Country overview: Bulgaria
- Situation summary
- Drug use among the general population and young people
- High-risk drug use
- Treatment demand
- Drug-related infectious diseases
- Drug-induced death and mortality among drug users
- Treatment responses
- Harm reduction responses
- Drug markets and drug-law offences
- National drug laws
- National drug strategy
- Coordination mechanism in the field of drugs
- Public expenditure
- Drug-related research
|Year||Bulgaria||EU (28 countries)||Source|
|Population||2013||7 284 552 ||505 665 739 ||Eurostat|
|Population by age classes||15–24||2013||10.9 %||11.5 % ||Eurostat|
|25–49||35.1 %||35.0 % |
|50–64||21.2 %||19.7 % |
|GDP per capita in PPS (Purchasing Power Standards) 1||2012||47||100||Eurostat|
|Total expenditure on social protection (% of GDP) 2||2011||17.7 %||29.0 % p||Eurostat|
|Unemployment rate 3||2013||13.0 %||10.8 %||Eurostat|
|Unemployment rate of population aged under 25 years||2013||28.4 %||23.4 %||Eurostat|
|Prison population rate (per 100 000 of national population) 4||2012||145.5||:||Council of Europe, SPACE I-2012|
|At risk of poverty rate 5||2012||21.2 %||17.0 % e||SILC |
p Eurostat provisional value.
1 Gross domestic product (GDP) is a measure of economic activity. It is defined as the value of all goods and services produced less the value of any goods or services used in their creation. The volume index of GDP per capita in Purchasing Power Standards (PPS) is expressed in relation to the European Union (EU-27) average set to equal 100. If the index of a country is higher than 100, this country's level of GDP per head is higher than the EU average and vice versa.
2 Expenditure on social protection contains: benefits, which consist of transfers, in cash or in kind to households and individuals to relieve them of the burden of a defined set of risks or needs.
3 Unemployment rates represent unemployed persons as a percentage of the labour force. Unemployed persons comprise persons aged 15 to 74 who were: (a) without work during the reference week; (b) currently available for work; (c) actively seeking work.
4 Situation of penal institutions on 1 September, 2012.
5 Share of persons aged 0+ with an equivalent disposable income below the at-risk-of-poverty threshold, which is set at 60 % of the national median equivalised disposable income (after social transfers).
A fourth national representative study among the general population was carried out in Bulgaria in 2012 among a sample of 5 325 people aged 15–64 on their use of and attitudes towards different psychoactive substances (the previous surveys were in 2005, 2007 and 2008). The data indicated that cannabis was the most frequently used substance, with last year prevalence at 3.5 % and last month prevalence at 2.0 %. When compared to the previous studies, a steady and significant increase in last year and last month prevalence of cannabis was reported among the general population. Cannabis also remained the most frequently used illicit substance among young adults aged 15–34. Last year and last month prevalence also increased among this age group when compared to previous years: in 2012 a total of 8.3 % reported they had used cannabis at least once in the last 12 month, while in 2008 the rate was 6.0 %, and in 2007 it was 4.4 %. For the same age group, last month prevalence of cannabis use was 4.8 % in 2012, an increase from 1.2 % in 2007 and 1.4 % in 2008. Ecstasy was the second most prevalent substance and the results of the studies indicated an increase in the reported use of the substance since 2007, in particular among younger adults. Prevalence of amphetamines, cocaine and heroin use remained low among the general population, and the latest study confirmed a declining trend in the reported use of these substances since 2005.
In 2011 the European School Survey Project on Alcohol and Other Drugs (ESPAD) study was conducted among 15- to 16-year-old students for the fourth time, with a sample size of 2 217. The reported lifetime prevalence of cannabis use was 24 %, compared to 22 % in 2007 and 21 % in 2003. Last year prevalence of cannabis use was 18 % and last month prevalence was 10 %, which is slightly higher than was reported in 2007 (17 % and 7 % respectively). Lifetime prevalence of amphetamines was 7 % in 2011, while for inhalants, ecstasy and cocaine it was 4 %. In 2007 lifetime prevalence rates were higher among males than females for all substances. The 2011 study found that males reported ever having used cannabis, ecstasy or LSD more frequently than females, whilst the rates for heroin and cocaine use were similar for males and females; however, lifetime prevalence of amphetamines and inhalant use was higher among females. It should be noted that the lifetime prevalence of cannabis use decreased from 27 % in 2007 to 25 % in 2011 among males, while it increased from 18 % to 22 % among females over the same period. Last year and last month prevalence rates for cannabis use were similar for both genders in the 2011 study.
