2008 NATIONAL REPORT (2007 data) TO THE EMCDDA by the Reitox National Focal Point “BULGARIA” New Development, Trends and in-depth information on selected issues REITOX TABLE OF CONTENTS Summary Part A: New Developments and Trends 1. National policies and context 2. Drug Use in the General Population and Specific Subgroups 3. Prevention 4. Problem Drug Use and Treatment Demand Population 5. Drug-Related Treatment 6. Health Correlates and Consequences 7. Responses to Health Correlates and Consequences 8. Social Correlates and Consequences 9. Responses to Social Correlates and Consequences 10. Drug Markets Part B – Selected Issues 11. Sentencing statistics Part C 14. Bibliography o Alphabetic list of all bibliographic references used- please use Harvard System o Alphabetic list of relevant data bases o Alphabetic list of relevant Internet addresses 15. Annexes o List of Standard Tables and Structured Questionnaires used in the text o List of Graphs used in the text o List of Maps used in the text Part D – Standard Tables and Structured Questionnaires Summary In 2007 amendments were made to the Drugs and Precursors Control Act (State Gazette, issue 55 from 6th July 2007). With them Regulation /ЕC/ № 111 / 2005 about the rules to control the trade with drug precursors between the community and third parties and Regulation /ЕС/ № 1277 / 2005 for applying the procedures introduced by Regulation /ЕС/ № 273 / 2004 and /ЕС/ № 111 / 2005 are completely enacted in the national legislation. The Act to Amend the Drugs and Precursors Control Act (DPCA, promulgated in the State Gazette, issue 55/6th July 2007) is in compliance with the Regulations of the EC, governing the drugs and precursors control. In order to improve the accessibility to treatment for the drug dependent patients, at the third regular session of the National Council for Drugs on 27th July 2006 a Concept was adopted for the development of a system of substitution and maintenance methadone treatment programs in Bulgaria and for the improvement of the access to them. In relation to this and according to an order of the Minister of Health a project has been prepared to amend Regulation № 24. At the Second Regular Session of the NCD which took place on 27th June 2007 a decision was made to elect two drug coordinators- one from the Ministry of Health (MH) and one from the Ministry of the Interior (MI). The representative of the MH is responsible for the sphere “Reduction of drug demand” and the representative of the MI would be responsible for the sphere “Reduction of drug supply”. 26 Regional Councils for Drugs have been established to implement the policy on drugs at local level. By the end of 2007 22 Prevention and Information Centers have been established. Slightly over a third of the respondent students (35,4 %) have used some kind of illicit narcotic substance at least once in their lives, which is down from the 2004 level (37,3 %) and slightly up from the 2006 level (33,5 %). The data from the two latest surveys seem to outline a trend of onsetting decline or at least stabilization of the number of students experimenting with narcotic substances. Marijuana is the most extensively used illicit narcotic substance (31,4 %), followed by the group of stimulants - amphetamines (10,9 %), ecstasy (9,7 %), cocaine (8,3 %), hallucinogenic mushrooms (6,9 %), and others. To provide options of access to health education in the system of the secondary education is among the main trends of work at national level. Within the frames of the general education the integrated approach to health education is stipulated in the State Educational Requirements for educational content and in the curricula. Basic knowledge, skills and attitudes are described there which are to be developed by the students. They include a large variety of competences- from knowing one’s own body and the changes that occur in it during the specific periods of growth, to understanding the meaning of belonging to specific groups and communities of people and acquiring a complex of psychological and social skills which everyone needs for his/her personal social and professional realization of full value. Most of the health educational programs which are implemented at school level combine the approaches of life skills and peer education. These skills are at the basis of developing active and positive personality capable of making decisions, resisting pressure and building up positive relationship with the others. This in turn is also the basis of prevention of the use of psychoactive substances. The programs for work with parents are aimed at supporting the family in their attempt to overcome the difficulties in the communication of the dependent individual with his/her relatives. The world practice has shown that the inclusion of the dependent individual in such programs increases