral convictions stand out among the subjective reasons. And among the protective factors, the most important ones are having alternative values (solidarity, cooperation, postponed gratification...), alternative activities (humanitarian, social, sport...), body and health-care, family stability, communication between parents and children, as well as school prevention against drugs and other preventive messages and activities. SOCIOLOGICAL INDICATORS AND PATTERNS OF DRUG USE 71

These reasons together with risk and protective factors, and their proven effective relationship with a higher or lower drug use, is what makes prevention the “key” to dealing with drugs. Galician society has formulated a rather clear and firm opinion about drugs and their related problems. As for the kind of assistance demanded by drug dependents themselves, we should point out, the detoxification from drugs, psychological help and psychotherapy, health-care in general, help in social reintegration, as well as specific help in work training and work integration. As for the most effective measures against drug addiction, Galician people in general believe that the most important are the following: the reduction of drug supply and their social presence by fighting drug-trafficking, preventive education at school, information campaigns about the risks and consequences of drugs, the improvement of life conditions in certain groups, motivation and positive stimulation; although there are also people who are in favour of decriminalizing drugs. These represent 14.7% of the whole Galician population aged 12 or over, whereas educative and assistance measures are favoured by 39.1%, and drug-dealing repression is mentioned by 46.2%. The Galician Plan on Drugs aims to solve these problems, and Chapter 11 of this report proposes a series of strategies to deal with drug problems (prevention strategies, treatment, social integration), etc. It is also essential to count on public support so that these measures can be effective and so that people should try to incorporate them into their different environments (family, school, community, work). And as a consequence of what we have seen in the different indicators, (degree of approval of the methadone and syringe- exchange programmes, protective effectiveness of school prevention, knowledge of the Galician Plan on Drugs, positive assessment of its work...), seems that a broader sector of the Galician population is favourably predisposed. This attitude could even be encouraged by the strategies proposed in chapter 11, such as: extension and consolidation of the structures of social participation; strategies to raise public awareness among the population in general and among social service professionals in particular, family values, etc. 4. PREVENTION INDICATORS 4. PREVENTION INDICATORS

In 1996 the so-called Evaluation System of Prevention and Social Reintegration Programmes was set up to evaluate the different programmes carried out in these fields by NGOs and the councils integrated in the Prevention and Social Reintegration Network of the GPD. The assessment of prevention programmes poses, in general, multiple difficulties, included among them: lack of theoretical reference models to orientate some programmes, inadequacy or incoherence of objectives, activities and the instruments to achieve them, the objectives are hardly operative and /or the lack of indicators for evaluating them, the management of these programmes is highly atomised (which makes them difficult to coordinate and also hampers the establishment of data gathering systems related to their activities and results), the distinct characteristics of the agents responsible for the implementation of the programmes (professionals specialised in prevention, volun- teers, etc) or the different levels of implementation and consolidation of the prevention programmes depending on the field they cover. All this gives way to completely different evaluation models for the contents of the programmes. With the introduction of the ESPSR -a pioneer initiative in Spain- we try to systematize all the activities, which are carried out in Galicia in the prevention and social reintegration fields, through an important number of organisations and public and private institutions, as a previous step to evaluate the coverage, results and costs of these programmes. The huge diversity of the prevention programmes that are being developed brings about different results in the quality and quantity of the information obtained about them, so in some cases we obtain information about their implementation levels, coverage, results and costs (for example, in the School Prevention Programme Against Drug Use), whereas in other cases it is only possible to discover their degree of implementation. This situation has made it advisable to apply progressively the set of evaluation instruments and indicators proposed by the ESPSR. The prevention process indicators proposed by the ESPSR and so far set up by the Com- missioner’s Office of the Galician Plan on Drugs in the Galician Ministry of Health are the following ones:

■ Number of prevention programmes.

■ Number of schools, pupils and teachers in school prevention programmes.

■ Number of parents in family prevention programmes.

■ Number of people taking part in community prevention activities.

■ Coverage of the programmes among the whole Galician population.

■ Coverage of the programmes among the people these activities are aimed at.

■ Number and type of activities in every intervention area.

■ Number and type of professionals and total number of hours devoted.

■ Budget per geographical area, activities and intervention areas.

■ Number and type of activities developed by collaborating organisations. The information available in Galicia about prevention indicators for the 1997-2001 period is divided according to the different intervention areas of the programmes; the types of programmes developed are as follows: 76 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

■ School prevention programmes. They are carried out at an academic level (primary and secondary schools, and other academic institutions) and are aimed at teachers and pupils.

■ Family prevention programmes. They take the family in itself as the objective of their work, and they are not directly related to academic institutions (for example, schools for parents).

■ Prevention programmes at the workplace. They are aimed at workers and are carried out at the workplace.

■ Prevention programmes for young people. They include the programmes aimed at young people in situations of special risk. They differ from school programmes because they are carried out outside school.

■ Community prevention programmes. They aim to intervene within the community, so people’s participation in the design and development of the programmes is essential. The programmes include, besides direct interventions within the community, informative and raising awareness activities. PREVENTION INDICATORS 77

4.1 LEVELS OF IMPLEMENTATION AND TYPOLOGY OF PREVENTION PROGRAMMES

In 2001, 127 councils (40% of the total number), which comprise 70% of Galician population, carried out prevention programmes against drug dependency, 6.7% more than the previous year. We must point out that there are eight community plans: Caranza (Ferrol), Distrito Quinto (A Coruña), Marín (Pontevedra), Riveira (A Coruña), Vite (Santiago de Compostela), Monteporreiro (Pontevedra), Casco Viejo (Vigo) and Teis (Vigo), which cover a population of 136,696 inhabitants. Through these plans different prevention activities (informative, raising awareness, sociocultural and formative) are carried out, in addition to others with the purpose of encouraging social integration. Besides these community plans, in 2001, other 230 prevention programmes were implemented. The distribution of the programmes in different areas of intervention confirms that school prevention programmes (30.7%) together with informative/formative programmes (24.8%) have the highest level of implementation followed closely by family-orientated programmes (22.6%) and those directed at young people (20.0%). On the other hand the programmes carried out at the workplace have a very limited presence (Chart 4.1).

Chart 4.1 Development of prevention programmes by intervention areas. Galicia, 2001

The provinces of Pontevedra and A Coruña comprise 76.5% of the prevention programmes developed in Galicia; there do not exist any significant differences among provinces in the distribution of those programmes in areas of intervention (Table 4.1).

Table 4.1 Development of prevention programmes by intervention areas. Galicia, 2001.

Programme Intervention Areas A Coruña Lugo Ourense Pontevedra Total

School prevention 27 10 8 28 73 (30.7%) Informative-formative 19 6 5 27 57 (24.8%) Family prevention 18 6 7 21 52 (22.6%) Prevention among young people 18 5 6 17 46 (20.0%) Prevention at the workplace 1 - 1 - 2 (0.9%) Total Programmes 83 27 27 93 230 78 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

The evolution observed in the number of prevention programmes conducted between 1997 and 2001 would confirm their rapid growth, with an increase close to 53.3%, rising from 150 to 230 (Graph 4.2). This increase was particularly intense in 2001, period when the number of the prevention programmes implemented rose 18.5%, coinciding with the pri- orities the 2001-2004 Galician Plan on Drugs establishes in this field, which means that both, prevention and social reintegration must be top priority areas of intervention.

Graph 4.2 Evolution of prevention programmes carried out in different areas. Galicia, 1997-2001

In the 1997-2001 period, the programmes aimed at young people (registering an increase of 91%), school prevention programmes, those family-orientated, informative and those aimed at raising public awareness (all of them with increases over 50%), would be the programmes that have increased most. Next we shall analyse the data derived from the prevention indicators in the three main programmes that are being carried out at present by the Commissioner’s Office of the Gali- cian Plan on Drugs. PREVENTION INDICATORS 79

4.2 SCHOOL PREVENTION PROGRAMME AGAINST DRUG USE (SPPDU)

Schools are a top priority area of intervention for the GPD as far as prevention is concerned. These programmes promote different useful strategies to encourage healthy lifestyles in general, and to prevent drug use and its related risks among pupils in particular -a highly vulnerable group- and at ages when people usually start taking drugs. The School Prevention Programme against Drugs Use (SPPDU) was set up in the 1994-95 school year, with the purpose of changing pupils beliefs and attitudes towards drugs, and of reducing their use and their intention of using drugs in the future. This is a programme with multiple components: informative strategies, enhancement of values, training in social abilities and in resistance abilities, decision-making techniques, emotional control techniques, promotion of healthy leisure activities, etc. The programme is aimed at all the pupils from primary school (5 year-olds) to post-obligatory education (18 year-olds). This is the only prevention programme in the whole European Union that covers all pre-university education.

A INTRODUCTION OF THE SPPDU

In the 2000/01 school year the SPPDU was working in 554 schools, with 74,499 pupils and 4,024 teachers (Table 4.2).

Table 4.2 Introduction of the SPPDU in the 2000/01 school year. Galicia

A Coruña Lugo Ourense Pontevedra TOTAL

Schools 238 58 37 221 554 Pupils 30,140 9,721 4,486 30,152 74,499 Teachers 1,627 540 284 1,573 4,024

The evolution of the introduction of the programme in the 1995-2001 period, would confirm that, after a steady increase in the previous years, in the 2000-2001 school year there was a decrease in the number of schools, students and teachers taking part in the programme. The number of schools has fallen by 12%, and the number of students and teachers has decreased even more intensely (28 and 22%, respectively), even dropping to lower levels than those of 1995/96. We must point out that in 2000/01 the programme contents and materials for secondary school children have been revised and up-dated, in view of the results of the SPPDU evaluation. We must indicate that, despite the sharp fall in 2000/01, within the 1995/2001 period, schools (408%), teachers (26%) and pupils (49%) taking part in the programme have increased considerably since 1994/95, when the programme was introduced. (Chart 4.3).

Chart 4.3 Evolution of the introduction of the SPPDU. Galicia, 1995-2001

SCHOOLS TEACHERS PUPILS (5-17) 80 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

B PROGRAMME COVERAGE

The scope of the SPPDU within the whole school community in Galicia is very extensive. In the 2000/01 school year the programme was being carried out in 554 schools, which meant it covered 29% of all schools in Galicia. (Table 4.3).

Table 4.3 Coverage of the SPPDU among schools. Galicia, 2000/01 school year

A Coruña Lugo Ourense Pontevedra TOTAL GALICIA

Total number of schools 804 224 198 670 1,896 Schools taking part in SPPDU 238 58 37 221 554 Coverage 30% 26% 19% 33% 29%

The coverage of the SPPDU with respect to the existing number of students in Galicia aged from 5 to 18 is situated at 18%. On the other hand the level of coverage reaches 63% of the total 118,383 pupils in schools where the programme was implemented during the academic year 2000/01 (Table 4.4).

Table 4.4 Coverage of the SPPDU among Galician pupils. Galicia, 2000/01 school year

A Coruña Lugo Ourense Pontevedra TOTAL GALICIA

Total number of pupils 168,050 49,571 44,507 15,027 412,955 Pupils in schools taking part 51,533 12,729 6,410 47,711 118,383 in the SPPDU Total number of pupils 30,140 9,721 4,486 30,152 74,499 taking part in SPPDU Coverage among total number 18% 20% 10% 20% 18% of pupils in Galicia Coverage among pupils in schools 58% 76% 70% 63% 63% taking part in the programme

The SPPDU coverage among teachers is more reduced than among pupils, reaching only 13% of all Galician teachers. The programme covers 43% of the teachers in the schools taking part in it. (Table 4.5).

Table 4.5 Coverage of the SPPDU in relation to Galician teachers. Galicia, 2000/01 school year

A Coruña Lugo Ourense Pontevedra TOTAL GALICIA

Total number of teachers 12,750 3,960 3,558 10,267 30,535 Teachers in schools taking part 4,139 1,095 588 3,571 9.393 in the SPPDU Total number of teachers 1,627 540 284 1,573 4,024 taking part in SPPDU Coverage among total number 13% 14% 8% 15% 13% of pupils in Galicia Coverage among pupils in schools 39% 49% 48% 44% 43% taking part in the programme

AThe SPPDU coverage increased in 1998/2000, and decreased in 2000/01. The sharpest declines took place in the number of pupils (Chart 4.4). PREVENTION INDICATORS 81

Chart 4.4 Evolution of the coverage of the SPPDU. Galicia, 1998-2001

C RESULTS OF THE SPPDU

To determine whether the programme had achieved its objectives, in 1999/2000 the GPD carried out a methodological study consisting of a quasi-experimental design with pre and post-testing (assessment of the same subjects before conducting the programme, at the beginning of the school year, and after completion, at the end of the school year) and with a comparison non-equivalent group (assessment of a random sample of pupils participating in the programme, and another random sample of non-participating pupils), establishing a double comparison: between the pre and post-test and between the experimental group and the control group. Despite the notable variations in the application of the SPPDU (conceived to be implemented with various levels of difficulty depending on the implication or commitment of the different schools), we find systematic differences, not due to chance, between the experimental group and the control group, which shows the positive effect the programme has in promoting attitudes against drug use, encouraging the decision not to use drugs and the reduction of use. The preventive effect of the programme is evident when we see that the use of drugs is much lower among the participants of programme than among non-participants. (Chart 4.5). The average cost of this programme per pupil in the 1999-2000 school year was 312 pesetas, which confirms the high level of effectiveness mentioned before, especially if we take into account that the average cost per patient treated in the GPD treatment centres during the same period of time was over 94,000 pesetas. 82 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Chart 4.5 Differences in the prevalence of drug use among participating pupils and non-participants in the SPPDU. Galicia, 1999/2000 school year

GROUP WITH SPPDU GROUP WITHOUT SPPDU AGE PERCENT Y Y Y Y Y Y TR TR TR TR TR TR USE USE ASY ECST HEROINE COCAINE ALCOHOL ALCOHOL TOBACCO CANNABIS HALLUCINOGEUS PREVENTION INDICATORS 83

4.3 FAMILY PREVENTION PROGRAMME

The Family Prevention Programme was introduced in 1994, and it was developed in the schools destined for parents, and also through informative workshops and others to raise awareness when parents cannot maintain a regular attendance, although the systematic data available dates from 1997 onwards, after the extension of the ESPSR. In 2001, 8,257 people took part in the programme, 2,052 within the 84 schools for parents promoted by the GPD and 6,205 through complementary informative/formative activities. The evolution of the number of participants in the family prevention programme between 1997 and 2001 has not demonstrated a steady rise, although, in the whole period, the number of parents taking part in the programme has grown intensively, having multiplied by 4.2 (Chart 4.6). The total number of parents taking part in the programme totals 22,209.

Chart 4.6 Number of parents participating in the Family Prevention Programme. Galicia, 1997-2001

Comparing the activities developed in family prevention in Galicia with those carried out in the rest of Spain in 1999 (last available data for the whole of Spain), we observe that Galicia covered 20% of the total number of parents involved in these activities in Spain (25,000) (GDNPD, 2000 b). 84 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

4.4 ENHANCEMENT OF VALUES-EDUCATIONAL PROGRAMME

Within the context of preventive strategies aimed at Galician teenagers and youths, in the 1996/97 school year an educational programme was set up dedicated to teaching values and prevention against drug use called “Cinensino”. This programme, which uses films as a motivating element, is aimed at Primary School 5th and 6th form children and at Sec- ondary School 7th and 8th form students and has the purpose of both reducing risk factors (low self-esteem, parents permissiveness towards drug use, precociousness in the use of legal drugs, etc) and of encouraging protective factors. In the 2000/01 school year 24,009 pupils took part in the programme. The volume of participants in this programme since its introduction in 1996/97 grew steadily until 1999/2000, and has stabilized from then on. The total number of participants in the 1996/2001 period totals 87,192 pupils (Chart 4.7).

Chart 4.7 Evolution of pupils participating in the Enhancement of Values-Educational Programme. Galicia, 1996/97-2000/01 school years PREVENTION INDICATORS 85

4.5 CONCLUSIONS

■ The prevention programmes developed in Galicia have registered an intense growth pattern in the past years; in the 1997-2001 period there was an increase of 53.3% (from 150 to 230).

■ School prevention programmes and informative-formative programmes are the most numerous, representing 31.7% and 24.8% of the total number of prevention programmes carried out in Galicia in 2001. The programmes aimed at families and young people follow in second pace.

■ Although during the 1999/2000 school year, the number of schools, teachers and pupils taking part in the School Prevention Programme against Drug Use dropped sharply with regard to previous years, the general number of participants in the programme has grown considerably since its introduction in the 1994/95 school year, with increases of 408%, 26% and 49% in the number of schools, teachers and pupils respectively.

■ The assessment of the prevention programme carried out in Galician schools (SPP- DU) shows its effectiveness in promoting attitudes of rejection towards drugs, in reducing the levels of drug use and in reinforcing the intention of not using them in the future.

■ In 2001, 8,257 parents took part in the activities of the family prevention programme, 4.2 times more than in 1997.

■ Despite the increase in the number of participants in family prevention programmes and, especially in prevention programmes at the workplace, they still have a long way to go. 5. SOCIAL REINTEGRATION INDICATORS 5. SOCIAL REINTEGRATION INDICATORS

Since its introduction in 1996, the ESPSR provides systematic information about the different programmes that encourage social reintegration, promoted in Galicia by public and private institutions integrated in the Prevention and Social Reintegration Network of the GPD. These programmes have been classified into 2 broad categories: a) General Pro- grammes developed by the Autonomous Administration or through European Union Plans, and b) Specific Programmes, which include the programmes carried out in day-centres, support workshops, and those providing legal advice. The indicators proposed by the ESPSR to assess the implementation of the social reintegration programmes, which have been conducted so far by the Commissioner’s Office of the Galician Plan on Drugs are the following:

■ Number of social reintegration programmes.