A study on drug use among a representative sample of students from 29 different universities across the country was conducted in 2010, and local surveys on drug use related risks were carried out in 2011 among school students (grades 7 to 13) in five cities.
The main objectives and features of Bulgaria’s prevention policy are: the expansion of systematic health education in the field of secondary education; the development and implementation of programmes targeting children and youth; the establishment and training of multidisciplinary teams; the organising and conducting of media campaigns for combating drugs and drug addiction; the expansion of sport and tourism programmes for children and young people; the development and implementation of programmes for high-risk groups and activities to integrate them into the community. National and municipal authorities share responsibility for the planning and implementation of prevention activities. Universal prevention predominates, while selective and indicative prevention activities are less common. Universal prevention is mainly implemented through the education system and coordinated by the Ministry of Education, Youth and Science (MEYS). The principal objectives of school-based prevention are to provide information and create a protective school environment. Most of the health educational programmes implemented in schools combine life skills and peer education; however, some programmes targeting parents are also available. Standardised school-based prevention protocols are scarce, and available programmes are usually designed or adapted for implementation at the local level. In 2011/12 and 2012/13, within the MEYS campaign Participate and Change, a number of informative and educational activities aimed at promoting children’s mental health and preventing substance abuse were implemented. Although universal substance abuse prevention activities focusing on the family remain rare, families are increasingly involved in general prevention activities. Selective prevention is mostly targeted at at-risk children and families, and is often based on information provision, while a peer-to-peer education model is also used. New groups identified for prevention activities include young people and children of Roma, Bulgarian and Turkish origin from disadvantaged communities. Bulgaria was the fourteenth EU Member State to introduce the pan-European telephone number for children at risk in 2009, although it is known more as a source of informational and emotional support on broader issues affecting the rights of children. Less than 1 % of calls responded to annually are linked to drug-related issues. The National Centre of Addictions also operates a free-of-charge helpline on addiction issues. In the past, projects for vulnerable children (in orphanages and shelter houses) have been implemented.
Indicated prevention is limited to training health, social and educational professionals on how to screen and implement ‘early’ and short interventions. In 2012 a day centre for counselling children, youth and parents on addiction problems was opened in Sofia, and provided services to about 300 people, mainly for alcohol-related issues, but also for issues relating to heroin and cannabis use.
The national focal point maintains a register of the prevention activities and performs a general overview of the prevention status. The 2013 National report indicates that about one-third of the prevention activities implemented in 2012 had been evaluated. Progress has recently been made in ensuring the quality of prevention activities and developing standards for projects to be funded.
View ‘Prevention profile’ for additional information.
Up to 2012 the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) defined problem drug use as injecting drug use (IDU) or long duration/regular drug use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis were not included in this category. However, in 2012 a new definition of ‘high-risk drug use’ was adopted. The new definition includes ‘problem drug use’, but is broader (mainly in its inclusion of high-risk use of more substances). Details are available here.
Based on data from the 2012 general population study, it is estimated, that about 0.2 % of 15- to 64-year-olds in Bulgaria used cannabis daily or almost daily within the past 30 days. No other estimates by an individual substance are available.
The available national estimate of problem drug use dates back to 2009 using the capture–recapture method with data sets from the police, emergency medical care and specialised addiction treatment facilities. The estimate indicated that there were 31 316 problem drug users in Bulgaria (range: 23 050 to 42 920), which is about 6.0 per 1 000 people aged 15–64 (95 % CI: 4.4–8.2).
