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 | 2010 | 45 989 016 | 501 105 661 p | Eurostat | |
| Population by age classes | 15–24 | 2010 | 10.6 % | 12.1 % p | Eurostat |
| 25–49 | 40.2 % | 35.8 % p | |||
| 50–64 | 17.4 % | 19.1 % p | |||
| GDP per capita in PPS (Purchasing Power Standards) 1 | 2009 | 103 | 100 | Eurostat | |
| Total expenditure on social protection (% of GDP) 2 | 2008 | 22.7 % p | 26.4 % p | Eurostat | |
| Unemployment rate 3 | 2010 | 20.1 % | 9.6 % | Eurostat | |
| Unemployment rate of population aged under 25 years | 2010 | 41.6 % | 20.9 % | Eurostat | |
| Prison population rate (per 100 000 of national population) 4 | 2009 | 173.1 | Council of Europe, SPACE I-2009 | ||
| At risk of poverty rate 5 | 2009 | 19.5 % | 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
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 living in family households. The results from the last survey conducted in 2009 showed that cannabis is the most commonly used illegal substance in Spain. 32.1 % of the respondents aged 15–64 reported lifetime use of cannabis, followed by cocaine (10.2 %), ecstasy (4.9 %) and amphetamines use (3.7 %). In 2009, last year prevalence of cannabis was 10.6 % (10.1 % in 2007 and 11.2 % in 2005), and last month prevalence, 7.6 % (7.1 % in 2007 and 8.7 % in 2005). Between 2007 and 2009, the proportion of monthly and daily users of tobacco slight increased, and the age differences (higher daily tobacco use prevalence among females aged 15–34 years and males 35–64 years) observed in the past in males and in females has faded away. With regard to alcohol, the recent data confirms rather stable situation. In 2009, likewise to 2007, a continuous rise in the proportion of young females who get drunk was observed. The use of sedatives (tranquillisers and/or sleeping pills with or without prescription) decreased in 2009 when compared to data from 2007 (last year prevalence).
Although the cannabis use increased between 2007 and 2009, the continuity of its use is not high. Only the third of those reporting ever used cannabis did it within the last year, and one fourth — within the last month. Likewise, the lifetime use of cocaine chlorhydrate increased between 2007 and 2009, however, the proportion of those who used cocaine chlorhidrate within past year and past month declined, and continuity of cocaine use is not high as well. Experimentation with base cocaine (crack) declined considerably following increase noted 2007 as well. Use of ecstasy, amphetamines and hallucinogenic drugs also remained stable or decreased. In 2009, the use of heroin and volatile inhalants remained at low levels although an increasing trend in experimental use of these substances has been observed since 1999.
Use of illegal psychoactive drugs is concentrated in sub-groups of people who have often used several drugs in given period. Polydrug use has become a very common consumption pattern where legal drugs (particularly alcohol) are almost always present. A significant proportion of the population perceives a relatively low associated risk to certain drug-related behaviours such as ‘drinking five or six glasses of alcoholic drinks’ on the weekend or daily, or ‘regular (once a week or more frequently) use of tranquillisers/sleeping pills’, or ‘trying once or twice cocaine or ecstasy`. Between 2007 and 2009, associated risk perception of most types of drug-related behaviours remained unchanged. However, risk perception with regard to the regular use of sedatives fell, while an increase of the associated risk perception when considering ‘one pack of cigarettes daily smoking’ was observed. For the same period (2007–09), a significant increase in perceived availability of the main illegal drugs was noted.
The last national survey on drug use among students aged 14–18 (ESTUDES) was conducted in 2008. In 2008, the most commonly used illegal drug was cannabis, with lifetime prevalence of 35.2 % compared to 41 % in 2004. Lifetime prevalence rates for other illegal drugs were 5.1 % for cocaine, 2.7 % for ecstasy, 3.6 % for amphetamines, and 4.1 % for hallucinogens. Only 0.9 % reported lifetime experience with heroin. In 2008, last year prevalence of cannabis consumption was 30.5 % and last month prevalence was 20.1 %.