■ Number of users of these programmes. 90 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

5.1 LEVELS OF IMPLEMENTATION AND TYPOLOGY OF SOCIAL REINTEGRATION PROGRAMMES

In 2001, 26 Galician town councils (8% of the total number) developed social reintegration programmes. In that period in Galicia 41 social reintegration programmes were implemented by councils and associations integrated in the Prevention and Social Reintegration Network of the GPD, 80% of them in the provinces of Pontevedra and A Coruña (Chart 5.1).

Chart 5.1 Implementation of social reintegration programmes per province. Galicia, 2001

SOURCE: Commissioner’s Office of the Galician Plan on Drugs

The evolution in the number of social reintegration programmes carried out in Galicia between 1997 and 2001 stabilizes from 1998 and remains stable in 2001 (Chart 5.2). This tendency is coherent with the stability in the volume of patients treated in the health-care centres of the GPD for the past years.

Chart 5.2 Evolution of the number of social reintegration programmes carried out in Galicia, 1997/2001 SOCIAL REINTEGRATION INDICATORS 91

Both the types and level of coverage of the social reintegration programmes introduced in Galicia differ from those of the rest of Spain. The data provided by the different Autonomous Communities in the 2000 Report of the National Plan on Drugs, indicate that the number of users of residential support resources are below the national average considering the proportion of users Galicia has in relation to the total number of people assisted in treatment centres, whereas the work training programmes exceed the average (Table 5.1)

Table 5.1 Number of social reintegration programmes-resources and users. Galicia and Spain, 2000

Type of Programme Spain Galicia Number of Programmes Number Number of Programmes Number and/or centres of users and/or centres of users

Residential support 111 3,055 3 68 resources Work training 499 18,042 75 1,466 programmes Work reintegration 108 4,677 11 258 programmes

SOURCE: Commissioner’s Office of the Galician Plan on Drugs and 2000 Report of the National Plan on Drugs. 92 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

5.2 SOCIO-LEGAL ADVICE PROGRAMMES

The Socio-Legal Advice Programme the GPD promotes is aimed, on the one hand, at drug dependents with legal problems undergoing treatment and their relatives and on the other hand, at the legal profession and the GPD professionals. Among the Programme’s objectives are: providing advice to drug dependents with legal problems, improving the coordination between the judicial and therapeutic systems, ori- entating and advising magistrates, judges and public prosecutors on drug dependents’ personal, family and social situations. The number of activities carried out within the Programme, which covers the eight specific services of the social reintegration area of the GPD, rose considerably during the 1999- 2000 period (Table 5.2), as the 4,508 interventions carried out last year prove.

Table 5.2 Activities of the Socio-Legal Advice Programme of the GPD, 1999-2000

ACTIVITIES 1999 2000

Court reports 617 1,133 Expert advice at police stations, 1,935 2,572 courts, prisons Expert advice to judges, 357 672 lawyers, prosecutors Attending trials 99 131 TOTAL ACTIVITIES 3,008 4,508 SOCIAL REINTEGRATION INDICATORS 93

5.3 CONCLUSIONS

■ The volume of social reintegration programmes carried out in Galicia has remained stable in the past years, in consonance with the relative stability observed in the number of patients treated in treatment centres.

■ Nearly 2,000 people per year benefit from the social reintegration programmes developed in Galicia, a figure which represents about 20% of all the patients who received treatment in the centres of the health-care system of the GPD.

■ Formative and work reintegration programmes are found to have the highest level of implementation in the area of social reintegration. 6. TREATMENT INDICATORS 6. TREATMENT INDICATORS

6.1 ADMISSIONS TO TREATMENT FOR THE USE OF PSYCHOACTIVE SUBSTANCES

6.1.1 ADMISSIONS TO TREATMENT IN EXTRAPENITENTIARY CENTRES In 2001 there were 3,666 admissions to treatment in the extrapenitentiary centres belong- ing to the Galician assistance network to drug dependents, 306 out of which were due to alcohol and tobacco abuse and/or dependency (8.3%) and the rest due to illegal drugs. The evolution of the admissions to treatment registered in Galicia shows they experienced a steady increase between 1986 and 1994, followed by a period of stabilization between 1995 and 1997, and then it initiated a decline from 1998 to 2000. In 2001 there was a certain rebound in admissions, which breaks the falling tendency of the last three years, since admissions increased by 4.6% in relation to 2000 (Graph 6.1).

Graph 6.1 Evolution of the admissions to treatment in the treatment centres of the GPD (Galicia, 1986-2001)

DFTP: Drug-Free Treatment Programme (*) The sum of admisions in the three programmes is higher than the total number of admisions because some patients are admitted to OATP: Opiate Antagonists Treatment Programme two or more programmes over a year ODTP: Opiate Derivatives Treatment Programme

The decline in admissions to treatment in the past four years is compatible with the slight increase in the number of people assisted in the GPD treatment centres. The expla- nation for these contradictory tendencies between the admissions to treatment (decrease) and the volume of assistance (rise) is due to the variations in the services offered to drug dependents that took place in the 90s. The level of development attained by the opiate derivatives treatment programmes (ODTPs) in the last years has contributed to the stabilization in the treatment of opiate users, preventing their wandering from one treatment centre to another. 98 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Whereas the admissions to opiate antagonist treatment programmes (OATPs) have dropped sharply (66.8% between 1995 and 2001), the admissions to ODTPs increased steadily until 1998, falling afterwards down to the 1996 levels. Despite this fall, the ODTPs are still the most common among the patients admitted to treatment every year in Galicia. On the other hand, the admissions to drug-free treatment programmes (DFTPs) have remained stable, with slight annual variations, since 1996. The overall decrease in the number of admissions to treatment in Galicia since 1998 has also been observed in the rest of Spain, but in this case only since 1999. In 2000 (last available national data) the volume of admissions in Spain registered a 9% fall in relation to 1998 (Graph 6.2).

Graph 6.2 Evolution of the admissions to treatment in Galicia and Spain, 1986-2000

6.1.2 ADMISSIONS TO TREATMENT IN PENITENTIARY CENTRES About 30% of the Spanish inmate population are in prison for crimes against public health and drug use is very common among them, as the estimates of the EMCDDA, based on local studies, confirm. About 90% of prisoners have taken illegal drugs some time in their lives (EMCDDA, 2001). As the analyses of the profiles of those admitted to treatment in the different GPD treatment centres reflect, a high percentage of drug dependents have been in prison some time in their lives. The markedly high prevalence of drug abuse and /or drug dependency, as well as of certain pathologies (tuberculosis, VIH/AIDS, hepatitis, etc.) and related risk practices among the prison population, justifies the introduction of specific programmes aimed at this group of people in the 5 prisons integrated in the GPD assistance network. The health-care and therapeutic support that prison health-care services have been providing for inmates have been reinforced progressively, first in 1997 with the introduction of opiate derivates treatment programmes in all Galician prisons, later in 2000 with the introduction of syringe-exchange programmes in all Galician prisons, with the purpose of enhancing the harm-reducing strategies within this group, and finally in 2002, with the introduction of an intra-penitentiary therapeutic community. TREATMENT INDICATORS 99

The analysis of the evolution followed by the admissions to treatment in Galician prisons shows that, after the marked increase they had registered from 1997 (year when authorised) there has been a significant decrease from 2000 onwards (Table 6.1.). In fact, in 2001 the admissions to treatment within prison have decreased 25% in relation to the previous year.

Table 6.1 Admissions to treatment in Galician prisons (1997-2000)

Admissions to treatment 1997 1998 1999 2000 2001

Opiate Derivatives Treat. Programme * 919 985 895 592 Opiate Antagonists Treat. Programme * 32 21 8 32 Drug Free Treat. Programme * 69 174 62 106 TOTAL ADMISSIONS 721 1,020 1,180 965 730

* Data not available

The ODTPs have the highest number of admissions, 5 times higher than those registered in DFTPs and OATPs. The evolution between 1998 and 2001 confirms that the admissions to ODTPs have declined considerably, whereas admissions to OATPs have remained stable and admissions to DFTPs have increased. 100 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

6.2 PATIENTS ADMITTED TO THE DIFFERENT TREATMENT PROGRAMMES

6.2.1 PATIENTS TREATED IN EXTRAPENITENTIARY CENTRES In 2001 a total of 11,815 people were treated in extrapenitentiary treatment centres in Galicia, a record figure in the history of the GPD treatment network. This figure evidences the continuity of the slightly rising tendency in the number of patients treated from 1996 after the huge increase recorded between 1992 and 1995 (Graph 6.3). This increase in the volume of treatment, even in those periods where admissions decreased, is due to the steady growth of the levels of permanence in treatment in the different programmes offered by the GPD, which will be later analysed. We must point out that 95.2% of the patients treated in the GPD treatment centres in 2001 were treated for illegal drug abuse and /or dependency, and 4.8% received assistance for drinking or smoking-related problems.

Graph 6.3 Evolution of the patients treated in the extrapenitentiary centres of the GPD treatment network, 1992-2001

The analysis of the distribution of the patients treated in the different programmes confirms that the opiate derivatives treatment programmes are the most important in the GPD treatment network, and they have been growing steadily year after year (in 2001 about 70% of the patients treated are in this type of treatment programmes). On the other hand, the number of those undergoing drug-free treatment programmes has remained relatively stable in the past years, they represent 20% of all the patients treated, whereas the number of patients in opiate antagonists treatment programmes dropped intensely and steadily between 1997 and 2001, reduced by half. This evolution is extremely significant for the planning of treatment services, since it would refute the idea that the increase in the supply of ODTPs would necessarily mean a decrease in the levels of DFTPS. The data available, so far, seems to confirm the possibility TREATMENT INDICATORS 101

that both types of programmes may coexist, at least in its present dimensions; since the rapid expansion of ODTPs has not meant the massive transfer of patients from DFTPs. In fact what has occurred is that patients, who had, so far, kept away from the assistance network took up treatment, thus improving drug dependents’ therapeutic, health-care and social control. The evolution of the volume of patients treated in the GPD treatment centres has some specific characteristics, different from those found in the rest of Spain, where since 1999 there has been a decrease in the number of patients treated in out patient/ambulatory centres that have DFTPs (7,4% between 1999 and 2000), whereas the patients enrolled in ODTPs grew by 9%. We must emphasize that the rhythm of growth of the patients treated in ODTPs has been much more intense in the rest of Spain, where the number multiplied by 4.4 between 1994 and 2000, whereas in Galicia they only increased 2.8 times (Graph 6.4).

Chart 6.4 Evolution of the patients in opiate derivatives treatment programmes in Galicia and Spain, 1994-2000

The fact that the number of patients in methadone treatment programmes has grown more significantly in Spain than in Galicia in the past years, is basically due to the fact that Galicia was the first Community to offer this sort of treatment, and the other Communities had to correct the shortage in vacancies that this kind of programme has demonstrated in recent years. If we analyse the patient rates treated in these therapeutic programmes in the different Autonomous Communities in the 1991-2000 period (Table 6.2), we see that Gali- cia had a 19.8 patient rate in ODTPs for every 100,000 inhabitants (the third position nationwide), and has grown in 2000 reaching a 295.5 rate, the second highest rate in the whole of Spain, after the Canary Islands. 102 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Table 6.2 Patients in methadone treatment programmes in the different Autonomous Communities (1991-2000). Patient rates per 100,000 inhabitants

CC.AA. 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Andalucía 14.8 26.1 38.6 58.6 122.3 159.5 193.5 220.0 241.0 257.7 Aragón 3.8 5.7 8.3 8.8 11.6 38.2 63.5 141.8 161.2 200.4 Asturias 98.5 120.0 134.0 137.9 137.4 163.7 191.6 200.9 229.9 256.3 Baleares 11.2 20.9 55.2 50.7 87.4 68.0 206.9 210.6 315.0 290.4 Canarias 2.5 5.3 11.3 21.5 28.5 172.7 214.2 271.8 315.9 339.1 Cantabria 8.1 25.2 43.9 62.9 91.1 140.7 208.4 217.2 295.2 257.2 C. La Mancha 0.0 0.0 0.0 0.0 0.5 3.5 16.1 60.2 103.3 132.9 C. León 8.9 13.2 23.0 42.2 59.0 79.1 90.4 144.1 170.0 193.1 Cataluña 6.9 27.3 34.7 46.2 61.1 83.9 103.5 120.9 130.8 140.2 Extremadura 0.0 27.2 29.9 34.2 175.2 238.2 271.7 149.8 133.7 143.0 Galicia 19.8 56.7 75.7 93.3 126.1 153.9 208.42 264.9 290.8 295.5 La Rioja 14.4 45.3 44.0 70.1 86.3 113.0 110.1 123.4 121.7 201.0 Madrid 3.9 6.0 6.9 13.3 25.2 81.2 80.3 141.8 143.0 161.7 Murcia 36.0 39.0 69.1 138.2 134.4 183.4 192.8 192.0 234.1 258.8 Navarra 0.0 0.0 5.7 58.9 89.2 115.9 141.0 117.3 160.0 186.4 País Vasco 0.0 28.9 28.8 35.6 47.9 67.8 75.0 78.1 118.6 111.2 Valencia 15.6 16.2 52.6 27.8 51.1 59.7 173.2 88.9 141.1 140.6

SOURCE: GMCDDA from the data provided by the Autonomous Communities

6.2.2 PATIENTS TREATED IN PRISON PROGRAMMES Just as has occurred with the GPD extrapenitentiary treatment services, the decrease in the number of admissions to treatment registered since 2000 is compatible with the increase in the total number of prisoners treated in Galician prisons, which experimented a 48% growth in the 1998-2001 period. The inflection in the volume of treatment registered in 2000 is related to the relocation of two prisons. (Chart 6.5).

Chart 6.5 Evolution of the volume of treatment in the GPD prison programmes. 1998-2001 TREATMENT INDICATORS 103

The opiate derivates treatment programmes monopolise the therapeutic services offered in Galician prisons, concentrating 89.3% of the patients treated in 2001. The predominant role of ODTPs in the treatment of drug dependent prisoners is directly related to the inmates’ profiles, who show, in general, greater social and health deterioration than patients who attend extrapenitentiary services. A similar evolution is observed among the prison population treated in the different prison treatment programmes, whose volume has grown steadily between 1995 and 2000, as a consequence of the increase in ODTPs in the different prisons (Chart 6.6).

Chart 6.6 Evolution of the number of inmates treated in the different therapeutic programmes. Spain, 1995-2000

(*) They include ambulatory and modular programmes (**) From 1998 data referring to Catalonian prisons are included SOURCE: Department of Penitentiary Institutions and Drug Dependency Department in Catalonia. 104 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

6.3 PROFILES OF THE GPD TREATMENT NETWORK USERS

6.3.1 GENERAL PROFILE OF THE PEOPLE ADMITTED TO TREATMENT The general profile of the patients admitted to treatment in the GPD treatment services for abuse and/or dependency on substances other than alcohol and tobacco is basically a poor- ly educated single thirty-year-old male, who lives with his parents (although one out of four lives with his partner and one out of three has got children), unemployed, user of heroin as the primary drug, with a long history of drug use, polydrug user, (especially of tobacco, cannabis, alcohol and cocaine), smoking drug user mainly, who has previously undergone some kind of treatment and who is seriously affected by infectious diseases (VIH/AIDS and hepatitis C and B) and psychiatric problems (Table 6.3). However, and as we shall later see, there are important differences in the profiles of the people treated, depending on whether they are new cases or patients who had previously undergone treatment.

Table 6.3 General profile of the patients admitted to treatment in the GPD treatment network for the use of drugs other than alcohol/tobacco. Galicia 2001

SOCIODEMOGRAPHIC AND SOCIAL STRATA VARIABLES

Sex M:F: 5,1 Average age 30.6 Marital status Single (69.3%) Married (17.6%) With primary education or lower 74.7% Occupation Unemployed (45.0%) Working (37.1%) Invalidity benefit/Pension (5.3%) Source of income Work (39.2%) Family help (23.8%) Marginal activities (10.5%) Living with Parents (49.3%) His/her own family (24.8%) With children 34.9% Drug dependent partner 19.1% TREATMENT INDICATORS 105

VARIABLES RELATED TO THE ACCESS TO TREATMENT

Previous treatment 71.2% (3.2 average previous treatments) Means of access Own initiative (46.7%) Family/friends (10.2%) Demand put forward Methadone (47.3%) Detoxification (18.9%)

AREA OF USE

Primary drug Heroin (86.3%) Cocaine (6.4%) Cannabis (3.1%) Heroin + cocaine (1.5%) Route of administration of primary drug Smoking/inhaling (60.7%) Injecting (31.4%) Years taking primary drug (average) 10.9 Average age of initiation of primary drug 19.8 Co-main drug used in the past thirty days Cocaine (22.8%) Tobacco (17.3%) Cannabis (15.3%) Alcohol (7.7%) Benzodiazepines (6.4%)

MEDICAL AREA

Prevalence of infectious diseases VIH/AIDS (12.2%) Hepatitis B (8.6%) Hepatitis C (18.4%) Psychiatric treatment 20.0% Hospital emergency episodes for overdose 21.5% (2.2 average)

JUDICIAL AREA

Criminal record (arrests) 54.2% (average arrests: 7.1) Imprisonment 34.6% (average: 2.2 times)

The general profile of drug dependents admitted to treatment has been changing progressively since 1994, when they started to be monitored, and we are able to observe the following: an important ageing process among the patients treated, the long time the primary drug has been used, the greatest demand of treatment for cocaine use, the prevalence of smoking/inhaling drug use to the detriment of injecting drug use, the important increase in the number of cases that have previously undergone treatment and the greater presence of related legal problems. (Chart 6.7.). 106 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Chart 6.7 Evolution of the profile of the GPD treatment network users. Galicia, 1994 -2001

Except *, the other values refer to the percentage of users with that characteristic.

