• Drug use among the general population and young people
• Prevention
• Problem drug use
• Treatment demand
• Drug-related infectious diseases
• Drug-related deaths
• Treatment responses
• Harm reduction responses
• Drug markets and drug-related offences
• National drug laws
• National drug strategy
• Coordination mechanism in the field of drugs
• Public expenditure
• Drug-related research

Drug use among the general population and young people

In 2008, a national representative study was repeated in the general population (aged 15–64 years) in Bulgaria, on the use and attitudes towards different psychoactive substances. Data indicated 7.3 % for lifetime prevalence of cannabis, 2.7 % for last-year prevalence and 1.4 % for the last-month prevalence. In 2005, lifetime prevalence of cannabis was 4.4 % and in 2007 was 5.6 %. Also in 2008, the survey’s results showed a lifetime prevalence of ecstasy of 1.7 %, cocaine 1.7 % and amphetamines 2.1 %. In the group of young adults (aged 15–34 years), lifetime prevalence of cannabis is also higher than for other substances: 14.3 % reported at least once use of cannabis, 3.6 % ecstasy use, 4.4 % amphetamines use and 3.0 % cocaine use. For the same age group, last-year prevalence of cannabis use was 6.0 % and ecstasy was 1.6 %.

In 2011, the ESPAD survey was conducted in the country among the 15–16 year old students for the fourth time (the sample size was 2 217). In 2011, the reported lifetime prevalence of cannabis use was  24 % compared to 22 % in 2007 and 21 % in 2003. In addition, 2011 results indicated a percentage of 18 % for last-year prevalence of cannabis and 10 % for last-month prevalence, both are slightly higher than the figures reported in 2007 (17 % and 7 % respectively). Lifetime prevalence of amphetamines is reported as 7 %, while the lifetime prevalence of inhalants, ecstasy and cocaine are at 4 %. In 2007, lifetime prevalence rates of all substances were higher among males than females. The most recent survey, however, indicates that boys report more frequently than girls ever using cannabis, ecstasy or LSD, while for heroin and cocaine the rates are similar, but lifetime amphetamines and inhalant use is more prevalent by girls. It should be added that the lifetime prevalence for cannabis dropped from 27 % in 2007 to 25 % in 2011 among boys, while it increased from 18 % to 22 % among girls for the same period of time. In addition, last-year and last-month prevalence rates for cannabis use are similar for both genders in the most recent study.

Apart from the above-mentioned studies, a study on drug use among students representing 29 universities across the country was conducted in 2010, and local surveys on drug use related risks were carried out in 2011 among students (grades 7 through 13) in five cities.

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Prevention

The main objectives and features of Bulgarian prevention policy are: the expansion of systematic health education in the field of secondary education; development and implementation of programmes targeting children and youth; establishment and training of multidisciplinary teams; organising and conducting media campaigns for combating drugs and drug addiction; elaboration of programmes for sport and tourism for children and young people; development and implementation of programmes for work with high-risk groups and activities aiming at integration into a community. National and municipal authorities share responsibility for planning and implementation of prevention activities. In 2010, nearly half of all activities were funded by municipalities.

Universal prevention prevails, while selective and indicative prevention activities remain less common. Universal prevention is mainly implemented through the education system and coordinated by the Ministry of Education, Youth and Science. The principal concrete objectives of school-based prevention are provision of information and a protective school environment. Most of the health educational programmes which are implemented at school level, combine the approaches of life skills and peer education, however, some programmes targeting parents are also available.

Standardised school-based prevention protocols are scarce. Selective prevention is mostly targeted at identifying at-risk children and families, is often based on information provision, while a peer-to-peer education model is also used. In 2010, around 800 specialists responsible for prevention of antisocial behaviour among juveniles and minors were trained on how to address psychoactive substance use among high-risk groups. Bulgaria was the 14th EU Member State which introduced the all-European telephone number for children at risk in 2009, although it is recognised more as a source for informational and emotional support on broader issues affecting the rights of children. Around 3 % of calls responded in 2010 were linked to drug-related issues. In the past, projects for vulnerable children (orphanages and shelter houses) have been implemented.

Indicated prevention is limited to training of health, social and educational sector professionals on how to screen and implement early and short interventions. 

The national focal point maintains a register of the prevention activities and performs a general overview on the prevention status. Recently, progress has been made in ensuring the quality of prevention activities in the country and developing standards for projects to be funded.

View ‘Prevention profile’ for additional information.

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Problem drug use

In 2009, the first national estimate of problem drug use was competed by the capture–recapture method using data sets from police, emergency medical care and specialised addiction treatment facilities. The estimate indicates that there are 31 316 problem drug users in the country (range from 23 050 to 42 920) which is about 6.0 per 1 000 persons ages 15–64 (95 % CI 4.4–8.2).

The EMCDDA defines problem drug use as intravenous drug use (IDU) or long duration/regular drug use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis are not included in this category.

