• 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-law offences
• National drug laws
• National drug strategy
• Coordination mechanism in the field of drugs
• Public expenditure
• Drug-related research

Drug use among the general population and young people

A general population survey on drug use (EDADES), targeted at people aged 15–64 living in family households, has been carried out in Spain on a biennial basis since 1995. The latest survey, in 2011, found that cannabis was the most commonly used illicit substance in Spain; 27.4 % of the respondents reported lifetime use of cannabis, followed by cocaine (8.8 %), ecstasy (3.6 %) and amphetamines (3.3 %). In 2011, last year prevalence of cannabis was 9.6 % (10.6 % in 2009; 10.1 % in 2007; 11.2 % in 2005), and last month prevalence was 7.0 % (7.6 % in 2009; 7.1 % in 2007; 8.7 % in 2005). Between 2007 and 2011 the proportion of monthly and daily users of tobacco slightly decreased when compared to the 2009 figure. Alcohol use was fairly stable. The prevalence of use of tranquillizers increased in 2011, making them the third most prevalent psychoactive substances after tobacco and alcohol.

Lifetime prevalence of cannabis use decreased slightly between 2009 and 2011, and continuity of use is fairly low. Only a third of those reporting ever having used cannabis had done so within the last year, and a quarter within the last month. Cannabis use remains more prevalent among males than females in all age groups; however, the gender gap is narrowing, especially among people aged 25 and over. Lifetime and last year use of cocaine chlorhydrate fell from 10.2 % in 2009 to 8.8 % in 2011. Experimentation with base cocaine (crack) was at the same level as in 2009. Amphetamines and ecstasy use also remained stable or fell, and heroin use remained at low levels. The study estimated prevalence of use of new psychoactive substances for the first time, and found that 3.6 % of adults reported ever having used them, with the highest prevalence rates among respondents aged 19–34. As with other illicit substances, use of new psychoactive drugs was reported more by males than females.

Use of illicit psychoactive drugs is concentrated in sub-groups of people who have often used several different drugs in a given period. Polydrug use remains a very common consumption pattern, with about half of those who used psychoactive substances reporting having used two or more substances in a given period, with licit drugs (particularly alcohol) almost always present and greater prevalence among those aged 18 and over. A significant proportion of the population perceives a relatively low associated risk for certain drug-related behaviours, such as ‘drinking five or six glasses of alcoholic drinks’ at the weekend or daily, or ‘regular (once a week or more frequently) use of tranquillizers/sleeping pills’, or ‘trying cocaine or ecstasy once or twice’. Between 2009 and 2011 the associated risk perception of most types of drug-related behaviours remained unchanged. However, risk perception with regard to the weekly and monthly use of cannabis increased. For the same period there was a decrease in the perceived availability of the main illicit drugs.

The most recent national survey on drug use among students aged 14–18 (ESTUDES) was conducted in 2010. It found that the most commonly used illegal drug was cannabis, with lifetime prevalence among the subgroup of 15- to 16-year-olds of 32 %, compared to 41 % in 2004. Lifetime prevalence rates for other illegal drugs were 3 % for cocaine and hallucinogens, 2 % for ecstasy, amphetamines and inhalants, and 1 % for heroin. Among 17- to 18-year-olds, the lifetime prevalence rates for cannabis were 49 %, followed by cocaine at 7 %. Use of cannabis in the past 30 days was reported by 26 % of the sample.

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Prevention

In Spain, drug prevention is organised and financed through the National Plan on Drugs, and at the level of autonomous communities through Municipal Drug Plans, while community-based programmes may also receive funding from the fund of assets seized from illicit drug trafficking and other related offences. The main features of prevention policy are strong cooperation with the educational system, high coverage of the school population with school-based prevention programmes, and important interventions in selective and indicated prevention areas.

Schools continue to be the preferred settings for universal prevention work in autonomous communities, with a wide variety of structured prevention programmes in the classrooms, extracurricular activities and also facultative training. Community-based prevention programmes organised by health centres are also increasingly available in schools. These programmes aim to increase the engagement of the health centre sector as points of reference in school- and community-based prevention. Their stress is on information provision, through a range of support materials. Schools provide parents with educational talks, distribute materials, and offer orientation and guidance services and informal courses. Increasing numbers of ‘parents’ schools’ are also available online, which inform parents about drugs and give advice about parenting skills. Prevention programmes based in universities have emerged in recent years. These programmes focus mainly on information provision and awareness raising, apply mainly peer-education methods and are delivered either online or via students’ university residences.

