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 | 2008 | 7 640 238 | 497 455 033 | Eurostat | |
| Population by age classes | 15–24 | 2008 | 13.1 % | 12.6 % 1 | Eurostat |
| 25–49 | 35.7 % | 36.3 % 1 | |||
| 50–64 | 20.5 % | 18.4 % 1 | |||
| GDP per capita in PPS (Purchasing Power Standards) 2 | 2007 | 37.3 | 100 | Eurostat | |
| Total expenditure on social protection (% of GDP) 3 | 2006 | 15 % | 26.9 % p | Eurostat | |
| Unemployment rate 4 | 2008 | 5.6 % | 7 % | Eurostat | |
| Unemployment rate of population agends under 25 years | 2008 | 12.3 % | 15.5 % | Eurostat | |
| Prison population rate (per 100 000 of national population) 5 | 2006 | 158.8 | Council of Europe, SPACE 2006.1 | ||
| At risk of poverty rate 6 | 2006 | 14 % | 16 % 7 | SILC, 2007 |
|
p Eurostat provisional value.
1 2007 figures.
2 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.
3 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.
4 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.
5 Situation of penal institutions on 1 September, 2006.
6 Share of persons aged 0+ with an equivalent disposable income below the at-risk-of-poverty threshold in the current year and in at least two of the preceding three years.
7 EU-25 countries.
Drug use among the general population and young people
In 2007, 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 5.6 % for lifetime prevalence of cannabis, 1.9 % for last year prevalence and 1.2 % for the last month prevalence. In 2005, lifetime prevalence of cannabis was 4.4 %. Also in 2007, the survey’s results showed a lifetime prevalence of ecstasy of 2 %, cocaine 1.4 %, amphetamines 1.4 %. In the group of younger adults (aged 15–34 years), lifetime prevalence of cannabis is also higher than for other substances: 11.4 % reported at least once use of cannabis, 4.3 % ecstasy use, 2.9 % amphetamines use and 2.6 % cocaine use. For the same group age, last year prevalence of cannabis use was 4.4 % and ecstasy was 1.4 %.
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.
Prevention
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 for assistance of parents; 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; and development and implementation of programmes for work with high-risk groups. 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. Systematic monitoring (databases) of funded programmes and their coverage and content does not exist. 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. Recently, projects for vulnerable children (orphanages and shelter houses) have been implemented.
A programme for the development of extra-curricular activities in schools, extending the activities to stimulate and develop the scientific, creative and sports gifts of the children are planned in extra-curricular activities regarding science, technology, art and sport. Selective prevention in recreational settings is carried out by municipalities with a focus on leisure-time activities, not specifically on clubs or parties. The evaluation of prevention is in an incipient stage but benefits from high priority.
Recently, progress has been made in ensuring the quality of prevention activities in the country and developing standards for projects to be funded. However, funds for prevention activities under the national programme for the implementation of the ‘National strategy for combating drugs 2003–08’ are rather insufficient for the implementation of prevention activities.
Problem drug use
Since the beginning of the 1990s, heroin has been 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 2007 was based on 17 treatment centres comprising of 12 outpatient services and 5 inpatient treatment centres. In 2007, a total of 1 398 clients entering treatment have been covered by the system, out of which 366 were first-time treatment clients.
Similarly to previous years, in 2007 opioids were reported as the primary drugs among the greatest share of all clients entering treatment at 97.8 %, and 93.5 % among first-time treatment clients. This was followed by cannabis at 0.7 % among all clients entering treatment and 2 % among first-time treatment clients.
In 2007, 39 % of all clients entering treatment were aged less than 25 years. A similar age distribution was also reported among new treatment clients with 50 % aged less than 25 years. In 2007, the male to female ratio for all treatment clients remained stable over the last 10 years at 83 % for male and 17 % for female. Also in 2007, a similar distribution was also reported among new treatment clients with 82 % for male and 18 % 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.
From 2006 to 2007, the prevalence of HIV among IDUs continued to be low: ten positive results (1.5 %) obtained from 1 289 tests. The extent of Hepatitis B infection was 5.6 % from 656 tests. This remains within the range of 5–7 %, which has been observed since 1995. For 2006 to 2007 for a same sample size of 1 262, the prevalence of HCV infections among IDUs was 51.1 % (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 2007, there were 52 direct drug-related deaths and the mean age was 30.1 years (29 deaths in 2006, 40 in 2005 and 26 in 2004). Since the beginning of the period under observation (1990) until now, 2007 was 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 Strategic Task 6 of the ‘National strategy for combating drugs 2003–08’ (‘providing an easier access to effective treatment programmes’), the National Centre for Addictions (NCA) 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 (NCA), 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 11 state psychiatric hospitals; 12 psychiatric dispensaries, 11 psychiatric wards of multi-profiled hospitals offering active treatment, and four 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 2007 a total of 2 910 clients were undergoing substitution treatment, 2 405 of whom were on methadone and 505 on slow-release morphine (Substitol).
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 2007, an estimated 735 000 syringes were distributed through specialised agencies and outreach programmes. Furthermore, 18 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 the infectious diseases’ units for treatment of AIDS in the cities of Plovdiv and Varna. For patients in substitution treatment is ensured in the municipal substitution programs in Sofia, Plovdiv and Varna. However, since 2000, the Bulgarian Government does not provide vaccinations against hepatitis B to drug users. In Sofia, one NGO provides free vaccinations to IDUs, but the number of those that have been vaccinated is small (19 drug users in 2006). 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 2007, Bulgaria reported a total of 3 947 drug law offences. Out of all the drug law offences reported in 2007, 52.2 % were cannabis related offences followed by 23.7 % for heroin and 21.8 % for amphetamines.
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. In 2007, the quantity of drug seizures increased substantially for herbal cannabis, heroin and ecstasy when compared to 2006. In 2007, a total of 3 219 kg of herbal cannabis was seized, 1 300 kg of heroin was seized and 24 155 tablets of ecstasy were seized. On the other hand, in 2007, the quantity of drug seizures decreased substantially for cannabis resin and cannabis plant, cocaine and amphetamines when compared to 2006. With a total of 6 kg of seized cannabis resin, 198 seized cannabis plants, 5 kg of cocaine seized and 177 kg of amphetamines seized in 2007.
In 2006, for the first time the Bulgarian Customs Agency seized a record breaking of 75 kg of ecstasy in seven seizures. One of the most frequently smuggled precursors in Bulgaria is ephedrine tablets, which are smuggled in small quantities from Turkey. In 2006, in seven seizures a total amount of 9 430 kg, 15 233 tablets and 200 ampoules of ephedrine were seized. For the first time in 2006, a considerable quantity (500 kg) of phenylacetic acid was seized.
National drug laws
On 2 April 1999, the Narcotic Substances and Precursors Control Act (NSPCA) was approved. 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.
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 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.
The NDC has established regional drug councils (RDC) for the implementation of drug policy at regional level. 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
Since 2003, the total number of seven general population surveys at national or local level with total of about 13 000 covered persons, four school surveys at national level with total of more than 10 000 covered pupils, 23 school surveys at local level with a total of about 40 000 covered pupils, three national surveys among specific groups of population with total of about 6 000 covered persons have been carried out by or with the active participation of the NFP.
Estimates of local prevalence of problem drug use in the capital of Bulgaria (Sofia) and in three of the biggest cities of the country (Varna, Plovdiv and Burgas), have been carried out using the capture–recapture method. Prevalence estimates of problem drug use in some of the smaller towns have been made through the multiplier method using treatment data.