Prevention
Universal prevention in schools continues to be the preferential setting for actions in every autonomous community in Spain, and they include structured prevention programmes in the classrooms, extracurricular activities and also facultative training. Additionally, community-based prevention programmes organised from health centres are spreading in schools. These programmes aim 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 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 2008, the number of problematic opiate users was estimated at 1.3 per 1 000 inhabitants aged 15–64, based on the treatment multiplier method. 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 2008, the data on treatment demand was gathered from 503 outpatient treatment centres and treatment units in prison.
During 2008, a total of 53 155 clients entered in treatment, out of which 22 944 were first time treatment clients. Data on people entering drug treatment showed that cocaine (chlorhydrate and/or crack) was the primary drug for 46.4 % of all clients, followed by opioids (36.4 %) and cannabis (14.0 %). Among those who entered treatment for the first time, 56.0 % were treated for cocaine, 22.0 % were treated for cannabis and 17.7 % for opioids.
In 2008, 43 % 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 29 % under the age of 25 years. As far as gender distribution is concerned 85 % of all clients entering treatment were male whereas, 15 % were female. A similar gender distribution was reported among first time treatment clients (84 % males vs. 16 % females).
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 that can be attributed to intravenous drug use has declined from 69.7 % in 1990 to 34.4 % in 2008. Regarding new HIV infections, in 2009, total of 184 new HIV cases were diagnosed among injecting drug users, while in 2008, 214 new HIV cases among injecting drug users were detected. The proportion of new HIV cases attributed to injecting drug use has declined from 19.9 % in 2004 to 8.2 % in 2008.This decrease might be related to the improvement of access and availability of maintenance treatments with methadone and the notable decrease of injecting drug use compared to other consumption patterns.
The national overall prevalence of HIV infection among injecting drug users in Spain (using data on drug treatment demand) in 2008 was 32.5 % among ever in life drug injectors (out of 8 126 people who were aware of their HIV test status).
Drug-related deaths
Since 1993, Spain has had a special registry (SR) based on forensic and toxicological sources that collects data on deaths due to acute reactions to drugs in some geographical areas (covering approximately 50 % of the Spanish population). 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. From 2003 onward, deaths started to be registered for the 10–64-year old group. In 2008, 424 drug-related deaths were registered by the Special Registry (SR).
Apart from the latter, the Spanish General Mortality Register (GMR) also provides information on deaths related to drug use. In 2008, 540 drug related deaths were registered by the GMR, 87 % of them were among males. However, this registry is believed to underestimate (40 %) the number of drug-related deaths when compared with the registered figures in the SR.
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 and fell to 518 in 2006 and remained relatively stable since then.
Treatment responses
In Spain, the implementation, management and evaluation of the resources and programmes for providing care for drug users come under the authority of the Autonomous Communities (Regions) and Autonomous Cities. Each of them is entitled to organise 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 remainders keep it as a separate network, although connecting with the general healthcare system.
The Government Delegation for the National Plan on Drugs, based within the Ministry of Health, Social Policy and Equality is responsible for monitoring and collecting data at national level on the above-mentioned activities.
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 Central Government, Autonomous Communities and Cities and some municipalities, mainly in the case of big cities.
There is a specific drug dependence care network which is widely distributed throughout the country. The majority of services in Spain are outpatient facilities, which are publicly owned. Healthcare and treatment are provided by the Autonomous Communities and Cities both for drug abuse disorders and for the rest of diseases as well.
In 2008, this care network included 491 outpatient facilities, where approximately 80 400 patients were assisted, 50 inpatient detoxification units, where 3 628 users were assisted, 129 therapeutic communities where 6 593 drug users were admitted and approximately 2 700 points where methadone substitution treatment was prescribed/dispensed.
The use of methadone was introduced and ruled in 1990 and the latest available estimate of the total number of patients in methadone maintenance programmes in 2008 was 81 390.
Both, buprenorphine and buprenorphine/naloxone combination are commercially available, under medical prescription, although its use is not widely spread. In 2009, around 15 clients were receiving this treatment. There is no general rule for public financing: some Regional Plans on Drugs financed this kind of treatment and some others do not.
