Spain

"The prevalence of use of illicit substances in Spain has been relatively stable in recent years, with more than one third of the adult population reporting lifetime use of an illicit substance. Cannabis is the most commonly used drug, with use mainly concentrated among adolescents and adults younger than 35 years. The prevalence of use of the most commonly consumed illicit drugs (cannabis and cocaine) showed a downward trend until 2017, when an increase was observed for both substances. The use of all illicit substances remains more prevalent among males than females.

"In 2017, 1 in 100 adults aged 15-64 years reported the use of new psychoactive substances. Most users of this type of substance were male and young and reported polydrug use (with other legal and illegal psychoactive substances).

"The Spanish cities of Barcelona, Castellón, Madrid, Santiago and Valencia participate in the Europe-wide annual wastewater campaigns undertaken by the Sewage Analysis Core Group Europe (SCORE). This study provides data on drug use at a municipal level, based on the levels of illicit drugs and their metabolites found in wastewater. The results of the 2018 study on stimulant drugs revealed high levels of cocaine metabolites in wastewater samples from all five cities, higher than the levels reported in some other European cities participating in the study. In addition, Barcelona recorded an increase in MDMA/ecstasy, amphetamine and methamphetamine residues between 2011 and 2018. A common pattern across the monitored cities was increased use of cocaine and MDMA at the weekends."

• Table: Prevalence of Past-Month Drug Use in Spain Among 15-64 Year Olds

"Among first-time clients entering specialised drug treatment in 2021, or most recent year available, with heroin as their primary drug, 19% (down from 38% in 2013) reported injecting as their main route of administration. In this group, levels of injecting vary between countries, from less than 10% in Denmark, Spain, France and Portugal to 60% or more in Czechia, Estonia, Latvia, Lithuania, Romania and Slovakia."

"The average age of onset of use of the different substances which was recorded in 2011 remained stable, generally speaking, compared to the year before. The substances shown as being used for the first time at a younger age are those showing the highest prevalence figures, in other words, tobacco and alcoholic beverages (16.5 and 16.7 years of age, respectively). Regarding illicit substances, the substance showing the youngest age of onset of use continues to be cannabis, the age of onset being 18.7 years of age. The greatest change in the age of onset of use compared to 2009 is for heroin, given that the age dropped from 22.9 years of age to 20.7 years of age in 2011. Apart from the above, the substance showing the oldest age of onset is that of the hypnosedatives (34.5 years of age), although this age drops to 27.8 years of age regarding non-prescription hypnosedatives. In this regard, from an overall standpoint, the age of onset of the use of the different drugs is within the 16-21 age range (Table 2.6 and Fig. 2.1)."

"The data available have limitations in respect to quality and coverage, however, the information available suggests that heroin was only present in the majority of overdose deaths in a relatively small number of EU countries. A significant share of overdose deaths was reported by Austria (67%), Italy (56%), Ireland (46% in 2017), Poland (44% in 2016) and Romania (43%). In 7 other European countries, heroin was found in approximately a quarter to a third of reported overdose deaths: Portugal (37%), Slovenia (33%), Denmark (36%), France (33% in 2020), Türkiye (32%), Spain (28% in 2020) and Norway (23%). In 2021, in the north of Europe, less than 1 in 6 overdose deaths in Finland, Sweden and in the Baltic countries was reported to involve heroin."

"Cannabis continues to be the illicit drug most used among the age 15-64 population legally residing in Spain, despite a slight detected in the three time-related indicators (sometime in their lives, within the last 12 months and within the last 30 days), having a bearing on the stabilization which had been noted over the last few years. This drop is of greater significance in experimental use, the only indicator which has risen considerably in the immediately prior edition and which had reach the highest levels since 1995, thus returning to the “sometime in one’s life” use data for 2007. (Fig. 2.11).
"In 2011, a total of 27.4% of the Spaniards within the 15-64 age range stated having used this substance at least once in their lifetime. This prevalences underwent an upward turn in 2009 (up to 32.1%), as a result of which the current figure means a drop in the use rate of 4.7 percentage points compared to the immediately previous measurement, thus returns to 2007 levels. Focusing on cannabis use within the last 12 months, the resulting prevalences is 9.6%, meaning 35% of the individuals who had used cannabis sometime in their lives, a percentage in keeping with that which had been found to exist in previous periods. Please note that the prevalence level for the last 12 months means a one-point drop compared to the immediately previous measurement, being the lowest since 2003 (the years in which maximums were recorded in this regard, with 11.3%).
"Analysing the results for use within the last 30 days, the resulting percentage of users is 7.0% of the population studies, meaning 73% of those who used this substance within the last 12 months and 25.5% of those who had used it at some time in their lives. In terms of prevalence, there is a 0.6-point difference compared to 2009, meaning the lowest figure since 2003.
"As regards daily cannabis use focusing on the last 30 days, a 1.7% prevalence is found to exist, without any substantial changes have occurred in this regard compared to previous years. Thus, it is found that one out of every four individuals who have used cannabis within the last 12 months, do so daily (24.3%). Furthermore, the age of onset of cannabis use is 18.7 years of age, thus following the past trend and thus being the illicit drug which is first used at the earliest age. (Fig. 2.11)."