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Treatment demand

The treatment demand data for Bulgaria for 2010 was based on 31 treatment centres. In 2010, a total of 1 573 clients entering treatment have been covered by the system, out of which 306 were first-time treatment clients.

Similarly to previous years, in 2010, opioids were reported as the primary drugs among the greatest share of all clients entering treatment at 87.4 % and  96 % among first-time treatment clients. This was followed by cannabis at 0.8 % among all clients entering treatment and 1.3 % among first-time treatment clients.

In 2010, 23 % of all clients entering treatment were aged less than 25 years. The percentage of new treatment clients aged less than 25 years was 35 %. In 2010, the male to female ratio for all treatment clients remained stable over the last 10 years at 81.4 % for male and 18.6 % for female. In 2010, a similar distribution was also reported among new treatment clients with 82.9 % for male and 17.1 % for female clients.

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Drug-related infectious diseases

In 2010, the National HIV Confirmatory Laboratory reported a total of 162 new HIV-positive cases were registered, and 56 of those cases were registered to injecting drug users.

Data on the prevalence of drug-related infectious diseases among current injecting drug users are reported by the Department ‘Prophylaxis, Diagnosis and Consultation of the Blood Transmitted Infections with a Laboratory’, at the National Centre for Addictions (NCA) in Sofia. The data refer to patients of the NCA and clients of the outreach programmes in Sofia.

In 2010, the prevalence of HIV among IDUs continued to show a stable uptrend since 2005 but remained low: 2.2 % obtained from 1 258 tests. The extent of hepatitis B infection (positive HBsAg) was 3.1 % from 1 248 tests, and some declining trend is observed. In 2010, for a sample size of 1 249, the prevalence of HCV infections among IDUs was 62.3 %, which continues the growing trend observed since 2007.

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Drug-related deaths

Data on drug-related deaths are collected by the General Mortality Registry at the National Institute of Statistics. The overall number of direct drug-related deaths in Bulgaria is low, nonetheless, there has been a significant increase in 2008, which was followed by a decline to 38 direct drug-related death cases in 2009 and 41 case in 2010 (74 deaths in 2008, 52 deaths in 2007, 29 deaths in 2006, 40 deaths in 2005 and 26 deaths in 2004). In 2010, the mean age was 37.7. Since the beginning of the period under observation (1990) until now, 2008 remains the year with the highest number of deceased in drug-induced deaths, according to national definitions.

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Treatment responses

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. As a general rule, treatment in public institutions is free of charge for the clients, while in private establishments, clients are asked to pay for the services received. Medically assisted treatment, which includes detoxification and opioid substitution treatment; and psychosocial rehabilitation programmes, such as ‘Therapeutic communities’, day care centres etc. are available in Bulgaria. 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. Non-governmental organisations are mainly providing psychosocial services through day care facilities.

The most common form of drug-related treatment in Bulgaria remains 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 2010, there were 30 specialised units delivering opioid substitution treatment. In 2010, a total of 3 012 clients were undergoing substitution treatment, 2 864 of whom were on methadone and remaining clients on slow-release morphine (Substitol). Slightly more than a quarter of clients in the methadone maintenance treatment are treated in the Ministry of Health or municipally-funded programmes, while the treatment of the remaining three quarters of clients as well as the treatment with Substitol is funded from private sources. 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 behaviour, the drop-out rates, mainly due to treatment fees, is one of the main concerns. The methadone maintenance is continued also if a client is imprisoned.

View ‘Treatment profile’ for additional information.

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Harm reduction responses

In Bulgaria, overdose and drug-related infectious disease prevention is carried out mainly by NGOs, which function in accordance with the implementation of the ‘HIV/AIDS Control and Prevention’ programme financed by the Global Fund for Fighting HIV/AIDS, Tuberculosis and Malaria. In 2010, eleven non-governmental organisations carried out activities aimed at prevention of drug-related infectious diseases. These NGOs target risk groups such as drug users of Roma origin, sex workers and IDUs, and provide services such as needle and syringe exchange, dissemination of information materials on safe injecting, overdose and infectious diseases. Services are provided through outreach work, mobile units or drop-in centres located in various cities across the country. In 2008, a new Internet-based system for all needles and syringe exchange reporting agencies was set up in thus establishing a working procedure for data reliability and consistency control. An estimated 677 000 syringes were distributed through specialised agencies and outreach programmes in 2010.

Furthermore, 19 medical services in the bigger towns provide anonymous and free counselling and testing for HIV/AIDS. All persons infected with HIV, as well as AIDS patients, are treated in the specialised ward of the Hospital for Infectious Diseases in Sofia, as well as in four infectious diseases’ units for treatment of AIDS in the cities of Plovdiv and Varna. Substitution treatment is ensured for patients in the municipal substitution programmes in Sofia, Plovdiv and Varna. However, since 2000, the Bulgarian Government does not provide vaccinations against hepatitis B to drug users, disregarding the fact the Action Plan of the National Strategy to Combat Drug Addiction foresees that as one of the subtasks to lower the prevalence of infectious diseases among injecting drug users. It should be noted that since 1993, vaccination against hepatitis B has been mandatory in Bulgaria for all new-born infants.

