Country overview: Bulgaria
- Situation summary
- Data sheet
- Barometer
Contents
- 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
- Drug-related research
| Year | Bulgaria | EU (27 countries) | Source | ||
|---|---|---|---|---|---|
| Population | 2010 | 7 563 710 | 501 105 661 p | Eurostat | |
| Population by age classes | 15–24 | 2010 | 12.1 % | 12.1 % p | Eurostat |
| 25–49 | 35.8 % | 35.8 % p | |||
| 50–64 | 20.8 % | 19.1 % p | |||
| GDP per capita in PPS (Purchasing Power Standards) 1 | 2009 | 44 | 100 | Eurostat | |
| Total expenditure on social protection (% of GDP) 2 | 2008 | 15.3 % | 26.4 % p | Eurostat | |
| Unemployment rate 3 | 2010 | 10.2 % | 9.6 % | Eurostat | |
| Unemployment rate of population aged under 25 years | 2010 | 23.2 % | 20.9 % | Eurostat | |
| Prison population rate (per 100 000 of national population) 4 | 2009 | 131.8 | Council of Europe, SPACE I-2009 | ||
| At risk of poverty rate 5 | 2009 | 21.8 % | 16.3 % | 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, 2009.
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).
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 2007, the ESPAD survey was repeated in the country among the 15–16 year old students (the sample size was 2 353). In 2007, the reported lifetime prevalence of cannabis use was 22 % compared to 21 % in 2003. In addition, 2007 results indicated a percentage of 17 % for last year prevalence of cannabis and 7 % for last month. Lifetime prevalence of amphetamines and ecstasy were both 6 %, lifetime prevalence of cocaine 3 %, this figure is similar as well for inhalants and for LSD. Lifetime prevalence of all substances are higher among males than females, for example regarding cannabis, figures were 27 % for males and 18 % for females.
Apart from the above mentioned studies, 22 local surveys on drug use and drug use related risks were carried out in the period 2005–09 among students (grades 7 through 13) in 18 cities.
Prevention
In 2009, the shift towards expansion of universal and indicative prevention, and declining selective prevention activities is noted in the country. The main objectives and features of 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. In 2009, less support to the activities geared towards families and parents in comparison with previous years was provided. 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.
Standardised school-based prevention protocols are scarce. The contents and components of the programmes in place are partly in line with international recommendations and the available knowledge base. An extra-curricural activity programme is planning to extend its activities to stimulate and develop scientific, creative and sports talents of children also in science, technology, art and sport classes.
Selective prevention is mostly targeted at identifying at-risk children in schools, is often based on information provision and has not been given broader political and practical relevance. 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 rights of children. In the past, projects for vulnerable children (orphanages and shelter houses) have been implemented.
Trainings of health care, social services and educational sector professionals how to screen and implement early and short interventions, opening a centre for children and adolescents who experiment with drugs are among the activities in the area of indicative prevention.
Systematic monitoring (databases) of funded programmes and their coverage and content does not fully exist, despite some steps which were already made in this direction in the last two years. 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.
Problem drug use
Since the beginning of the 1990s, heroin has been and still continues to be the illicit drug associated with the highest level of drug-related problems. Based on the multiplier method using treatment data, and at the same time estimations from police, it was estimated that in 2004–05 there are about 20 000 to 30 000 problem heroin users in the country. The number of problem heroin users has remained relatively stable. A study conducted in 2005 reported an estimate of approximately 12 000 problem heroin users in the capital city (13 cases per 1 000 inhabitants aged 15–64). No reliable estimates exist for other problem drug users such as cocaine and stimulant users, because their reported number is not yet statistically relevant.
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.
Treatment demand
The treatment demand data for Bulgaria for 2009 was based on 31 treatment centres comprising of 25 outpatient services and 6 inpatient treatment centres. In 2009, a total of 1 860 clients entering treatment have been covered by the system, out of which 373 were first-time treatment clients.
Similarly to previous years, in 2009 opioids were reported as the primary drugs among the greatest share of all clients entering treatment at 97.1 % and 92.8 % among first-time treatment clients. This was followed by amphetamines at 1.1 % among all clients entering treatment and 3.5 % among first-time treatment clients.
In 2009, 28 % of all clients entering treatment were aged less than 25 years. The percentage of new treatments clients aged less than 25 years was 39 %. In 2009, the male to female ratio for all treatment clients remained stable over the last 10 years at 87 % for male and 13 % for female. In 2009, a similar distribution was also reported among new treatment clients with 83 % for male and 17 % for female clients.
Drug-related infectious diseases
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 2009, the prevalence of HIV among IDUs continued to show a stable uptrend since 2005 but remained low: 2.7 % obtained from 960 tests. The extent of Hepatitis B infection (positive HBsAg) was 5.8 % from 941 tests. This remains within the range of 5–7 %, which has been observed since 1995. In 2009 for a sample size of 955, the prevalence of HCV infections among IDUs was 61.2 %, which is slightly up from 57.5 % observed from 752 tests in 2008. (the rate of HCV infections in the EU ranges from over 94 % to below 10 %).
