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Drug treatment overview for Bulgaria

Map of Bulgaria

1. National context

The NCA is the main body entrusted with organising and ensuring the quality of substance abuse treatment, which is done through methodological guidance and training professionals. The NCA compiles a number of registers that document available treatment options, so that coordination of the different treatment programmes can also be improved.

Drug-related treatment is mainly delivered by a combination of public and private institutions and in outpatient and inpatient settings. As a general rule, clients do not pay for treatment received in public institutions, while in private establishments clients pay for the services they receive. Medically assisted treatment, which includes inpatient and outpatient detoxification and opioid substitution treatment (OST), and non-residential and residential psychosocial rehabilitation programmes such as therapeutic communities, day-care centres, etc. are available in Bulgaria. Drug treatment is provided by 12 state psychiatric hospitals, 12 regional mental health centres, 17 psychiatric wards of multi-profiled hospitals offering active treatment and five psychiatric clinics at university hospitals. Non-governmental organisations (NGOs) mainly provide psychosocial services through day-care facilities.

Drug treatment is mainly focused on opioid users, and the most common form of drug-related treatment in Bulgaria remains OST with methadone, which was officially introduced in 1995. Slow-release morphine (Substitol) was also introduced as a recognised substitution drug in 2006. In 2012 several new regulations were adopted that set out the terms and conditions for the provision of treatment with opioid agonists and antagonists. Buprenorphine, registered in the country in 2008, was finally included in the list of substances for substitution treatment. In 2012 there were 30 specialised units delivering OST in 14 cities and towns. A total of 3 563 clients were undergoing OST, 3 419 of whom were on methadone, six were on buprenorphine-based OST, with the remaining on Substitol. Just over a third of clients on methadone maintenance treatment were treated through Ministry of Health or municipally funded programmes. Treatment of the remaining two-thirds of clients, and treatment with Substitol and buprenorphine-based OST, is provided against a monthly co-payment fee paid by clients. Although the evaluation of substitution treatment in 2009 showed that it had contributed toward improvements in the physical and mental well-being of the clients and a reduction in their criminal behaviour, drop-out rates remained one of the main concerns. Methadone maintenance is continued if a client is imprisoned. In 2012 a total of 75 prisoners had received methadone maintenance treatment.

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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.

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3. Treatment demand

Table 1: Number of clients entering treatment in Bulgaria by year
Clients in treatment 2010 2011 2012 2013
Number of all clients entering treatment 1573 2490 2049 1354
Number of all clients entering treatment with known primary drug 1559 2366 1977 1351
% of which for opioid use 87.4 79.3 82 89.8
% of which for cocaine use 0.1 0.8 0 0.8
% of which for cannabis use 0.8 4.3 3 1.6
% of which for stimulants use (other than cocaine) 0.8 1.7 2 2.7
Number of new clients entering treatment 306 517 325 256
Number of new clients entering treatment with known primary drug 301 295 300 256
% of which for opioid use 96.0 93.2 84 81.6
% of which for cocaine use 0 1.4 1 2.7
% of which for cannabis use 1.3 3.1 6 3.5
% of which for stimulants use (other than cocaine) 1.0 2.0 8 10.2

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.
For an explanation of terms used, see the definitions of terms.
Sources:

Reitox national reports 2014 and TDI tables.
EMCDDA Statistical Bulletin 2015.

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4. Treatment provision

Table 2: Opioid substitution treatment provision in Bulgaria
Opioid substitution treatment 2010 2011 2012 2013
Number of clients in opioid substitution treatment 3012 3452 3445 3563
of which with methadone 2864 3269 3302 3419
of which with buprenorphine 0 0 0 6
Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HRS section).
‘N. Av.’ stands for ‘No information available’.
For an explanation of terms used, see the definitions of terms.
Sources:
Standard Tables 24 (ST24) on 'Treatment availability' submitted in 2014.
Table 3: Year of official introduction of opioid substitution treatment substances in Bulgaria
Applied substances in opioid substitution treatment Officially introduced in
Methadone (MMT)  
Buprenorphine (HDBT)  
Heroin assisted treatment,including as trials  
Slow-release morphine  
Buprenorphine/naloxone combination  
Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HRS section).
‘N. App.’ stands for ‘Not applicable’.
For an explanation of terms used, see the definitions of terms.
Sources:
Reitox national reports.
Table 4: Legal framework of opioid substitution treatment in Bulgaria
Legal framework of opioid substitution treatment Methadone Buprenorphine
Do office-based medical doctors have the right to initiate the prescription of substitution treatment?    
Do specialised medical doctors have the right to initiate the prescription of substitution treatment?    
Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HRS section).
For an explanation of terms used, see the definitions of terms.
'Specialised medical doctors' refers to specifically trained or accredited office-based medical doctors.
Sources:
Structured Questionnaire on 'Treatment programmes'(SQ27P1), submitted in 2014.

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5. References and links

Related EMCDDA resources

 

External links

Please note that the EMCDDA is not responsible for the content of external sites.

Treatment inventories

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About the EMCDDA

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the reference point on drugs and drug addiction information in Europe. Inaugurated in Lisbon in 1995, it is one of the EU's decentralised agencies. Read more >>

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Page last updated: Friday, 22 May 2015