Country overview: Spain
- 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 | Spain | EU (27 countries) | Source | ||
|---|---|---|---|---|---|
| Population | 2008 | 45 283 259 | 497 455 033 | Eurostat | |
| Population by age classes | 15–24 | 2008 | 11.2 % | 12.6 % 1 | Eurostat |
| 25–49 | 40.6 % | 36.3 % 1 | |||
| 50–64 | 16.9 % | 18.4 % 1 | |||
| GDP per capita in PPS (Purchasing Power Standards) 2 | 2007 | 105.5 | 100 | Eurostat | |
| Total expenditure on social protection (% of GDP) 3 | 2006 | 20.9 % | 26.9 % p | Eurostat | |
| Unemployment rate 4 | 2008 | 11.3 % | 7 % | Eurostat | |
| Unemployment rate of population agends under 25 years | 2008 | 24.6 % | 15.5 % | Eurostat | |
| Prison population rate (per 100 000 of national population) 5 | 2006 | 146.1 | Council of Europe, SPACE 2006.1 | ||
| At risk of poverty rate 6 | 2006 | 20 % | 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
Since 1995, a general population survey on drug use (EDADES) is conducted in Spain on a biennial basis and is targeted at persons aged 15–64. The results from the survey conducted in 2005 showed that cannabis is the illegal substance most commonly used in Spain. 28.6 % of the respondents aged 15–64 reported lifetime use of cannabis, followed by cocaine (7.0 %), ecstasy (4.4 %), while the same proportion reported amphetamines and hallucinogens use (3.4 %). In 2007, 27.3% of the sample reported lifetime use of cannabis, followed by cocaine (8.3 %), ecstasy (4.2 %) and amphetamines (3.8 %). In 2007, last year prevalence of cannabis was 10.1 % (11.2 % in 2005), and last month prevalence, 7.1 %. Between 2003 and 2007, use of tobacco fell. The proportion of monthly and daily users of alcohol fell. However, there was a rise in the proportion of young females who get drunk. The use of sedatives (tranquilisers and/or sleeping pills) increased, from 5.1 % in 2005 to 8.6 % in 2007. Between 2005 and 2007, cannabis use fell and cocaine powder use remains stabilised, after several years of continuous increases. In the same period, experimentation with and use of base cocaine (crack) grew considerably. Use of ecstasy, amphetamines and hallucinogenic drugs has stabilised or is decreasing. Use of heroin and volatile inhalants remains at low levels, however, since 1999, a trend towards an increase in experimentation with these substances has been observed.
Use of illegal psychoactive drugs is concentrated in sub-groups of people who have often used several drugs in given period. A significant proportion of the population perceives a relatively low risk attached of drinking five or six glasses of alcoholic drinks on the weekend or daily, smoking a packet of cigarettes daily, and habitual use of cannabis or tranquilisers/sleeping pills. Between 2005 and 2007, perceived risk of most types of drug use behaviours increased. However, perceived risk towards regular use of sedatives fell, and perceived risk towards daily smoking of a packet of cigarettes remained stable. Between 2005 and 2007, there was a significant decrease in perceived availability of the main illegal drugs; after several years of increase.
The last national survey on drug use among students aged 14–18 (ESTUDES) was conducted in 2007. In 2007, the most commonly used illegal drug was cannabis, with lifetime prevalence of 37 % compared to 41 % in 2004. Lifetime prevalence rates for other illegal drugs were 4 % for cocaine, 3 % for ecstasy, 3 % for amphetamines, 4 % for hallucinogens and 3 % for solvents. Only 1 % reported lifetime experience with heroin. In 2007, last year prevalence of cannabis was 30 % and last month prevalence was 20 %.
Prevention
Universal prevention in schools continues to be the preferential setting for actions in every autonomous community in Spain. Additionally, the new ARGOS programme (community-based prevention organised from health centres) aims to increase the engagement of the health centre sector as points of reference in school and community-based prevention. It has a strong informative character through a range of support materials. Schools provide parents with educational talks, distribution of materials, orientation and guidance services, and informal courses. Universal community-based prevention programmes are, to a great extent, alternative leisure programmes in public places such as youth clubs, sports centres, schools and community centres. The majority of activities are recreational and sports-related and few activities of a cultural nature are offered. Programmes conducted in habitual places of drug use, e.g. in areas around bars, nightclubs and music concerts, are carried out by peer mediators that work to detect problematic cases and provide information and advice about drugs and their various forms of use.
