Topics
1. National context
As part of its task to implement the ‘National strategy for combating drugs 2009–13’ (‘providing an easier access to effective treatment programmes’), the National Centre for Addictions (NCDA) has started working out a system for referring patients to treatment. Different types of registers are compiled and kept at the National Centre for Addictions, so that the coordination among the different treatment programmes could be improved and the options for information broadened.
Drug-related treatment is mainly delivered by a combination of public and private institutions. Until 2005, the outpatient psychosocial treatment was predominantly financed by the National Programme for Prevention, Treatment, and Rehabilitation of Drug Addictions. Medically-assisted treatment is mainly funded by the Ministry of Health. The financing of residential psychiatric treatment is the responsibility of the government through the Ministry of Health and through municipal budgets. In Bulgaria, drug treatment is provided by 12 state psychiatric hospitals; 12 regional psychiatric dispensaries, 14 psychiatric wards of multi-profiled hospitals offering active treatment, and five psychiatric clinics at university hospitals.
The most common form of drug-related treatment in Bulgaria is substitution treatment with methadone, a substance which was officially introduced in 1996. Slow release morphine (Substitol) has also been introduced as a recognised substitution drug in 2006. Buprenorphine has been registered in 2008, but it is still not involved in the list of substances for substitution treatment in Bulgaria. In 2006, a national programme for the development of a system of methadone maintenance programmes in the Republic of Bulgaria for the period 2006–08 was adopted by the Council of Ministers. The strategic goal of this programme was to reduce drug use and the related health and social risks, through the development of effective and accessible programmes for methadone maintenance treatment. As a consequence, in recent years there has been an increase in the number of specialised units delivering methadone substitution treatment. In 2009, a total of 3 104 clients were undergoing substitution treatment, 2 886 of whom were on methadone and 218 on slow-release morphine (Substitol). Although the evaluation of substitution treatment programmes in 2009 showed that it had contributed towards improved physical and mental wellbeing of the clients and reduction of their criminal behavior, high drop-out rates is one of the main concerns. The methadone maintenance is continued also if a client is imprisoned. In 2009, 30 people continued to receive methadone after the arrest.
2. Treatment registries and monitoring systems
As part of its task to implement Strategic Task 6 of the ‘National strategy for combating drugs 2003–08’ (‘providing an easier access to effective treatment programmes’), the National Centre for Addictions (NCA) has started working out a system for referring patients to treatment. Different types of registers are compiled and kept at the National Centre for Addictions (NCA), so that the coordination among the different treatment programmes could be improved and the options for information broadened.
3. Treatment demand
| Clients in treatment | 2007 | 2008 | 2009 |
|---|---|---|---|
| Number of all clients entering treatment | 1398 | 1824 | 1860 |
| % of which for opioid use | 97.8 | 96.7 | 97.1 |
| % of which for cocaine use | 0.3 | 0.1 | 0.1 |
| % of which for cannabis use | 0.7 | 1.0 | 0.6 |
| % of which for stimulants use (other than cocaine) | 0.7 | 1.8 | 1.3 |
| Number of new clients entering treatment | 366 | 403 | 373 |
| % of which for opioid use | 95.0 | 88.6 | 92.8 |
| % of which for cocaine use | 1.1 | 0.0 | 0.0 |
| % of which for cannabis use | 2.0 | 4.0 | 1.9 |
| % of which for stimulants use (other than cocaine) | 2.0 | 6.5 | 3.5 |
| Notes: The variation across time, in particular with regard to the absolute numbers of clients in treatment, should be interpreted with caution as coverage data may have changed over time. For further information on coverage details please refer to the relevant EMCDDA Statistical Bulletin. In 2003 data cover the capital and the three biggest cities, In 2005 data cover 10 cities including the 3 biggest cities. For an explanation of terms used, see the definitions of terms. Sources: Reitox national reports 2009 and TDI tables (ST34) V. 1.0-2007, questions 13.1.1 and 13.1.2. EMCDDA Statistical Bulletins 2005, 2007 (Tables TDI 4 and 5) and 2011 (Tables TDI 2 and 5). | |||
4. Treatment provision
| Type of treatment | Availability |
|---|---|
| Psychosocial out-patient interventions | Limited |
| Psychosocial in-patient interventions | Limited |
| Detoxification | Limited |
| Substitution/maintenance treatment | Extensive |
| Notes: For an explanation of terms used, see the definitions of terms. Based on question 3.1 " Please assess the current availability of the treatment interventions below in relation to the user needs, judging the degree to which treatment capacity matches the demand" of Structured Questionnaire SQ27P1 on 'Treatment programmes'. Rating Scale (level of availability):
Reitox national reports 2008, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | |
| Opioid substitution treatment | 2007 | 2008 | 2009 |
|---|---|---|---|
| Number of clients in opioid substitution treatment | 2910 | 3238 | 3104 |
| of which with methadone | 2405 | 2863 | 2886 |
| of which with buprenorphine | 0 | 0 | 0 |
| Notes: For a detailed European overview please see Table HSR-3 in the EMCDDA Statistical Bulletin 2011. ‘N. Av.’ stands for ‘No information available’. For an explanation of terms used, see the definitions of terms. Sources: Reitox national reports 2009, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | |||
| Applied substances in opioid substitution treatment | Officially introduced in |
|---|---|
| Methadone (MMT) | 1996 |
| Buprenorphine (HDBT) | N.App. |
| Heroin assisted treatment | N.App. |
| Slow-release morphine | 2006 |
| Buprenorphine/naloxone combination | 2008 |
| Notes: For a detailed European overview please see Table HSR-1 in the EMCDDA Statistical Bulletin 2011. ‘N. App.’ stands for ‘Not applicable’. For an explanation of terms used, see the definitions of terms. Sources: Reitox national reports 2009, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | |
| Legal framework of opioid substitution treatment | Methadone | Buprenorphine |
|---|---|---|
| Do office-based medical doctors have the right to initiate the prescription of substitution treatment? | N.App. | N.App. |
| Do specialised medical doctors have the right to initiate the prescription of substitution treatment? | N.App. | N.App. |
| Notes: For a detailed European overview please see Table HSR-2 in the EMCDDA Statistical Bulletin 2011. ‘N. App.’ stands for ‘Not applicable’. 'Specialised medical doctors' refers to specifically trained or accredited office-based medical doctors. Sources: Reitox national reports 2009, Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2008 and 2005, Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2004, 2006 and 2008. | ||
Treatment availablity in Europe
The graphic below presents an overview of treatment provision by different types of service (psychosocial outpatient, substitution, psychosocial inpatient and detoxification) in different European countries and can be used for comparative purposes. Click on the thumbnail to view it.
Figure 1: Treatment availability in Europe, 2007
5. References and links
Related EMCDDA resources
- Health and social responses statistics
- Treatment demand statistics
- Annual report on the state of the drugs problem
- National reports for Bulgaria
- Country overview for Bulgaria
- Drug treatment responses page
- Best practice portal
- Treatment demand key indicator page
For a comprehensive overview on drug treatment systems, availability and utilisation in Europe, please consult the 2008 online report on ‘Quality of treatment services in Europe — drug treatment — situation and exchange of good practice’ published by the Directorate General for Health and Consumers.
External links
Please note that the EMCDDA is not responsible for the content of external sites.
Treatment inventories
- Bulgaria NFP (BG)