The profile of the users admitted to treatment for illegal drug abuse and/or dependency in the Galician drug dependency treatment network is significantly different from the rest of Spain. In Galicia the percentage of users who have undergone previous treatment is higher, heroin plays a more important role as the primary drug that justifies treatment, to the detriment of cocaine and cannabis, processes that we shall later analyse.

a) Drug that provokes treatment A vast majority of the admissions to treatment registered in the GPD treatment network in 2001 were due to heroin as the primary drug (78.6%), followed, far behind, by those caused by alcohol (7.0%) and cocaine (5.8%). The rest of psychoactive substances, such as cannabis (2.8%), synthetic drugs (0.6%) or tobacco (2.0%), are hardly relevant (Table 6.4).

Table 6.4 Distribution of the admissions to treatment by psychoactive substances. Galicia 2001 PRIMARY DRUG SUBSTANCES %

Heroin 78.6 Alcohol 7.0 Cocaine 5.8 Cannabis 2.8 Synthetic drugs 0.6 Tobacco 2.0 Heroin + Cocaine 1.3 Others 1.9 TREATMENT INDICATORS 107

As can be inferred from this data, heroin continues to be the drug that causes the highest percentage of all the admissions to treatment, even though it is important to note that it has lost relevance in favour of substances such as alcohol and cocaine. The admissions to treatment for heroin use have decreased sharply among patients who have not undergone previous treatment. On the other hand, the admissions to treatment for cocaine use have been increasing progressively, and between 1995 and 2001 they have actually trebled, both among the patients without previous treatment and among those previously treated. (Graph 6.8).

Graph 6.8 Evolution of the admissions to treatment for heroin and cocaine use, according to whether they have undergone previous treatment or not. Galicia, 1995-2001

We must highlight the increase in the admissions to treatment for cannabis use among the patients not previously treated, whereas the presence of synthetic drugs has slightly declined among this type of patients in 2001 (Graph 6.9).

Graph 6.9 Evolution of the admissions to treatment for cannabis and synthetic drug use, depending on whether patients have undergone previous treatment or not. Galicia, 1995-2001 108 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

The role that the different psychoactive substances play in the admissions to treatment in Galicia is significantly different compared to results in the rest of Spain. The admissions to treatment for heroin use in Galicia are at present much higher than the ones registered in the rest of Spain, in contrast with the lesser importance of the admissions caused by cannabis and cocaine use, which are half of those registered nationwide (Graph 6.10). These differences become more acute among those admitted to treatment for the first time. Whereas among these cases, heroin continues to be the primary drug most commonly used in Galicia, in the rest of Spain it caused only 47.6% of the admissions registered in 2000, followed by cocaine (32.1%) and cannabis (14.5%).

Graph 6.10 Admissions to treatment for heroin and cocaine use. Galicia and Spain, 1986-2001

Source of the data about Spain: SEIT Reports

The evolution of the admissions to treatment in Galicia from 1986 to 2001, according to the primary drug used, presents the following characteristics:

■ The fall in the number of admissions to treatment caused by heroin use from 1999 on, particularly among those admitted to treatment for the first time.

■ The pattern of the admissions to treatment produced by cocaine use has been an irregular one, and after having risen between 1996 and 1999, they have decreased. Although between 2000 and 2001 the admissions for cocaine use dropped in general, both among the patients previously treated and those who undergo treatment for the first time, the decrease has been more intense among the latter.

■ The admissions to treatment caused by the use of cannabis have been rising progressively among the patients without previous treatment, although altogether they are still not very significant among all the admissions registered. This evolution is quite similar to the one registered in the rest of Spain up to 2000 (last available data). In Spain the admissions to treatment for heroin use have continued to drop from 1997, whereas the admissions for cocaine use, which had registered a sharp increase up to 1999, suffered a slight decent in 2000, due to the decrease in the admissions of patients without previous treatment, although the number of admissions for cocaine use among those previously treated has continued to grow. The admissions for cannabis have also increased slightly, especially among those patients without previous treatment. TREATMENT INDICATORS 109

b) Existence of previous treatment Having undergone previous treatment or not is a variable that introduces significant differences in the profiles of the people admitted to treatment and is directly linked to the type of drug that causes these admissions. The evolution of this indicator is basically characterised by the degree of consolidation of the treatment services (the greater their scope and duration, the higher the proportion of patients previously treated) and by means of their capacity of adaptation to the new demands posed by drug abuse (admittance or incorporation of new users to the treatment network). Up to 1994 most of the drug users admitted to treatment, demanded the services of the GPD treatment services for the first time, situation which has reversed from 1995 up to the present, as we can verify when we see that 71.2% of the patients admitted to treatment in 2001 had undergone previous treatment (Graph 6.11). This increase in the percentages of patients previously treated is also registered in Spain, although in this case with less intensity, as it is proved by the fact that 64.2% of the admissions to treatment registered in Spain in 2000 took place among patients previously treated.

Graph 6.11 Evolution of the proportion of users admitted to treatment, depending on whether they have undergone previous treatment or not. Galicia-Spain, 1991-2000

Source of the data about Spain: SEIT Reports The profile of the patients admitted to treatment for the first time differs considerably from the profile of those previously treated, being the first group younger (28.4 years old) than the second one (31.5 years old); the period of time when the drug that causes the treatment has been used is shorter (8 years compared to 12 years); their family integration is higher, the times they were imprisoned or admitted into hospital emergency wards are fewer; injecting drug use is less common among them and consequently, the incidence of infections caused by VIH/AIDS, VHB and VHC is lower (Chart 6.12). As it has been already stated, the existence of previous treatment or not is also linked to the weight the different substances have in the admissions to treatment, in such a way that cocaine or cannabis have a more relevant presence (cocaine caused 12.4% of the admissions and cannabis 9.5 %), among those without previous treatment, to the detriment of heroin, which appears as the primary drug in 71.6% of the admissions (Chart 6.13). In general there are no significant differences (just some minor ones) between the profiles of the people admitted to treatment in Galicia and in the rest of Spain, according to whether they have undergone previous treatment or not. The basic differences are: the importance of the role of cocaine as the primary drug among those admitted to treatment for the first time (32,1% of the admissions registered in Spain in 2000 among the patients without previous treatment were caused by cocaine use), and the resulting decline in injecting drug use. 110 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Chart 6.12 Profile of patients depending on whether they have undergone previous treatment or not. Galicia, 2001

Except *, the other values refer to the percentage of users with that characteristic.

C Distribution according to gender

Chart 6.13 Drug responsible for admission to treatment depending on whether they have undergone previous treatment or not (%). Galicia, 2001

SYNTHETIC DRUGS: 2.2% SYNTHETIC DRUGS: 0.2%

HEROIN+COCAINE: 1,6% HEROIN+COCAINE: 1.4%

CANNABIS: 9.5% CANNABIS: 0.6%

COCAINE: 12.4% COCAINE: 4.1%

HEROIN: 71.6% HEROIN: 92.2%

NO PREVIOUS TREAT. WITH PREVIOUS TREAT.

Since 1987 males have outnumbered females in the admissions to treatment registered in the GPD treatment services and that disparity still exists today. In 2001 the M:F ratio (number of males per females) was of 5 to 1, a disproportion that can be explained by the traditional overrepresentation of males among illegal drug users. This disparity is even more intense in the rest of Spain, where the M: F ratio was 5 to 6 in 2000 (last available data) (Graph. 6.14). TREATMENT INDICATORS 111

Graph 6.14 Male:Female Ratio among those admitted to treatment. Galicia and Spain, 1987-2001

Source of the data about Spain: SEIT Reports

Graph 6.15 Male:Female Ratio by treatment programme. Galicia, 1989-2001

The disproportion in favour of males in the admissions to treatment is a constant in all the programmes carried out in Galicia, although slightly less acute in the opiate derivatives treatment programmes, where the M: F ratio is 4 to 8. The fact that the females who take up treatment present more deteriorated health, psychological and social condition than their male counterparts explains their higher presence in ODTPs (Graph 6.15). d) Distribution according to age

The average age of the patients in the Galician treatment services has been rising progressively from 24.5 years in 1987 to 30.4 years in 2001; a similar process (although somewhat less intense) has occurred in the rest of Spain (Graph 6.16). The fact that the incorporation of new heroin users was very limited in the 90s, has prompted the progressive ageing of the group of those moderately “hooked”, who just like the opiate users group, still cause the greatest number of admissions to treatment. 112 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Graph 6.16 Average age of those admitted to treatment. Galicia-Spain, 1987-2001

Source of the data about Spain: SEIT Reports

Graph 6.17 Average age according to treatment programme. Galicia, 1989-2001

The average age of the persons admitted to treatment differs, depending on whether they have undergone previous treatment or not. The average age of the patients admitted to treatment for the first time is 3.1 years lower (28.4 compared to 31.5). The average age of the people admitted to treatment also differs depending on the type of programme they follow. The ODTP users are the oldest on average (30.8 in 2001), 2.5 years older than the DFTP users and 3.2 years older than the OATP users (Graph 6.17).

e) Average age in the initiation of use of drugs and period of time taking the primary drug

In 2001 the average age in the initiation of the use of the primary drug was 19.8 years among all the patients admitted to treatment, with a 12-month-difference depending on whether they had undergone previous treatment (20.5) or not (19.5). There are no marked age differences in the introduction to the use of drugs in relation to the type of programme patients take part in (19.8 among ODTP and DFTP users and 19.1 among OATP users). TREATMENT INDICATORS 113

In consonance with the increase in the average age of the patients admitted to treatment, there has also been an increase in the number of years of use of the primary drug, which has gone up from 4.8 years in 1987 to 10.9 years in 2001, a tendency similar to the one observed in the rest of Spain (Chart 6.18).

Chart 6.18 Evolution of the average number of years the patients admitted to treatment have been taking the primary drug. Galicia-Spain, 1987-2001

Source of the data about Spain: SEIT Reports

As the patients admitted in ODTPs are the oldest, logically they are the ones who have been taking the primary drug for the longest period of time: 11.2 years on average in 2001, compared to 8.4 years among the patients in DFTPs and 7.8 years among those in OATPs. However, there is a difference in the evolution of the period of drug use: between 1989 and 2001 the years of use of the primary drug have remained stable among the 8 to 11-year period in ODTPs, whereas there have been remarkable increases in the remaining programmes (Graph 6.19).

Graph 6.19 Evolution of the average number of years of use of the primary drug according to treatment programme. Galicia, 1989-2001

In 2001 the average period of time of primary drug use was 8.0 years among those admitted to treatment for the first time in Galicia, which is the average period of time peo- 114 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

ple wait to take up treatment since initiation of primary drug. This period of time is significantly shorter than the one found among patients previously treated (12.0 years) and similar to that registered in the rest of Spain (7.8 years among those admitted to treatment for the first time in 2000).

f) Routes of primary drug administration

The impact of the harm-reducing strategies implemented from the early 90s to deal with the huge prevalence of infections caused by VIH/AIDS among drug dependents, has made it possible that from 1994 injection is no longer the most popular route of administration of the primary drug among people admitted to treatment in the GPD centres, thus increasing the smoking-drug use. The intensity of the changes registered in the route of administration of the primary drug is obvious when we see that in 2001, 60.7% of the patients admitted to treatment were smoking/inhaling drug users, as compared to 31.4% who were injecting drug users (Graph 6.20).

Graph 6.20 Route of administration of primary drug (%). Galicia-Spain, 1991-2001

Source of the data about Spain: SEIT Reports

The progressive fall in injecting drug use, especially significant among the patients admitted to treatment for the first time, is quite clear, confirmed by the fact that in 2001 only 15.3% of the patients were injecting drug users; most of them were smoking/inhaling drug users (68.2%). Although from 1991 the tendency to give up the injecting drug use has had a similar intensity in the rest of Spain, we must point out that in Galicia, injecting drug use continues to be more common, as a consequence of the higher prevalence this tendency has had in this Community (causing the onset to be higher) and due to the fact that a proportion- ately higher number of heroin users are treated in the centres of the Galician drug dependency network, bearing in mind that heroin is highly linked to injecting drug use.

g) Multiple substance abuse among admissions

Polydrug use is a widely consolidated pattern among the patients treated. The analysis of the substances taken in the thirty days prior to beginning of treatment enables us to identify some drug associations among the patients admitted to treatment in the GPD centres in 2001 (Table 6.5): TREATMENT INDICATORS 115

■ Cocaine appears as the co-primary drug in 22.8% of the admissions, followed by cannabis (15.3%), alcohol (7.7%) and benzodiazepines (6.4%). The presence of these co- primary drugs differs according to the type of programme followed.

■ These same substances, especially alcohol (24.1%) and cannabis (21.1%), register a high prevalence of use as the secondary, tertiary or quaternary drug taken in the previous thirty days among the people admitted to treatment.

Table 6.5 Co-primary drug and additional substances taken in the thirty days prior to start of treatment, 2001

PROGRAMME CO-PRIMARY DRUG OTHER DRUGS (2nd, 3rd or 4th) 1 2 3 4 1 2 3 4

TOTAL ADMITTED 22.8% 15.3% 6.4% 7.7% 8.6% 21.1% 13.3% 24.1% DFTP 20.5% 15.9% 6.2% 9.9% 11.1% 21.9% 11.9% 23.8% ODTP 25.3% 12.1% 7.3% 5.1% 10.2% 21.0% 16.2% 21.1% OATP 19.4% 22.2% 5.8% 5.3% 11.8% 24.7% 12.9% 24.7%

1 = COCAINE 2 = CANNABIS 3 = BENZODIAZEPINES 4 = ALCOHOL Among the total number of patients admitted to treatment in Spain in 2000 we find a high level of use of additional substances in the thirty days prior to onset of treatment, especially of cocaine (56.3%), cannabis (36.8%), alcohol (32.0%), hypnotics and sedatives (18.9%). The data provided by the same indicator about Galicia confirm the use of cannabis (39.4%), alcohol (35.1%), hypnotics and sedatives (26.2%) as secondary drugs in higher percentages than those found in the rest of Spain, with the exception of cocaine, whose levels are lower (44.6%). The analysis of the use of these additional substances in relation to the primary substance of abuse at admission is particularly relevant. Among the cases admitted to treatment in Spain in 2000 for the use of heroin as the primary drug we also find the use of cocaine (69.5%), cannabis (35.9%), alcohol (25%), hypnotics and sedatives (22%), percentages that are slightly higher among the patients not previously treated (70.5% for cocaine, 37.9% for cannabis and 25.1% for alcohol). On the other hand, among the cases admitted to treatment for the use of cocaine we detect a high prevalence of alcohol use (58.5%) and cannabis (48.6%), whereas the uses of heroin (14%) and ecstasy (9%) are quite limited. Among the patients previously treated the use of heroin is higher (24.4%), whereas the levels of alcohol (53.7%) and cannabis (45.7%) are lower than those registered among the patients not previously treated (61.5% and 50.0% respectively). These data confirm the important presence of cocaine among heroin users, as this is a widely generalised polydrug use pattern among the patients treated. We should also point out that the association of the use of heroin and cocaine does not hold true inversely, since only a small proportion of those admitted to treatment for cocaine abuse and/or dependency are heroin users. The pattern of polydrug use among the people admitted to treatment for cocaine abuse would be what has been called a recreational use, with a prepon- derance of alcohol and cannabis as additional drugs. The European Monitoring Centre for Drugs and Drug Addiction provides us with some data about the people admitted to treatment for drug abuse in the different countries of the European Union. Despite the different methods of data gathering, it is possible to identify some common traits among those patients (Table 6.6). 116 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002 (a) The data about Austria r (c) The data about France r (b) The Danish data about opiates r T Sweden U. Kingdom (g) Por Luxembur Italy (e) Irland Holland Gr France (c) Finland Spain Denmar Belgium Austria (a) Ger able 6.6 IV r gramme exclusively annual r eece oute of administration is at 100%. tugal (f) many (d) ecor ck (b) d. T g raits of the patients tr . Ther efer to the patients under efor efer to the patients included in some substitution pr 1998 1999 1999 1999 1999 1999 1999 1999 1999 1999 1998 1999 1999 1999 1999 Y e the data about opiates as primar ear efer to her A verage 34.0 27.1 27.0 30.9 24.6 31.4 26.1 30.4 31.0 32.9 28.2 28.0 27.7 n.a. Age oin exclusively going tr eated for dr male/female . Distribution eatment r by gender 75/25 72/28 74/26 70/30 86/14 70/30 81/19 75/25 85/15 75/25 69/31 78/22 84/16 80/20 egister y dr ug use pr ug and the ed in the o - primar oblems in dif administration (d) The Ger (e) The data about Italy include both the patients that have taken up tr IV r and the ones who continue with their tr and the CLH. to her 37.0 66.0 48.9 10.0 60.6 21.0 29.0 69.8 y dr oute of n.a. n.a. n.a. n.a. 100 n.a oin and the data about r man data about the intratravenous r ug (%) fer ent EU countries Opiates (a) 43.0 (35.0) 83.6 (74.5) 73.4 (66.0) 63.2 (14.5) 31.5 (81.6) 74.6 (26.9) 64.7 (49.8) 89.5 (72.0) 71 (47) 74 (76) 49 (53) n.a. oute of administration cocaine r 100 32 eatment fr oute of administration opiates r 6.5 (26.5) 4.3 (14.5) 1.2 (14.0) 21.2 (2.5) 17.0 (4.7) 7.7 (24.3) 1.6 (16.7) om last year 0.2 (n.a.) Cocaine 11 (89) 1 (33) 6 (4) n.a. n.a. (between brackets % IV r . eatment this year Amphetamines (a) eflect the crack % distribution of primar 39.1 (85.7) 1.4 (10.0) 2.6 (10.4) 0.3 (6.7) 0.6 (2.3) 0.0 (0) 8 (42) 5 (9) efer n.a. n.a. n.a. n.a. 1.0 (f) The Por SOURCE: Eur (g) In the United Kingdom data r inter tinguish the types of dr ventions and not the total number of patients; ther oute of administration) tuguese data about the tr 0.9 (7.7) Ecstasy 4.9 (0) 0.8 (0) 0.5 (0) 0.1 (0) opean Monitoring Centr 1 (1) n.a. n.a. n.a. n.a. 0.0 1.0 0,3 y dr ugs. Hallucinogens ug 0.1 (n.a.) 1.3 (n.a) 0.1 (4.3) 0.6 (0.0) 0.2 (0) 0.1 (0) n.a. n.a. 0.2 0.0 0,0 0.0 1.0 efer to April-September eatments demanded r e for Dr ugs and Dr 19.0 (n.a.) Cannabis 22.2 (n.a) 10.0 (0,5) 22.6 (0.0) 5.6 (0.0) 16.5 (0) 10.0 (0) 16.0 (0) 6.9 (0) ug Addiction, 2001. 10.0 n.a. 8,0 7.0 efor efer to the total number of , 1999. e it is not possible to dis 0.4 (21.6) 0.7 (14.3) 0.4 (n.a.) 1.0 (1.3) 0.6 (1.7) 1.0 (1.3) 4.0 (0.7) Others 2.0 (0) 1 (36) 43.0 n.a 1.0 0.0 - TREATMENT INDICATORS 117

6.3.2 PROFILE OF THE PATIENTS ADMITTED TO THE DIFFERENT TREATMENT PROGRAMMES There are some relevant differences among the profiles of the patients treated in the various GPD treatment programmes (Chart 6.21). Just as has occurred in previous years, the patients in opiate derivatives treatment programmes have a more deteriorated profile (more social, legal and health problems associated with the use of drugs), whereas the patients in opiate antagonists treatment programmes are the best adapted, and the users of drug-free treatment programmes are in an intermediate position between the other two groups.