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Drug markets and drug-related offences

‘The Balkan route’ used for trafficking heroin originating in Afghanistan to western Europe passes through Bulgaria and heroin remains the most often seized drug by the Customs Administration. In recent years, some criminal groups have made attempts to use the route also for cocaine smuggling. Another peculiarity for the Bulgarian drug market is a presence of a large number of smaller criminal groups with no contacts between each other and with distinctly separated distribution and smuggling channels.

In 2010, Bulgaria recorded a total of 6 577 reports of persons committing drug law offences. Out of all those offences reported in 2010, 52.9 % were cannabis-related offences followed by 20.5 % for heroin.

Data for the quantity of drug seizures in Bulgaria is provided by the Chief Directorate ‘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, as well by the National Customs Agency and Border Police. In 2010, the quantity of seized drugs dramatically dropped for heroin to 330 kg (1 183 kg in 2009, 1 227 kg in 2008). The decline was noted also in the seized amounts for amphetamine (199 kg in 2010, 253 kg in 2009, 430 kg in 2008),  cannabis resin (0.1 kg in 2010, 45 kg in 2009, 0.1 kg in 2008), herbal cannabis (39 kg in 2010, 46 kg in 2009, 12 kg in 2008), ecstasy (5 515 tablets in 2010, 22 395 tablets in 2009, 13 332 tablets in 2008) and cocaine (30 kg in 2010, 235 kg in 2009, 10 kg in 2008). While the number of cannabis plants seized doubled when compared to 2009 figures (1 277 in 2010, 623 in 2009, 4 894 in 2008).

In 2010, five clandestine laboratories for production of amphetamines and methamphetamines were detected in the country, along with 26 cannabis cultivation sites.

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National drug laws

On 2 April 1999, the Narcotic Substances and Precursors Control Act (NSPCA) was approved. In 2010, amendments harmonised the NSPCA with other national legal acts, clarified drug coordination mechanisms at national and regional levels, roles of different entities involved in drug-related activities, 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 which exonerated addicts found in possession of quantities which suggested that the drug was for personal use. With an amendment adopted in 2006, sanctions for drug possession were reduced, with the amendment also taking into account the differentiation between high-risk and moderate-risk substances. Use itself is penalised as an administrative offence for high-risk drugs (List 1), fined LEVS 500–5 000. Possession of any drug is punished by 1–6 years for high risk and up to 5 years for moderate risk substances, though minor cases can be settled with a fine of up to LEVS 1 000.

Trafficking carries penalties of 2–8 years for high risk and 1–6 years for moderate risk substances, but particularly large amounts or other aggravating circumstances can lead to up to 15 years in prison.

View ‘Legal profile’ for additional information.

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National drug strategy

The National Anti-drug Strategy, 2009–13, was adopted on 22 October 2008 by the National Drugs Council at its third regular meeting. Taking into account both the EU drugs strategy 2005–12 and an assessment of the Bulgarian National Anti-drug strategy 2003–08’s implementation, the current strategy is balanced and comprehensive. Both the strategy and the action plan that supports its implementation, the Action Plan of the National Anti-Drug Strategy 2009–13, are based on the same five pillars: demand reduction; supply reduction; information systems and research; coordination and international cooperation; legislative improvement. Focusing on illicit drugs, the strategy has two main goals: (1) To protect the health and welfare of both the public and individuals and guaranteeing a high level of public security through a balanced and integrated approach to drugs and drug use; (2) Reducing 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.

View ‘National drug strategies’ for additional information.

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Coordination mechanism in the field of drugs

Established in 2001 by the law for the control of narcotic substances and precursors of 1999, the National Drugs Council is a body of the Council of Ministers of the Republic of Bulgaria. Operating at the inter-ministerial level, it is responsible for the implementation and coordination policy against the abuse of drugs and drug trafficking. Chaired by the Minister of Health, the Council includes three deputy chairpersons (the Secretary General of the Ministry of 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 Council had established a total of 26 Municipal Drug Councils by the end of 2010. These bodies function as regional/local coordination structures in municipalities that are regional administrative centres. The Municipal Drug Councils are complemented by 26 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. 

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Public expenditure

In Bulgaria, the financing of drug-related activities is decided annually by those entities in charge of their implementation. The available data on drug-related public expenditure remain very limited and are insufficient for analysis. In 2010, a survey was conducted in order to improve the methods used and data collected in this area, but the final report is not yet available. A new estimate of drug-related public expenditure is foreseen for 2012.

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Drug-related research

Most drug-related research in Bulgaria focuses on the prevalence and characteristics of drug use among different categories of the population, including those in the university and prison setting, and on the health and legal-related consequences of drug use. Most of the studies have been carried out by or with the active participation of the NFP.

Studies mentioned in the 2011 Bulgarian National report include research on the estimation of problem drug use, on the behavioural characteristics of injecting drug uses and on the availability of treatment in psychiatric wards.

View ‘Drug-related research’ for additional information.

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