Treatment demand data are collected through the National Monitoring System for Drug-Related Treatment Demand. Treatment demand data for 2012 was based on 57 (of 128) treatment units. A total of 2 049 clients entered treatment, of which 575 were new clients entering treatment for the first time.
Similar to previous years, in 2012 opioids, mainly heroin and mostly used by injection, were the most-reported primary drugs by all treatment clients, at 83 %, and among new treatment clients the figure was 84 %. These figures show a declining tendency when compared with previous years. It is noticeable that 8 % of new treatment clients reported amphetamine as their primary substance of abuse, which was the second most reported drug following heroin in 2012.
In 2012 some 16 % of all treatment clients, and 30 % of new treatment clients, were under the age of 25. The largest group of treatment entrants were 25 to 34 years old. The gender distribution of all treatment clients has remained stable over the last 11 years at 80 % male and 20 % female. A similar distribution was also reported among new treatment clients, with 79 % male and 21 % female.
Until 2004 only sporadic cases of human immunodeficiency virus (HIV) linked to injecting drug use were notified in Bulgaria. Since 2004, however, there has been a steady increase in new HIV cases linked to injecting drug use, from seven cases in 2004 to 74 cases in 2009, with a reduction in the number in the following years. In 2012 the Ministry of Health reported 157 new HIV positive cases, of which 40 were linked to injecting drug use.
Data on the prevalence of drug-related infectious diseases among current injecting drug users are reported by the Laboratory of the Blood Transmitted Infections Department at the National Centre for Addictions (NCA) in Sofia. The data refer to NCA patients and clients of outreach programmes in Sofia. Additional information is gathered from testing clients who enter drug treatment programmes (opioid substitution treatment and rehabilitation) in the regional treatment centres of Blagoevgrad, Bourgas, Pazardjik, Pernik, Pleven, Plovdiv, Sofia and Varna.
In 2012 the prevalence of HIV was 3.6 % for treatment clients who inject drugs in a sample of 662 people tested in Sofia, with higher prevalence rates in the younger age groups (below 25 years). Among 559 treatment clients tested, the prevalence of hepatitis B virus (HBV) infection (positive HBsAg) was 5.7 %. The prevalence of hepatitis C virus (HCV) infections was 67.8 % from a sample of 593 treatment clients, which indicates stabilisation at the 2011 levels after a five-year period in which the prevalence gradually increased (from 52.4 % in 2004 to 67.8 % in 2011).
Data on drug-induced deaths are collected by the General Mortality Registry at the National Institute of Statistics. Data extraction and reporting is not fully in line with the EMCDDA definitions and recommendations, due to coding specificities.
The overall number of direct drug-induced deaths in Bulgaria is low. There was a significant increase in 2008 when 74 deaths were registered, though this was followed by a decline to 24 reported drug-induced deaths in 2012. All but two deaths in 2012 were males. The mean age at the time of death was 28 years. The year 2008 remains the high point in the number of drug-induced deaths since the start of the period under observation in 1990.
The drug-induced mortality rates among adults (aged 15–64) was 4.8 deaths per million in 2012, below the European average of 17.1 deaths per million.
The NCA is the main body entrusted with organising and ensuring the quality of the substance abuse treatment, which is done through methodological guidance and training of 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, 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, 16 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 opioid substitution treatment (OST) with methadone, which was officially introduced in 1996. 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 regulations 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 31 specialised units delivering opioid substitution treatment in 14 cities and towns. A total of 3 445 clients were undergoing substitution treatment, 3 302 of whom were on methadone, with the remaining on Substitol. No clients were admitted to the treatment with buprenorphine, although 30 places were provided in 2012. Just over a third of clients on methadone maintenance treatment were treated through Ministry of Health or municipally funded programmes, while treatment of the remaining two-thirds and treatment with Substitol was funded from private sources. 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.
View ‘Treatment profile’ for additional information.
In Bulgaria, the prevention of overdoses and drug-related infectious diseases is implemented in accordance with the National Strategy to Combat Addictions; the National Programme of Prevention and Control of HIV and Sexually Transmitted Diseases; the Narcotic Substances and Precursors Control Act; the HIV/AIDS Control and Prevention Programme financed by the Global Fund to Fight AIDS, Tuberculosis and Malaria (the project funds will run until 2014); and the Regulation issued by the Minister of Health on terms and conditions for implementing harm reduction programmes, which was adopted in 2011.
