Bulgaria Country Drug Report 2018

Treatment

The treatment system

The National Centre for Addictions (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 opioid substitution treatment (OST) and non-residential and residential psychosocial rehabilitation programmes, for example in 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 2016, there were 32 specialised units delivering OST in 16 cities and towns.

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Treatment provision

In 2016, the majority of clients were treated in specialised outpatient drug treatment centres. Of these clients, approximately 7 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 2016.

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OST was the treatment that was most commonly provided in these specialised outpatient settings. At the end of 2016, 3 338 clients received OST, which indicates a stable trend since 2011. Almost all OST clients received methadone-based medication, while 4 % received slow-release morphine.

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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.