Annual Report of National Drugs Council on Drugs and Drug Addictions Problems in Bulgaria

Annual Report of National Drugs Council on Drugs and Drug Addictions Problems in Bulgaria 2001 43

NATIONAL DRUGS COUNCIL

BULGARIAN NATIONAL FOCAL POINT

on drugs and drug addiction related problems

ANNUAL REPORT

OF NATIONAL DRUGS COUNCIL

on drugs and drug addictions problemsin Bulgaria

2001

April 2002

Sofia

Annual Report of National Drugs Council on Drugs and Drug Addictions Problems in Bulgaria 2001 43

Annual Report

on drugs and drug addictions problems in Bulgaria

2001

Team of Editors:

Dr. Vlatko Gligorov (Head of the Team)

National Coordinator of the Bulgarian Focal Point

Dr. Georgi Vassilev (Chief Consultant)

Director of the National Centre for Addictions at the MoH

Momtchil Vassilev (Editor-in-chief)

Head of Department at the National Centre for Addictions at the MoH

Theodora Kousheva (Team Coordinator)

Expert at the Bulgarian Focal Point

Acknowledgements of the participation and the contribution
to the elaboration of this report:

Inter-institutional work group

Anna Gotchkova

Chief Expert at the “Customs” Agency, “Drugs” Department, at the MoF

Elena Arapkyoulieva

Government Expert, “Legislative Council” Directorate at the MoJ

Evgeni Kostov

National Service for Combating Organized Crime

Fanny Mihailova

Head of the National Drugs Service at the MoH

Lilyana Spassova

National Institute for Criminal Law and Criminology

Mimmi Borissova

Chief Expert, “Drugs” Sector, Directorate of National Police, MoI

colleagues from the National Centre for Addictions

Alexander Hodonovksi

Dr. Alexander Kanchelov

Dr. Daniela Alexieva

Gallin Gergov

Dr. Nikolai Tomov

Roumen Georgiev

Despina Gigova

Maria Vassileva - Valova

as well as

Stanislav Radoslavov

PR at the Secretariat of the National Drugs Council

Demetra Novakova

Government Expert, “Customs” Agency, “Drugs” Department, at the MoF

Nadya Dimitrova

Pharmacist, “Drugs Policy” Directorate at the MoH

Annual Report of National Drugs Council on Drugs and Drug Addictions Problems in Bulgaria 2001 43

Annual Report of National Drugs Council on Drugs and Drug Addictions Problems in Bulgaria 2001 43

