Country overview: Turkey
- Situation summary
- Drug use among the general population and young people
- High-risk drug use
- Treatment demand
- Drug-related infectious diseases
- Drug-induced deaths and mortality among drug users
- 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 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 of 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 interventions are mostly targeted at young people, and many of them are implemented in the educational system. The methods used include counselling support, seminars, discussion panels and conferences. Manualised 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 the 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 have yet been undertaken on the effectiveness and outcomes of prevention interventions.
View ‘Prevention profile’ for additional information.
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. However, in 2012 a new definition of ‘high-risk drug use’ was adopted. The new definition includes ‘problem drug use’, but is broader (mainly in its inclusion of high-risk use of more substances). Details are available here.
A population size estimate of problem opioid users has been performed annually in Turkey since 2007, using the mortality multiplier method. The most recent study, from 2011, suggested that there were around 12 733 opioid users (range: 11 126 to 26 537), which corresponds to a rate of 0.3 opioid users per 1 000 population aged 15–64.
Treatment demand data in Turkey is provided by the Directorate-General for Health Services of the Ministry of Health. In 2012 data were reported from 18 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 2012 a total of 4 720 clients entered inpatient treatment, of which 2 519 were new clients entering treatment for the first time. Some 75 % of all treatment clients reported opioids as their primary drug, followed by 16 % for cannabis and 2 % for cocaine. A similar pattern was identified among new treatment clients, with 68 % reporting opioids, mainly heroin, followed by 22 % for cannabis and 2 % for cocaine. Injecting drug use was common and was reported by 49 % of all treatment clients and 43 % of new treatment clients who demanded treatment due to the use of opioids.
Some 45 % of all treatment clients were under the age of 25. New treatment clients tended to be younger, with 53 % under 25. The gender distribution was similar among all and new treatment clients, with 94 % male and 6 % female.
The Public Health Agency of the Ministry of Health and the Ministry of Health General Directorate of Health Services provide data on human immunodeficiency virus (HIV) in Turkey. In 2012 the Public Health Agency recorded six new HIV cases among people who inject drugs (PWID).
In 2012 around 912 hepatitis C virus (HCV) and 156 hepatitis B virus (HBV) cases with injecting drug use as a likely transmission route were reported in Turkey. Since the transmission routes were not provided by the patients, the transmission routes for all the HCV and HBV cases are assumed to be due to injecting drug use.
HBV, HCV and HIV testing is also carried out among PWID admitted to the Alcohol-Substance Addiction Research, Therapy and Education Centres (AMATEM). In 2012 some 0.7 % of 1 821 clients tested were HIV positive, 8.6 % tested positive for HBV and 50.1 % for HCV.
Drug-induced deaths are reported by the Council of Forensic Medicine under the Ministry of Justice from a special death registry, which is based on autopsy reports from across Turkey. Data extraction and reporting is in line with the EMCDDA definitions and recommendations.
In 2012 some 162 drug-induced deaths were reported, which is an increase compared to previous years (104 in 2011; 126 in 2010; 153 in 2009; 159 in 2008; 147 in 2007). The majority of the deceased were male (156). The mean age of victims was 30.2 years. Toxicological analysis was available for all confirmed drug-induced deaths, and opiates were involved in 124 reported death cases. However, more than one substance was detected in over two-thirds of the deaths.
The drug-induced mortality rates among adults (aged 15–64) is 3.1 deaths per million in 2012, lower than the European average of 17.1 deaths per million.
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 2012 there were 25 active inpatient and outpatient treatment units, and there are plans to increase the number of units in the future. The majority of drug-related treatment services take place in inpatient settings. Funding for drug-treatment services is mainly provided by the state through health or social insurance funds.
The majority of treatment services for drug users treat addiction in general, providing treatment for both alcohol and illicit drugs. The primary approach of treatment programmes is to help a client achieving a drug-free state. The interventions consist of psychotherapeutic and supporting methods.
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. Opioid substitution treatment (OST) is prescribed by psychiatrists within AMATEMs. In 2012 there were 28 656 clients in the OST programme with a buprenorphine-based medication.
View ‘Treatment profile’ for additional information.