Chart 6.21 Profile of the users admitted to treatment according to programme. Galicia, 2001

■ The ODTP users are older than the users of the other programmes and have been taking the primary drug for longer; most of them were injecting drug users before taking up treatment and had already undergone previous treatment. At the same time they present more social problems (high unemployment rates, their sources of income are derived mostly from marginal activities), they have more health problems (more admissions into emergency services, highly affected by infectious diseases) and more penal-legal problems. ■ On the other hand, the OATP users are better adapted, they are younger and the time they have been taking drugs is shorter. They are less affected by infectious diseases; they present higher levels of family and work integration, and fewer legal- penal problems. ■ As for the users of DFTPs, they present an intermediate profile between the ODTP and the OATP users. The analysis of the patients’ profiles over a long period of time would confirm that the social deterioration of the patients incorporated to ODTPs would have reversed in 2001, having improved their family and work conditions, having become less dependent on marginal activities and with fewer legal-penal problems (Graph 6.22). 118 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Graph 6.22 Evolution of the social profile of users admitted to opiate derivatives treatment programmes. Galicia, 1998-2001 TREATMENT INDICATORS 119

6.4. EVALUATION OF THE TREATMENT SERVICES

In order to evaluate the efficacy and efficiency of the Galician drug dependency network, the GPD set up a Treatment Evaluation System in 1994. This system, besides enabling us to monitor the users over a long period of time, provides us with important indicators to assess the activities developed in the different treatment programmes; indicators such as: reasons for leaving the programmes, reasons for remaining in them, and reasons for participating in the different activities offered in each programme. However, the evaluation data referring to 1994 must be taken with caution, since it was then when the Treatment Evaluation System was set up, so for this reason we have decided to start analysing their evolution from 1995.

6.4.1 REASONS FOR LEAVING THE PROGRAMMES The indicator of the reason to leave the programme/centre includes five different motives: therapeutic discharge, drop out, expulsion, force majeure, and change of programme. The analysis of the reasons for leaving the programmes helps us to assess the results of those programmes, although we should bear in mind the recidivist character the World Health Organisation attributes to drug dependency. A high percentage of the therapeutic discharges from a programme proves its effectiveness, but this does not mean that there will not be relapses into drug use among the patients treated. Just as the drop out of a programme should not necessarily mean the fail- ure of the therapeutic process, since it is quite frequent that the patients who undergo treatment, resume it after a certain period of time. At the same time the change of programme reflects the constant efforts made by the professionals to guarantee a more per- sonalized treatment for each patient, trying to offer them the most suitable type of programme or resource, thus facilitating the patients’ permanence in treatment, which just as several follow-up studies confirm, is one of the main predictive variables of the positive evolution of the treatment. The main reasons for leaving the different programmes of the GPD treatment network in 2001 were: change of programme (especially among the OATP users), followed by dropouts and therapeutic discharges (Table 6.7). The expulsions were practically non-existent; making up only 0.2% of all the leaves registered in the whole network.

Table 6.7 Reasons for leaving according to programme. Galicia, 2001

REASON TO LEAVE DRUG-FREE T.P. OPIATE OPIATE TOTAL DERIVATIVES T.P. ANTAGONISTS T.P. LEAVES Number % Number % Number % Number %

Change of programme 343 43.2 582 49.2 323 56.0 1,248 48.9 Drop out 193 24.3 341 28.9 159 27.5 693 27.1 Therapeutic discharge 233 29.3 103 8.7 72 12.5 408 16.0 Force majeure 25 3.2 151 12.8 23 4.0 199 7.8 Expulsion 0.0 0.0 5 0.4 0 0.0 5 0.2 TOTAL 794 100 1,182 100 577 100 2,553 100

There are some differences in the reasons for leaving the various types of programmes, especially in therapeutic discharges, changes of programme and leaves due to force majeure since the percentages of dropouts are similar in all the programmes. The OATPs register higher percentages of leaves for change of programme, whereas the ODTPs con- centrate most of the leaves due to force majeure. 120 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

On the other hand, the highest percentages of therapeutic discharges are registered in the DFTPs (29.3%), which have a “final” orientation (focused on abstinence and prior to therapeutic discharge), whereas other programmes, especially the ODTPs have intermediate objectives. By analysing the evolution between 1995 and 2001 of the main reasons for leaving the GPD treatment network we reach some interesting conclusions:

■ The change of programme, which has traditionally been the main reason for leaving, has decreased significantly in DFTPs, which would reflect the steady consolidation of the work of the GPD treatment network, improving the selection of the therapeutic processes and prolonging the permanence in the treatments prescribed. (Chart 6.23).

Chart 6.23 Leaves due to change of programme. (Galicia, 1995-2001)

■ Dropouts have experimented a highly positive evolution in all the programmes (Chart 6.24), especially in the most demanding ones (DFTPs and OATPs), what would undoubtedly reflect the progressive improvement of the quality of the attention given. This tendency is highly positive, since it means longer continuance in the treatment, which, as already mentioned, increases the possibilities of success of the programmes. Besides, the longer permanence in the treatment, whether it is successful or not, brings about the achievement of complementary objectives to abstinence, such as the giving-up of certain risk practices. Despite the positive evolution of dropouts from 1995, they are still quite numerous in ODTPs, if we bear in mind the objectives of this type of therapeutic treatment (abstinence in addition to the reduction of harm associated with the use of opiates) and the fact that they are orientated to patients with a high level of deterioration.

■ Therapeutic discharges have an irregular evolution, with increases in the most demanding programmes and decreases in ODTPs (Chart 6.25). We must point out the huge increase in discharges from DFTPs (from 6.3% in 1994 to 29.3% in 2001), which confirms, in the first place, that rehabilitation is possible (at least for one out of four of the patients in DFTPs) and in second place, the progressive improvement in the quality of the services offered. TREATMENT INDICATORS 121

Graph 6.24 Leaves due to dropouts. (Galicia, 1995-2001)

Graph 6.25 Leaves due to therapeutic discharges. (Galicia, 1995-2001)

6.4.2INDICATORS OF PERMANENCE, ACTIVITIES AND ATTENDANCE The indicator of permanence in programme measures the average number of days the patients spend in the different programmes until they leave them. It must be pointed out that there are marked differences in this indicator according to the type of programme (Chart 6.26), which in 2001 oscillated between 634.3 days in ODTPs and 277.5 days in DFTPs. The tendencies observed in the indicator of permanence in the programme between 1995 and 2001 confirm the increase in the average number of days of permanence in all the programmes, much more intense in ODTPs and OATPs, as can be expected from pro- 122 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Chart 6.26 Evolution of the average number of days spent in a programme. Galicia, 1995-2001

Chart 6.27 Average number of interventions by type of programme. (Galicia, 1995-2001)

grammes that try to link the drug dependent population to the therapeutic processes, fos- tering the users’ fidelity to the programme. Although less intense, the evolution of the days of permanence in DFTPs has also been positive, having almost doubled between 1994 and 2001, increasing the prospects of success in this kind of treatments. Parallel to the increase in the number of days of permanence under treatment, we also observe a general growth in the average number of interventions carried out in all the programmes (Chart 6.27), as well as in the number of days the patients go to the centre while they remain under treatment (Graph 6.28). However, we must point out that from 1999 the number of days with interventions have remained stable or have even diminished slightly in the case of OATPs, which would confirm a relationship -not very intense, though- between the indicator of permanence and the indicator of activity in the different programmes. TREATMENT INDICATORS 123

Graph 6.28 Average number of days with interventions (days going to the centre) by type of programme. (Galicia, 1995-2001)

Graph 6.29 Evolution of the indicators of permanence, activity and attendance in DFTPs. Galicia, 1995-2001

The increase in the number of the activities carried out with the patients would be linked to their longer permanence in the programme and, on the contrary, (just as occurred with OATPs in 2001) their decrease would be linked to their shorter permanence, although the increase in permanence is not directly proportional to the intensity of the treatment, so slight increases in the activity ratios would be linked to important improvements in the levels of permanence. These associations are observed in DFTPs (Graph 6.29), in OATPs (Graph 6.30) and in ODTPs (Chart 6.31). 124 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Graph 6.30 Evolution of the indicators of permanence, activity and attendance in OATPs. Galicia, 1995-2001

Graph 6.31 Evolution of the indicators of permanence, activity and attendance in ODTPs. (Galicia, 1995-2001) TREATMENT INDICATORS 125

6.5 CONCLUSIONS

■ From 1998, and after years of constant growth, the admissions to treatment in the extra-penitentiary centres of the GPD treatment network have been decreasing. Despite the rebound registered in 2001, with 3,666 admissions, the incorporation of patients to treatment would have declined altogether by 22.4% in the past five years. This tendency is also observed in Spain, although more intensely in this case.

■ The decline in the number of incorporations to treatment is compatible with the increase in the number of the people treated in the extrapenitentiary treatment centres, trend which would have become less acute from 1996. In 2001 with 11,815 patients treated, the Galician assistance network has reached its historical peak.

■ The efforts made by the GPD to widen the scope of their programmes to attend to the population with drug abuse and drug dependency problems are evident if we take into account that the rates of the patients admitted to treatment per 100,000 inhabitants registered a 57.2% increase between 1991 and 2000, rising from 76.3 to 120.0. In fact, our Community was the fifth one with the highest rate of admissions to treatment following the Canary Islands, Andalusia, Valencia and the Balearics.

■ The slight increase registered in the past years in the volume of the people treated in the GPD treatment centres, despite the decline observed in the admissions to treatment, has been possible thanks to the higher levels of fidelity or permanence in the therapeutic processes, as a consequence of the important increase in the availability of opiate derivatives treatment programmes, which have contributed to reducing the mobility of patients through the different services.

■ The vast majority of the demands of treatment, and consequently, of the people treated in the GPD treatment centres, are due to the abuse and/or dependency on illegal drugs. The abuse of substances, such as alcohol and tobacco, are responsible for only 4.8% of the total number of patients treated. We must bear in mind that most alcoholics are treated in the Mental Health System.

■ The increase in the supply of ODTPs in the past years in Galicia, justified by the progressive social and health deterioration of opiate users, has meant an increase of over 200% in the number of patients treated in these programmes between 1996 and 2001, whereas the number of OATP users decreased by 44%, remaining stable the number of patients in DFTPs in the same period of time. Whereas in Galicia, the larger number of people treated in ODTPs is compatible with the stabilization of the numbers of patients in DFTPs, in the rest of Spain, there seems to be a transfer of users from DFTPs (which register decreases in the numbers of patients treated) to ODTPs.

■ The general profile of the patients admitted to treatment is basically that of a thirty- year-old single male, with poor education, unemployed, user of heroin as the primary drug, who has been taking drugs for a long time, polydrug user, preferably a smoking/inhaling drug user, who has previously undergone treatment and highly affected by infectious diseases such as VIH/AIDS, hepatitis C and B and with psychiatric problems. This profile has changed in the past years. At present the patients treated are older, they have been taking drugs for longer, the cases previously treated have increased, most of them are no longer injecting drug users (from 71.3% of the people admitted to treatment in 1991 to 34.2% in 2001) the legal problems associated with drug use have increased. The users in ODTPs present higher levels of social and health deterioration, whereas the OATP users present fewer problems.

■ Although heroin has lost considerable weight in the admissions to treatment from the mid 90s, its use continues to be the most important reason for demanding treatment in the GPD centres (78.6% in 2001), followed by alcohol (7.0%) and cocaine (5.8%). The admissions to treatment in Galicia present substantial differences in 126 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

relation to the rest of Spain. In Galicia the influence of heroin is higher, and the admissions due to cocaine and cannabis are much lower. These differences are still more acute among the people admitted to treatment for the first time.

■ The fall in the number of users who change programmes and the decline in the number of dropouts have been made possible thanks to the consolidation of the work carried out in the centres and services provided by the GPD. The evolution of these indicators, which mean the improvement of the levels of permanence, is facilitating the users’ fidelity to their treatments and improving the programmes’ prospects of succeeding. The huge increase in the number of therapeutic discharges in DFTPs between 1995 and 2001 (from 6.3 to 29.3%) confirms the progressive improvement of the quality of the services offered to the Galician drug dependent population.

■ A high percentage of drug dependents treated in the GPD centres have a criminal record, which justifies the reinforcement that the services of the penitentiary centres have registered in Galicia. In 2001 a total of 1,640 inmates underwent treatment in the GPD intra-penitentiary centres, 48% more than in 1998. About 90% of the patients treated in Galician prisons are in ODTPs. 7. HEALTH-CARE INDICATORS 7. HEALTH-CARE INDICATORS

7.1 INFECTIOUS DISEASES ASSOCIATED WITH THE USE OF DRUGS

Drug use, in particular injecting drug use, is closely related to the presence of certain infectious diseases. The prevalence of infections caused by VIH/AIDS, hepatitis C and B or tuberculosis is much higher among drug users than among the Galician population in general. The data available concerning these diseases come basically from two sources: the data provided by the Treatment Evaluation System, referring to the drug dependents undergoing treatment, and the data provided by the Galician Record on Aids, which compiles all the diagnosed and recorded cases of Aids, which are voluntarily reported by the medical profession.

7.1.1 INFECTIOUS DISEASES IN PATIENTS UNDERGOING TREATMENT The prevalence of diseases such as hepatitis C and B and VIH/AIDS among the people admitted to treatment for the use of illegal drugs who have submitted themselves to different medical tests and examinations is very high, particularly among the users of opiates derivatives treatment programmes (Chart 7.1).

Chart 7.1 Prevalence of infectious diseases among drug users admitted to treatment for abuse and/or dependency on illegal drugs, according to programme. Galicia, 2001

The incidence of this type of diseases is closely related to certain risk practices, injecting drug use among them. Precisely the great prevalence of injecting drug use among the cases who have undergone previous treatment explains, to a large extent, the fact that the patients infected who have undergone previous treatment are twice as many as the patients admitted to treatment for the first time. (Chart 7.2). In fact, the improvements achieved in this area last year, have caused a steady fall in the number of drug dependents undergoing treatment who are infected with these diseases. 130 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Chart 7.2 Prevalence of infectious diseases among the GPD treatment network users, according to whether they have undergone previous treatment or not. Galicia, 2001

40% 38%

35%

30%

25% 22,5%

20%

15,3% 15% 14,8%

10,1% 10% 8,4%

5,4% 4,9% 5%

0% VIH/AIDS Hepatitis B Hepatis C Intravenous route Without previous treatment 5,4% 4,9% 8,4% 15,3% With previous treatment 14,8% 10,1% 22,5% 38%

The estimates provided by the European Monitoring Centre for Drugs and Drug Addic- tion (EMCDDA, 2001) seem to confirm the stabilization of VIH, after the sharp fall registered among injecting drug users from the mid 90s. However, in countries such as Austria, Luxemburg, Ireland, the Netherlands, Portugal and Finland, VIH transmission might be increasing among certain groups of injecting drug users. The prevalence of hepatitis C is higher than VIH in the European Union, oscillating from 40 to 90% among injecting drug users, depending on the countries of reference. There is no defined tendency in the evolution of this disease in the limited number of countries that include this indicator in their reports. On the other hand, the prevalence of hepatitis B is also high among this group of drug users, but lower than hepatitis C. Although there are no updated estimates about the prevalence of other infectious diseases such as tuberculosis among drug dependents undergoing treatment, there exists partial data confirming its high incidence among drug dependents. The report produced about tuberculosis in Galicia in 1997 (by the GALICIAN MINISTRY OF HEALTH AND SOCIAL SERVICES, 1997) stated that the incidence rate of this disease in our Community was 65.8 cases out of every 100,000 inhabitants, rate which rose to 101.2 among those aged between 25 and 34 years. Although in most of the cases of tuberculosis registered there is no recorded risk factor associated with the disease, we do find two closely related to the use of drugs: alcohol consumption in 10.3% of the cases and VIH positive in 10.2%. On the other hand, a study carried out nationwide in 1999 (INSTITUTO DE SALUD CAR- LOS III, 1999) confirmed the fact that drug use is the most commonly detected risk factor among the diagnosed cases of tuberculosis (particularly, having injected drugs on some occasion, having a case history of alcoholism and having used non-injected heroin and cocaine). Also reflected is the association of tuberculosis with VIH/AIDS, since a significant percentage of patients with tuberculosis were infected with VIH/AIDS.