Universal community-based prevention programmes are largely provided through 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; however, their number has declined in recent years. Programmes conducted in places where drug use is common, such as around bars, nightclubs and music concerts, are carried out by peer mediators who work to identify problematic cases and provide information and advice about drugs and their various forms of use. In 2009, under the Working Agreement between the Government Delegation for the National Plan on Drugs and the Spanish Hotels and Catering Trade Federation, a special training programme was initiated on how to prevent and reduce the risk of drugs and promote the responsible serving of alcohol among professionals in the industry.

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 minors experiencing academic difficulties in schools. There are also selective prevention programmes for families at risk, female former drug users with children, and specific programmes for ethnic minorities, and for young people 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.

Mass media campaigns continue to play a major role, while less effort is put into environmental strategies.

View ‘Prevention profile’ for additional information.

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Problem drug use

Between 1999 and 2002 several estimates of problem drug use were made, applying the demographic and multiplier methods. In 2010 the number of problem opiate users (heroin in particular) was estimated at 1.2 per 1 000 inhabitants aged 15–64 (95 % CI, 1.1–1.3), based on the treatment multiplier method. This means that on average 38 500 problem opiate users were estimated to be living in 2010 in Spain. With regards to problem injecting drug users, the estimated average number in 2010 was 7 393 people (7 098–7 886), based on treatment data, the majority of whom were using heroin or other opiates. The 2012 Annual report also discusses the estimated number of problem opioid, injecting, cocaine and cannabis users in Spain, which are based on multipliers derived from the most recent general population study and the European School Survey Project on Alcohol and Other Drugs (ESPAD). Incidence estimation studies showed a sharp decline in the number of new problem heroin users and an increase in new problem cocaine users, in a longer-term perspective.

Up to 2012 the 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.

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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 2010 the data on treatment demand was gathered from 507 outpatient treatment centres and treatment units in prisons.

A total of 53 508 clients entered treatment in 2010, of which 26 805 were first time treatment clients. Data on people entering drug treatment showed that cocaine (chlorhydrate and/or crack) was the primary drug for 41.4 % of all clients, followed by opioids (34.3 %) and cannabis (21.0 %). Among those who entered treatment for the first time, 45.3 % were treated for cocaine, 32.3 % for cannabis and 18.2 % for opioids. Injecting drug use has fallen dramatically in the past 30 years among those admitted to treatment, regardless of the primary substance. Thus in 2010, among all opioid users admitted to treatment, only 15.8 % injected the drug while among new treatment clients one in ten opioid users injected it. Polydrug use prevails among Spanish treatment clients, with around two-thirds of the treatment clients reporting using two or more substances within 30 days prior to admission for treatment.

In 2010 some 20 % of all clients entering treatment were under the age of 25, while 45 % were aged 35 years and over. Among new treatment clients, the proportions of those under the age of 25 and aged 35 years and over were similar, at 30 % and 32 % respectively. In terms of gender distribution, 85.1 % of all clients entering treatment were male and 14.9 % were female. A similar gender distribution was reported among new treatment clients (84.5 % male and 15.5 % female).

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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 declined from 69.7 % in 1990 to 28 % in 2010. Regarding new HIV infections, 148 new HIV cases were diagnosed among injecting drug users in 2011. The number of new HIV cases among injecting drugs users and the proportion of new HIV cases attributed to injecting drug use also declined significantly from 2004 to 2011. This decrease might be related to the improvement in access to, and availability of, maintenance treatments with methadone and the notable decrease of injecting drug use compared to other consumption patterns.

In 2010 the national overall prevalence of HIV infection among injecting drug users, using data on drug treatment demand, was 33.6 % of 7 243 people tested. The decline in HIV prevalence among injecting drug users is also confirmed by data from EPI-HIV group and hospital HIV/AIDS survey.

Viral hepatitis B and C is not yet systematically monitored in Spain. However, data from different published studies indicate that from 73.3 % to 85.9 % of injecting drug users might be infected with hepatitis C virus, while up to 22.5 % of injecting drug users might be infected with hepatitis B virus.

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Drug-related deaths

Since 1993 Spain has had a Special Registry (SR) based on forensic and toxicological sources that collects data on deaths caused by acute reactions to drugs in specific 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) amongst those aged 15–49. From 2003 onward the age group registered has been expanded to cover those aged 10–64. In 2010 the SR registered 517 drug-related deaths.

In addition to the SR, the Spanish General Mortality Register (GMR) also provides information on deaths related to drug use. In 2010 the GMR registered 393 drug-related deaths, 84 % of which were males, and the average age was 39 at the time of death. 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 an acute reaction to drugs fell between 1999 and 2001, remained stable until 2005 at approximately 670, and has since resumed a downward trend.