"Among the illicit psychoactive substances, cocaine in general (powder and/or base) is the substance showing the second highest prevalence of use in Spain, after cannabis, among the individuals within the 15-64 age range.
"Powder cocaine has an 8.8% prevalence for the sometime in their lives indicator, being the form and type most used of all. Nevertheless, in 2011, a break was found to exist with the upward trend which had been taking place for the past ten years and which had reached its peak level in 2009, with a 10.2% prevalence among the population surveyed and showing a higher degree of growth than in previous years (with a 2.2 percentage point increase compared to the year before). In any case, this reduction is not as yet important enough to return to the levels of 2007 (8.0%) nor to the previous years.
"Continuing with powder cocaine use, the 'within the last 12 months' time-related indicator consolidated, in 2011, the downward trend which had begun in 2007 (which a maximum prevalence of 3.0% was reached) to the 2.2% level currently noted. The same is true for the 'within the last 30 days' time frame. In this case, 2005 and 2007 marked maximums (1.6%), whilst in 2011, the prevalence level was half a percentage point lower (1.1%), although the greatest drop in this regard occurred in 2009, from 1.6% to 1.2%). (Fig. 2.18)."

"For base cocaine (crack), prevalence levels are similar to those of 2009, the year which marked a turnaround in the rise which had been being seen and which reached its highest peak in 2007 (1.8% for some time in their lives; 0,5% within the last 12 months and 0.3% within the last 30 days). In 2011, it was found that the number of individuals who had used base cocaine sometime in their lives had decreased to half compared to 2007, although this reduction must continue in order to achieve the levels recorded for the years showing the lowest prevalence in this series. Similarly, it must be stressed that, in 2011, the percentages found for use within the last 12 months (0.2%) and within the last 30 days (0.1%) are among the lowest figures. (Fig. 2.19)."

"Among the illicit psychoactive substances, ecstasy is ranked next in importance after cannabis and cocaine in Spain. In 2011, an overall drop has been reported in the use of ecstasy for the three customary time-related indicators (by 3.6% among sometime in their lives population, by 0.7% for the last 12 months and by 0.3% within the last 30 days). (Fig. 2.25).
"This decline is sharper in experimental use, which is particularly significant, given that ecstasy is used mainly this way and additionally taking into account that, in 2009, the 'sometime in their lives' use took an upward turn and showed the highest degree of prevalence of the entire historical series (4.9%). This percentage has dropped by 1.3 percentage points in 2011 down to the lowest level for the last ten years. However, regarding ecstasy use within the last 12 months and within the last 30 days, the prevalences show minimal declines, remaining at levels nearing those found in 2009, which, in this case, had already undergone a decrease compared to 2007.
"Similarly, the average age of onset of use is at 20.8 years of age (20.5 in 2009), which is a positive albeit not a major change."

"Drinking alcoholic beverages is spread throughout practically all of Spain’s society. Thus, in 2011, a total of 90.9% of Spain’s population within the 15-64 age range had drunk an alcoholic beverage at some time in their lives, 76.6% of the population having admitted drinking alcoholic beverages sometime within the last 12 months and 62.3% having done so within the last 30 days. For all of the time frequencies included, alcoholic beverage use was lower in 2011 than in 2009 (-3.3, -2.1 and -1.0 percentage points, respectively), the year in which the levels of use had rallied for all of the time periods. In 2011, daily alcohol use dropped by 0.8 percentage points compared to 2009, down to 10.2%, thus recouping 2007 levels (Fig. 2.6 and Table 2.12)."