In 2012 services to prevent drug-related infectious diseases were provided through needle exchange at 102 different sites, located in 20 towns, mainly by NGOs. In addition to targeting people who inject drugs, these NGOs also target other risk groups, such as drug users of Roma origin and sex workers, and provide information materials on safe injecting, overdose and infectious diseases in addition to supplying sterile injecting equipment. Services are provided through outreach work, mobile units or drop-in centres. In 2008 a new Internet-based system for all needles and syringe exchange reporting agencies was set up, which established a working procedure for data reliability and consistency control. An estimated 467 000 syringes were distributed through specialised agencies and outreach programmes in 2012. Syringes are sold at pharmacies, but there are no pharmacy-based programmes providing sterile needles and syringes to PWID.
Ten NGOs, the NCA and 19 medical services in the bigger towns provide anonymous counselling and testing for HIV/acquired immune deficiency syndrome (AIDS). People infected with HIV, and AIDS patients, are treated in five specialised wards established in the clinics for infectious diseases. Since 2000 the government has not implemented specific vaccination campaigns against HBV among drug users, regardless of the fact that the Action Plan of the National Strategy to Combat Drug Addiction identifies this as one of the subtasks necessary to lower the prevalence of infectious diseases among PWID. It should be noted that in 1993 vaccination against HBV became mandatory in Bulgaria for all newborn infants.
Bulgaria is mainly considered to be a transit country for all illicit substances, with trafficking activity shaped by supply and demand in western European and Middle Eastern countries. However, some production of synthetic stimulants is constantly reported.
Data on the quantity of drugs seized in Bulgaria is provided by the Chief Directorate for Combating Organised Crime (CDCOC), the Chief Directorate for Counteraction of Criminality, Public Order Preservation and Prevention (National Police Service) at the Ministry of the Interior, and by the National Customs Agency and Border Police.
The Balkan route, used for trafficking heroin from Afghanistan to western Europe, passes through Bulgaria and law enforcement data indicate that heroin is also stored and repackaged in the country. In recent years some criminal groups have also attempted to use the route for cocaine smuggling to central and western Europa. Bulgaria remains a production site of amphetamine and methamphetamine, although this is mainly for domestic consumption, and in 2012 seven clandestine amphetamine and methamphetamine production laboratories were detected in the country.
In recent years, trafficking of marijuana through Bulgaria towards western Europe has also intensified. Quantities of all cannabis products seized increased in 2012. Thus a record amount of 15 967 kg of cannabis resin was seized, mainly due to a few large seizures; in addition, law enforcement agencies reported seizing 1 319 kg of herbal cannabis, which is the second-largest quantity seized in Bulgaria since 1998 (4 211 kg seized in 2005). Cannabis is increasingly cultivated domestically and a record 13 072 plants were seized in 2012.
The quantity of heroin seized fell dramatically in 2012, compared with preceding years, to 285 kg (1 183 kg in 2009; 1 227 kg in 2008). Even though the number of amphetamine-containing substance seizures increased in 2012 when compared to 2011, the quantities seized declined. The quantity of cocaine seized increased to 115 kg, following a period in 2010–11 when small quantities of the substance were seized. With regard to ecstasy, the quantity seized remained below the amounts seized in 2005–06 and 2008–09, while an increasing number of seizures containing new psychoactive substances, such as synthetic cannabinoids and cathinones, was observed.
In 2012 Bulgaria recorded 8 322 individuals committing drug-law offences. Some 62.5 % of offences were cannabis-related, and 22.7 % were amphetamine-related.
The Narcotic Substances and Precursors Control Act (NSPCA) was approved on 2 April 1999. Further amendments passed in 2010 harmonised the NSPCA with other national legal Acts, and clarified drug coordination mechanisms at the national and regional levels, the roles of different entities involved in drug-related activities, and the establishment of the national focal point, and added several new controlled substances and plants.
