Country overview: Turkey
- 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-related offences
- National drug laws
- National drug strategy
- Coordination mechanism in the field of drugs
- Public expenditure
- Drug-related research
|Year||EU (27 countries)||Source|
|Population||2011||73 722 988||502 476 606 p||Eurostat|
|Population by age classes||15–24||2011||17.0||:||Eurostat|
|GDP per capita in PPS (Purchasing Power Standards) 1||2010||49||100||Eurostat|
|Total expenditure on social protection (% of GDP) 2||2009||:||29.5 % p||Eurostat|
|Unemployment rate 3||2011||8.8||9.7 %||Eurostat|
|Unemployment rate of population aged under 25 years||2011||16.8||21.4 %||Eurostat|
|Prison population rate (per 100 000 of national population) 4||2010||165.9||:||Council of Europe, SPACE I-2010|
|At risk of poverty rate 5||2010||:||16.4 %||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, 2010.
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).
To date, no representative nationwide general population survey was carried out in Turkey. However, in 2010, a pilot study was conducted in Ankara province, and the first general population study is proposed to take place in 2011.
In 2003, an ESPAD survey, (6 149 sample size) for those aged 15–16 years, has been conducted in six metropolitan cities (Adana, Ankara, Diyarbakır, İstanbul, İzmir and Samsun). According to the result of this study, 5 % of the sample reported the use inhalants at least once in their life (lifetime prevalence), 4 % cannabis, 2 % ecstasy, 2 % heroin, and 2 % cocaine. Last-year prevalence for cannabis use was reported by 5 % and last-month prevalence by 3 % of the students.
Universal drug prevention in Turkish schools falls under the responsibility of the Ministry of Education and on a local level, provincial steering committees chaired by deputy governors have been established to prepare action plans in line with the needs of their provinces.
The main prevention programmes undertaken in Turkey focus on increasing awareness of drugs and dissemination of information; however, some initiatives to increase individual and social skills among young people; and to reinforce environments that may deter drug-taking among vulnerable populations have been recently launched.
Prevention programmes are mostly targeted at young people through seminars, discussion panels and conferences. Standardised programmes are rare. Various conferences, seminars, theatre performances and awareness-raising activities are organised mainly by the Ministry of Interior–Turkish National Police, around the themes of alcohol and drug addiction. Recently, the Ministry of Health has launched a ‘Life-skills based training programmes’ for 10-to-19-year old young people, implemented by peer-trainers and counsellors. A peer education programme is started also at Duzce Provincial National Education Directorate.
There are some family-based prevention projects, partially targeted at vulnerable families. Also, the few selective prevention interventions are preponderantly focused on awareness-raising and information provision, while existing children and youth centres provide some social help and referrals to treatment institutions to homeless children and young people.
Indicated prevention is not developed yet.
No research studies on effectiveness and outcomes of prevention interventions have been undertaken yet.
View ‘Prevention profile’ for additional information.
In 2009, a population size estimate of problem opiate users was performed using the mortality multiplier method. The study suggests that there are around 17 392 opiate users (lowest estimate 15 197; highest estimate 36 246) which correspondents to a rate of 0.3 opiate users per 1 000 population aged 15–64.
Further to that, in 2008, a capture–recapture study was implemented in Istanbul, Ankara and Izmir to estimate the population of problem drug users. Police or criminal justice, health and social security data from the respective cities were used for the study. The estimates for Istanbul and Ankara were calculated, while it was not possible to provide data on the PDU population in Izmir, because the data sources did not yield any overlaps.
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 data in Turkey is provided by the Directorate-General for Treatment Services of the Ministry of Health. In 2010, data are reported from 15 out of 22 inpatient treatment centres. The data from outpatient services are not reported due to limited staff resources and lack of appropriate data collection tools for these settings.
During 2010, a total of 2 900 inpatient clients entered treatment, out of which 1 657 were first-time clients. Data regarding treatment clients suggest that 69.1 % of all clients entering treatment reported opioids as the primary drug, followed by 18.2 % for cannabis and 2.2 % for cocaine. Among first-time treatment clients, likewise distribution was identified, with 65.4 % for opioids, followed by 21.2 % for cannabis and 1.6 % for cocaine.
Furthermore, in 2010, 38 % of all clients entering treatment were aged less than 25 years. A higher percentage in age distribution was reported among new treatment clients, with 45 % under the age of 25 years. As far as gender distribution is concerned, 94.8 % of all clients were male, whereas a relatively smaller proportion of 5.2 % were female. A similar distribution in gender was reported among first-time treatment clients with 96.4 % for male and 3.6 % for female.