"In regard to cases of alcohol poisoning, 19.3% of the age 15-64 population admitted having experienced some episode of drunkenness at some time within the last twelve months on being surveyed (25.9% males vs. 12.6% females). A total of 5.4% acknowledged having experienced drunkenness more than once a month within the last twelve months, whilst 13.9% had done so less often (Fig. 2.8). The comparison of these figures to those found for 2009 reveal a 0.6 percentage point rise in the number of individuals who had gotten drunk more than once a month within the last twelve months, totalling the highest figures since 1995.
"The group leading the acute alcohol poisoning prevalence is that of the males within the 15-34 age group, given that 41.3% of them have experienced drunkeness within the last 12 months compared to the 23.5% of females of the same age. The breakdown by both age and gender together shows a drop in 2011 of the prevalences of drunkenness in all of the categories studied (Fig. 2.9) as compared to 2009 in which they showed an overall increase."

"In 2011, a total of 71.1% of the individuals within the age 15-64 age group in Spain had used tobacco at least once in their lives (Fig. 2.2), meaning a drop of 3.3 percentage points compared to the last measurement taken but not reaching the levels of previous years which in no case surpassed 70%.
"Focusing on tobacco use within the last 12 months, the degree of prevalence drops to 40.2%, meaning 56.1% of those individuals who had used tobacco sometime in their lives (Fig 2.3). Although this percentage is similar to that reported in for 2009, (57.1% of those who had smoked at some time in their lives had done so within the last 12 months), the degree of prevalence is the lowest for the entire time period analysed. This is likewise the case for the time indicator for within the last 30 days, which shows the lowest level of all the years studied, 37.6% of Spain’s age 15-64 population (Fig. 2.2). Lastly, focusing on the daily tobacco use within the last 30 days, the prevalence drops to 30.4%. Worthy of note is the fact that, for calculating the continuity of use, a quotient is calculated between the prevalence for the nearest time horizon and the furthest time horizon to be taken into account. For example, to ascertain how many of those individuals who have smoked within the last 12 months have also smoked within the last 30 days, the prevalence for the last 12 months has been divided by the prevalence for the last 30 days. The average age of onset of use (Fig. 2.2) was 16.5 years of age in 2011, remaining constant over the course of time, whilst the average age of onset for daily tobacco use has lowered to 18.5 years of age (compared to 19.3 years of age in 2009).
"Daily smoking is more widespread among males in all age groups (Fig. 2.4), reaching its maximum level in the 34-55 age segment (38.1%) whilst women show the greatest prevalence in the 25-34 age range (31%). The greatest difference between genders is found in the 55-64 age range (27.5% of the males compared to 16.3% of females) whilst the percentages show themselves to be more evenly matched in the 15-24 age range (28.7% of males compared to 24.8% of the females). Daily cigarette smoking among Spaniards within the 15-64 age range within the last month is of 13.6 cigarettes. Males smoke more cigarettes daily (14.6 cigarettes) than women (12.3 cigarettes)."

"The Spanish government continued to implement its 2017-2024 national strategy to fight addiction. The strategy prioritizes equal access to treatment for minors, women, and the elderly. Spanish authorities estimate that 9.5 percent of Spaniards consume marijuana and 2 percent consume cocaine.

"Spain continued to enjoy excellent bilateral and multilateral law enforcement cooperation with international partners in 2020. Cooperation on EU operations in the Mediterranean continued, and U.S. law enforcement agencies maintained strong working relationships with Spanish authorities, leading to significant drug seizures and arrests. In October, for example, Spanish, Dutch, and U.S. law enforcement worked collaboratively to make arrests to dismantle a Dutch transnational criminal organization, which was alleged to have shipped 20 MT of cocaine through the United States and 5 MT of cocaine through European ports."