TABLE OF CONTENTS

Page
SUMMARY / 9
PART 1
NATIONAL STRATEGIES:
INSTITUTIONAL & LEGAL FRAMEWORKS / 15
1.  Developments in Drug Policy and Responses / 16
1.1. Political framework in the drug field
Anna Gochkova, Dr. Georgi Vassilev, Momtchil Vassilev, Theodora Kusheva / 16
1.2. Policy implementation, legal framework and prosecution
Anna Gochkova, Dr. Georgi Vassilev, Momtchil Vassilev / 19
1.3. Developments in public attitudes and debates
Dr. Georgi Vassilev, Momtchil Vassilev / 24
1.4. Budget and funding arrangements
Alexander Hodonovsky / 32
PART 2
EPIDEMIOLOGICAL SITUATION / 33
2.  Prevalence, Patterns and Developments in Drug Use
Momtchil Vassilev / 35
2.1 Main developments and emerging trends
Momtchil Vassilev / 35
2.2 Drug use in the population
Momtchil Vassilev / 36
2.3 Problem drug use
Momtchil Vassilev / 41
3. Health Consequences / 42
3.1 Drug treatment demand
Momtchil Vassilev / 42
3.2 Drug-related mortality
Mimi Borissova, Momtchil Vassilev / 44
3.3 Drug-related infectious diseases
Dr. Nikolai Tomov / 44
3.4 Other drug-related morbidity
Momtchil Vassilev / 46
4. Social and Legal Correlates and Consequences / 47
4.1 Social problems
Momtchil Vassilev / 47
4.2 Drug offences and drug-related crime
Evgeny Kostov, Mimi Borissova / 48
4.3 Social and economic costs of drug consumption
Momtchil Vassilev / 48
5. Drug Markets / 50
5.1 Availability and supply
Evgeny Kostov / 50
5.2 Seizures
Anna Gochkova, Lilyana Spassova, Mimi Borissova / 50
5.3 Price, purity
Lilyana Spassova / 53
6. Trends per Drug
Momtchil Vassilev / 58
7. Discussion / 58
7.1. Consistency between indicators / 58
7.2. Implications for policy and interventions / 58
7.3. Methodological limitations and data quality / 58
PART 3
DEMAND REDUCTION INTERVENTIONS / 59
8.  Strategies in Demand Reduction at National Level
Dr. Georgi Vassilev / 61
8.1. Major strategies and activities
Dr. Georgi Vassilev / 63
8.2. Approaches and New Developments
Dr. Georgi Vassilev / 64
9. Intervention Areas
Galin Gergov / 64
9.1 Primary prevention
Galin Gergov / 64
9.1.1 Infancy and Family
Galin Gergov / 65
9.1.2 School programmes
Galin Gergov / 65
9.1.3 Youth programmes outside schools
Galin Gergov / 65
9.1.4 Community programmes
Galin Gergov / 65
9.1.5 Telephone help lines
Dr. Nikolai Tomov / 65
9.1.6 Mass media campaigns
Stanislav Radoslavov / 65
9.1.7 Internet
Stanislav Radoslavov / 72
9.2 Reduction of drug related harm
Dr. Nikolai Tomov / 73
9.2.1 Outreach work
Dr. Nikolai Tomov / 73
9.2.2 Low threshold services
Dr. Nikolai Tomov / 74
9.2.3 Prevention of infectious diseases
Dr. Nikolai Tomov / 74
9.3 Treatment
Dr. Georgi Vassilev / 75
9.3.1 Treatments and health care at National level
Dr. Georgi Vassilev / 76
9.3.2 Substitution and maintenance programmes
Dr. Alexander Kanchelov / 77
9.4 After-care and re-integration
Roumen Georgiev / 78
9.4.1 Education and training
Roumen Georgiev / 79
9.4.2 Employment
Roumen Georgiev / 79
9.4.3 Housing
Roumen Georgiev / 79
9.5 Interventions in the Criminal Justice System / 79
9.6 Specific targets and settings / 79
10. Quality Assurance / 79
10.1 Quality assurance procedures
Dr. Alexander Kanchelov / 79
10.2 Evaluation
Dr. Alexander Kanchelov / 79
10.3 Research / 80
10.4 Training for professionals
Dr. Daniela Alexieva / 80
REFERENCES / 83
Bibliography: books and reviews / 85
Data base: software used, Internet addresses / 86
ANNEX / 87
Drug monitoring systems and sources of information / 89
Drugs and precursors control act / 91
List of Tables used in the text / 123
List of Figures used in the text / 124
List of Abbreviations used in the text / 125

Summary

The major objective of the national drug policy of Republic of Bulgaria for the year 2000 was the development of the National Anti-Drugs Strategy through a Twinning Covenant with the United Kingdom – Ref. No BG 2000-JH-02.

Another major objective was the development and adoption of the National Programme for Prevention, Treatment and Rehabilitation of Drug Addictions in Republic of Bulgaria, 2001 – 2005. It was developed in 2000 and it was adopted by the Council of Ministers with Decision № 159/ 22.03.2001. The programme was based on the experience of the developed countries in Europe and North America in such activities and was entirely in compliance with the adopted Drugs Strategy and Programme of the European Community (2000 – 2004).

The main objective of the National Programme is to support the implementation of health care reform in the field of problems related to abuse of narcotic drugs. It is based on the idea that the system of general practitioners should play a very important role for improvement of medical and other care for abusers and dependents on narcotic drugs. The education and training of GPs for early detection of abuse and for brief interventions with the individuals and their families will contribute to the improvement of quality and drastic expansion of the health care coverage of persons with problems.

In late 2000 the Prime Minister of the republic of Bulgaria – Ivan Kostov – forwarded an open letter to 16 non-governmental organizations, calling for united efforts of all parties concerned to overcome the drug abuse problem.

“I can assure you that the Bulgarian Government is seriously concerned by this problem and we shall do our best to solve it, whatever the difficulties may be. The problem of addictions has become one of the greatest threats to human life and health, and above all to children and the young generation”, emphasized the Prime Minister.

Concerning the public perception of the drug issues – there is growing concern in the public opinion, related to the extent, social price and consequences of the drug abuse and addiction, especially in the major cities of Bulgaria. The drug abuse and addiction are more regarded as posing risk to everybody and in need for rapid measures. As a whole, the public opinion shows opinion about the non-satisfactory level of development of the state, communal and societal responses towards measures for providing prevention, treatment and rehabilitation. There is a clear appeal from the public opinion about the rapid development and delivery of national policy and programs in the field.

The survey in Sofia revealed that public attitude to drug users is balanced, with approximately equal “weight” of people with positive attitude (of course, not in the meaning of encouraging) and people with negative attitude, with slight prevalence of the former group.