Turkey is affected by three main heroin drug trafficking routes — the Balkan route, the northern (Black Sea) route and an eastern Mediterranean route. Heroin originating from Afghanistan is trafficked through Turkey en route to western Europe. Cannabis is mainly produced for the domestic market, and is subject to local and regional trafficking mostly 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, although Afghanistan is believed to be its country of origin. Cocaine enters Turkey from South America for domestic use and en route to other European countries, Azerbaijan and northern Iraq. There are indications that some organised crime groups that were previously involved in heroin trafficking are also increasingly involved in the smuggling of cocaine. 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 and its availability in the market has significantly declined. Methamphetamine, originating in 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 to a lesser extent for Europe. 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 2012 some 83 133 drug-law offences were registered in Turkey, an increase when compared to 2011. Most of these offences were related to drug use or possession (86 %). A substantial proportion of offences (82.1 %) were related to cannabis, followed by 5.3 % for ecstasy and 5.0 % for heroin. Following a reduction in the number of registered offences related to heroin, cannabis and Captagon in 2011, an increasing trend for offences involving these substances that was observed between 2007–10 resumed in 2012. A steady increase in ecstasy and methamphetamine related offences registered since 2010 also continued.
Cannabis products remain the most-seized drugs, and data available since 2003 shows increase in the seized quantities of herbal cannabis and cannabis resin. In 2012 a sharp increase in herbal cannabis seizures from 55 251 kg in 2011 to 124 673 kg was reported, while the amount of cannabis resin seized increased from 21 141 kg in 2011 to 27 413 kg. In 2012 a total of 3 646 seizures of cannabis plants were reported, which is less than reported in period 2009–11.
The quantity of heroin seized sharply increased, from 3 710 kg in 2001 to 16 059 kg in 2009, while in the following years the amounts seized fell to 7 294 kg in 2011, indicating a heroin shortage in the market. In 2012, however, the amount seized increased to 13 301 kg.
Cocaine seizures increased approximately fourfold in the period 2008–12 (from 94 kg to 476 kg). In 2011 a record quantity of 592 kg was seized, which is explained by the seizure of a large amount of substance in one large operation. Captagon seizures have shown a rapid decline since 2008, when close to 3 million tablets were seized, to a total of 181 387 Captagon tablets in 2012. A total of 4 445 ecstasy seizures were recorded in 2012, which resulted in a record seizure of almost 3 million tablets and 357 kg of ecstasy. The number of methamphetamine seizures continued to increase following the first seizures in 2009, and a total quantity of 502 kg was seized in 2012.
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 5–15 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.
View the European Legal Database on Drugs (ELDD) for additional information.
Turkey’s National Drug Policy and Strategy Document, 2013–18 was approved by the Prime Minister in September 2013. Prepared by the Turkish Monitoring Centre for Drugs and Drug Addiction (TUBİM) in consultation with government ministries and non-state stakeholders, the strategy draws on the Turkish constitution’s provision for a drug policy that includes preventative action against addiction. The strategy is built on a balanced approach and the need for a multidisciplinary response to drug problems. Constructed around the pillars of drug supply reduction and drug demand reduction, it states the priorities set by the Turkish government in the fight against illicit drugs. These include the need to develop a rapid intervention system to combat new psychoactive substances and to target drug trafficking as a means of funding terrorist activities. Drug use is identified as a major public health challenge in the strategy, which underlines the need to prevent drug use and to provide treatment and reintegration for drug users. The strategy endorses an approach based on effective coordination at the national level coupled with international cooperation, as well as using research and evaluation to support anti-drug activities.
The national strategy is being implemented through two action plans, the first of which runs from 2013–15. It sets out 84 actions that are designed to meet the 29 strategic objectives laid out in the national strategy.
View ‘National drug strategies’ for additional information.
The National Drug 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. Comprised of academics from a range of disciplines, TUBIM’s Scientific Committee reviews evidence related to drug policy issues and provides advice to government.
There are currently 81 Provincial Drug 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 has been improved every year since 2012. Estimates suggest that drug-related public expenditure was TRY 396 792 280 in 2012 (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 2013 Turkish National report mainly focus on aspects related to supply and markets but responses to the drug situation and prevalence incidence and patterns of drug use have also been mentioned.
View ‘Drug-related research’ for additional information.