"The estimates of problem use indicate that the total number of problem heroin users (prevalence) peaked in Spain in the early 1990’s with more than 150,000 heroin users, as of which time these numbers began to decline.
"Due to the small number of heroin users found in the samples, it is practically impossible to obtain reliable estimates directly from the population-based surveys as to the percentage of users who have started treatment for this substance and to be able to apply the in-treatment multiplier method. However, previously, in the 2007 Household Survey on Alcohol and Drugs in Spain (EDADES), the nominative method, a variation on the in-treatment multiplier method, was employed.
"To date, problem heroin users have therefore been being estimated by using the multiplier figures found in the 2007 Household Survey on Alcohol and Drugs in Spain (EDADES) and by applying this multiplier to the data available regarding treatment in Spain (indicator of admissions to treatment, users who have undergone treatment at outpatient centres and number of users in treatment with opiate maintenance) for the years 2006, 2007, 2008 and 2009.
"In 2011, the Household Survey on Alcohol and Drugs in Spain (EDADES) once again included the questions necessary so as to be able to apply the nominative method, thus making it possible to update the in-treatment multiplier. For this purpose, those surveyed were asked whether they knew any heroin users, and for each one of the heroin users they knew, those surveyed were to indicate if they knew whether or not those in question had started treatment for dependence on this drug within the last 12 months.
"Thus, valid answers were obtained on 1427 reported users, a total of 643 (45%) of whom had started treatment for dependence according to those surveyed. By applying this multiplier to the 17,325 'individuals admitted to treatment for heroin in 2010', the figure of 38,500 problem heroin users is calculated."

"In 2010, a total of 93,732 illicit drug users were treated at outpatient centres throughout Spain. If the same spread as recorded in the treatment demand indicator ('admitted to treatment within the last 12 months') for heroin for that same year (2010) is assumed for this group, we would find 93,732 x 32.4% = 30,369 individuals who had been in treatment for heroin in 2010 and, by applying the multiplier (30,369 x 100/45), an estimate of 67,487 problem heroin users in the population would be calculated.
"Lastly, it must not be overlooked that the previous estimates (38,500 and 67,487) would be, generally speaking, those heroin users who are not in treatment with opioid maintenance (OMT), as these are recorded separately. In 2010, according to the data furnished by the Autonomous Communities, there were 81,022 in OMT. It is known that a none too negligible percentage (around 40%) of the users on OMT additionally use heroin, as a result of which 81,022 x 40% = 32,408 could also be considered problem users.
"Thus, the sum of the aforementioned (32,408) and the estimates previously calculated in parallel (38,500 based on the TDI and 67,487 based on the total number of individuals treated for drug use at outpatient centres) makes it possible to establish a range within which the final estimate of problem users in Spain in 2010 (70,908 and 99,895 individuals) would fall. These figures mark an approximate 3.7% average increase compared to the figures estimated for 2009 included in the 2011 Spanish National Report (68,056-96,624 individuals).
"There is no clear-cut consensus among the experts as to whether those heroin users who are undergoing treatment, regardless of whether or not they are undergoing maintenance treatment, must continue being considered 'problem users'. The inclusion and exclusion-related criteria being used by the different countries to estimating the number of problem drug users vary greatly and are based on widely differing reasons."

"Concerning the estimated number of injecting drug users, valid answers of 1551 named injecting users were obtained in the 2011 Household Survey on Alcohol and Drugs (EDADES), a total of 741 (48%)of whom had started treatment for drug abuse or dependence according to those surveyed, which, applied to the 3,549 injecting users (injection within the 12 months immediately prior to being admitted to treatment) who were admitted to treatment in Spain in 2010 led to an estimate of 7,393 (3,549/0.48) recent injecting drug users in 2010 who would not be in OMT [Opioid Maintenance Treatment]. To estimate the number of injecting users who were patients in OMT in 2010, it is assumed, as in previous years, that 40% of this population has used heroin within the last 12 months and that 17% thereof have been injecting drug users. Thus, the estimate would be of at least (81,022 patients in OMT in 2010 x 40% who have used heroin within the last 12 months = 32,408 and 32,408 x 17% injecting = 5,509).
"Hence, based on the treatment indicator data and on the estimated number of injecting users among those patients in OMT, estimates would be found of 12,902 (7,393 + 5,509) recent (within the last 12 months) injecting drug users, meaning a 8.1% decline in the estimated number of injecting drug users in comparison to the figures estimated for 2009, mainly at the expense of a decline in the number of injecting users admitted for treatment in 2010.
"One must bear in mind that, in the 2011 Spanish National Report, a review was conducted of the relative importance the injecting route has among those admitted to treatment for heroin use in general and among the group of those considered “older” (long-duration users older than 39 years of age) in particular, it was deemed appropriate to assume an injecting use among those undergoing OMT treatment similar to that which is found both among all of those admitted to treatment for heroin and among the “older” group, which was 17% in 2009 and remained unchanged in 2010. The percentage employed previously had been 40%, which is not in keeping with the decline in injecting use among heroin users recorded over the past few years.
"However, when, instead of using the number of injecting users admitted to treatment, the estimated number of injecting users who had undergone some treatment for drug abuse or dependence in 2009 was used (6,186 individuals, calculated based on the number of drug users for whom care was provided in 2010 = 93,732, multiplied by 6.6%, which is the percentage of those admitted for treatment – for any drug- in 2010 who had injected drugs within the last 12 months), an estimate was calculated of 12,888 (6,186/0.48 = 12,888). Lastly, on adding the estimated number of injecting users among those undergoing OMT, the figure of 18,397 (12,888 + 5,509) recent injecting users is calculated.
"Therefore, the estimated figure of recent injecting users (within the last 12 months) would fall within the range of 12,902 – 18,397 individuals."

