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-law 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||2012||74 724 269||503 663 601 b p||Eurostat|
|Population by age classes||15–24||2012||16.8 %||11.7 % b p||Eurostat|
|25–49||37.5 %||35.4 % b p|
|50–64||13.1 %||19.5 % b p|
|GDP per capita in PPS (Purchasing Power Standards) 1||2011||52||100||Eurostat|
|Total expenditure on social protection (% of GDP) 2||2010||:||29.4 % p||Eurostat|
|Unemployment rate 3||2012||8.1 %||10.5 %||Eurostat|
|Unemployment rate of population aged under 25 years||2012||15.7 %||22.8 %||Eurostat|
|Prison population rate (per 100 000 of national population) 4||2011||171.9||:||Council of Europe, SPACE I-2011|
|At risk of poverty rate 5||2011||:||16.9 % e||SILC |
p Eurostat provisional value.
b Break in series.
1 Gross domestic product (GDP) is a measure of economic activity. It is defined as the value of all goods and services produced less the value of any goods or services used in their creation. The volume index of GDP per capita in Purchasing Power Standards (PPS) is expressed in relation to the European Union (EU-27) average set to equal 100. If the index of a country is higher than 100, this country's level of GDP per head is higher than the EU average and vice versa.
2 Expenditure on social protection contains: benefits, which consist of transfers, in cash or in kind to households and individuals to relieve them of the burden of a defined set of risks or needs.
3 Unemployment rates represent unemployed persons as a percentage of the labour force. Unemployed persons comprise persons aged 15 to 74 who were: (a) without work during the reference week; (b) currently available for work; (c) actively seeking work.
4 Situation of penal institutions on 1 September, 2011.
5 Share of persons aged 0+ with an equivalent disposable income below the at-risk-of-poverty threshold, which is set at 60 % of the national median equivalised disposable income (after social transfers).
The first general population study on the prevalence of drug use in Turkey was conducted in 2011 by the Turkish Monitoring Centre for Drugs and Drug Addiction (TUBİM). The study covered 25 regions (the Van region was not included, as an earthquake occurred there during the study period) with a sample size of 8 045 people aged 15–64, a response rate of 43.9 %. The European Model Questionnaire was adapted to the national context and face-to-face interviews were carried out with the respondents. Around 2.7 % indicated use of any illicit substance during their lifetime, and cannabis was the most prevalent illicit substance ever used, at 0.7 % of the respondents. About 0.3 % of respondents had used cannabis in the past 12 months, while 0.2 % had used it in the last 30 days. Lifetime prevalence rates for amphetamines were reported at 0.3 %, followed by ecstasy at 0.1 %. The highest rates of illicit drug use were reported among males aged 15–34. Thus 1.6 % of male respondents in this age group had ever used cannabis, 0.7 % had used amphetamine and 0.2 % had used ecstasy. The study indicated that among females drug use prevalence increased between the ages of 25–44, and twice as many female respondents reported using tranquilisers or sedatives without a doctor’s prescription.
In 2003 a European School Survey Project on Alcohol and Other Drugs (ESPAD) study with a sample size of 6 149 young people aged 15–16 years was conducted in six metropolitan cities (Adana, Ankara, Diyarbakır, İstanbul, İzmir and Samsun). The study found a lifetime prevalence of 5 % for inhalants, 4 % for cannabis, 2 % for ecstasy, 2 % for heroin and 2 % for cocaine. Last year prevalence for cannabis use was reported by 5 % of the students, and last month prevalence by 3 %.
In 2011 TUBİM conducted an Attitude and Behaviour Survey on Tobacco, Alcohol and Drug Use among students aged 14–19 (second year high school), using a self-administered questionnaire. About 1.0 % of 15-year-old students reported lifetime use of any drug, while the proportion increased to 1.5 % if all respondents were considered. About 0.3 % of all respondents reported ever having used cannabis, although this rate should be treated with caution as it was calculated based on open-ended questions to which responses were frequently not given.
The Ministry of Education has responsibility for universal drug prevention in Turkish schools. At the 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 people’s awareness of drugs and the dissemination of information. Some initiatives have recently been launched that aim to increase individual and social skills among young people and to support environments that may deter drug taking among vulnerable populations.
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.