Selective prevention with vulnerable groups is a priority in the action plan on drugs and a large part of the preventive efforts in this area are focused on at-risk minors. There are also new selective prevention programmes for families at risk, former female drug users with children, as well as specific programmes for ethnic minorities aimed at gypsy families and youths with problems related to drug addiction and broken families as a result of drug use. There is a large and well researched indicated prevention programme for disruptive children in Galicia.
The main features of prevention policy in Spain are strong cooperation with the educational system, full coverage of the school population with school-based prevention programmes, and important interventions in selective and indicated prevention. Mass media campaigns continue to play a major role while less effort is put into environmental strategies.
Problem drug use
Between 1999 and 2002, several estimates of problem drug use were made, applying the demographic and multiplier methods. In 2002, the number of problematic opiate users was estimated at 4.04 per 1 000 inhabitants aged 15–64, based on the treatment multiplier method. In 2007, Spain has conducted a study looking at the possibilities of estimation of problem drug use from the general population survey (by nomination technique and directly). However, the figures obtained were not considered scientifically sound enough to be trusted.
Incidence estimation studies showed sharp decline of new problem heroin users and increase of new problem cocaine users in a longer-term perspective.
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
Treatment demand data in Spain is collected from each region and collated at the Government Delegation for the National Plan on Drugs. In 2006, the data on treatment demand was gathered from 497 outpatient treatment centres.
During 2006, a total of 49 283 clients entered in treatment, out of which 22 333 were first time treatment clients. Data regarding all clients entering treatment suggest that 45.1 % of all clients reported that cocaine was the primary drug, followed by 40.4 % for opioids and 10.4 % for cannabis. Among first time treatment clients, 60.3 % were treated for cocaine, 18.5 % were treated for cannabis and 15.4 % for opioids.
In 2006, 42 % of all clients entering treatment were more than 35 years of age. A different distribution in age distribution was reported among new treatment clients with 31 % under the age of 25 years. As far as gender distribution is concerned 84 % of all clients entering treatment were male whereas, 16 % were female. A similar distribution in gender distribution was reported among new treatment clients with 83 % for male and 17 % for female.
Drug-related infectious diseases
The national AIDS Registry collects data on diagnosed AIDS cases in Spain. The registry also provides data on the cause of infection, including information on injecting drug use among diagnosed AIDS cases. These data show that the proportion of AIDS cases infected due to intravenous drug use has declined from 69.7 % in 1990 to 46.3 % in 2004. In 2006, 1 605 cases were diagnosed which represent 43 % of which were attributed to the use of injecting drugs. The national overall prevalence of HIV infection among injecting drug users in Spain in 2006 is ranges between 36.4 % and 39.7 % with 10 262 persons tested. It is assumed that this decrease can be attributed to the improvements that have been made in the fight against drugs such as the widespread availability of maintenance treatments with methadone and the notable decrease in injections as the manner of using heroin.
Drug-related deaths
Since 1993, Spain has had a special registry based on forensic and toxicological sources, that collects data on deaths due to acute reactions to drugs in different geographical areas. Data is collected on deaths with judicial intervention where the direct and main cause is an acute adverse reaction after a non-medical and deliberate use of psychoactive substances excluding alcohol and tobacco in the population aged 15–49 years old.
In 2006 there were 518 deaths related to drug use. Despite the fact that the quality of information provided by the General Mortality Register (RGM) has improved in recent years, there is an underestimation in the number of deaths calculated from the RGM when compared with the REM in those regions where the indicator is being implemented. The RGM underestimation in regard to the REM is 17 %, according to the most recent calculations undertaken.
According to the GMR, the number of deaths due to acute reaction to drugs fell between 1999 and 2001, remained stable until 2005 at approximately 670 annual deaths and fell in 2006 to 518 deaths.