"It is complicated to decide what criteria to use for considering a pattern of cocaine use to be a case of problem use solely by virtue of the characteristics thereof, given that it is well known that very different types of combinations among the intensity of use at each given time, the frequency with which used, the age at which used, the other psychoactive substances with which cocaine is combined and the different underlying disorders of those who use cocaine can cause problems for cocaine users.
"As a starting point, within the context of the information available in the 2011 Household Survey on Alcohol and Drugs (EDADES), a problem user is considered as being that user who states having used cocaine on 30 days or more within the last 12 months and/or on 10 days or more within the last 30 days. In 2011, according to the Household Survey on Alcohol and Drugs (EDADES), there were a total of 121,130 cocaine users1 in Spain who had used cocaine on 30 days or more within the last 12 months and 48,561 who had used cocaine on 10 days or more within the last 30 days, a total of 45,608 of whom who met the requirements (use on 30 days or more within the last 12 months and us on 10 days or more within the last 30 days) may be ruled out for the sake of avoiding repetitions,. The estimated number would then total 124,083 problem cocaine users."

"In addition to the length of continuous use, from the Public Health standpoint, it also seems important to take into consideration the cases of use at very young ages. Thus, a parallel estimate was made, considering problem users as being all those 20 years of age or younger (approximate age by which the CNS has fully matured) who had used cocaine on 10 days or more within the last 12 months and at least on 1-3 days within the last 30 days, having totalled 12,181 in number on the Household Survey of Alcohol and Drugs (EDADES), representing 16.7% of the cocaine users (12 months) in this age range.
"To these numbers, it would be necessary to add those users over 20 years of age who used cocaine on 30 days or more within the last 12 months and/or on 10 days or more within the last 30 days (118,356 individuals), theoretically assuming that those who, as a result of being chronologically old enough, had reached psychophysical maturity, would be less susceptible than the youngest individuals to be harmed as a result of using cocaine, for equal amounts used. According to this hypothesis, in 2011, 130,537 (12,181 + 118,356) would be recorded.
"Hence, according to the method employed for these estimates, the number of problem cocaine users could be said to fall within the range of 124,083 – 130,537 individuals. This means an approximate 6% decline in comparison to 2009, which might be explained by the downward trend in the prevalence of cocaine use within the last 12 months and within the last 30 days found in the Household Survey on Alcohol and Drugs (EDADES) for the 2009-2011 period. Nevertheless, despite this fact, an estimated number is found for users on 10 days or more within the last 30 days which is higher than the number found in 2009, which would mean that, despite the fact that the trend in the prevalences of overall use may indicated an improvement in the situation generally speaking, it must not be inferred from this that problem use is behaving in the same way."

"The prevalences found by way of this study show that 0.4% of the age 15-64 population has injected heroin, cocaine or other illicit drugs sometime in their lives (0.6% of the males and 0.2% of the females). Focusing on the results by the ages of those interviewed, those individuals who are within the 35-44 age group are found to be those showing the highest prevalence (0.8%) (Table 2.37)."