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. According to the amended Spanish Royal Decree 5/1996, methadone and buprenorphine treatment can be initiated by specialised medical doctors and treatment centres. 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, overdose prevention activities, sterile material, emergency care and assistance to injecting drug users who are not usually in contact with any assistance intervention. Around 41 500 drug users have been assisted at harm reduction programmes in 2008 (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 2009, NSPs were readily available and distributed about 3 422 000 syringes. Seven facilities for supervised drug consumption were available in the regions: Madrid (one facility), Catalonia (five facilities) and the Basque Country (one facility) in 2008.
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 the Andean region in South America, practically all hashish seized comes from territories under Moroccan control, heroin from Afghanistan via Turkey and the Balkan route, 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 (CICO). 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 2009, a significant increase in the seizures of cannabis resin and herbal cannabis was registered, although amounts seized were lower than in previous year. In 2009, 227 539 seizures resulted in 444 581 kg of cannabis resin seized, but 86 015 herbal cannabis seizures resulted in 1 673 kg of herbal cannabis seized. After the steady increase in the quantity of ecstasy tablets seized between 2006 and 2008, in 2009, the quantity of seized ecstasy declined to 404 380 tablets. Although the number of heroin seizures increased in 2009, the amounts seized decreased from 548 kg seized in 2008 to 300 kg in 2009. The total number of cocaine seizures also increased in 2009, however the amount seized was slightly lower than in 2008 (25 349 kg and 27 981 kg respectively) and since 2006, continues a downward trend. Both the number of amphetamine seizures and the quantity of amphetamine seized in 2009 exceed the 2008 figures.
In 2009, a total of 397 620 drug law offences were reported, out of which 81.3 % were cannabis offences, followed by 13.1 % for cocaine offences and 2.8 % 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. 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.
With regard to emerging new psychoactive substances, 2-benzylpiperazine was brought under control in Spain in 2009.
National drug strategy
A new Spanish National Drug Strategy (2009–16) was adopted in early 2009 and it was complemented in October of that year by a new drugs action plan 2009–12. The strategy, which is comprehensive and focuses on illicit drugs, alcohol and other substances, has five fields of action: demand reduction (prevention, risk reduction and harm reduction, treatment and social reintegration); supply reduction; improvement of basic and applied scientific knowledge; training; and international cooperation. Two specific chapters of the strategy are also devoted to its coordination and to its evaluation. The strategy has several objectives, including diminishing the use of legal and illegal drugs, to delay the age of initiation of contact with drugs, to guarantee quality assistance, adapted to the needs of all people affected by drug use, to reduce or limit the harm caused to drug users health and to facilitate their social integration. The complementary action plan includes 68 actions to be implemented until 2012 with a mention, for each action, of the responsible party as well as the indicator for evaluation and the corresponding data source.
Spain has also developed a specific Action programme against cocaine 2007–10 which is structured around four main areas: coordination, demand reduction, international cooperation and supply control. By the end 2009, more than 300 actions have been initiated in the framework of the programme.
Coordination mechanism in the field of drugs
The drug policy is coordinated by an Inter-ministerial Group, chaired by the Minister for Health, Social Policy and Equality, and including the Ministers for Foreign Affairs and Cooperation, Justice, the Interior, Education, Work and Immigration and Territorial Policy and Public Administration, as well as several Secretaries of State. 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 Plan on Drugs. It has the status of a Directorate-General and reports to the General Secretary for Social Policy of the Ministry of Health, Social Policy and Equality. The Government Delegate for the National Plan on Drugs is the National Coordinator of the drug policy in Spain.
The Sector Conference (political scope) of the National Plan on Drugs is the means of cooperation between the Central Government and the Administrations of the Autonomous Communities and Cities. 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 drug policy in their respective territories.
The Inter-autonomic Commission (management scope) 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 (commonly known as Regional Drug Commissioners).
So, there is a Drug Commissioner in each one of the 17 Autonomous Communities and in two Autonomous Cities (Ceuta and Melilla). They communicate with the Government Delegation through their participation in the Inter-autonomic Commission and the Sector Conference.
The Joint Congress-Senate Commission for the Study of drug problem consists of parliamentarians, has political mandate and its scope of work is limited to parliamentarian actions.
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, the Spanish Network on Addictive Disorders 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. Recent drug-related studies mentioned in the 2010 Spanish National report mainly focused on aspects related to responses to the drug situation, but research on prevalence, determinants and consequences of drug use are also reported.