There are some family-based prevention projects, partially targeted at vulnerable families. At a community level, prevention activities are mainly informative; they are organised by TUBİM Provincial Contact Officers, Provincial Directorates of Public Health and Department of Religious Affairs. The few selective prevention interventions that are available generally focus on awareness raising and information provision, while existing children and youth centres provide some social assistance and referrals to treatment institutions for homeless children and young people.
Indicated prevention has not yet been developed in Turkey.
No research studies on the effectiveness and outcomes of prevention interventions have yet been undertaken.
View ‘Prevention profile’ for additional information.
A population size estimate of problem opiate users has been performed annually since 2007, using the mortality multiplier method. The most recent study, from 2011, suggests that there are around 12 733 opiate users (range: 11 126 to 26 537), which correspondents to a rate of 0.3 opiate users per 1 000 population aged 15–64.
In 2008 a capture–recapture study was implemented in Istanbul, Ankara and Izmir to estimate the population of problem drug users (PDUs). Police or criminal justice, health and social security data from the respective cities were used in the study. The estimates for Istanbul and Ankara were calculated, but it was not possible to provide data on the PDU population in Izmir because the data sources did not yield any overlaps. The study to estimate problem opiate users using capture–recapture methodology was initiated in 2010 using five data sources for the same three cities. While estimates for Istanbul and Ankara where calculated, the study again did not yield results about the estimated size of problem opiate users in Izmir due to the disparity in data sources used for this city. In 2010 the method was also used to estimate the number of problem cannabis users in Ankara and Izmir.
Up to 2012 the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) defined problem drug use as injecting drug use (IDU) or long duration/regular drug use of opiates, cocaine and/or amphetamines. Ecstasy and cannabis were not included in this category. Details are available here.
Treatment demand data in Turkey is provided by the Directorate-General for Health Services of the Ministry of Health. In 2011 data were reported from 11 of 22 inpatient treatment centres. The data from outpatient services were not reported due to limited staff resources and lack of appropriate data collection tools for these settings.
In 2011 a total of 2 117 clients entered inpatient treatment, of which 1 084 were new treatment clients. Some 70.3 % of all clients entering treatment reported opioids as their primary drug, followed by 17.1 % for cannabis and 2.2 % for cocaine. Among new treatment clients a similar pattern was identified, with 64.7 % reporting opioids, mainly heroin, followed by 22.1 % for cannabis and 2.3 % for cocaine.
Some 43 % of all clients entering treatment were under the age of 25. This figure was higher among new treatment clients, with 50 % under the age of 25. With regard to gender, 93.4 % of all clients were male and 6.6 % were female. Among first-time treatment clients 93.5 % were male and 6.5 % were female.
In 2011 around 351 hepatitis C virus (HCV) and 53 hepatitis B virus (HBV) cases with injecting drug use as a likely transmission route were reported in Turkey. However, the data should be treated with caution as the transmission route was missing for about half of all diagnosed HCV cases and about 99 % of all diagnosed HBV cases. Regarding HIV, data from the Ministry of Health General Directorate of Essential Health Services recorded five new HIV cases among IDUs in 2011.
HBV, HCV and HIV testing is also carried out among injecting drug users admitted to the Alcohol-Substance Addiction Research, Therapy and Education Centres (AMATEM). In 2011 some 0.3 % of 716 clients tested were HIV positive. With regard to HBV, testing revealed 7.5 % positive results among 707 clients tested, while for HCV there were 48.6 % positive tests among 722 clients tested.
Up to 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 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–Department of the Institution of Forensic Medicine; the Turkish National Police Department of Anti-smuggling and Organised Crime; and the General Command of Gendarmerie Department of Anti-smuggling and Organised Crime. Following the activities of this working group, the Ministry of Justice–Department of the Institution of Forensic Medicine established a special death registry based on autopsy results from across Turkey, which has became the main source of data on drug-related deaths.
In 2011 some 104 drug-related deaths were reported (126 in 2010; 153 in 2009; 159 in 2008; 147 in 2007). The mean age was 35.9 years at the time of death and 95.2 % were male. Toxicological analysis was used to confirm that opiates were involved in 82.8 % of reported death cases with know toxicological results.
The implementation of drug-related treatment in Turkey falls under the responsibility of the state, and the Science Committee for Methods of Drug Addiction Treatment is responsible for its national coordination. 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 2011 there were 22 active treatment units, and there are plans to increase the number of units in the future. Funding for drug-treatment services is mainly provided by the state through health or social insurance funds, is compensated by the state in extraordinary cases, or is covered by the social solidarity fund.