Treatment responses
Drug treatment at national level is coordinated by the Government Delegation for the National Plan on Drugs, based within the Ministry of Health and Social Policy, which is responsible for promotion, monitoring and evaluation of drug treatment. Due to the decentralised state structure of autonomous cities and communities, these units have also established specific drug treatment strategies/action plans, and thereby appoint regional drug treatment coordinators. The public sector is mostly involved in the delivery of treatment, followed by NGOs and private organisations. In Spain, funding of drug treatment is provided mostly by the public budget of the state and autonomous regions.
There is a specific drug dependence care network which is widely distributed throughout the country. Healthcare and treatment are provided by the Autonomous Communities both for drug abuse disorders and for the rest of diseases as well. Each Autonomous Community is entitled to organize and deliver health interventions the way they feel it is most appropriate according to their own schemes, budgets and workforce.
Some of them have integrated treatment for drug abuse disorders within primary care units, some within mental health services and the remainder keeps it as a separate network although connecting with the general healthcare system.
In 2007, this care network included 497 outpatient facilities, where more than 79 000 patients were assisted, 51 inpatient detoxification units, where 3 500 users were assisted, 119 therapeutic communities were 5 500 drug users were admitted and around 2 500 points where methadone substitution treatment was prescribed/dispensed.
The majority of programmes use methadone which was introduced in 1990 and the estimated total number of patients in methadone maintenance treatment in 2007 was 81 706. Buprenorphine has been legally introduced as a maintenance drug in 1996 yet it is currently not commercially available. Another substitution drug, Buprenorphine/naloxone combination is commercially available in Spain, although it is not financed by the national drug funding system.
Substitution treatment is available at specialised outpatient centres, at other health and mental health centres and at hospitals. Pharmacies are involved in dispensing medication to patients.
Quality standards and monitoring systems for clients in substitution treatment exist at the level of the autonomous communities and data are reported to the Government Delegation for the National Plan on Drugs.
Harm reduction responses
National priorities in the prevention of infectious diseases among drug users include needle and syringe programmes, voluntary counselling and testing of infections and hepatitis vaccination programmes. These services are provided by a large public network of facilities, including social emergency centres, mobile units and pharmacies.
Most specialist harm reduction programmes include a socio-sanitary service that offers preventive educational interventions, sterile material, emergency care and assistance to injecting drug users who are not usually in contact with any assistance intervention. Around 45 000 drug users have been assisted at harm reduction programmes in 2007 (social emergency centres, mobile units, pharmacies and supervised drug consumption premises). Public outpatient clinics also carry out harm reduction activities, as well as several NGOs. In 2007, NSPs were readily available and distributed about 3 486 000 syringes, including about 14 000 at NSPs in prisons. Seven facilities for supervised drug consumption are available in Madrid, Barcelona and Bilbao in 2007.
Drug markets and drug-related offences
Due to its geographical position, Spain is one of the countries in the European Union most targeted by international drug traffickers. According to the information from law enforcement agencies, seized cocaine generally originates from Colombia, an estimated 93 % of hashish comes from territories under Moroccan control, heroin from Turkey, while synthetic drugs are smuggled into Spain from the Netherlands and Belgium.
In Spain, data on the number and quantity of drug seizures is reported by the criminal intelligence central unit at the Ministry of Interior. Over the last 10 years, the number of seizures has increased notably in a constant and almost linear trend, indicative of the ongoing efforts against illegal drugs. In 2007, a significant increase in the quantity of seizures was reported for herbal cannabis with a total of 1 233 kg as compared to 2006 with a total of 510 kg of seizures. An increase was also reported in the quantity of ecstasy seizures with a total of 490 595 of seized tablets in 2007 when compared to 481 595 of seized tablets in 2006.
In 2007, a total of 278 797 drug law offences were reported, out of which 73.4 % were cannabis offences, followed by 17.7 % for cocaine offences and 3.1 % for heroin offences.