In 2010, around 604 hepatitis C and 3 099 hepatitis B cases were diagnosed in Turkey, however, the proportion of the cases linked to injecting drug use is unknown.
Regarding HIV, data from the Ministry of Health General Directorate of Essential Health Services, recorded a total of six IDUs declaring being HIV positive in 2009.
The first sero-behavioural study among 168 IDUs was carried out in Gaziantep in 2009. The testing revealed no IDUs infected with HIV, however, the HCV prevalence was 5.3 %, while 42.9 % of the sample tested positive for HBV.
HBV, HCV and HIV testing is implemented also among injecting drug users admitted to the Alcohol-Substance Addiction Research, Therapy and Education Centre (AMATEM). In 2010, out of 644 persons, 0.5 % tested positive for HIV. With regard to HBV, testing revealed 4 % of positive results among 618 tested clients, while 33 % positive tests were revealed among 666 tested AMATEM clients.
Until 2005, data on drug-related deaths were collected and accessible through police records. In 2006, within the framework of the Phare project and in direct collaboration with the EMCDDA, a special working group on drug-related deaths data was created. This new working group is composed of three main partners. The Ministry of Justice–Council of Forensic Medicine; Turkish National Police Department of Anti-smuggling and Organised Crime and the General Command of Gendarmerie Department of Anti-smuggling and Organised Crime.
In 2010, there were 126 drug-related deaths reported (153 in 2009, 159 in 2008, 147 cases in 2007 and 51 cases in 2006), with 94.4 % being male and with a mean age of 34.2 years. The toxicological analysis confirmed that opiates (alone or in combination with other substances) were involved in 88.9 % of reported death cases.
The implementation of drug-related treatment in Turkey falls under the responsibility of the state, where the Science Committee for Methods of Drug Addiction treatment is responsible for the national coordination of drug-related treatment. The main tasks of this committee are to monitor, accredit and evaluate treatment services.
The treatment is provided through the Alcohol-Substance Addiction Research, Therapy and Education Centres (AMATEMs), psychiatric clinics of public hospitals under the Ministry of Health, and university-based treatment units. In 2010, a total of 22 treatment units are active. The funding for drug treatment services is mainly provided by the state through health or social insurance funds, or is compensated by state in special occasions, or covered by the social solidarity fund.
The majority of treatment services for problem drug users are aimed at dealing with addiction in general and not specifically for users of illicit drugs. Treatment programmes aimed at achieving a future drug-free life is the main approach adopted by Turkish treatment programmes. The interventions consist of psychotherapeutic methods and supporting methods, with the majority of drug-related treatment services taking place within inpatient settings.
In 2009, a combined buprenorphine and naloxone medication has been licensed in Turkey and its use in drug addiction treatment for detoxification and substitution since 2010.
View ‘Treatment profile’ for additional information.
The third ‘National strategic AIDS action plan for the years 2007–11’ was adopted in 2006. This action plan includes targets and strategies concerning prevention, diagnosis and increased access to treatment, increased education, development of legislation, social support, monitoring, and evaluation of activities regarding HIV/AIDS/HBV/HBC.
Currently, the needle and syringe exchange programmes are available in Turkey.
Turkey is located in the region that is affected by three main heroin drug trafficking routes, namely: the Balkan route, the northern (Black Sea) route and an eastern Mediterranean route. The Balkan route directly affects Turkey. Cocaine enters Turkey from South America for mainly domestic use. Cannabis is mainly produced for domestic market, however, there is cannabis resin entry from Syria and Iran in small amounts. Turkey has a long territory on the so-called Balkan transit route for opium and its derivatives originating from Afghanistan en route to Western Europe. Captagon (amphetamine) tablets originating in eastern Europe are smuggled through Turkey en route to countries in the Middle East, while there is also an opposite route from Syria to Turkey. The last, however, is used to smuggle the substance for the domestic market. In 2009, methamphetamine, originating from Iran, was seized for the first time in Turkey. The investigation indicated that Turkey was used a transit country, and the substance was smuggled into the country for further transportation to the South-eastern Asia region. Ecstasy seized in Turkey originates in the Netherlands and Belgium, although in 2010 one clandestine laboratory producing ecstasy was also seized in the country. Ecstasy trafficked to Turkey is mainly for the domestic market, although it targets larger urban and touristic areas along the Mediterranean and Aegean coastline.
In 2010, the total number of drug-related offences, which resulted in drug seizures, amounted to 81 960, which is almost two times more figures registered in 2009. Most offences (90.5 %) were related to cannabis, followed by 5.1 % for heroin related offences and 1.7 % for ecstasy and 1.5 % for cocaine.