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 (74 deaths in 208, 52 deaths in 2007, 29 deaths in 2006, 40 deaths in 2005 and 26 deaths in 2004). In 2009, the mean age was 30.9. 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.
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. Until 2005, the outpatient psychosocial treatment was predominantly financed by the National Programme for Prevention, Treatment, and Rehabilitation of Drug Addictions. Medically-assisted treatment is mainly funded by the Ministry of Health. The financing of residential psychiatric treatment is the responsibility of the government through the Ministry of Health and through municipal budgets. 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.
The most common form of drug-related treatment in Bulgaria is 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 2006, a national programme for the development of a system of methadone maintenance programmes in the Republic of Bulgaria for the period 2006–08 was adopted by the Council of Ministers. The strategic goal of this programme was to reduce drug use and the related health and social risks, through the development of effective and accessible programmes for methadone maintenance treatment. As a consequence, in recent years there has been an increase in the number of specialised units delivering methadone substitution treatment. In 2009, a total of 3 104 clients were undergoing substitution treatment, 2 886 of whom were on methadone and 218 on slow-release morphine (Substitol). 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 behavior, high drop-out rates is one of the main concerns. The methadone maintenance is continued also if a client is imprisoned. In 2009, 30 people continued to receive methadone after the arrest.
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. 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 669 000 syringes were distributed through specialised agencies and outreach programmes in 2009.
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 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.
Drug markets and drug-related offences
In 2009, Bulgaria recorded a total of 4 612 reports of persons committing drug law offences. Out of all those offences reported in 2009, 51.4 % were cannabis related offences followed by 24.2 % for amphetamines and 21.8 % 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 2009, the quantity of seized drugs decreased for heroin (1 183 kg in 2009, 1 227 kg in 2008), amphetamine (253 kg in 2009, 430 kg in 2008), cannabis plants (623 in 2009, 4 894 in 2008) and increased for cannabis resin (45 kg in 2009, 0.1 kg in 2008), herbal cannabis (46 kg in 2009, 12 kg in 2008), ecstasy (22 395 tablets in 2009, 13 332 tablets in 2008) and cocaine (235 kg in 2009, 10 kg in 2008).
Ephedrine had been the most frequent precursor smuggled in Bulgaria in the past years (2006–08), however, it is noticeable that in 2009 no cases of illicit traffic of any precursors has been established and no ephedrine was seized in the country.
National drug laws
On 2 April 1999, the Narcotic Substances and Precursors Control Act (NSPCA) was approved. In 2009, amendments harmonised 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.
National drug strategy
The first national anti-drug strategy of the Republic of Bulgaria covered the period 2003–08. It is complemented by an action plan which was adopted in 2003 and revised in 2006. A national programme for the development of methadone maintenance was also adopted in 2006. The national anti-drug strategy is comprehensive, covering both drug demand and drug supply reduction. Its main goals are operational: to achieve a balanced policy in the drugs field, through reinforcing strategic coordination and improving the exchange of information between different ministries and departments, as well as strengthening the role of the regional drug councils as important strategic partners at the local level in the fight against drugs. Since 2009, new anti-drug strategy has been started for the period 2009–13.
Coordination mechanism in the field of drugs
A National Drug Council (NDC) has been established according to the Law for Control of Narcotic Substances and Precursors of 1999. It is responsible for the implementation of the national policy against drug abuse, as well as for the fight against drug trafficking. The NDC is chaired by the Minister of Health. His deputies are the General Secretary of the Minister of Interior and a deputy Minister of Justice. The members are representatives of the Presidency of the Republic of Bulgaria, the Supreme Cassation Court, the Supreme Administrative Court, the Supreme Cassation Prosecution Office, the National Investigation Service, and the concerned ministries and departments.
By the end of 2009, the NDC has established 26 regional drug councils (RDS) for the implementation of drug policy at regional level. Funded through municipal budget as a state-delegated activity, these include senior representatives of all departments, institutions, and organisations which work in the field of drugs, and they have functions and objectives determined by the Regulations for the Organisation and Activities of the NDC. RDCs are considered one of the key elements in the implementation of the national anti-drug strategy of the Republic of Bulgaria.
Drug-related research
Most drug-related research in Bulgaria focuses on the prevalence and characteristics of drug use, informational and service needs, attitudes towards drugs and drug use and other relevant drug-related issues among different categories of population: general population surveys, school population surveys, specific population (university students and prisoners), mortality cohort studies, hepatitis C virus prevalence studies among injecting drug users, as well as prevalence estimates of problem drug use at city and local level using capture–recapture techniques, and have been carried out by or with the active participation of the NFP.
Studies mentioned in the 2010 Bulgarian National report include research into the attitudes and use of psychoactive substances, prevention activities at local level and drug-related deaths.