There are variances in the approach of young people and the elderly in determining the reasons for drug use. The boundary between the two age-generation groups was somewhere at about 30-35 years. Most of the young people took (directly or indirectly) a sort of exculpatory position, focusing their attention above all on the load of problems (personal, in the family or social), alienation (in the family or in society) or merely innocent curiosity.

The responses of the elderly were rather different. Most of them were of didactic and reprehensive nature, gravitating around imitation, lack of commitment and excessive lack of control.

One of the issues increasingly discussed in the media, which concerns mostly young people and which therefore should commit them to take a certain stance is: whether to legitimize the use (and trade, respectively) of soft drugs and marijuana in particular.

A national survey “Youth – 2000” of the NCSPO provides good opportunities in this respect due to the integrated indicator of the attitude of young people to the de-criminalization of “soft” drugs in Bulgaria. The data shows unequivocally that in spite of the more and more liberated thought and behavior (for better and for worse) of the Bulgarian youngsters, the general attitude is still intolerant to drugs, including the so-called “soft” drugs. One in eight persons (12,3 %) was for legitimizing their use and trade, while of the opposite opinion (prohibition) were more than 3/4 of the polled (76,4 %). The ratio is approximately 6 : 1 in favor of those rejecting the legitimization.

The expert estimates on drug use by the population made by the National Centre for Addictions are based both on the data collected by various surveys (repeated, probing, regional and local, monitoring, etc.) and on the continuous observations conducted by specialists, sporadic and permanently collected data through unconventional paths, etc.

According to the expert estimates the probable approximate annual number of drug abusers for the year 2000 is, respectively by type of drug:

Heroin - between 47 000 and 57 000;

Cocaine - between 5 000 and 10 000;

Various forms of cannabis - between 80 000 and 110 000;

Amphetamines - between 10 000 and 15 000;

Benzodiazepine - between 40 000 and 50 000;

Hallucinogens - between 1 500 and 3 500;

Volatile solvents - between 1 000 and 3 000.

The latest studies in the capital city show that almost one of four students in Sofia has used one illegal drug or another at least once in his life .

The past years show a marked growth in drug abuse and first of all of marihuana. As per a mass study organised by the end of the year 1995 among secondary school students at 10 schools in Sofia, about 12% of them at one time or another in their life had used a psychoactive drug substance. As per the same index two years later, that time among secondary school students in the town of Kozloduy, such use had been ascertained by about 15% of the inquired, and two years after that another study in Sofia the occurrence of drug abuse there had been fixed at 20-21%. Only a year later that percentage had marked a growth of 6-7 points.

If the data from Bulgaria are compared with those from other countries – participants in the European Project on School Studies in the Field of Alcohol and Other Drugs Abuse (known as ESPAD), it will become evident that Bulgaria is to be ranked 18th in the list of 30 countries. The data from the year 1999 show that in Bulgaria about 14% of the students at the age of 15-16 (that has been the target group of the study) have used some drug at least once in their life.

The results show that marihuana has been the drug most commonly used by the students in Sofia. As per the study made in the year 2000 almost every one of four students has smoked at least once such a cigarette, while every one of ten has done that during the month before. In comparison with previous studies the growth has been considerable (see above). The other drug substances used (at least once in life) are hashish (6%), other forms of cannabis (8%), cocaine (4%), different kinds of ecstasy and heroin (2% for each), etc.

The number of drug substances tried by young people is growing.

In accordance with ESPAD about 12% of the 15-16 year old students in Bulgaria have used hashish or marihuana at least once in their life.

As a difference from the “mass consumption” marihuana, heroin still remains as the most problematic drug in Bulgaria. Practice shows that it is difficult its use (more particularly its regular use) to be registered only on basis of analogue school studies, because the drug addicted usually leave school soon. On the other hand, taking into consideration other studies and observations, it is the most commonly used one by the drug addicted. And one thing more, which is quite indicative – by the end of the last decade in each year from 95 to 97 percentage of those demanding treatment in connection with a drug abuse problem in the specialised centres in Sofia have used heroin.

The study from the year 2000 has confirmed certain tendencies in connection with the gradual growth of the list of really used drug substances in our country. Although relatively slower, but quite more noticeably a growth in the use of relatively new substances has been observed too – methadone, amphetamines, ecstasy, LSD. Along with them should be mentioned also the new (with regard to our practice) forms of combined use, registered as the result of a number of observations. To start with the mechanical combination of drugs (for instance of heroin and cocaine, the so-called “speedball”) and come to the more complicated organic mixtures (the so-called “drug grass”, for instance).

There is an interesting difference between the relative share of women among those who have used something (at least once) and the rather small share of women in the addict population. The most logical explanation for such variance could be found in two directions – the pattern “try out of curiosity” prevails in women from the point of view of values and behaviour, and on the other hand – women develop tolerance to substances relatively slower.