The majority of treatment services for problem drug users treat addiction in general and are not specifically for users of illicit drugs. The primary approach is through treatment programmes that aim to achieve a drug-free future. The interventions consist of psychotherapeutic and supporting methods. The majority of drug-related treatment services are in inpatient settings.
In 2009 a combined buprenorphine/naloxone medication was licensed in Turkey, and it has been used in drug addiction treatment for detoxification and substitution since 2010. In 2011 there were 8 074 clients in the opioid substitution treatment programme with a buprenorphine-based medication.
View ‘Treatment profile’ for additional information.
The third National Strategic AIDS Action Plan for 2007–11 was adopted in 2006. This action plan included targets and strategies for prevention, diagnosis and increased access to treatment, increased education, development of legislation, social support, and the monitoring and evaluation of activities regarding HIV/AIDS, HBV and HBC.
Currently, the needle and syringe exchange programmes are available in Turkey.
Turkey is affected by three main heroin drug trafficking routes — the Balkan route, the northern (Black Sea) route and an eastern Mediterranean route. Opium and its derivatives from Afghanistan are trafficked through Turkey en route to western Europe. Cannabis is mainly produced for the domestic market, and is subject to local and regional trafficking mainly carried out by family-type structures of 3–15 people. In addition to domestic cultivation, small amounts of cannabis resin are smuggled to Turkey from Iran. Cocaine enters Turkey from South America for domestic use as well as en route to other European countries. Captagon (amphetamine) tablets originating in south-eastern Europe are smuggled through Turkey en route to countries in the Middle East, although there are indications that in recent years production of that substance has moved to the Middle East. No evidence of Captagon production on Turkish territory was found in 2011, although two sites that were tableting amphetamine powder were seized. Methamphetamine, originating from Iran, was seized for the first time in 2009, and seizures of the substance have since increased. Methamphetamine seized in Turkey is primarily destined for the south-east Asia region and European countries. Ecstasy seized in Turkey originates in the Netherlands and Belgium. Ecstasy trafficked to Turkey is mainly for the domestic market, although it targets larger urban and tourist areas along the Mediterranean and Aegean coastline.
In 2011 some 67 099 drug-law offences resulted in drug seizures, fewer than in 2010. Most of these offences were related to drug use or possession. A substantial proportion of offences (87.5 %) were related to cannabis, followed by 4.9 % for heroin and 3.9 % for ecstasy. Following a reported increase between 2007–10 for offences related to heroin, cannabis and Captagon, the number of offences related to these substances fell in 2011. At the same time, a sharp increase was registered in ecstasy- and methamphetamine-related offences.
The largest increase in the number of seizures and quantity of substance seized in 2011 was in the stimulant market, compared to 2010 data, which corroborates with the drug-law offence data for the same time period. Thus the numbers of cocaine seizures rose to 1 457 and a record quantity of 592 kg was seized. In 2011 a total of 1 094 770 Captagon tablets were seized, which is more than in 2010 but fewer than the record amounts seized between 2002–09. The decline in ecstasy seizures registered between 2006–09 was interrupted in 2010 by an increase in the number of seizures, an upward trend that continued in 2011. Some 2 587 ecstasy seizures were recorded in 2011, which resulted in the largest quantity seized since 2006 (1 047 59 tablets in 2007; 1 041 111 in 2008; 432 513 in 2009; 924 861 in 2010; 1 364 253 in 2011). The number of methamphetamine seizures continued to increase following the first seizures in 2009 and a total of 350 kg was seized in 2011.
Although cannabis products remain the most-seized drug, the figures have reduced over time for all cannabis substances. Data available since 2003 shows an increase in the quantity of cannabis resin (816 kg in 2003 to 29 156 kg in 2010), while in 2011 the amount of the seized cannabis resin fell slightly to 21 141 kg. Although the number of herbal cannabis seizures fell, the amount of herbal cannabis seized continued to increase, from 7 007 kg in 2003 to 55 251 kg in 2011. In 2011 a total of 7 318 seizures of cannabis plants were reported (11 271 in 2010). The quantity of heroin seized also sharply increased, from 3 710 kg in 2001 to 16 059 kg in 2009. However, in 2010 it fell to 12 690 kg, and in 2011 the quantity seized fell to 7 294 kg, the lowest figure since 2003.