The increase in the number of drug-related offences was followed also by an increase in the number of seizures for all drugs, except amphetamines in 2010. Data available since 2003 showed an increase in the quantity of cannabis resin and herbal cannabis seized (816 kg in 2003 to 29 156 kg in 2010 and 7 007 kg in 2003 to 414 154 kg in 2010 respectively). In a total of 11 271 seizures of cannabis plants, around 3 766 plants were seized. The quantity of heroin seized has also shown a sharp increase since the beginning of the century, from 3 710 kg in 2001 to 16 059 kg in 2009, while in 2010 only 12 690 kg were seized. In 2010, there was a record number of 1 249 cocaine seizures and record amount of 302 kg of the seized substance reported. The decline is ecstasy seizures registered between 2006–09, was intercepted in 2010 by a raise in the number seizures to 1 371 and resulted in doubling of the seized amounts when compared to 2009 data (432 513 tablets in 2009 and 924 861 tablets in 2010). The number of methamphetamine seizures continued to rise following the first seizures in 2009 and total of 126 kg of the substance was seized in 2010.
According to the Turkish Penal Code, which came into force in 2005, it no longer criminalises consumption per se, but outlines prison sentences of one to two years for those who buy, receive or possess drugs for personal use; there is also the option of treatment and/or probation for up to three years. If addicts refuse treatment or do not comply with probation requirements, the courts can decide on sentencing. There is also the possibility of judicial supervision rather than arrest under the Penal Procedure Code, for manufacture and dealing with drugs (Article 188), with a maximum possible sentence of three years. For any offence committed under the influence of drugs, there is no penalty for an offender who could not comprehend or control his actions (this exemption will not apply if the drugs were taken deliberately). Instead, such offenders and those posing a serious threat to society due to addiction, may be sent to a secure institution for treatment and protection. The Turkish Civil Code, however, has provisions which may restrain activity or place drug users in a health or educational institution or detain in a case his/her drug use poses a significant threat in term of safety and security to others.
Production and import or export of drugs are punished by a minimum sentence of 10 years, and sale or supply by a sentence of 5–10 years. In this case, punishments are linked to drug type, with a specific requirement to increase the above sentences by 50 % if the drugs involved are cocaine, heroin, morphine or morphine base; a similar increase is obliged for involvement of organised crime, or individuals in positions linked to legal trade such as doctors, pharmacists, health officers, etc.
In 2008–09, two new psychoactive substances, BZP and m-CPP, were put under control in Turkey.
Turkey’s National Policy and Strategy Document on Counteracting Addictive Substance and Substance Addiction 2006–12 replaces the former Strategy Document on Preventing, Monitoring and Management on Drug Addiction 1997–2006. The new strategy is comprehensive, focuses mainly on illegal drugs and covers the same five pillars as in the EU strategy: coordination, supply reduction, demand reduction, international cooperation, and information/research/evaluation. It also has 12 main objectives, among which are: (1) preventing addictive substance trafficking and abuse, and (2) protecting the whole population and risk groups. The new strategy is complemented by an action plan for the period 2007–09 which was adopted in December 2007. This plan was evaluated in early 2010 and is replaced by a second national action plan for the years 2010–12.
View ‘National drug strategies’ for additional information.
The Narcotic Coordination Committee has been established recently through the first action plan, and is covering all aspects of the drug phenomenon, not only addiction. This committee consists of all relevant representatives of Ministries. The Turkish Monitoring Centre for Drugs and Drug Addiction (TUBIM), a division affiliated to the General Directorate of Security /Anti-Smuggling and Organized Crime Department, coordinates correspondents all over the country. As of mid-2010, provincial coordination committees are set up in 65 out of total of 81 provinces.
In Turkey, the financing of drug-related activities is decided annually by the entities in charge of their implementation. The reporting of drug-related public expenditures is limited and incomplete. Therefore, it is not possible to provide an estimate of drug-related public expenditure for this country.
In the past, research was mainly carried out by professionals in treatment centres. Recently, there is an increasing interest in the field of drug-related research with the support of the EMCDDA, through the national focal point. There is no specific budget for public institutions to carry out drug research, but funds are available for some studies. There are a few NGOs that carry out drug research. In recent years, the national focal point, thanks to different EU projects, has been promoting research in this field amongst partners and universities. Some studies such as PDU estimation in three cities, pilot GPS and infectious diseases have already been put in place. Publication on this field is limited but a national addiction congress takes place every year.
Recent drug-related studies mentioned in the 2011 Turkish National report mainly focused on aspects related to the consequences of drug use, but studies on responses to the drug situation and on prevalence of drug use are also mentioned.
View ‘Drug-related research’ for additional information.