Bulgaria Country Drug Report 2018

Drug harms

Drug-related infectious diseases

In the last three years, the prevalence of injecting-related HIV has been rather stable, with approximately 1 in 10 new HIV cases registered in Bulgaria associated with this transmission route.


Data on the prevalence of drug-related infectious diseases among people who inject drugs (current users) are reported by the Laboratory of the Blood-Transmitted Infections Department at the National Centre for Addictions (NCA) in Sofia. The data refer to NCA patients and clients of outreach programmes in Sofia. Additional information is gathered from clients who are tested upon entering regional drug treatment centres (for opioid substitution treatment or rehabilitation).

Prevalence of HIV and HCV antibodies among people who inject drugs in Bulgaria (%)
region HCV HIV
Year of data: 2016
National : :
Sub-national 57.8 - 68.5 1.7 - 3.0

Hepatitis C virus (HCV) infection is the most common drug-related infection in Bulgaria. In 2016, as in the previous year, subnational estimates suggest that approximately 6 out of 10 drug treatment clients in Sofia were HCV positive. The prevalence of HIV infection among this group was approximately 3 %. Approximately 4 % of those tested had a positive test for chronic hepatitis B virus infection (positive HBsAg).


Drug-related emergencies

According to data from the National Centre of Public Health and Analyses (NCPHA), a total of 2 781 people sought medical aid in emergency care centres as a result of drug dependency in 2016. Data on drug-related emergencies are also available at individual facility level. The Centre for Emergency Medical Aid of Sofia reported 496 emergency cases related to illicit drug use (including abstinence syndrome), of which 109 cases were related to overdose with an illicit substance.

The toxicology clinic in Pirogov Hospital in Sofia reported 227 emergency clients in 2016, one third of whom required assistance because of cannabis use, followed by those who sought help as a result of amphetamine, cocaine, heroin and methadone use. Since 2017, one emergency department in a hospital in Sofia has participated in the European Drug Emergencies Network (Euro-DEN Plus) project, which was established in 2013 to monitor acute drug toxicity in sentinel centres across Europe.

Drug-induced deaths and mortality

Drug-induced deaths are deaths that can be attributed directly to the use of illicit drugs (i.e. poisonings and overdoses). The general mortality register reported a decline in drug-induced deaths for 2008-14, with some stabilisation at low levels in recent years. All but four of the victims in 2016 were male. The mean age at the time of death was 38 years.

The drug-induced mortality rate among adults (aged 15-64) was 4.47 deaths per million in 2016, which is lower than the most recent European average of 21.8 deaths per million.



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Methodological note: Analysis of trends is based only on those countries providing sufficient data to describe changes over the period specified. The reader should also be aware that monitoring patterns and trends in a hidden and stigmatised behaviour like drug use is both practically and methodologically challenging. For this reason, multiple sources of data are used for the purposes of analysis in this report. Caution is therefore required in interpretation, in particular when countries are compared on any single measure. Detailed information on methodology and caveats and comments on the limitations in the information set available can be found in the EMCDDA Statistical Bulletin.