In 2004 the Penal Code was amended to remove the clause that exonerated drug users found in possession of a drug in a quantity that suggested that it was for personal use. With an amendment adopted in 2006, sanctions for drug possession were reduced, and the amendment also took into account the differentiation between high-risk and moderate-risk substances. Drug use itself is penalised as an administrative offence for high-risk drugs (List 1) and a fine can be imposed of between BGN 2000–5 000. Possession of any drug is punished by one to six years’ imprisonment for high-risk substances and up to five years for moderate-risk substances, though minor cases prosecuted under the Penal Code can be settled with a fine of up to BGN 1 000.
Trafficking carries penalties of imprisonment of between two and eight years for high-risk substances and one to six years for moderate-risk substances, but particularly large amounts or other aggravating circumstances can result in prison sentences of up to 15 years.
View the European Legal Database on Drugs (ELDD) for additional information.
The National Anti-Drug Strategy 2009–13 was adopted on 22 October 2008 by the National Drugs Council at its third regular meeting. The strategy takes into account both the European Union Drugs Strategy 2005–12 and an assessment of the implementation of the Bulgarian National Anti-Drug Strategy 2003–08, ensuring it is balanced and comprehensive. Both the National Anti-Drug Strategy 2009–13 and the Action Plan that supports its implementation are based on the five pillars of: demand reduction; supply reduction; information systems and research; coordination and international cooperation; and legislative improvement. Focusing on illicit drugs, the strategy has two main goals: (i) to protect the health and welfare of both the public and individuals and to guarantee a high level of public security through a balanced and integrated approach to drugs and drug use; and (ii) to reduce the supply of illicit drugs and chemical precursors through the use of efficient law enforcement and control agencies, alongside taking preventative action against drug-related crime and ensuring effective collaboration through a common approach. During 2013 an interdepartmental group was established to develop a new national drugs strategy and action plan for the period 2014–18.
View ‘National drug strategies’ for additional information.
Established in 2001 by the Narcotic Substances and Precursors Control Act of 1999, the National Drugs Council is a body of the Council of Ministers of the Republic of Bulgaria. Operating at the interministerial level, it is responsible for the implementation and coordination of policy against drug abuse and drug trafficking. Chaired by the Minister of Health, the Council includes three deputy chairpersons (the Secretary General of the Ministry of the Interior, the Deputy Chairperson of the State Agency for National Security and a Deputy Minister of Justice), a secretary and 24 members. Key ministries involved in the fight against drugs are represented on the Council, including the President of the Republic of Bulgaria, the Supreme Court of Cassation, the Supreme Administrative Court, the Supreme Prosecutor’s Office of Cassation, the National Investigation Office and other institutions.
The Narcotic Substances Section is part of the Pharmaceutical Products, Medical Devices and Narcotic Substances Directorate at the Ministry of Health. This Section is responsible for assisting the Minister to control scheduled substances for medical purposes and meet Bulgaria’s obligations under international drug-control treaties.
By the end of 2011 the Council had established 27 Municipal Councils on Narcotic Substances. These bodies function as regional/local coordination structures in municipalities that are regional administrative centres. The Municipal Councils are complemented by 27 prevention and information centres that operate at the city/local level. The centres collect, analyse and provide information for the coordination and implementation of programmes and strategies at the municipal level.
In Bulgaria, the available data on drug-related public expenditure remain very limited and are insufficient for analysis. In 2013 a survey was implemented to explore ways of improving the methods used and the data collected in this area, and the final report is expected by the end of 2014.
View ‘Public expenditure profile’ for additional information.
Most drug-related research in Bulgaria focuses on the prevalence and characteristics of drug use among the general population and among other categories of the population (including those in school, university and prison settings), and on the health and legal consequences of drug use. Most of the studies have been carried out by or with the active participation of the national focal point.
Other studies mentioned in the 2013 Bulgarian National report include research on the prevalence, incidence and patterns of drug use among new clients, responses to the drug situation, the consequences of drug use, and drug markets.
View ‘Drug-related research’ for additional information.