7.1.2 CASES OF AIDS AMONG DRUG USERS Since 1984, when the first case of AIDS was diagnosed in Galicia, the evolution of this disease, whose defining criteria have been modified since 1994 following the criteria of the European Centre for the Epidemiological Surveillance of AIDS, has had two clearly differentiated phases: in the first one, lasting from 1994 to 1996, the cases diagnosed rose (with slight increases and decreases); and in the second one (since 1997), there has been a marked decrease in the number of new cases, decreasing from 365 in 1996 to 100 in 2001 (Graph 7.3). HEALT-CARE INDICATORS 131

The annual incidence of the disease (frequency of new cases registered every year divided by every million inhabitants) also reflects this falling tendency. In only four years its incidence has gone down from 134.0 (1996) to 36.6 (2001). This positive evolution of the cases of AIDS registered in the past years is the result of the efforts made in the prevention of this disease and in the treatment of those affected, in particular due to the efficacy of anti- retroviral treatments.

Graph 7.3 Number of cases and incidence of AIDS.Galicia, 1984-2001

INCIDENCE CASES

Source: Galician Record on ADIS

Galicia is situated in an intermediate position in the whole of Spain with relation to AIDS rates, being slightly under the national average (37.1). Similar to results in Galicia, the rest of Spain has also been registering an intense reduction in the number of cases of AIDS from 1995. The analysis of the main socio-demographic characteristics of those infected with AIDS diagnosed in Galicia in 2001 would confirm that most of them are males (79%), aged between 25-29 and 30-34, with a progressive increase of the average ages when the disease is diagnosed, reaching 36 years of age in 2001. The influence that the use of drugs has in the transmission of VIH/AIDS infection is obvious if we take into consideration that 67.8% (1,969 cases) of the total number of cases of AIDS (2,903 cases) diagnosed from the onset of the disease up to December 31st, 2001 were “injecting drug users”. This route of transmission is more relevant in Galicia than in the rest of Spain (64.8%), in consonance with the greater traditional presence of injecting drug use among Galician opiate users. The analysis of the cases of AIDS diagnosed in Galicia in 2001 (Chart 7.4) confirms that injecting drug use continues to be the most common way of transmission (61%), both among males (65%) and among females (44%), although among the latter the incidence is the same as among heterosexuals. These are followed by the next categories according to their relevance: heterosexual relations without protection (23%) and homo-bisexual practices (4%). Injecting drug use is also the principal means of transmission in the rest of Spain (52%), both among males (53%), and females (48%). The evolution of the relevance that injecting drug use has had in the transmission of AIDS in Galicia since 1986 is marked by its constant decline among both sexes (Chart 7.5). Between 1998 and 2001, 61% of males and 52% of females were infected by it, whereas between 1986-1989 the infected males were calculated at 76% and the infected females at 73%. 132 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Chart 7.4 Diagnosed cases of Aids by category of transmission. Spain and Galicia, 2001

GALICIA

IDU 61%

HETEROSEXUAL T. 23%

HOMO/BISEXUAL T. 4%

UNKNOWN 8%

OTHER 4%

SPAIN

IDU 52.2%

HETEROSEXUAL T. 23.7%

HOMO/BISEXUAL T. 13.5%

UNKNOWN 9.4%

OTHER 1.2%

At the same time, in the past years we observe a significant increase in the percentage of Galician people, both males and females, infected by heterosexual transmission, clearly constituting the second cause of contagion of the disease. The evolution in Galicia of the new cases of AIDS diagnosed among injecting drug users between 1990 and 2001 is very similar to the one registered in the rest of Spain, with constant increases up to the mid 90s, and steady decreases from then on. The fall in the volume of new cases among drug injectors has taken place in Galicia since 1997, two years later than in the rest of Spain (Graph 7.7). When analysing the evolution of the cases of AIDS, we should bear in mind that, this disease is a delayed consequence of VIH/AIDS infection, and for this reason the general fall registered in the new cases of AIDS (particularly among injecting drug users) is the result of the harm-reducing strategies implanted several years ago, whose results are visible only after a long period of time. Despite this positive evolution, Galicia and the rest of Spain present much higher Aids rates than other European countries. South-western European countries, particularly Por- tugal and Spain, present the highest rates of annual incidence of AIDS among drug users (EMCDDA, 2001) (Table 7.1). HEALT-CARE INDICATORS 133

Chart 7.6 Categories of AIDS transmission by gender. Galicia, 1986-2001

MALES FEMALES

1986–1989 1986–1989

IDUs 76% Homo./bi. T. 9% IDUs 73% Homo./bi. T. Heter. T. 6% Other 9% Heter. T. 20% Other 7%

1990–1993 1990–1993

IDUs 74% Homo./bi. T. 11% IDUs 72% Homo./bi. T. Heter. T. 8% Other 4% Heter. T. 21% Other 7%

1994–1997 1994–1997

IDUs 69% Homo./bi. T. 9% IDUs 55% Homo./bi. T. Heter. T. 18% Other 4% Heter. T. 37% Other 8%

1998–2001 1998–2001

IDUs 61% Homo./bi. T. 9% IDUs 52% Homo./bi. T. Heter. T. 20% Other 10% Heter. T. 37% Other 11%

SOURCE: Galician Record on AIDS 134 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Graph 7.7 Evolution of the number of cases of AIDS associated with injecting drug use, according to year of the diagnosis. Spain-Galicia, 1990-2001

Table 7.1 Cases of AIDS diagnosed in 1999 among injecting drug users for every million people. EMCDDA

COUNTRIES CASES OF AIDS AMONG DRUG USERS (FOR EVERY MILLION PEOPLE) Portugal 60 Spain 42 Italy 16 France 4 Austria 2 Ireland 2 Luxemburg 2 Denmark 1 The Netherlands 1 Sweden 0.9 Belgium 0.7 Norway 0.7 Germany 0.6 United Kingdom 0.4 Greece 0.3 Finland 0.0

7.1.3 PREVENTION OF INFECTIOUS DISEASES AND REDUCTION OF RISK PRACTICES With the purpose of preventing the transmission of infectious diseases, particularly VIH/AIDS, as well as of reducing certain risk practices, the General Bureau of Public Health of the Galician Government (Xunta de Galicia) has been conducting since 1992 several programmes among injecting drug users, consisting in the distribution of packages with preventive material (Chart 7.8) and has also set up a syringe exchange programme, in which all the Galician prisons have participated since 2000. HEALT-CARE INDICATORS 135

Chart 7.8 Number of preventive packages distributed among injecting drug users at pharmacies and exchange points. Galicia, 1992-2001 This exchange programme has proved to be very active. In 2001 almost half a million prevention packages and 162,288 condoms were distributed. (Table 7.2).

DISTRIBUTIÓN POINTS PHARMACIES

Table 7.2 Evolution of the number of prevention packages, condoms and leaflets distributed within the exchange programme. Galicia, 1996-2001

1996 1997 1998 1999 2000 2001

Preventive packages 386,108 545,610 567,950 620,890 456,298 492,613 distributed Condoms distributed 80,000 25,000 92,000 185,750 139,684 162,288 Exchange programme - 7,000 8,807 1,000 530 300 leaflets distributed 136 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

7.2 HOSPITAL INDICATORS

7.2.1 HOSPITAL DISCHARGES FOR DRUG DEPENDENCY From 1993 the Galician Health Service (GHS) has an information system called Minimum Data-Base Set (MDBS), compiled from the data in clinical records and discharge reports registered by the health-care professionals working at the 21 GHS hospitals. These records are highly useful for planning and evaluating the activities carried out at the hospitals, as for improving their administration. The Minimum Data-Base Set gathers, among others, data about the drug dependents admitted to the GHS hospitals (code 304. of the CIE-9-MC 4th edition has been established as search condition), with reference to hospitalisation (discharges), not patients. The MDBS indicate that between 1995 and 1999 there was a steady increase in the number of discharges for drug dependency problems as the main diagnosis, doubling at the end of the period. After reaching the maximum number of discharges in 1999 (2,173 discharges), a falling trend seems to set in, intensifying in 2001. (Graph 7.9).

Graph 7.9 Hospital discharges with diagnosed drug dependency (Galicia, 1995-2001)

Source: MDBS. Galician Health Service.

In 2001, apart from the 490 hospital discharges where drug dependency appears as the main diagnosis, there were other 20,659 discharges with drug dependency as the secondary diagnosis.

7.2.2 HOSPITAL DETOXIFICATION UNITS (HDUS) HDUs are mechanisms, which, within a hospital area, carry out the in-patient detoxification treatments proposed by the DTUs integrated in the GPD treatment network. The activity carried out by the six HDUs in Galicia in 2000 (last available data) points to a slight decline in the number of patients admitted into these services in relation to previous years (426 in 2000 compared to 458 in 1999). This reduction in the number of admissions in the Galician HDUs coincides with the slightly more intense fall registered in the rest of Spain, where after steady interannual HEALT-CARE INDICATORS 137

growths up to 1997, in 1998 the number of patients treated began to fall steadily. The accumulated fall between 1998 and 2000 is estimated at 21.5% for the whole of Spain and at 9.7% for Galicia (Graph 7.10)

Graph 7.10 Evolution of the users treated in the HDUs. Spain and Galicia, 1995-2000

SOURCE: Report of the National Plan on Drugs, 2000. 138 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

7.3 CONCLUSIONS

■ The drug users admitted to treatment present high rates of infectious diseases, such as VIH (12.2%), hepatitis B (8.6%) and C (18.4%) and tuberculosis.

■ Important differences have been found in the level of prevalence of these infectious pathologies depending on whether they are patients who had undergone previous treatment or not. The fact that the prevalence of infections by hepatitis (B and C) and VIH is respectively, two and three times, lower among the patients admitted to treatment for the first time, confirms the positive impact of prevention strategies, of control programmes over these diseases, as well as harm-reducing schemes, which have made it possible that at present the number of drug injecting patients has been reduced over 40% from 1991.

■ Injecting drug use continues to be the primary way of AIDS transmission in Galicia, responsible for 67.8% of the total number of cases diagnosed since the outbreak of the epidemic up to the present. However, among the new cases diagnosed in the past years we see that this way of transmission has lost relevance (it was the way of transmission in 61% of the cases diagnosed in 2001) and that there has been an increase in heterosexual transmission.

■ Hospital discharges related to drug dependency have started to decrease since the year 2000. In 2001 they descended to 490, 4.4 times fewer than in 1999. This evolution would be due to the improved attention and health-care control of Galician drug dependents with problematic drug use. 8. MORTALITY INDICATORS 8. MORTALITY INDICATORS

8.1 MORTALITY FROM ACUTE REACTION TO THE USE OF DRUGS

The indicator for mortality resulting from acute reaction to the use of drugs was incorporated in Galicia in 1992 and from then on Galicia has thorough data about the evolution of the number of deaths caused by acute reaction, about the characteristics of these deaths and of the deceased, as well as of the substances which provoked them. This indicator covers the whole Galician territory, which is not the case in the other Autonomous Communities. In 2001 there were 40 deaths caused by acute reaction after taking drugs in Galicia, 35 of them (87,5%) were toxicologically confirmed, and all of them were caused by overdose, not having identified any toxic adulteratant to which the deaths could be attributed. The general characteristics of the deaths registered in 2001 as well as their evolution from 1999 can be found in the following table (Table 8.1):

Table 8.1 General characteristics of the deaths caused by acute reaction to the use of drugs. Galicia 1992-2001

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Number Only 35 51 73 49 64 65 68 66 57 35 of deaths Toxicologically confirmed Confirmed 41 61 82 52 73 71 73 72 61 40 and unconfirmed

Sex Males 86.0 90.2 89.0 89.8 98.4 92.3 98.5 87.9 87.7 91.4 Females 14.0 9.0 11.0 10.2 1.6 7.7 1.5 12.1 12.3 8.6 Ratio M:F 6.0 9.2 8.1 8.8 63.0 12.0 67.0 7.2 7.1 10.6

Age Average 28.0 28.5 27.5 27.7 29.9 29.3 30.3 31.8 31.6 32.7 Minimum 16 17 18 16 15 17 18 20 17 3 (*) Maximum 40 47 43 45 46 45 45 45 47 49

Scene of Home 37.1 39.2 39.7 34.7 42.2 50.8 60.3 50.0 57.9 65.7 Death Hotel 8.6 2.0 2.7 4.1 3.1 1.5 2.9 1.5 0.0 0.0 Street 34.3 29.4 34.4 32.7 31.3 27.7 26.5 31.8 26.3 20.0 Public establ. 0.0 5.9 0.0 8.2 4.7 6.2 2.9 10.6 3.5 0.0 Hospital 5.7 11.8 12.3 16.3 10.9 10.8 4.4 4.5 5.3 0.0 Prison 0.0 2.0 4.1 2.0 3.1 0.0 1.5 0.0 1.8 2.9 Others 2.9 5.9 6.8 2.0 4.7 3.0 1.5 1.5 5.3 11.4 Unknown 11.4 3.9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Substance Heroin 74.0 69.0 79.5 85.7 73.4 56.9 52.9 37.9 50.8 42.8 Cocaine 6.0 14.0 1.4 2.0 7.8 10.7 14.7 27.3 19.2 14.4 HRN+COC 20.0 17.0 19.2 12.2 18.7 32.4 32.4 34.8 29.8 42.8

Route adminis. Injecting 75.0 70.0 82.0 85.7 81.0 72.0 68.0 56.0 45.6 28.6

VIH Positive - - 73.0 48.9 51.6 53.8 52.9 37.9 42.2 34.3

Hometown Pontevedra 54.3 49.0 52.0 32.6 42.2 44.6 45.6 37.9 40.4 34.3 A Coruña 40.0 39.2 36.9 48.9 40.6 40.0 39.7 48.5 45.6 42.9 Lugo 2.9 5.8 0.0 12.2 9.4 7.7 11.8 7.6 3.5 5.7 Ourense 2.9 5.8 10.9 6.1 7.8 7.7 2.9 6.1 10.5 17.1

Note: The data refer to deaths toxicologically confirmed. All the values are percentages except the Number of deaths, the Ratio M: F and the Age. The 1992 data refer only to a six-month-period (*) The minimum age registered in 2001, three years, refers to an accidental intoxication suffered by a toddler. 142 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

■ Just as in previous years, we observe a clear prevalence of males among the deceased (91.4%).

■ The average age of the deceased is 32.7. The ages range from 3 (a toddler’s accidental death) to 49. Just as occurs with other indicators (that of admissions for treatment), in the past decades we have observed a rising tendency in the ages of the deceased (Chart 8.1), process, which becomes clear when we see that the 35-39 age group registers the highest mortality rates (28.5%). 62.8% of the deceased are between 25 and 39 years old.

Chart 8.1 Average age of the deceased for acute reaction to drug use. Galicia, 1994-2001

■ The provinces of A Coruña (42.9%) and Pontevedra (34.3%) are responsible for most of the deaths for acute reaction registered in Galicia.

■ Most of the corpses are found in the victims’ homes (65.7%) or in the street (20.0%), as has happened in the past years (Graph 8.2). Since 1992, when the indicator was incorporated, the number of corpses found in the street has decreased, losing ground to those found at home, which would indicate the higher level of social integration of the deceased drug users.

■ In 66% of the cases the route of administering the drug that caused the death is unknown, whereas in 29% of the cases we identify injecting drug use, which confirms the fact that from 2000 injecting drug use has no longer been the most commonly identified type of drug use among the deceased, who rather presented inhaling or oral drug use, which leave no trace. In fact, the increase in the percentage of the cases where the administration route of the drug is unknown runs almost parallel to the fall in injecting drug use, which previously had been identified in 85.7% of the deaths that occurred in 1995 (when it reached its peak), whereas in 2001 it was only identified in 28.6% of them.

■ The prevalence of infection caused by VIH/AIDS among the victims is very high (34.3%), even though it has descended sharply since 1994 (73.0%), (first available data about this variable), consequence of the decline in injecting drug use mentioned before.

■ Most deaths occurred after having taken heroin alone, (42.8%) or mixed with other substances. The deaths after the mixed use of heroin and cocaine are also very high MORTALITY INDICATORS 143

Graph 8.2 Places where the deaths for acute reaction to drug use have occurred. Galicia, 1994-2001

Chart 8.3 Routes of drug administration among the deceased for acute reaction to drug use. Galicia, 1994-2001

Chart 8.4 Substances found in those who have died of acute reaction to the use of drugs. Galicia, 1994-2001 144 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

(42.8%), followed by those caused by cocaine (14.4%), taken alone or mixed with other substances. In no case has methadone been found responsible for any of the deaths analysed.

