Country overview: Bulgaria
- Drug use among the general population and young people
- Problem drug use
- Treatment demand
- Drug-related infectious diseases
- Drug-related deaths
- 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 (27 countries)||Source|
|Population||2012||7 327 224
||503 663 601 b p||Eurostat|
|Population by age classes||15–24||2012||11.4 %||11.7 % b p||Eurostat|
|25–49||35.1 %||35.4 % b p|
|50–64||21.3 %||19.5 % b p|
|GDP per capita in PPS (Purchasing Power Standards) 1||2011||46||100||Eurostat|
|Total expenditure on social protection (% of GDP) 2||2010||18.1 %||29.4 % p||Eurostat|
|Unemployment rate 3||2012||12.3 %||10.5 %||Eurostat|
|Unemployment rate of population aged under 25 years||2012||28.1 %||22.8 %||Eurostat|
|Prison population rate (per 100 000 of national population) 4||2011||151.1||:||Council of Europe, SPACE I-2011|
|At risk of poverty rate 5||2011||22.3 %||16.9 % e||SILC
p Eurostat provisional value.
b Break in series.
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, 2011.
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 national representative study among the general population was repeated in Bulgaria in 2008 among people aged 15–64 on their use of and attitudes towards different psychoactive substances. The data indicated that lifetime prevalence of cannabis use was 7.3 %, last year prevalence 2.7 % and last month prevalence 1.4 %. In 2005 lifetime prevalence of cannabis was 4.4 % and in 2007 it was 5.6 %. The 2008 survey showed the lifetime prevalence of ecstasy was 1.7 %, cocaine 1.7 % and amphetamines 2.1 %. Among young adults aged 15–34 lifetime prevalence of cannabis was higher than for other substances: 14.3 % reported they had used cannabis at least once, 3.6 % had used ecstasy, 4.4 % amphetamines and 3.0 % cocaine. For the same age group, last year prevalence of cannabis use was 6.0 % and of ecstasy was 1.6 %.
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 was 18 % and last month prevalence was 10 %, 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 boys, while it increased from 18 % to 22 % among girls 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 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 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; 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; expansion of sport and tourism programmes for children and young people; 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. In 2011 nearly two-thirds of all activities were funded by municipalities.
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, 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. Universal prevention activities focusing on the family remain rare and are implemented locally, mostly within school-based prevention activities. One example is a programme in Ruse on preventing drug use.
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. In 2011 around 1 000 specialists responsible for the prevention of antisocial behaviour among juveniles and minors were trained on how to tackle psychoactive substance use among high-risk groups. 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 in 2011 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 health, social and educational 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 of the prevention status. 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.
In 2009 the first national estimate of problem drug use was completed using the capture–recapture method, using data sets from the police, emergency medical care and specialised addiction treatment facilities. The estimate indicates 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).
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. Details are available here.
Treatment demand data for 2011 was based on 60 treatment units. There were a total of 2 490 clients entering treatment, of which 517 were new treatment clients.
Similar to previous years, in 2011 opioids were the most-reported primary drugs by all treatment clients, at 79.3 %, and among new treatment clients the figure was 93.2 %. These figures showed a declining tendency when compared with previous years. The second most-reported drug was cannabis, at 4.3 % among all treatment clients and 3.1 % among new treatment clients.
In 2011 some 23 % of all treatment clients, and 29 % of new treatment clients, were under the age of 25. The male to female ratio for all treatment clients has remained stable over the last 10 years at 80.2 % male and 19.8 % female. A similar distribution was also reported among new treatment clients, with 84.3 % male and 15.7 % female.
In 2011 the Ministry of Health reported a total of 201 new HIV-positive cases, of which 63 were registered to injecting drug users.
Data on the prevalence of drug-related infectious diseases among current injecting drug users are reported by the Prophylaxis, Diagnosis and Consultation Department of the Blood Transmitted Infections with a Laboratory, at the National Centre for Addictions (NCA) in Sofia. The data refer to NCA patients and clients of outreach programmes in Sofia.
In 2011 the prevalence of HIV among IDUs continued to show a stable increasing trend since 2005 but remained low at a rate of 2.8 % from a sample of 1 140 tests. The prevalence of hepatitis B virus infection (positive HBsAg) was 4.5 % from a sample of 1 130 tests. The prevalence of hepatitis C virus (HCV) infections among IDUs was 67.8 % from a sample of 1 138, which continues the increasing trend observed since 2007.
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. There was a significant increase in 2008 when 74 deaths were registered, though this was followed by a decline to 25 direct drug-related deaths in 2011. Around 88 % of deaths in 2011 were males and the mean age at the time of death was 31.5 years. The year 2008 remains the high point in the number of drug-induced deaths, according to national definitions, since the start of the period under observation in 1990.
