In the last 20 years, human immunodeficiency virus (HIV) infection has represented one of the main health problems associated with drug use in Spain. However, since the end of the 1990s, a significant decrease has been observed in HIV infection associated with injecting drug use.
Although the incidence of HIV infection remains low, in 2014, approximately one third of people who have ever injected drugs and entered treatment in Spain were HIV positive. Information on hepatitis C virus (HCV) and hepatitis B virus (HBV) infection among people who inject drugs (PWID) at the national level is routinely collected through the treatment demand indicator, with the first data on self-reported HBV and HCV status available from 2014. A recently published cohort study reported that up to three quarters of PWID are HCV positive (as determined by the presence of anti-HCV antibodies).
Newly diagnosed HIV cases attributed to injecting drug use
NB Year of data 2015, or latest available year. Source: ECDC.
Information on drug-related emergencies in Spain originates from the National Plan on Drugs, which was introduced in 1987, and which monitors hospital emergencies directly caused by non-medical use of psychoactive substances among 15- to 54-year-olds. In 2014, 6 441 emergency episodes related to drug use were notified, continuing the rather stable trend seen over the previous five years. Cocaine was the substance most frequently reported as the cause of the emergency episodes, followed by cannabis. The proportion of cannabis-related emergency episodes shows a clear upward trend since 2000, while the proportion of heroin-related intoxications fell by a factor of 3 during the same period. Amphetamines and MDMA were less common causes of drug-related emergencies in Spain in 2014; however, there are some indications of an upward trend in the last five years.
Prevalence of HIV and HCV antibodies among people who inject drugs in Spain
NB Year of data 2014
Characteristics of and trends in drug-induced deaths in Spain
NB Year of data 2014. Source: the General Mortality Register.
Drug-induced deaths are deaths that can be attributed directly to the use of illicit drugs (i.e. poisonings and overdoses).
The Special Registry, based on forensic and toxicological sources, indicated stable trends in drug-induced deaths in the last five years, with 556 drug-induced deaths reported in 2014. According to the available toxicological results, opioids, followed by cocaine, were found in the majority of deaths; however, there has been a decrease in the proportion of deaths attributed to both substances in recent years. Most victims were male and more than half were older than 45 years, which mirrors the ageing of the Spanish heroin users’ cohort.
In 2014, the General Mortality Register (GMR) reported 455 drug-induced deaths according to the national definition.
Data from a recent mortality study in Spain suggest that 4 out of 100 overdoses among 18- to 30-year-old heroin users are fatal. Another study examined mortality among a cohort of cocaine users admitted for treatment in Spain. The results indicate that the age-standardised mortality among those who use cocaine and heroin, or only cocaine, is higher than that of the general population.
The drug-induced mortality rate among adults (aged 15-64 years) is 14.8 deaths per million in 2014, which is lower than the latest estimated European average of 20.3 deaths per million.
Drug-induced mortality rates among adults (15-64 years)
NB Year of data 2015, or latest available year.