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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 region is entitled to organise and deliver health interventions according to its own plans, budgets and personnel. Some have integrated treatment for drug abuse disorders within primary care units, some within mental health services, and some have a separate treatment network that retains a connection with the general healthcare system. As a general rule, care is organised on three levels. The level of primary health care acts as gatekeeper, the secondary level provides integrated treatment services, and tertiary level care units supply highly specialised and long-term care, such as detoxification or residential treatment.

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 the national level on the above-mentioned activities.

The public sector is the primary provider of treatment, followed by non-government organisations (NGOs) and private organisations. In Spain, drug treatment is mostly funded by the public budget of the central government, autonomous communities and cities and by some municipalities, usually the big cities.

A specific drug dependence care network is widely distributed throughout the country. The majority of services are provided through outpatient facilities, which are publicly owned. Healthcare and treatment for drug abuse, and for other diseases, are provided by the autonomous communities and cities.

In 2010 this care network included 526 outpatient facilities that treated approximately 93 300 patients, 53 inpatient detoxification units that treated 3 984 users, 128 therapeutic communities that admitted 7 596 drug users and 2 526 points where methadone substitution treatment was prescribed/dispensed.

Methadone was introduced and licensed as a treatment in 1990; the latest available estimate of the total number of patients in methadone maintenance programmes in 2010 was 81 022.

Buprenorphine and buprenorphine/naloxone combinations are commercially available under medical prescription, although their use is not widespread. In 2010 around 1 350 clients were receiving this treatment. There is no general rule for public financing — some regional plans on drugs finance this kind of treatment, and 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.

View ‘Treatment profile’ for additional information.

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Harm reduction responses

National priorities for 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 41 social emergency centres, 30 mobile units and 1 526 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. Public outpatient clinics, and several NGOs, also carry out harm reduction activities. In 2011 a total of 1 029 NSPs distributed about 2.7 million syringes. Eight facilities for supervised drug consumption were available in the regions: Madrid (one facility), Catalonia (six facilities) and the Basque Country (one facility).

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Drug markets and drug-law offences

Due to its geographical position, Spain is one of the countries in the European Union most targeted by international drug traffickers. According to information from law enforcement agencies, seized cocaine generally originates from the Andean region in South America and is destined for other European countries; practically all hashish seized comes from territories under Moroccan control; heroin comes from Afghanistan via Turkey and the Balkan route; and synthetic drugs are smuggled into Spain from the Netherlands and Belgium.

In Spain, data on the number and quantity of drug seizures are reported by the Criminal Intelligence Central Unit at the Ministry of Interior (CICO). In 2011 a record number of 140 952 herbal cannabis seizures resulted in 17 535 kg of the substance seized, which is almost nine times more than in 2010. The number of cannabis resin seizures increased again in 2011, but the amount seized was lower than in previous years. In 2011 some 199 770 seizures resulted in 355 904 kg of cannabis resin seized, highlighting a declining trend since 2008. With regards to cocaine, the total number of seizures was slightly higher than in 2010, while the amount seized (16 609 kg) was the lowest recorded since 2002, and a slight downward trend has been noted since 2006. The number of heroin seizures continued to decline in 2011, with 412 kg seized; this quantity is more than in 2009 and 2010. Following an increase in the number of ecstasy tablets seized in 2010, the number seized fell almost three times in 2011. The number of amphetamine seizures increased in 2011,with a slight drop in the quantity seized in 2011 when compared to 2010.

In 2011, a total of 415 354 drug-law offences were reported, of which 84.6 % were cannabis offences, followed by 10.8 % cocaine offences and 2.0 % heroin offences.

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National drug laws

The Law on the Protection of Citizens’ Security (1992) classes drug consumption in public and illicit possession as serious order offences punishable by administrative sanctions. In 2010 the organic law enacted amendments to the penal code in reference to drug-related provisions. Fines are the usual punishment, but the law anticipates that the execution of the fine can be suspended if the person freely attends an official drug treatment programme. For trafficking, Spanish law lays down penalties in line with the seriousness of the health damages associated with the drugs and any aggravating and mitigating circumstances that may exist, such as sale to minors under 18 or the sale of large quantities. Penalties can be up to 20 years and 3 months in prison, with such long terms reserved for cases with aggravating circumstances. When no such circumstances exist, sentences can be between one to three years if the drugs do not cause serious health damage, and, in line with the amendments enacted in 2010, up to six years when they do. The new provision of the penal code allows the courts to impose lesser sentences in cases where there are no aggravating circumstances and to change the applicable prison sentences for a crime committed within a criminal organisation, based on the role of a person in such an entity. In all cases, a fine is also imposed. In 2011, the Royal Decree 840 set out a procedure for the suspension of enforcement of prison sentences of five years and less for those sentenced for offences committed due to the use of illicit substances in cases when the offender agrees to participate in a treatment programme.