As part of its task to implement the National Strategy for Combating Drugs 2009–13 (‘providing easier access to effective treatment programmes’), the National Centre for Addictions has started to work out a system for referring patients to treatment. The National Centre for Addictions compiles a number of registers that document available treatment options, so that coordination of the different treatment programmes can be improved.
Drug-related treatment is mainly delivered by a combination of public and private institutions. 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 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 substitution treatment with methadone, which was officially introduced in 1996. Slow-release morphine (Substitol) was also introduced as a recognised substitution drug in 2006. Buprenorphine was registered in 2008, but it is still not included in the list of substances for substitution treatment in Bulgaria. In 2011 there were 32 specialised units delivering opioid substitution treatment in 14 cities and towns. A total of 3 452 clients were undergoing substitution treatment, 3 269 of whom were on methadone, with the remaining on Substitol. 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, mainly due to treatment fees, still remain one of the main concerns. Methadone maintenance is continued if a client is imprisoned.
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; and the Regulation issued by the Minister of Health on terms and conditions for implementing harm reduction programmes, which was adopted in 2011.
In 2011 services to prevent drug-related infectious diseases were provided in 17 towns, mainly by NGOs. The NGOs target risk groups, such as drug users of Roma origin, sex workers and injecting drug users (IDUs), and provide services such as needle and syringe exchange, and information materials on safe injecting, overdose and infectious diseases. Services are provided through outreach work, mobile units or drop-in centres in cities across the country. 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 643 000 syringes were distributed through specialised agencies and outreach programmes in 2011.
Nineteen medical services in the bigger towns provide anonymous and free counselling and testing for HIV/AIDS. People infected with HIV, and AIDS patients, are treated in the specialised ward of the Hospital for Infectious Diseases in Sofia, and in four infectious diseases units in the cities of Plovdiv and Varna. Substitution treatment is provided in the municipal substitution programmes in Sofia, Plovdiv, Pazardjik and Varna. However, since 2000 the government has not provided vaccinations against HBV for drug users, regardless of the fact that the Action Plan of the National Strategy to Combat Drug Addiction identifies it as one of the subtasks necessary to lower the prevalence of infectious diseases among IDUs. It should be noted that since 1993 vaccination against HBV has been mandatory in Bulgaria for all newborn infants.
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 attempted to use the route for cocaine smuggling as well. Bulgaria remains a significant production site of amphetamine and methamphetamine, and in 2011 some 11 clandestine amphetamine and methamphetamine production laboratories were detected in the country. Another peculiarity of the Bulgarian drug market is the presence of a large number of smaller criminal groups that act independently and have distinctly separate distribution and smuggling channels.
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.
Although the quantity of heroin seized fell dramatically to 330 kg in 2010 and 385 kg in 2011 compared with preceding years (1 183 kg in 2009; 1 227 kg in 2008), it remains the most often seized drug. Amphetamines increased in the drug market, and 233 kg of amphetamine, 95 litres of amphetamine base, 200 amphetamine tablets, and 29 kg and 11 litres of methamphetamine were seized in 2011. The quantity of cocaine seized continues to decline, and in 2011 only 4 kg was seized. Cannabis is increasingly cultivated domestically; in 2011 the number of cannabis cultivation sites detected was 35, and a record of 7 456 plants were seized. Quantities of cannabis resin and herbal cannabis also increased compared to 2010. Thus 1 035 kg of herbal cannabis was seized, which is the second ever highest amount seized in Bulgaria since 1998 (4 211 kg seized in 2005). With regard to ecstasy, the quantities seized remained below the amounts seized in 2005–06 and 2008–09, while an increasing number of seizures containing synthetic cannabinoids and cathinons was observed.
In 2011 Bulgaria recorded 6 167 individuals committing drug-law offences. Some 55.6 % of offences were cannabis-related, and 15.8 % were heroin-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 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 500–5 000. 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 can be settled with a fine of up to BGN 1 000.
Trafficking carries penalties of imprisonment for two to 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 ‘Legal profile’ 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 current strategy takes into account both the EU 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 of the National Anti-Drug Strategy 2009–13, which supports its implementation, are based on the same five pillars: 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.
View ‘National drug strategies’ for additional information.
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 27 Municipal Councils on Narcotic Substances by the end of 2011. 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 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 available.
View ‘Public expenditure profile’ for additional information.
Most drug-related research in Bulgaria focuses on the prevalence and characteristics of drug use among different categories of the population, including those in 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.
Studies mentioned in the 2012 Bulgarian National report include research on the estimation of problem drug use, health-related consequences of drug use and on drug markets..
View ‘Drug-related research’ for additional information.