■ Since 1992 a significant reduction in the presence of heroin in the bodies examined (70.4 to 42.8 %) has been observed, to the detriment of the presence of cocaine (from 6.0 to 14.4%) and very significantly with respect to that of heroin and cocaine together, which has risen from 20.0% to 42.8% (Graph 8.4).

■ Polydrug use is undoubtedly a characteristic element of the deceased, as the identification of more than one drug in 65.7% of the dead bodies confirms. It is possible to identify relevant associations with alcohol and benzodiazepines among those who died from heroin use, and alcohol among those who died after taking cocaine.

Table 8.2 Substances found in the bodies of those who died of acute reaction to the use of drugs (Number of cases where each substance has been identified. Galicia 2001

Heroin Cocaine HRN + COC

Methadone 4 2 6 Alcohol 4 0 0 Benzodiazepines 1 1 1 Alcohol + benzodiazepines 1 0 3 Alcohol + others 2 1 0 Benzodiazepines + others 2 1 2 TOTAL 15 5 15

The evolution of the number of deaths from acute reaction after taking drugs in Gali- cia from 1992 has stabilized since 1996, after an initial increase and a later decline from 2000 on. The decline in the number of deaths attributable to acute reaction was particularly intense in 2001 (a 34.4% decrease from the previous year), which means that the number of deaths regressed to 1992 levels. It is not possible to compare the evolution of this indicator in Galicia and in the rest of Spain, since the changes that took place in Spain within the coverage of this indicator determine that the number of deaths should depend, to a great extent, on the number of people monitored, which has been progressively growing in these years. Nevertheless it is possible, to compare the evolution of the mortality rate in five of the largest cities in Spain, (Barcelona, Bilbao, Madrid, Valencia and Zaragoza), which have been monitored since 1983, where we can verify that, after having reached their highest peak in 1991, the number of deaths descended 55% between 1992 and 2000, dropping from 536 to 241. These data point out that the decline in the number of deaths registered in Galicia in 2000, would have started in the rest of Spain several years before, just in the same way as drug use appeared in Galicia five years later than in the big Spanish cities. When comparing the characteristics of the deaths registered in Galicia and in the rest of Spain in 2000, we find some similarities. These data refer to 104 judicial areas in 12 different Autonomous Communities, which cover nearly 39% of the Spanish population (Table 8.3). MORTALITY INDICATORS 145

Chart 8.5 Number of toxicologically confirmed deaths caused by acute reaction to the use of drugs, Galicia, 1992-2001

Table 8.3 General characteristics of the deaths caused by acute reaction to the use of drugs. Galicia and Spain, 2000 GALICIA SPAIN (*)

Number of Deaths 61 444 Sex Males 87.7% 86.9% Females 12.3% 13.1% Ratio M:F 7.1 6.6 Average age 31.6 33.3 Age Group 15-19 3.5% 1.4% 20-24 8.8% 8.4% 25-29 28.1% 20.6% 30-34 29.8% 25.5% 35-40 19.3% 24.8% 40-44 7.0% 14.0% ≥ 45 3.5% 5.4% Scene of Death Home 59.7% 50.6% Street 26.3% 24.4% Public place 3.5% 3.9% Hospital 5.3% 7.8% Prison 1.8% 1.8% Other 5.3% 11.5% VIH Antibodies Positive 42.2% 45.2% Substances Opiates 91.8% 89.4% Cocaine 44.3% 54.4% Benzodiazepines 37.7% 53.0% Alcohol 39.3% 35.5% Cannabis 0.0% 15.2% Amphetamines 1.6% 6.9%

(*) Data referred to 104 judicial areas of 12 Autonomous Communities, which almost cover 39% of the Spanish population. 146 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

As for the deaths caused by acute drug intoxication in the European Union, and taking into account the partial data provided by the EMCDDA, it must be indicated that the number of deaths fluctuate between 7,000 and 8,000 in all European countries in the 1994-1999 period. Opiates are present in almost every death, and alcohol, benzodiazepines or cocaine are usually found also. Although the tendencies of the deaths caused by acute reaction to drug use in the Euro- pean Union are divergent among the different countries (EMCDDA, 2001), it is possible to note a global stabilization, favoured by the reduction in certain risk practices, such as injecting drug use and the relative stability in the number of problematic drug users. Coun- tries, such as Austria, France, Germany, Luxemburg, Italy and Spain present declining trends, whereas Greece, Ireland and Portugal would be registering relevant increases in this type of deaths. MORTALITY INDICATORS 147

8.2 DEATHS IN ROAD ACCIDENTS ASSOCIATED WITH THE USE OF DRUGS

The use of alcohol and other drugs has a very negative impact on driving, being one of the main risk factors associated with road accidents, together with excessive speed, fatigue and distractions. Motor vehicle accidents constitute the first cause of death in Spain among females aged 1 to 34 and among males aged 1 to 24, the responsibility of 40% of these deaths is attributed to alcohol consumption. The huge impact that the use of alcohol and other drugs has on the casualty and mortality rates associated with road accidents, becomes clear when we observe the results of the analysis that the National Institute of Toxicology carried out in one out of four drivers who died in road accidents in Spain. These are the main characteristics found in a sample of 100 corpses of drivers who died in road accidents in Galicia in 2001 (Table 8.4).

Table 8.4 General characteristics of the drivers who died in road accidents in Galicia. 2001.

TOTAL SAMPLE ANALYSED: 100 corpses

Sex Males 82%) Females (18%) Day of the accident Working day (53%) Bank holiday/weekend (47%) Age Under 31 (38%) Scene of Death Road (87%) Hospital (13%)

SOURCE: National Institute of Toxicology (Ministry of Justice). Department of Madrid.

The results of the analyses confirm the presence of alcohol and other drugs or psychotherapeutic/prescribed drugs in 49% of the drivers’ bodies (Chart 8.6).

Chart 8.6 Presence of alcohol, other drugs, and psychotherapeutic drugs in drivers who died in road accidents in Galicia. 2001

NO SUBSTANCE 51%

ALCOHOL AND PSYCHOTHERAPEUTICS 2% ALCOHOL AND OTHER DRUGS 2%

PSYCHOTHERAPEUTICS 2%

ALCOHOL, OTHER DRUGS AND PSYCHOTHERAPEUTICS 1%

DRUGS OTHER THAN ALCOHOL 2%

DRUGS AND PSYCHOTHERAPEUTICS 1%

ETHYLIC ALCOHOL ONLY 40%

SOURCE: National Institute of Toxicology (Ministry of Justice). Department of Madrid

The real impact of alcohol consumption on driving becomes clear when we analyse the concentrations of ethylic alcohol in the dead, and find that 36% of them present a level of 148 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Chart 8.7 Distribution of ethylic alcohol detected (grammes per litre) in dead drivers by levels of concentration. Galicia, 2001

16% 16%

14%

12%

9% 10% 8%

6% 5% 4% 3% 4%

0% 0,10-0,30 0,31-0,50 0,51-0,80 0,81-1,50 1,51-2,50 +2,51

alcohol of over 0,5 grammes per litre of blood, maximum level of alcohol permitted by law for drivers in general (Chart 8.7), (0,3 g/l. for learners and professional drivers). We should also point out the high concentration of alcohol observed in a very significant number of drivers, 24% of them presented alcohol concentrations of over 1.51 g/l. The analysis of positive breath tests (identification of alcohol in different concentrations) according to different age groups confirms its high prevalence among the youngest deceased (under 20). So in 45.5% of the dead under 20, alcohol was identified, percentage only surpassed by the group aged between 41 and 60, which concentrated the highest pro- portions of positive breath tests. (Chart 8.8).

Chart 8.8 Positive breath tests by age groups. Galicia, 2001 (*)

(*) The percentages are calculated over the total number of deaths in each age group. MORTALITY INDICATORS 149

8.3 MORTALITY RATE FROM AIDS AMONG DRUG USERS

Of the total number of cases registered in Galicia from the outbreak of the epidemic, we have evidence to prove that approximately 55% of them died (53% nationwide). Despite the fact that the number of deaths caused by AIDS among injecting drug users has been dropping sharply in Galicia in the past years, they still have a great impact among the younger age groups. Between 1993 and 1996 AIDS represented the first cause of death among those aged between 25 and 34 years. From 1997 to 1999, AIDS became, after road accidents, the main cause of death in this age group, although its rates have experienced a considerable decline since 1996 (Graph 8.9).

Graph 8.9 Mortality rates among those aged between 25 and 34 according to specific groups. Galicia, 1991-1999

ROAD ACCIDENTS

VIH/AIDS

ISQUEMIC HEART DISEASE

HEPATIC DISEASE/ CIRRHOSE

TRACHEA OR LUNG TUMOR

Source: General Bureau of Public Heath. Galician Government 150 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

8.4 CONCLUSIONS

■ Deaths caused by acute reaction to the use of drugs have stabilized in Galicia since 1996 with a significant decrease apparent in the past two years, particularly intense in 2001, when a total of 40 deaths were registered, 34.4% fewer than the previous year.

■ Between 1992 and 2001 we observe an important decline in injecting drug use and in infection rates caused by VIH/AIDS among the people who died of acute reaction to the use of drugs. At the same time, the use of heroin has also dropped (despite the fact that this substance is still the cause of most deaths from acute reaction), whereas there has been an increase in the mixed use of heroin and cocaine and of cocaine alone.

■ Also confirmed is the tremendous impact that alcohol and other drugs have on casualty and mortality rates in road accidents, with the presence of alcohol verified in 40% of the Galician drivers’ bodies that died in road accidents in 2001. Drugs and psychotherapeutics were found in 9% of them.

■ The negative impact of alcohol consumption on driving becomes clear when we see that 36% of the dead drivers presented blood alcohol concentration levels over the maximum legal level (0.5 g/l) and that in 24% of the cases the level of alcohol was over 1.5 g/l. We should also point out that the presence of alcohol was identified in different levels of concentration in 45.5% of the drivers under 20 who died in road accidents.

■ Deaths caused by AIDS among injecting drug users have dropped in the past years. However, AIDS continues to be, after road accidents, the second cause of mortality among the Galician population aged between 25 and 34. 9. DRUG SUPPLY INDICATORS 9. DRUG SUPPLY INDICATORS

9.1 SUBSTANCES SEIZED

In 2001 a total of 6,653.7 kilos of cocaine, 5,272.0 of hashish and 118.1 of heroin were seized in Galicia (Table 9.1), much smaller amounts than those registered in the previous year, and specially inferior to the average number of seizures carried out in the period between 1986 and 2001. The province of Pontevedra concentrates most of the cocaine (99.3%), heroin (92.5%) and hashish seizures (65.4%) in our Community in 2001.

Table 9.1 Drug seizures in Galicia per province (*). 2001

SUBSTANCES A CORUÑA LUGO OURENSE PONTEVEDRA TOTAL GALICIA

Cocaine 41.4 0.1 1.4 6,610.8 6,653.7 Hashish 1,800.4 2.6 18.2 3,450.8 5,272.0 Heroin 2.6 5.6 0.7 109.2 118.1 LSD 19 3 0 7 29 Ecstasy 1,513 293 172 1,301 3,279

(*) The quantities seized of cocaine, hashish are heroin are measured in kilos and the quantities of LSD and ecstasy are in units SOURCE: Public Prosecutor’s Office for the Prevention and Repression of Illegal Drug Trafficking in Galicia.

These figures represent new historical maximums in the cocaine and heroin seized in Galicia and mean Galicia recovers its traditional protagonism in the seizure of illegal drugs above the national average, after sharp decrease undergone in 2000. In fact, the cocaine and heroin seized in 2001 represented 19.7% and 18.7%, respectively, of the total number of seizures in the whole of Spain. On the other hand, the amounts of hashish, LSD and ecstasy that were seized in Galicia are very limited compared to the national average. (Table 9.2).

Table 9.2 Quantity in kilos of the drugs seized in Galicia over the total national. 2000-2001

SUBSTANCES SEIZURES YEAR 2000 (*) SEIZURES YEAR 2001 (*) GALICIA SPAIN % TOTAL GALICIA SPAIN % TOTAL NATIONAL NATIONAL

Cocaine 135.3 6,165 2.2% 6,653.7 33,681 19.7% Hashish 117 474,505 0.02% 5,272.0 514,182 1.0% Heroin 54.8 485 11.3% 118,1 630.6 18.7% LSD 197 7,542 2.6% 29 26,535 0.1% Ecstasy 15,235 891,652 1.7% 3,279 860,164 0.4%

(*) The quantities seized of cocaine, hashish and heroin are measured in kilos and the quantities of LSD and ecstasy are in units. SOURCE: Central Unit of Criminal Intelligence. Home Office.

The analysis of the substances seized by the different police forces involved in the fight against drug trafficking is a useful indicator for assessing the evolution of the supply of different drugs. Although the close link between supply and demand is well known, we must be cautious when interpreting the existing data, since the variations in the volume of seizures of a substance are not always necessarily attributable to changes in drug depen- 154 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

dents’ use habits. Other factors should also be taken into consideration, such as the degree of pressure exerted in the repression of drug trafficking, the changes within the large international organisations of drug distribution (which make that, at any given time, an area or country becomes an important area of introduction, transit or distribution of substances, which are then sent to final markets in other countries), or the outcome of a successful police operation capable of distorting the annual statistics. Despite all these precautions, we are able to establish - after long periods of observation- a certain correlation between the evolution of drug seizures (and consequently of drug supply) and trends in use. When analysing the evolution of drug seizures in Galicia between 1986 and 2001 we find significant differences depending on the type of substance seized. (Chart 9.1):

Chart 9.1 Quantities of heroin, seized in Galicia, 1986-2001

KILOGRAMMES

120 118,1

100

60 54,8

40 28,5 18,9 21,2 21,7 13,2 15,7 20 10,2 11,5 8,1 7,4 3,6 5,1 3,1 3,2

0 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 AVERAGE HEROIN IN THREE YEARS PERIOD

Source: Public Prosecutor’s Office for the Prevention and Repression of Illegal Drug Trafficking in Galicia

Quantities of cocaine, seized in Galicia, 1986-2001

KILOGRAMMES 7000 6653,7

6000 5619,9

5000 4665,7 4180,2

4000 2847,7 3028,9 3000

2000 1569,1 1377,4 97,3 662,6 1000 56,1 29,1 49,9 24,3 191,2 135,3 0 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 AVERAGE COCAINE IN THREE YEARS PERIOD

Source: Public Prosecutor’s Office for the Prevention and Repression of Illegal Drug Trafficking in Galicia DRUG SUPPLY INDICATORS 155

Quantities of hashish, seized in Galicia, 1986-2001

KILOGRAMMES 38489 40000 36054

35000

30000

25000

20000 14112 15000

10000 7772 7836 7207 5981 6738 5272 773 2798 5000 1440 1603 726 170 117 0 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

AVERAGE HASHISH IN THREE YEARS PERIOD

Source: Public Prosecutor’s Office for the Prevention and Repression of Illegal Drug Trafficking in Galicia

■ Cocaine seizures have become the most numerous, ahead of hashish. There was a marked increase in cocaine seizures from 1986 to 1999; period when the amounts seized multiplied by 58. After the brusque decrease registered in the year 2000, there was an intense rebound last year, signifying the continuity of the rising tendency of cocaine seizures registered in the past years.

■ Hashish seizures have become the second most numerous ones. After the steady increase in seizures between 1986 and 1998, there was an important decrease in Galicia in the 1999-2000 period. Despite the rebound registered in 2001, there has been an overall decline in hashish seizures in Galicia in the past three years.

■ The seizures of heroin have always been scarce in Galicia, in consonance with the low prevalence of use of this substance among the Galician population. The stability, characterising the volume of heroin seizures in the 90s, broke down sharply in 2000, with a large increase in seizures, reinforced in 2001. This change of trend is due not so much to the incorporation of new users (as in the past years heroin use has registered a decline), but to the changes in the modus operandi of the large trafficking organisations, which will be later analysed.

■ Finally, we must point out that the seizures of LSD and ecstasy are very limited in Gali- cia, in consonance with the low prevalence of use of these substances. In the 2000- 2001 period there was a decrease in the volume of seizures of these substances. Galicia has always played an important role in the international trafficking of cocaine, which comes from South America and is then destined to Spanish and European markets. The Colombian cartels, which are in control of the trafficking of this substance, have used the Atlantic Sea routes for the introduction of cocaine in Europe, which accounts for the important volume of cocaine seizures registered in Galicia. Nevertheless, the growing control of the traditional introduction routes and the success of some important police opera- tions against drug trafficking, are causing major changes in the modus operandi of these organisations, modifying the routes of introduction and the means used to introduce the substances (the use of cargo ship containers, which dock at different ports before reaching their final destination, is becoming increasingly more frequent). 156 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Graph 9.2 Cocaine seizures in Galicia and in Spain, 1986-2001

KILOGRAMMES 1200

1000

800

600

400

200

0 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 España 407 413 480 713 886 741 672 604 824 546 537 479 418 1159 485 630,6 Galicia 8 4 5 3 3 18 13 28 10 11 21 22 7 16 54,8 118,1

Source: Public Prosecutor’s Office for the Prevention and Repression of Illegal Drug Trafficking in Galicia and central unit of Criminal Intelligence (Home Office)

Graph 9.3 Hashish seizures in Galicia and in Spain, 1986-2001

600000 KILOGRAMMES

500000

400000

300000

200000

100000

0 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 España 47867 59210 90940 64225 70076 104751 121439 160169 219176 197024 247321 315328 428236 431165 474505 514182 Galicia 726 7772 1440 5981 773 7836 1603 6738 36054 2798 38489 7207 14112 170 117 5272

AVERAGE COCAINE IN THREE YEARS PERIOD

Source: Public Prosecutor’s Office for the Prevention and Repression of Illegal Drug Trafficking in Galicia and central unit of Criminal Intelligence (Home Office)

However, Galicia has always played a secondary role in the international distribution of heroin and hashish, being, in this case, the final destination of these substances, not the entrance and redistribution point. The heroin used in Galicia and in Spain comes basically from Afghanistan and Pakistan, from where it is introduced by the Turkish mafia through the so-called Balkan Route until it reaches its final users. On the other hand, the hashish that comes from Morocco enters the European continent mainly through the south of Spain, from where it is distributed by road to other countries.

