Topics
1. National context
In Spain, the implementation, management and evaluation of the resources and programmes for providing care for drug users come under the authority of the Autonomous Communities (Regions) and Autonomous Cities. Each of them is entitled to organise and deliver health interventions the way they feel it is most appropriate according to their own schemes, budgets and workforce. Some of them have integrated treatment for drug abuse disorders within primary care units, some within mental health services and the remainders keep it as a separate network, although connecting with the general healthcare system.
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 national level on the above-mentioned activities.
The public sector is mostly involved in the delivery of treatment, followed by NGOs and private organisations. In Spain, funding of drug treatment is provided mostly by the public budget of the Central Government, Autonomous Communities and Cities and some municipalities, mainly in the case of big cities.
There is a specific drug dependence care network which is widely distributed throughout the country. The majority of services in Spain are outpatient facilities, which are publicly owned. Healthcare and treatment are provided by the Autonomous Communities and Cities both for drug abuse disorders and for the rest of diseases as well.
In 2008, this care network included 491 outpatient facilities, where approximately 80 400 patients were assisted, 50 inpatient detoxification units, where 3 628 users were assisted, 129 therapeutic communities where 6 593 drug users were admitted and approximately 2 700 points where methadone substitution treatment was prescribed/dispensed.
The use of methadone was introduced and ruled in 1990 and the latest available estimate of the total number of patients in methadone maintenance programmes in 2008 was 81 390.
Both, buprenorphine and buprenorphine/naloxone combination are commercially available, under medical prescription, although its use is not widely spread. In 2009, around 15 clients were receiving this treatment. There is no general rule for public financing: some Regional Plans on Drugs financed this kind of treatment and some others do not.
Substitution treatment is available at specialised outpatient centres, at other health and mental health centres and at hospitals. 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 substitution treatment exist at the level of the autonomous communities and data are reported to the Government Delegation for the National Plan on Drugs.
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.
3. Treatment demand
| Clients in treatment | 2007 | 2008 | 2009 |
|---|---|---|---|
| Number of all clients entering treatment | 50555 | 53155 | N.Av. |
| % of which for opioid use | 39.3 | 36.4 | |
| % of which for cocaine use | 45.6 | 46.4 | |
| % of which for cannabis use | 11.7 | 14.0 | |
| % of which for stimulants use (other than cocaine) | 0.8 | 1.2 | |
| Number of new clients entering treatment | 23034 | 22944 | N.Av. |
| % of which for opioid use | 16.9 | 17.7 | |
| % of which for cocaine use | 58.3 | 56.0 | |
| % of which for cannabis use | 20.1 | 22.0 | |
| % of which for stimulants use (other than cocaine) | 1.2 | 1.5 | |
| 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. 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 Bulletin 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 | Extensive |
| Psychosocial in-patient interventions | Extensive |
| Detoxification | Extensive |
| 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 | 81706 | 81425 | N.Av. |
| of which with methadone | 81706 | 81390 | |
| of which with buprenorphine | 0 | 15 | |
| 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) | 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 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 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 Table HSR-2 in the EMCDDA Statistical Bulletin 2011. 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: 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 Spain
- Country overview for Spain
- 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.
- Sociedad Científica española de Estudios sobre el alcohol, el alcoholismo y las otras Toxicomanías (ES)
Treatment inventories
- Government Delegation for the National Plan on Drugs (ES, CA, EU, GL, EN, FR)
- Andalucía Autonomous Community (ES)
- Aragón Autonomous Community (ES)
- Asturias Autonomos Community (ES)
- Baleares Autonomous Community (ES, CA)
- Canarias Autonomous Community (ES)
- Cantabria Autonomous Community (ES)
- Castilla-La Mancha Autonomous Community (ES)
- Castilla y León Autonomous Community (ES)
- Cataluña Autonomous Community (ES, CA, EN)
- Extremadura Autonomous Community (ES)
- Galicia Autonomous Community (ES, GA)
- Madrid Autonomous Community (ES)
- Murcia Autonomous Community (ES, CA, EU, GL, EN, FR)
- Drogomedia (País Vasco Autonomous Community) (ES, EU)
- La Rioja Autonomous Community (ES)
- Valencia Autonomous Community (ES, CA, EU, GL, EN, FR)
- Ceuta Autonomous City (ES, CA, EU, GL, EN, FR)
- Melilla Autonomous City (ES)
- Sistema estatal de información permanente sobre adicciones a drogas (SEIPAD) (ES, CA, EU, GL, EN, FR)