National drug laws
The law on protection of citizens' security (1992) considers drug consumption in public, as well as illicit possession, as a serious order offence punishable by administrative sanctions. Fines are the usual punishment, but the law foresees that the execution of the fine can be suspended if the person freely attends an official drug treatment program. For trafficking, the Spanish law lays down penalties in line with the seriousness of the health damages associated to the drugs and any aggravating and mitigating circumstances that may exist. Penalties can reach up to 20 years and three months in prison, with such long terms reserved for cases with aggravating circumstances such as sale to minors under 18, or the sale of large quantities (over 500 doses). When no such circumstances exist, those who have committed the crime can be sentenced to prison for one to three years if the drugs do not cause serious health damage, and from three to nine years when they do. In all cases, a fine is also imposed.
National drug strategy
A new National Drug Strategy 2009–16 has been launched in 2009 and was approved by the Council of Ministers on 23 January. The strategy, which is comprehensive and focuses on both legal and illegal drugs and drew on the expertise and outcomes gathered through the past eight years and complies with the broad outlines of the European Drug Strategy 2005–12. The new strategy recognises that significant changes have occurred in recent years such as a remarkable change in the profile of psychoactive substance users, new polydrug use patterns, a close relationship between consumption and leisure activities, ageing of problematic users, introduction of new substances into the market, an increase of mental disorders linked to use of psychoactive substances, changes in care networks, etc.
In order to implement this strategy, two four-year and consecutive action plans (2009–12 and 2013–16) will be drafted. The strategy responds to six general principles: consideration of scientific evidence; social participation; a joint approach; a comprehensive approach; equality and a gender focus. It also establishes 13 general objectives and dedicates a special and specific chapter to coordination activities. There are five main intervention areas: reduction of demand (prevention, risk and harm reduction, treatment and social integration) supply reduction; improvement of basic and applied scientific knowledge; training and international cooperation.
On the other hand, assessment of the National Drug Strategy 2000–08 is about to be completed and the Action Programme on Cocaine 2007–10 is currently being implemented.
Coordination mechanism in the field of drugs
The drug policy is coordinated by an Inter-ministerial Group, chaired by the Minister for Health and Social Policy, and including the Ministers for Justice, Education, the Interior, Work and Immigration, Territorial Policy and Foreign Affairs and Cooperation as well as the Secretaries of State for Treasury, for Economy, for Security and for Relations with the Spanish Parliament and the General Secretary of Health. The Secretary of this Inter-ministerial Group is the Government Delegate for the National Plan on Drugs.
The Government Delegation for the National Plan on Drugs carries out the function of coordinating the different institutions included in the national drug plan. It has the status of a Directorate-General and reports to the General Secretary for Social Policy of the Ministry of Health and Social Policy. The Government Delegate for the national drug plan is the national drug coordinator.
The ‘Sector conference’ of the National Plan on Drugs is the means of cooperation between the State Administration and the administrations of the autonomous regions. It is made up of the Inter-ministerial Group and the regional ministers of the departments of the autonomous regions, which have been assigned responsibility for the area of prevention and assistance for people with drug dependency problems.
The Inter-regional Committee, chaired by the Government Delegate for the National Plan on Drugs, reports to the Sector Conference and is made up of all the Deputy Directors-General of the Government Delegation, as well as those responsible for the regional drug plans.
Finally, there is a Drug Commissioner in each of the 17 autonomous communities and in the two autonomous cities (Ceuta and Melilla). They communicate with the Government Delegation through their participation in the Inter-regional Committee and the Sector conference.
Drug-related research
Biomedical research and health sciences in Spain are important aspects of the national research and development plan. This effort is funded through the general state budget and prioritises, amongst other areas, further exploration into knowledge on addiction neurobiology. The plan also considers it important to identify behavioural, sociological and environmental risk factors, as well as the interaction among them (community epidemiology) and the application of ‘quality’ to clinical practice. University departments and research networks are the main actors in undertaking drug-related research, while the management of public funds and the coordination aspects are carried out through the Carlos III Health Institute and the Government Delegation for the National Plan on Drugs. National scientific journals and specialised websites are the main channels for national dissemination of drug-related research findings.