With regard to emerging new psychoactive substances, ketamine was brought under control in Spain in 2010, and mephedrone and tapentadol in 2011. In 2011 a procedure was adopted allowing new psychoactive substances to be classified as narcotic drugs at the national level.

View ‘Legal profile’ for additional information.

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National drug strategy

A new Spanish National Drug Strategy (2009–16) was adopted in early 2009. 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 evaluation. The strategy has 14 objectives, including: reducing the use of legal and illegal drugs; delaying the age of first contact with drugs; guaranteeing quality assistance adapted to the needs of all people affected by drug use; reducing or limiting the harm caused to drug users’ health; and facilitating their social integration.

The first of two four-year action plans to implement the strategy was adopted in October 2009 covering the period through to the end of 2012. Containing the same fourteen objectives as the national strategy, the plan is organised into six areas: coordination; demand reduction; supply reduction; improvement of knowledge; training; and international cooperation. It includes 68 actions and identifies those responsible for delivering them, as well as the indicators to be used for evaluation and the respective data sources. An evaluation of the National Action Plan 2009–12 has been conducted and a new National Action Plan for the period 2013–16 is being developed.

Spain also developed a specific Action Programme Against Cocaine 2007–10, structured around four main areas: coordination; demand reduction; international cooperation; and supply control. By the programme’s conclusion at the end of 2010, some 520 actions had been undertaken within its framework.

At the regional level, all of Spain’s 17 autonomous communities have developed regional strategies that address drug dependency issues. In 2011 Catalonia, Galicia and the Basque Country launched revised strategies, while Navarre developed a new document in 2012.

View ‘National drug strategies’ for additional information.

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Coordination mechanism in the field of drugs

In Spain, drug policy is coordinated by an inter-ministerial group chaired by the Minister for Health, Social Services 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 Delegate for the National Plan on Drugs carries out the function of coordinating the different institutions at the central administrative, regional/autonomous community and local administrative levels that are included in the National Plan on Drugs. The role 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 drug policy in Spain.

The sectoral conference (at the political level) of the National Plan on Drugs is the means of cooperation between the central government and the administrations of the autonomous communities and cities. Chaired by the Minister for Health, Social Services and Equality, 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 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, which 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).

There is a drug commissioner in each 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 the Drug Problem consists of members from both chambers in the Spanish Parliament (Congress of Deputies and Senate). It writes reports on drug issues and makes proposals to the government in this area.

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Public expenditure

In Spain the national drug strategy and action plans have no associated budgets and there is no review of executed expenditures. One study looked at the social costs of drug use and included an estimate of drug-related expenditures. (¹) The study did not, however, distinguish between public and private expenditure.

Spanish authorities provide a partial estimate of drug-related public expenditures by central government and autonomous regions (communities and cities) every year. However, the estimate covers neither all sectors nor all regions and includes mostly labelled expenditures. (²) Comparability over time is limited because reporting entities and data collection methods have changed.

In 2010, labelled public expenditures were estimated to represent 0.04 % of GDP. Most of the funds (67.9 %) were spent by the autonomous communities and cities, and central government spent 32.1 %. In the autonomous regions, 79.3 % went to treatment, 16.1 % to prevention and the rest to research and institutional cooperation.

The available information does not allow the total size and trends in drug-related public expenditures to be reported.

(¹) A. Garcia-Altes, J.M. Olle, F. Anoñanzas and J. Colom (2002), ‘The social cost of illegal drug consumption in Spain’, Addiction 97, pp. 1145–53.

(²) Some of the funds allocated by governments for expenditure on tasks related to drugs are identified as such in the budget (‘labelled’). Often, however, the bulk of drug-related expenditure is not identified (‘unlabelled’) and must be estimated by modelling approaches. The total budget is the sum of labelled and unlabelled drug-related expenditures.

View ‘Public expenditure profile’ for additional information.

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Drug-related research

In Spain, biomedical research and health sciences 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 coordination 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 2012 Spanish National report mainly focused on aspects related to consequences of drug use, but research on prevalence of drug use is also reported.

View ‘Drug-related research’ for additional information.

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