S DRUG SUPPLY INDICATORS 157

Graph 9.4 Cocaine seizures in Galicia and in Spain, 1986-2001

KILOGRAMMES

35000

30000

25000

20000

15000

10000

5000

0 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 España 669 1134 3461 1852 5382 7574 4454 5350 4016 6897 13743 18418 11688 18110 6165 33681 Galicia 97 29 50 56 663 1569 24 191 1377 2850 4666 3029 4180 5620 135,3 6654

Source: Public Prosecutor’s Office for the Prevention and Repression of Illegal Drug Trafficking in Galicia and central unit of Criminal Intelligence (Home Office)

Some international agencies have pointed out the possibility that the increase in pop- py growing registered in Central and South America may bring about the introduction of heroin from this area into the European markets, using the cocaine routes. Precisely the use of the same routes for the introduction of heroin in Spain and Europe could explain the important volume of heroin trafficking registered in Galicia between 2000 and 2001. The trends in the seizures registered in Galicia within the 1986-2001 period show some differences with respect to the whole of Spain, which could be summarised as follows: ■ Spain has registered a sustained fall in heroin seizures since the early 90s, reversing from 1999 (Graph 9.2), a year before Galicia. ■ The seizures of cocaine in Galicia have shown a steady decline since the mid 90s, which became more significant in the 1999-2000 period. On the contrary, the seizures of this substance in Spain present an intense and prolonged rising trend, having doubled in the past five years (Graph 9.3). ■ The evolution of cocaine seizures in Galicia coincides with that registered in the rest of Spain, (in consonance with the important weight that drug seizures have in our Community in relation to the rest of Spain), characterised by a rising trend, which was reversed sharply in the year 2000. In the year 2001, there was a marked rebound in cocaine seizures in Galicia, which reached historical peaks in both cases (Graph 9.4). As for the evolution of LSD or MDMA (ecstasy) seizures, we should note that their scarce volume means that any minimal fluctuation might cause a sharp change of trend (for example the units of ecstasy seized dropped from 15,235 in 2000 to 3,279 in 2001), which, together with ecstasy’s recent introduction in the illegal market, impedes us from making an accurate evaluation of these trends. In Spain ecstasy seizures rose sharply between 1992 and 1995, starting an intense decline afterwards up to 1998, and then experienced a rapid increase again until peaking in 2000-01. Finally, we should point out that the different evolution of the volume of drug seizures registered in Galicia would be due to the loss of protagonism that the Galician Autonomous Community has started to register in the past years within the drug trafficking registered in Spain. As far as drug seizures in the European Union countries are concerned, the “ 2001 Annu- al Report on Drug Dependency in the European Union” produced by The EMCDDA, notes the following trends within the 1985-1999 period (Graph 9.5): 158 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Graph 9.5 Amount of cannabis, cocaine, heroin and amphetamines seized in the European Union countries, 1985-1999

Source: Reitox Focal Points

■ Heroin seizures have stabilised, after the increase registered up to 1991-92. In 1999 over seven tons of this substance were seized.

■ Over forty tons of cocaine were seized in the European Union in 1999, most of them in Spain. After a steady increase up to 1990, the amounts seized remained stable up to 1994, when they resumed their rising trend.

■ Cannabis seizures are the most numerous in the European Union, the amounts seized increased considerably since 1985. From the mid 90s, the seizures have increased more moderately, totalling eight hundred thousand kilos per year in the past years. Just as in the case of cocaine, Spain is the European country where the largest amounts of cannabis are seized.

■ The seizures of synthetic drugs have not followed a uniform evolution. Ampheta- mine seizures have increased progressively from 1985 up to the present, whereas LSD seizures, which grew up to 1993, have declined in the past years. On the other hand, ecstasy seizures increased up to 1996, stabilised afterwards and then rose again in 1999. DRUG SUPPLY INDICATORS 159

Graph 9.6 Degree of purity of the cocaine and heroin seized in Galicia*. 1990-2000

Source: Galician Department of the Ministry of Health *Only data include about A Coruña and Lugo

9.2 PURITY AND PRICES OF SUBSTANCES

Since 1992 the Galician Department of the Ministry of Health has released systematic data about the average purity percentages found in the samples from seizures. The degree of purity of cocaine was higher than that of heroin in the period between 1990 and 2000. In the year 2000, the rate of average purity in the heroin seized was 36.2%, whereas in cocaine it went up to 55.6%. From the early 90s we have noticed a steady decline in the degree of purity of cocaine. Heroin, on the other hand, follows a different pattern: after a relative increase in purity registered in the first half of the decade, it has decreased again since 1996. It is also convenient to study the samples analysed taking into account their weight and their distribution throughout the Galician provinces, data available since 1996. The objective is to check whether the degree of purity decreases progressively as we descend the distribution chain until reaching the street drug dealer (samples of less weight). The results are in Tables 9.3 and 9.4. 160 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Table 9.3 Degree of purity of the heroin seized in relation to the weight of the sample. A Coruña and Lugo

A Coruña 1996 1997 1998 1999 2000 Net Weight (gr) Samples Purity Samples Purity Samples Purity Samples Purity Samples Purity

0.000–0.249 0 — 807 40.49 709 37.34 493 37.62 316 35.26 0.250–0.350 81 42.80 63 38.91 56 42.40 43 38.66 45 38.55 0.351–0.500 68 44.46 52 44.55 56 40.58 31 40.78 40 39.00 0.501–1.500 110 42.83 88 45.02 67 38.67 49 37.12 35 37.77 1.501–3.000 26 45.52 13 36.48 17 39.02 17 32.82 17 38.60 3.001–10.000 21 41.45 12 38.47 11 40.96 13 29.68 12 34.46 10.001–15.000 0 — 2 45.04 1 45.68 3 33.25 3 41.91 15.001–40.000 10 47.96 6 47.87 2 54.98 4 43.26 5 41.09 40.001–100.000 10 48.66 3 41.50 0 — 7 39.62 4 34.11 100.001–300.000 3 57.10 2 17.47 3 22.88 0 — 1 30.14 300.001–500.000 7 55.55 2 39.42 4 48.66 0 — 0 — 500.001–950.000 0 — 0 — 0 — 2 46.93 0 — 950.001–1,050.000 0 — 3 4.74 0 — 0 — 0 — >1,050.000 0 — 10 37.16 0 — 0 — 1 37.10

Lugo 1996 1997 1998 1999 2000 Net Weight (gr) Samples Purity Samples Purity Samples Purity Samples Purity Samples Purity

0.000–0.249 0 — 65 43.67 82 34.67 76 41.99 29 34.74 0.250–0.350 6 44.83 11 36.89 5 37.09 6 30.12 8 35.03 0.351–0.500 11 44.37 18 51.56 9 37.64 6 28.53 0 — 0.501–1.500 27 40.92 21 39.27 2 51.32 10 36.61 7 35.25 1.501–3.000 11 44.12 7 45.17 2 39.26 3 47.85 1 44.27 3.001–10.000 15 41.59 9 46.12 2 33.13 6 45.92 2 47.00 10.001–15.000 0 — 4 27.68 1 40.18 0 — 0 — 15.001–40.000 0 — 3 31.34 3 40.44 0 — 0 — 40.001–100.000 1 11.80 1 11.04 0 — 0 — 0 — 100.001–300.000 0 — 0 — 0 — 0 — 0 — 300.001–500.000 0 — 0 — 1 24.85 0 — 0 — 500.001–950.000 0 — 0 — 0 — 0 — 0 — 950.001–1,050.000 0 — 0 — 0 — 0 — 0 — >1,050.000 0 — 0 — 0 — 0 — 0 —

SOURCE: Galician Department of the Ministry of Health DRUG SUPPLY INDICATORS 161

Table 9.4 Degree of purity of the cocaine seized in relation to the weight of the sample. A Coruña and Lugo

A Coruña 1996 1997 1998 1999 2000 Net Weight (gr) Samples Purity Samples Purity Samples Purity Samples Purity Samples Purity

0.000–0.249 0 — 208 60.52 219 63.07 211 63.44 100 59.17 0.250–0.350 22 51.77 31 62.92 34 68.21 47 60.33 30 51.92 0.351–0.500 15 62.91 30 65.62 28 62.49 52 65.63 38 57.61 0.501–1.500 34 58.64 55 58.64 45 64.42 57 68.00 57 53.81 1.501–3.000 13 47.95 13 63.09 12 73.06 21 64.83 17 57.32 3.001–10.000 16 60.98 21 57.49 18 60.96 40 68.53 17 52.68 10.001–15.000 2 27.85 6 67.00 5 68.77 6 70.71 1 37.07 15.001–40.000 8 63.98 4 66.16 4 68.34 8 69.95 11 51.45 40.001–100.000 5 62.72 3 68.71 7 68.70 10 75.12 1 80.83 100.001–300.000 4 74.37 0 — 2 80.34 7 69.94 1 90.98 300.001–500.000 6 79.26 4 76.79 0 — 1 35.28 1 22.26 500.001–950.000 8 74.19 6 62.82 2 71.06 0 — 0 — 950.001–1,050.000 6 75.79 1 87.85 2 81.25 5 77.56 1 78.62 >1,050.000 4 83.05 0 — 3 69.07 2 75.10 0 —

Lugo 1996 1997 1998 1999 2000 Net Weight (gr) Samples Purity Samples Purity Samples Purity Samples Purity Samples Purity

0.000–0.249 0 — 6 81.54 18 56.51 7 70.91 13 48.83 0.250–0.350 2 54.00 3 52.13 3 74.46 8 72.46 5 48.88 0.351–0.500 1 77.50 3 70.91 1 82.15 6 72.94 4 36.40 0.501–1.500 1 55.70 8 61.67 4 75.28 5 58.48 12 58.56 1.501–3.000 0 — 0 — 0 — 1 63.27 1 42.96 3.001–10.000 2 87.30 2 81.43 3 75.48 9 62.02 4 56.07 10.001–15.000 0 — 0 — 0 — 2 46.63 0 — 15.001–40.000 0 — 2 81.04 1 75.87 4 67.36 1 77.10 40.001–100.000 0 — 2 54.52 1 8.00 0 — 0 — 100.001–300.000 0 — 0 — 1 81.60 1 15.24 1 21.82 300.001–500.000 0 — 0 — 0 — 0 — 0 — 500.001–950.000 0 — 0 — 0 — 1 82.59 0 — 950.001–1,050.000 0 — 0 — 0 — 3 76.41 0 — >1,050.000 3 58.59 0 — 1 84.00 0 — 0 —

SOURCE: Galician Department of the Ministry of Health 162 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

As for heroin, the degree of purity found in the different samples is similar; no significant differences, depending on the weight of the sample, were appreciated. The case of cocaine is a bit different, since although in some small samples no clear trends can be detected, it is from 100 grammes on, when we have observed a pattern of greater purity over the years. The purity of the different drugs has remained stable in the Spanish market in the past years. During the first semester in 1992, the average levels of purity of the heroin and cocaine doses sold on a small scale in Spain (standard purity of a dose) were 25% for heroin and 45% for cocaine. On the other hand the levels of purity increase considerably in the heavier samples, reaching 54% in heroin and 71% in cocaine sold per kilo (Table 9.5). Both the prices and purity of heroin, cocaine and hashish have remained stable in the past years, reaching prices of 10,152; 9,577 and 645 pesetas per gramme respectively when sold on a small scale.

Table 9.5 Prices and purity of the different drugs in Spain (first semester 2002). Source: GDNPD

SUBSTANCES DOSE GRAMMES KILOS UNIT Weight Purity Price Purity Price Purity Price Price (mg) (%) (Pts) (%) (Pts) (%) (Pts) (Pts)

HEROIN 114 26 1,500 34 10,512 54 7,130,264 - COCAINE 171 44 2,164 50 9,577 71 5,937,444 - HASHISH - - - - 645 - 237,433 - LSD ------1,515 AMPHETAMINES ------754 ECSTASY 300 ------1,925 SPEED 300 - 1,433 - 4,264 - 2,933,541 - DRUG SUPPLY INDICATORS 163

9.3 CONCLUSIONS

■ In the year 2001, 6,653.7 kilos of cocaine were seized in Galicia, the greatest amount of this substance ever seized in our Community. This figure confirms the rising trend registered from the early 90s in cocaine seizures, and the predominant role Galicia has as the entrance point for the cocaine that comes from South America destined for the Spanish and European markets (in 2001, 19.7% of the total cocaine confis- cated in Spain was seized in Galicia).

■ Since 2000 and more intensely since 2001, Galicia has registered a new trend: the huge increase in the seizures of heroin, which had so far been destined exclusively for the local market, and had very low relevance. The 118.1 kilos of heroin seized in 2001, besides establishing a historical peak, confirm the relevant role Galicia has recently acquired in the traffic of heroin destined for the Spanish and European markets (18,7% of the heroin seizures carried out in Spain, took place in Galicia).

■ The seizures of hashish in Galicia, 5,727 kilos in 2001, have declined sharply in the past three years, ranking second after cocaine. The traffic of hashish in our Community plays a secondary role, mainly destined to the local market. The seizures registered in Galicia represent only 1.0% of the total number of seizures registered in Spain.

■ The amounts of LSD and ecstasy seized in Galicia are very small, having declined even more since the year 2000, in consonance with the low-use prevalence they register and the role of Galicia as the final destination of these substances.

■ The prices and purity of the different substances remain stable in the market. 10. LEGAL-PENAL INDICATORS 10. LEGAL-PENAL INDICATORS

10.1 ARRESTS AND REPORTS FOR DRUG TRAFFICKING

In 2001, 756 people were arrested in Galicia for drug trafficking, whereas the number of people reported as suspects to the police totalled 4,983; the highest percentage of arrests (39.9%) and reports (44.2%) were found in the province of Pontevedra (Table 10.1).

Table 10.1 Arrests and reports for illicit drug trafficking in Galicia and Spain. 2001

A CORUÑA LUGO OURENSE PONTEVEDRA TOTAL TOTAL GALICIA NATIONAL

ARRESTED 258 79 117 302 756 17,380 REPORTED 1,701 819 261 2,202 4,983 112,270 TOTAL 1,959 898 378 2,504 5,739 129,650

Since 1980 the annual number of people arrested for drug trafficking in Galicia has remained stable, fewer than 1,000 persons, with the only exception of 1995, where the number of people arrested rose to 1,767 (Graph 10.1).

Graph 10.1 People arrested in Galicia for illegal drug trafficking, 1986-1996*

Source: Public Prosecutor’s Office for the Prevention and Repression of Illegal Drug Trafficking in Galicia * From 1996, it has not been possible to offer differentiated data about the number of people arrested and those reported, as they are included in the same group.

If we add to the number of arrests, the number of people reported for drug trafficking who have been taken to police stations, even though after the preliminary investigations, they were not taken to court, the total number of people would be over 5,000 per year (Chart 10.2). In the year 2001 their number increased, totalling 5,739 persons, a level similar to the one registered in 1998. 168 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Chart 10.2 People arrested and reported in Galicia for illegal drug trafficking, 1996-2001

Source: Public Prosecutor’s Office for the Prevention and Repression of Illegal Drug Trafficking in Galicia

The stability in the number of people arrested and/or reported for drug dealing in Galicia from 1986 contrasts with the marked increase registered in the whole of Spain, where their volume has multiplied by 6.7 in the 1986-2001 period (Graph 10.3). This different evolution explains the progressive reduction in the number of detentions and reports for drug dealing in Galicia with respect to the national total (4.4% in 2001 compared to 8.1% in 1996).

Graph 10.3 People arrested and reported for illegal drug trafficking in Galicia and in Spain, 1986-2001(*)

Sources: Public Prosecutor’s Office for the Prevention and Repression of Illegal Drug Trafficking in Galicia and Central Unit of Criminal Intelligence (Home Office) (*) We only have accumulated data of the detainees reported in Galicia from 1996

In the European Union the existing data refer to the “arrests for crimes against the laws on drugs”, which differ in each country, depending on the national legislation in effect, which, usually do not distinguish between drug dealing and possession of drugs. The trends followed by this indicator point to the growing increase in the number of detentions from 1985 on in the European Union, especially intense in Finland, Greece or Portugal. In the past three years, Greece, Ireland, Spain and Portugal are the countries that have registered a greater increase in the number of detentions for drug-related crimes. LEGAL-PENAL INDICATORS 169

10.2 LEGAL PROCEEDINGS FOR DRUG TRAFFICKING

In the year 2001 the number of legal proceedings initiated for drug dealing were 5,981, the highest number ever in our Community. This figure means a 34% increase with relation to the previous year, and the reversal of the falling tendency registered from 1996. The intensification of legal actions against drug dealing that took place in 2001 is in consonance with the number of the people arrested and reported for these types of crimes, and with the greater volume of the drug seizures registered in Galicia in this period. The evolution of the legal proceedings initiated in Spain in the 1986-2001 period has not been linear; we can observe four different moments: a Between 1986 and 1991 there was a progressive increase in the number of proceedings although their volume remains low (The total number of proceedings in that period were 6,004, almost 1,000 per year). b Between 1992 and 1995 the number of proceedings initiated stabilizes, with an annual average of 3,800, after trebling with respect to the previous period. c After the rebound registered in 1996 (5,892 proceedings), there comes a decline, with some ups and downs, up to 2000. d Finally, as it has already been stated, in the year 2001 a new peak is reached in the number of proceedings initiated, which reverses the falling tendency of the past years.

