The NCA is the main body responsible for organising drug treatment. The NCA compiles a number of registers that document available treatment options.
Drug treatment is mainly delivered by a combination of public and private institutions, in outpatient and inpatient settings. As a general rule, clients do not pay for drug treatment they receive in public institutions, while in private establishments clients pay for the services they receive. Drug treatment available in Bulgaria includes inpatient and outpatient detoxification and OST and non-residential and residential psychosocial rehabilitation programmes, such as therapeutic communities or day-care centres.
The outpatient network includes specialised drug treatment centres and units in mental health centres or at psychiatric
offices, while inpatient drug treatment is provided by hospital based residential drug treatment units in psychiatric or general hospitals, in mental health centres and by therapeutic communities.
Drug treatment in Bulgaria is mainly focused on opioid users, and the most common form of drug-related treatment remains OST. Methadone was officially introduced in 1995, slow-release morphine (Substitol) became available in 2006 and buprenorphine became available in 2008. In 2015, there were 30 specialised units delivering OST in 14 cities and towns. Although the 2009 evaluation of OST indicated that this treatment contributed towards improvements in the physical and mental wellbeing of clients and a reduction in their criminal behaviour, drop-out rates remained one of the main concerns.
Trends in percentage of clients entering specialised drug treatment, by primary drug in Bulgaria
NBYear of data 2014.
Opioid substitution treatment in Bulgaria: proportions of clients in OST by medication and trends of the total number of clients
NBYear of data 2015. SROM: Slow-release oral morphine.
In 2014, the majority of the 2 131 clients who entered drug treatment in Bulgaria were treated in specialised outpatient drug treatment centres.
Of these clients, approximately 8 out of 10 sought treatment as a result of primary opioid use, and opioid users constituted the majority of all treatment clients, although a decrease of approximately one third was observed between 2005 and 2015.
OST was the treatment that was most commonly provided in these specialised outpatient settings. In 2015, 3 423 clients received OST, which indicates a stable trend since 2011. Almost all OST clients received methadone-based medication, while 5 % received slow-release morphine.