The Turkish Penal Code, which came into force in 2005, no longer criminalises consumption per se, but sets 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 of up to three years. If addicts refuse treatment or do not comply with probation requirements, the courts can decide on sentencing. Judicial supervision rather than arrest is also available for the manufacture of and dealing in drugs, under the Penal Procedure Code (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 (although this exemption does not apply if the drugs were taken deliberately). Instead, such offenders and those posing a serious threat to society due to their addiction may be sent to a secure institution for treatment and protection. However, the Turkish Civil Code has provisions that may restrain activity or place drug users in a health or educational institution or in detention in cases where their drug use poses a significant threat to the safety and security of 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 these sentences by 50 % if the drugs involved are cocaine, heroin, morphine or morphine base; a similar increase is imposed in cases where organised crime is involved, or where those convicted held positions linked to legal trades such as doctors, pharmacists, health officers, etc.
According to the Law for Protection of the Family and Prevention of Violence against Women adopted in 2012, mandatory drug treatment can be applied as a punishment for persons who commit a violent act against women under the influence of alcohol and drugs. In 2011 an amendment to the third section of the Law Regarding the Establishment and Broadcasting of Radio and Television Services came into effect, setting a provision that broadcasting services may not promote the use of addictive substances such as alcohol, tobacco products and drugs, and the provision also includes gambling.
Turkey’s National Policy and Strategy Document on Counteracting Addictive Substance and Substance Addiction 2006–12 replaced the Strategy Document on Preventing, Monitoring and Management on Drug Addiction 1997–2006. The new strategy, prepared under the coordination of TUBİM (see coordination section below), is the central reference document in the drugs field in Turkey. It is primarily concerned with illicit drugs, but also addresses alcohol and tobacco in the areas of prevention and treatment. The strategy is built around the same pillars and cross-cutting themes as the EU Drugs Strategy 2005–12: (i) coordination; (ii) supply reduction; (iii) demand reduction; (iv) international cooperation; and (v) information/research/evaluation. It also has 12 main objectives, including the prevention of trafficking and abuse of addictive substance, and the protection of the population as a whole, and risk groups. The strategy is complemented by two action plans for the periods 2007–09 and 2010–12. The second action plan was developed on the basis of an evaluation of the earlier plan. A new strategy for the period following 2012 is currently being developed.
View ‘National drug strategies’ for additional information.
The Narcotic Coordination Committee was established on the basis of the first action plan and addresses all aspects of the drug phenomenon, not only addiction. This committee consists of representatives from all ministries involved in implementing drug policy.
The Turkish Monitoring Centre for Drugs and Drug Addiction (TUBİM) is attached to the General Directorate of Security/Anti-Smuggling and Organised Crime Department under the Turkish National Police. It is responsible for the coordination and implementation of the national drugs strategy, and for monitoring the drug situation. It does this through its network of provincial focal points around the country. TUBİM is tasked with drafting national drug action plans and updating them, and also manages Turkey’s National Early Warning System for monitoring new psychoactive substances.
There are currently 81 provincial coordination committees throughout Turkey, covering all provinces. Provincial drug action plans have been established in 78 provinces. The tasks of the secretariat for the provincial action plans and the provincial coordination committees are carried out by a governorship in one province, the Provincial Health Directorates in 73 provinces, the Provincial Security Directorate in four provinces, and the Provincial National Education Directorate in three provinces.
In Turkey, the financing of drug-related activities is decided annually by the entities in charge of their implementation.
Until 2011 the reporting of drug-related public expenditures was very limited and incomplete. In 2011 a preliminary questionnaire was sent to drug-related public services for the first time and this was improved in 2012. Estimates suggest that drug-related public expenditure was TRY 372 638 683 in 2011 (0.03 % of gross domestic product). However, the completeness of this estimate is unknown.
View ‘National drug-related public expenditure’ for additional information.
To date, research has mainly been carried out by professionals in treatment centres. Recently, however, there has been 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. A number of non-government organisations carry out drug research. In recent years the national focal point, through support provided by a number of EU projects, has been promoting research in this field amongst partners and universities. Some studies have already been put in place, including PDU estimation in three cities, a pilot general population survey, a student population survey and an infectious diseases survey. Publication in this field is limited. The Turkey Drug Conference takes place annually.
Recent drug-related studies mentioned in the 2012 Turkish National report mainly focus on aspects related to the prevalence and consequences of drug use.
View ‘Drug-related research’ for additional information.