multi-fold the possibility for the dependent member of the family to start drug - free life. 23 prevention and Information Centers have been established by the end of 2007 in the towns of Blagoevgrad, Bourgass, Varna, Veliko Turnovo, Vidin, Vratsa, Gabrovo, Dobrich, Kurdjali, Kyustendil, Pazardzik, Pernik, Pleven, Plovdiv, Razgrad, Rousse, Silistra, Sliven, Smolyan, Sofia, Haskovo, Shumen and Jambol. The general estimation that can be made on the basis of the available data is that the number of problem heroin users has remained relatively constant and stable in the recent few years and that there are even slight indications of on-setting decline. The estimated total number of problem heroin users in Bulgaria remains between 20 000 and 30 000. This estimation was made in the period 2004-2005 by employing the Multiplier Method Using Treatment Data and due to its “obsolescence” the National Focal Point has planned to launch, in the autumn of 2008, the preparation for performing two independent estimations of the prevalence of problem drug use on national level by using the Capture-Recаpture Method and the Multiplier Method Using Treatment Data. It is expected that the first results will be yielded in September-October 2009. In 2007 the monitoring system of treatment demand covered 1398 persons, whose therapy began that year at 5 hospital and 12 out-of-hospital units and centres in 5 of the most significant (in terms of treatment capacity) Bulgarian cities. For a number of reasons and mostly due to the relatively “favourable” effect/availability relation heroin continues to be the most popular drug among the problem users. In each of the last 5 years between 95 % and 98 % of the persons seeking treatment at the specialized centers in connection with a drug addiction problem had used heroin and/or other opiates. The majority of the problem heroin users apply the injection pattern of intake. There are continuous signs of gradual reduction of the sharing of used needles and syringes by injecting users, which is a good prerequisite for diminishing the health damage of drug use. According to the data of the National Police Service in 2007 the number of the registered narcotic substance users was 2654. In 2006 their number was 2883, i.e. there was a decline of about 9 %. The system of treatment is developed within the frames of the concept of an integrated approach to the treatment of addictions. The treatment of patients with addictions is of two main types; drug-free treatment and medically assisted treatment. The drug-free treatment and the resocialization of drug addicted persons is done in 7 rehabilitation programs with a total capacity of 125 positions situated on the territory of Sofia-city, Sofia-district and in Varna. The day centers represent an effective form of organizing the outpatient treatment of addicted persons. In the country function 5 programs of the type “Day Center for Rehabilitation”, 4 of which are in Sofia, and 1 program is in Varna. In Sofia an evening program functions for employed patients and for patients - students. By 31st December 2007 in the country are operative 17 substitution and maintenance programs with a total number of positions 2,910 in them, of which 2,405 are for treatment with methdone hydrochloride and 505 for treatment with morphin sulfate pentahydrate (substitol). In 2007, the persons who died as a result of use of narcotics (according to the above set definition) are 52. Since the beginning of the period under observation (1990) until now, in 2007 there were most death cases of causes specified in the definition for such, related to the use of narcotics. For the whole 18-year period, there were less cases 1992 and 1994 – 8 cases a year. As of 31.12.2007 in Bulgaria 815 HIV-positive persons are registered officially by the Ministry of Health. The number of the newly registered HIV-positive persons in 2007 is 126, 105 of which are male and 21 female. The rate of the HIV infection continues to be low, compared to the rate of the prevalence in the other countries from the region, but over the last three years there is a tendency of increasing this rate among the number of the injecting drug users. The rate of Hepatitis B infection remains around 5% (5.64%), which has been constant for 10 years now and it is comparable to the general Hepatitis B morbidity for the country. It can be noted that there is a tendency for the rate of the infected persons to remain the same, which may be due to the better work of the programs for exchange of needles and syringes The rate of the individuals infected with Hepatittis C virus for all the IDUs tested at the NCA is 57.10 %. Despite the on-going studies of drug-related deaths even in 2007, sufficiently accurate and reliable information about the deaths caused by an overdose or because of drug use is still not available.