Graph 10.4 Legal proceedings for drug trafficking in Galicia, 1986-2001

Source: Public Prosecutor’s Office for the Prevention and Repression of Illegal Drug Trafficking

The evolution of this indicator in the 1986-1999 period, last available national data, is different from the registered in the rest of Spain. In fact, in Spain, the decline in the number of legal proceedings had started before (in 1995) and has been more intense. To illus- trate this evolution, note that the legal proceedings in Spain for drug dealing had a 41% decrease, totalling 31,016 the past year. Galicia ranked second only after Andalusia in the number of legal proceedings for drug dealing in 1999 (Table 10.2). 170 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Graph 10.5 Legal proceedings for drug trafficking in Galicia and in Spain, 1986-1999

Source: Public Prosecutor’s Office for the Prevention and Repression of Illegal Drug Trafficking

Table 10.2 Legal proceedings for drug trafficking by AA.CC. 1999

Autonomous Proceedings Community

Andalucía 10,348 Galicia 5,064

Cataluña 3,967 Murcia 1,970 Canarias 1,852 C. Valenciana 1,477 Madrid 1,154 País Vasco 1,140 Extremadura 1,000 Baleares 719 Castilla y León 508 Castilla-La Mancha 480 Asturias 471 Aragón 314 Cantabria 297 Navarra 156 La Rioja 99 SPAIN 31,016

Source: Public Prosecutor’s Office for the Prevention and Repression of Illegal Drug Trafficking LEGAL-PENAL INDICATORS 171

10.3 REPORTS FOR DRIVING WITH BLOOD ALCOHOL CONCENTRATION LEVES OVER THE LEGAL LIMIT

The number of preliminary investigations and reports for driving under the effects of alcohol in Galicia rose in 2001, totalling 2,216 and 8,105 respectively (Table 10.3). It should be remembered that on May 6th, 1999 Traffic Regulations set the limit at 0.5 grs per litre for drivers in general, and 0,3 grammes/litre for professional drivers and learners.

Table 10.3 Number of proceedings and reports for blood alcohol concentration levels over the legal limit by Autonomous Communities (except Catalonia and the Basque Country). Spain, 2001

NUMBER OF PROCEEDINGS NUMBER OF TOTAL FOR BLOOD ALCOHOL C. LEVELS REPORTS PROCEEDINGS AND REPORTS Accident Infraction Breath tests Refusals TOTAL

Andalucía 742 867 7,252 73 8,934 14,052 22,986 Aragón 113 91 37 23 264 2.453 2,717 Asturias 268 131 207 18 624 3,376 4,000 Baleares 248 171 306 11 736 1,703 2,439 Canarias 383 209 45 64 701 6,776 7,477 Cantabria 111 75 161 15 362 1,436 1,798 Castilla y León 274 219 241 36 770 6,748 7,518 C. La Mancha 325 337 1,215 33 1,910 3,927 5,837 Extremadura 126 181 311 6 624 1,437 2,061 GALICIA 594 454 1,109 59 2,216 8,105 10,321 A Coruña 325 271 798 21 1,415 2,692 4,107 Lugo 106 74 59 11 250 884 1,134 Ourense 64 75 205 12 356 863 1,219 Pontevedra 99 34 47 15 195 3,666 3,861 Madrid 638 447 547 35 1,667 3,155 4,822 Murcia 191 134 119 14 458 2,575 3,033 Navarra 36 21 17 3 77 1,188 1,265 Rioja, La 36 43 172 4 255 718 973 C. Valenciana 579 343 521 37 1,480 9,896 11,376 TOTALES 4,664 3,723 12,260 431 21,078 67,545 88,623

Galicia registers a very high number of traffic offences for exceeding the level of alcohol permitted by law, concentrating the 11.6% of the total number of reports or proceedings in the whole of Spain, except Catalonia and the Basque Country. Only Andalusia and Valencia, that have a much larger population, register a higher number of reports and proceedings. If we compare this indicator in relation to the population, we see that Galicia, with a proceed- ing/report rate of 37.8 per 10,000 inhabitants, ranked second after the Canary Islands (42.0) in the number of proceedings and reports for driving with levels of alcohol above the legally permitted, a much higher rate than the one registered nationwide (27.1). The comparison of the tendencies registered in the 1998-2001 period of the number of reports for driving with levels of alcohol exceeding those permitted by law shows that they have increased more intensely in Galicia than nationwide (Table 10.4), having quadrupled in that period in Galicia, whereas in Spain they have not even doubled (they had an 85% increase). As for the proceedings initiated, we should point out that their decline has been more marked in Galicia (-55%) than in the rest of Spain (-35%). 172 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

Table 10.4 Evolution of the proceedings and reports for blood alcohol concentration levels above the legal limit. Galicia and Spain (*), 1998-2001.

1998 1999 2000 2001 Spain Galicia Spain Galicia Spain Galicia Spain Galicia

Reports 36,503 1,965 42,467 4,042 56,199 5,980 67,545 8,105 Proceedings 32,680 4,838 26,122 3,150 24,425 2,216 21,078 2,216 Accident R./P. 5,131 698 4,325 550 4,762 561 4,664 594 Infraction R./P. 5,089 646 3,552 415 3,622 395 3,723 454 Refusal R./P. 583 54 445 40 411 46 431 59 Breath 21,877 3,440 17,800 2,145 15,630 1,214 12,260 1,109 test R./P. TOTAL 69,583 6,803 68,589 7,192 80,624 8,196 88,623 10,321

(*) National data, except the Basque Country and Catalonia (in order to facilitate the interannual comparison we have decided to exclude the data about Catalonia from the national data, as in the period analysed there has not been a uniform coverage in that Community: in 1997, 1998 and 1999 there were no data available about Girona, whereas in 2000 the data about Girona and Lleida were missing). SOURCE: Prepared for report from the data provided by the General Directorate of the Civil Guard. Traffic Division.

Chart 10.6 Evolution of the proceedings initiated and sanctions imposed for the use of drugs on the public highway and sanctions suspended for initiating rehabilitation treatment. Galicia, 1997-2001 LEGAL-PENAL INDICATORS 173

10.4 ADMINISTRATIVE SANCTIONS FOR THE USE OF DRUGS ON THE PUBLIC HIGHWAY

In the year 2001 a total of 3,168 legal proceedings were initiated in Galicia and 2,019 administrative sanctions were imposed for the use of drugs on the public highway, in application of the 25th article of the 1/1992 organic law for the protection of public safety. It must be pointed out that in this same period, 14.8% of the sanctions imposed were suspended as the people sanctioned initiated a detoxification treatment, in application of the second section of the same article of the organic law (Chart 10.6). The evolution registered in the past years confirms the progressive decline both, in the proceedings initiated (from 1997), and a much more marked decline in the case of administrative sanctions (from 1999), as proves the fact that the sanction rates per 10,000 inhabitants descended from 11.4 in 1998 to 7.4 in 2001. These trends are substantially different from those registered in the rest of Spain, where since 1997 there has been a steady increase in the number of proceedings initiated, especially marked in 2001, and in the number of sanctions imposed (Chart 10.7). This divergent trend explains the fact that the sanction rates per 10,000 inhabitants have risen in Spain, reaching 12.8, almost twice as many as those registered in Galicia. On the contrary, there is a coincidence in the decline in sanctions suspended for initiation of treatment, despite this in the whole of Spain the suspended sanctions represented 7.0% of the total sanctions imposed, as compared to 15% in Galicia, where this type of interventions would play a more active role in spurring those sanctioned to initiate treatment.

Chart 10.7 Evolution of the administrative sanctions imposed and suspended for initiation of treatment. Spain and Galicia, 1997-2001

SPAIN Sanctions Suspended for Treat Sanctions imposed

GALICIA Sanctions Suspended for Treat Sanctions imposed 174 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

10.5 CONCLUSIONS

■ In the past years and particularly in 2001, the repression of drug trafficking has intensified in Galicia. The reinforcement of the repression of these activities becomes evident, not only because of the increase in drug seizures, but also because of the rise in the number of persons arrested and reported for committing this type of criminal offences, as well as because of the increase in the proceedings initiated.

■ In the year 2001, a total of 5,739 persons were arrested and reported in Galicia for drug trafficking, a figure slightly higher than that registered from 1995 on (5,500 persons per year), which means a 16.2% increase with relation to 2000.

■ In 2001, a total of 5,981 legal proceedings were initiated in Galicia for drug trafficking, 34% more than in 2000, reaching its peak since 1986. Therefore, the falling tendency in the volume of legal proceedings that had started in 1997 has been reversed.

■ Galicia is after the Canary Islands, the Community which registers the highest rates per 10,000 inhabitants of sanctions imposed for driving with blood alcohol concentration levels over the legally permitted (it concentrates 11.6% of the total number of sanctions imposed in Spain), registering an increase, higher than the national average.

■ The number of administrative sanctions imposed for the use of drugs on the public highway has declined progressively in the past five years, falling to 2,000 per year. Despite this, this type of measure is a relatively useful instrument to encourage the initiation of treatment (about 15% of the sanctions imposed were suspended because the persons sanctioned initiated rehabilitation treatments). 11. GENERAL PROPOSALS OF INTERVENTION 11. GENERAL PROPOSALS OF INTERVENTION

One of the main objectives of the Galician Monitoring Centre for Drugs and Drug Addic- tion is to provide an objective up-dated global vision of the drug use and abuse issue, which will help to improve the development of programmes and measures designed to tackle the problems derived from the use of drugs, adjusting the different programmes of intervention to the needs existing at every moment. The intense efforts made by all the professionals who collaborate with the GPD in the gathering and analysis of data about drug use, drug dependency and their related effects, which have culminated in the presentation of the current report, serve to facilitate the evaluation of the results and impact of the strategies carried out in Galicia in the field of drug use and abuse, which should be promoted in the future. Committed to this purpose, a series of general proposals of intervention will be formulated, based on the technical analysis of the set of data gathered in this General Report of the GMCDDA 2002, whose development would involve, -provided they are taken into consideration- not only the Galician Plan on Drugs of the Galician Government (Xunta de Gali- cia) but also all public administrations and Galician social organisations.

11.1 PROPOSALS OF INTERVENTION IN THE FIELD OF PREVENTION

The analysis of the risk factors associated with the use of drugs, the variables that stimulate or favour it, point to the existence of a series of particularly powerful or influential factors, such as: those related to the family environment (parents’ abuse of alcohol and other drugs, poor relationship between couple and between parents and children), the availability of substances, situations of stress and personal tension or work instability. This reality justifies the following proposals: 1 Considering that some family factors are included among the most influential risk factors in the use of drugs, prevention family-orientated programmes should be a top priority, incorporating strategies directed at modifying parents’ attitudes towards their children’s use of drugs and at encouraging dialogue and support between parents and children. 2 Given that the accessibility to these substances (they are easily obtainable) is another powerful risk factor, prevention strategies should intensify the measures to reduce drug supply and the promotion of their use, encouraging the development of legal or administrative regulations that restrict their supply, reinforcing the restrictions on alcohol and tobacco advertising and the repression of illicit drug trafficking. 3 The important number of risk factors associated with the work environment would make it advisable to design and implement specific prevention programmes adapted to the peculiarities of the work environment, which could be later extended. On the other hand, the analysis of protective factors against the use of drugs, those that help to prevent, limit or delay its use, shows that the most influential ones are the follow- 178 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

ing: taking part in school prevention programmes, developing personal values (such as, cooperating with others, health-care), taking part in alternative social, humanitarian or sport activities, adequate dialogue between parents and children and a stable family environment. For these reasons we propose that: 4 School prevention programmes should be fostered, increasing the efforts made in the past years to cater for all the Galician schoolchildren.

● Within the school prevention programmes we should include strategies aimed at preventing and/or delaying the age of initiation in the use of substances, such as tobacco, alcohol or cannabis, which show important levels of prevalence and which are the drugs of reference for Galician adolescents.

● The extension of school prevention programmes should be preceded by the development of a series of interventions among teachers, such as: providing them with information on the situation of drug use among schoolchildren and on the prevention programmes carried out in Galicia, making them aware of the role they play in the development of prevention strategies, and carrying out formative activities about the prevention of drug dependency and how to lead a healthy life. 5 The programmes of education in values, aimed at encouraging alternative social values, should be generalised among all Galician schoolchildren and adolescents, above all if we keep in mind that their protective influence is closely associated with the participation in alternative social and free-time activities, reinforcing one another in their preventive influence. The epidemiological studies stress the fact that public attitudes and opinions about drugs and their effects are closely related to their use habits in such a way that, in general, there is a negative correlation between the risk associated with a substance and its prevalence of use (the smaller the risk perceived, the greater the use). Consequently, it is essential to continue working trying to modify the dominant social perceptions of drugs, foster- ing interventions such as: 6 It is necessary to reinforce the informative strategies, and those that raise awareness about the consequences of drug use, particularly of alcohol, tobacco and cannabis, which are still highly tolerated and socially accepted. This type of strategy should try to eliminate some stereotypes about drugs, and the distorting effect of advertising; at the same time we should generate an alternative culture to drugs that includes the promotion of a healthy life among its values. 7 As a complementary and support strategy to informative strategies and those to raise awareness, we consider necessary the reinforcement of community prevention programmes, helping to create and maintain structures that allow for or foster social participation and citizens’ co-responsibility for solving the problems that affect them. 8 The growing number of drug dependents with children in their care who attend treatment centres, calls for the development of specific prevention activities with these particularly vulnerable children (HAWKINS, J.D. et al. 1992), aimed at the children themselves, at their legal guardians, and the professionals at the centres and services for the protection of minors. The high prevalence of some infectious-contagious diseases among drug users implies a serious risk for public health, which calls for the extension of strategies for their prevention; for this reason we propose: 9 To extend prevention and control programmes over hepatitis B, tuberculosis and VIH/AIDS infection among the users of the different treatment centres, their relatives and acquaintances, when believed convenient. GENERAL PROPOSALS OF INTERVENTION 179

11.2 PROPOSALS OF INTERVENTION IN THE FIELD OF TREATMENT

As we have indicated before, Galicia has a well-developed and consolidated treatment network; that is why the efforts in this field should be directed primarily, on the one hand, towards the recruitment of the persons with drug abuse and/or dependency problems and who do not make demands for treatment, and on the other, to improve the quality of the services provided to those who are already undergoing treatment. Consequently, we formulate the following proposals: 10 The treatments provided by the GPD should be diversified and specialised, extending the services offered by treatment centres, and designing specific programmes of support and treatment for certain groups (for example minor offenders in the Gali- cian network of protection centres for children, with drug abuse problems) and some substances (such as cannabis derivatives or synthetic drugs), whose users present specific profiles and needs. 11 The efforts to diversify and specialise the treatment supply should be accompanied by a supportive strategy that ensures the extension of the supply of resources and services provided in the treatment network, and the adequate people’s perception, who do not always perceive that they can get support and attention for their problems in centres usually associated with the treatment of heroin users. 12 There is a need to intensify the efforts to help the persons with legal problems related to drug abuse and/or dependency, particularly young abusive drinkers. 13 The harm-reducing programmes should be extended in order to cut down on the mortality rates associated with the use of drugs and the prevalence of certain infectious-contagious diseases and risk practices, particularly injecting drug use and prac- ticing unprotected sex. The design of harm-reducing schemes should contemplate specific strategies aimed at reducing the negative impact of alcohol use, particularly on road and work accidents. 14 Considering the importance of drug use as a risk factor for tuberculosis, we should increase the percentage of alcohol and other drug users who undergo treatment. The prevention and treatment of infectious diseases associated with the use of drugs must be a top priority among the inmate prison population, highly vulnerable to them, and where their transmission is particularly easy. 15 The supply of basic social assistance and health-care services to drug dependents who, showing a high level of deterioration, do not undergo any treatment, must be fostered, preventing, in this way, their future deterioration, and allowing for a minimum health-care control over them and facilitating their access to treatment programmes adapted to their profile. 180 THE GALICIAN MONITORING CENTRE FOR DRUGS AND DRUG ADDICTION GENERAL REPORT. 2002

11.3 PROPOSALS OF INTERVENTION IN THE FIELD OF SOCIAL REINTEGRATION

The analysis of the activities carried out so far in this field make clear the difficulties in the coverage of those programmes, with relation to their potential users (the 12,000 users who underwent treatment the past year). The insufficient implementation of social reintegration programmes is a constant within the whole of Spain, due to the fact that they are primarily run by local social services and non governmental organisations, and also due to the need to integrate, as much as possible, the interventions carried out within standard programmes, factors which usually cause the atomisation of the interventions carried out, preventing an adequate record of them. Next, several proposals will be formulated focusing on certain organizational aspects of the social reintegration programmes: 16 The extension and consolidation of the community structures of participation and coordination (creation and dynamization of social nets), which will make possible the design and development of programmes of social reintegration by the professionals and representatives of the different institutions and social organisations involved in this process. 17 To encourage raising-awareness strategies aimed at the professionals of the different social services and at the population in general to prevent the rejection and exclusion of the ex- drug dependent population. 18 To stimulate the incorporation of drug dependents undergoing treatment to standard education or skill-development programmes. 19 To extend the data available regarding the contents, the impact and the results obtained by the social reintegration programmes, which have been implanted so far. 12. BIBLIOGRAPHY 12. BIBLIOGRAPHY

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