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Drug treatment overview for Spain

Map of Spain

1. National context

In Spain the overall policy for drug treatment is guided by the National Drug Strategy for 2009–16, which is implemented by means of two Four-Year Action Plans for 2009–12 and 2013–16.

At the same time, implementation, management and evaluation of the resources and programmes for providing care for drug users come under the authority of the 17 autonomous communities (regions) and two autonomous cities. Each region is entitled to organise and deliver health interventions according to its own plans, budgets and personnel. Some have integrated treatment for drug abuse disorders within primary care units, some within mental health services, and some have a separate treatment network that retains a connection with the general healthcare system. As a general rule, care is organised on three levels. The level of primary healthcare acts as gatekeeper, the secondary level provides integrated treatment services, and tertiary level care units supply highly specialised and long-term care, such as detoxification or residential treatment.

The Government Delegation for the National Plan on Drugs, based within the Ministry of Health, Social Policy and Equality, is responsible for monitoring and collecting data at the national level on the above-mentioned activities.

The public sector is the primary provider of treatment, followed by non-government organisations (NGOs) and private organisations. Drug treatment is mostly funded by the public budget of the central government, autonomous communities and cities and by some municipalities, usually the big cities.

A specific drug dependence care network is widely distributed throughout the country. Therapeutic provision comprises outpatient and inpatient treatment networks.

The outpatient network includes low-threshold services (including 12 supervised drug consumption facilities, 52 social emergency centres and 36 mobile units) and 527 specialised drug treatment centres, which are the most numerous facilities and constitute the backbone of the treatment system and mental health units. A team of multidisciplinary staff usually manage clients in outpatient settings, providing psychosocial treatment, case management and referral to other services. Screening of clients’ mental health, and mental health services, are available to lesser extent, while part of these services provides outreach for clients in the community.

The inpatient network includes 60 hospital detoxification units, 40 support apartments for treatment and social reintegration, therapeutic communities (the most numerous and characteristic facility within the network, in total about 129), and 82 penitentiary centres.

Opioid substitution treatment (OST) is available at about 2 000 specialised outpatient centres, at other health and mental health centres, at inpatient facilities and in prisons. Pharmacies are involved in dispensing medication to patients. According to the amended Spanish Royal Decree 5/1996, methadone and buprenorphine treatment can be initiated by specialised medical doctors and treatment centres. Quality standards and monitoring systems for clients in OST exist at the level of the autonomous communities, and data are reported to the Government Delegation for the National Plan on Drugs.

Methadone was introduced and licensed as a treatment in 1990. The latest available estimate of the total number of patients in methadone maintenance treatment in 2012 was 69 111, and it is free for clients.

The buprenorphine/naloxone combination is offered by the National Health Service, but is mainly used at low doses for clients who were stabilised on methadone. In 2012 around 2 166 clients were receiving this treatment. Clients receiving the buprenorphine/naloxone combination must partially cover the commercial costs of the medication.

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2. Treatment registries and monitoring systems

Monitoring systems for clients in substitution treatment exist at the level of the Autonomous Communities and data are reported to the Government Delegation for the National Plan on Drugs.

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3. Treatment demand

Table 1: Number of clients entering treatment in Spain by year
Clients in treatment 2010 2011 2012 2013
Number of all clients entering treatment 53508 N.Av. 50281 N.Av.
Number of all clients entering treatment with known primary drug 53508   50281  
% of which for opioid use  34.3   30  
% of which for cocaine use  41.4   40  
% of which for cannabis use  21.0   26  
% of which for stimulants use (other than cocaine)  1.2   1  
Number of new clients entering treatment 26805 N.Av. 24999 N.Av.
Number of new clients entering treatment with known primary drug 26805   24999  
% of which for opioid use  18.2   13  
% of which for cocaine use  45.3   43  
% of which for cannabis use  32.3   39  
% of which for stimulants use (other than cocaine)  1.4   1  
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 Spain
Opioid substitution treatment 2010 2011 2012 2013
Number of clients in opioid substitution treatment 82372 76263 N.Av. N.Av.
of which with methadone  81022 74199    
of which with buprenorphine  1350 2064    
Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HSR 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 Spain
Applied substances in opioid substitution treatment Officially introduced in
Methadone (MMT) 1990
Buprenorphine (HDBT) 1996
Heroin assisted treatment,including as trials 2003
Slow-release morphine N.App.
Buprenorphine/naloxone combination N. Av.
Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HSR 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 Spain
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 pecialised medical doctors have the right to initiate the prescription of substitution treatment? N.App. N.App.
Notes:
For a detailed European overview please see the EMCDDA Statistical Bulletin 2015 (HSR 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: Thursday, 28 May 2015