"As shown in Table 4.5 above, in 2010, a total of 4.6% of Spain’s students within the 14-18 age range might be involved in a use of drugs which may cause them some type of problem. The prevalence of problem use, calculated by means of the CAST [Cannabis Abuse Screening Test] scale, reveals an upward trend in Spain within the 2006-2010 time period, despite a slight decline in cannabis use having been record for the same period.
"The upward trend revealed by the results of the CAST scale fits in with the rise recorded in the number of individuals admitted for treatment due to cannabis among minors within the past few years. Hence, the percentage of individuals admitted for treatment among minors related to cannabis was 69.2% in 2005, 72.4% in 2006, 78.4% in 2007, 83.8% in 2008, 84.4% in 2009 and 89.5% in 2010.
"The analysis of the CAST scale on the 2007 ESPAD survey (students ages 15-16 from different European countries) resulted in a 2% problem cannabis use prevalence figure (similar to that recorded in Spain in 2006), using cut-off points similar to those used in the case of Spain. However, even though these are the cut-off points which are used as standard practice, studies have now been published pointing out certain advantages being involved in using lower cut-off points when the CAST scale is used as a screening method for the general population. Hence, the 2011 ESPAD survey recorded a 5% prevalence of problem use when a >2 cut-off point was used."

"A total of 17,183 new HIV cases were notified within the 2003-2010 period. The annual rates of newly-diagnosed cases per million inhabitants ranges from 96.4 in 2003 to 90.0 in 2009 and 88.5 in 2010.
"Situation by transmission categories (2010): Transmission among males who have sexual relationships with males was the most frequent (46.1%), followed by heterosexual transmission, which totalled 33.1%, and that of injecting drug users, which amounted to 5.9% (Fig. 6.2). Therefore, 79.0% of the newly-diagnosed HIV cases for 2010 were sexually-transmitted. Breaking the transmission categories down by gender, among males, homosexual transmission totals 56.0% of the newly-diagnosed HIV cases and heterosexual transmission, 23.0%. Among females, the vast majority entail heterosexual transmission, totalling 80% of the newly-diagnosed cases (Fig. 6.3).
"Time Trend (2004-2010 Period): The trend in the rates of newly-diagnosed HIV cases vary depending on the mechanism of transmission: Among injecting drug users, the downward trend is continuing regarding the number of newly-diagnosed HIV cases (18.9 / million inhabitants in 2004 compared to 6.7 /million inhabitants in 2010), whilst the rates are tending to stabilize in the case of heterosexual transmission and are clearly rising in homosexual transmission among males."

"According to the National Epidemiology Centre, a total of 80,827 AIDS cases had been notified from 1981 up to June 30, 2011.
"Current situation: In 2010 (at June 30, 2011), a total of 930 cases had been notified, its being estimated that, after making adjustments as a result of delayed notification, that a total of 1,162 cases were diagnosed in 2010. A total of 77% of these newly-diagnosed cases were males. The median age was age 42, being somewhat older among the males than among the females. A total of 28% of those who were diagnosed with AIDS in 2010 contracted the infection as a result of sharing injecting material for injecting drug use. A total of 33% contracted the infection as a result of unprotected heterosexual relations. The transmission secondary to male-to-male sexual contact totals 26% of all cases and 34% if only male cases are considered.
"Time trend: The diagnosis of AIDS cases, which peaked in the 1990’s, has been showing a downward trend since that time, totalling 83% since 1996 (the year prior to HAART becoming widely-available) up to 2010. In 2009, the number of cases declined by 16% among males and by 18% among females. As far as the transmission mechanism is concerned, the percentage of AIDS cases which can be attributed to injecting drug use has declined over the past few years following the peak recorded in 1990 (69.6%) whilst the percentage of cases in the sexual transmission category has risen. In 2009, there was a 26% drop in the percentage of ADIS cases diagnosed among injecting drug users. This decline may be due to several factors which have had a bearing on the course of this epidemic in recent years, one of the most noteworthy being the high degree of availability of methadone maintenance treatments and the decline in the use of the injecting route of administration for heroin use. There was a 20% decline in the number of cases involving heterosexual transmission in 2009 and a 1% decline in the cases involving male-to-male sexual contact."

"In 2010, a total of 53,508 admissions were recorded in Spain for treatment for psychoactive substance abuse or dependence (not including alcohol or tobacco). Within the 1998-2002 period, the number of admissions for treatment declined, from 54,338 in 1998 (the year in which the largest number of admissions were recorded) down to 46,744 in 2002. However, within the 2002-2004 period, a rise occurred, totalling up to 52,128 admissions in 2004, which then declined again in 2005 (50,630) and 2006 (49,283). As of 2006, a new rise has taken place, bringing the number of admissions for treatment up to figures nearing those of 1998.
"The decline within the 1998-2002 period might have been due to the effect of the methadone maintenance programs which meant that many heroin users ceased rotating through the treatment services. The rise within the 2002-2004 period and from 2006 to 2008 could be explained by the rise in the number of admissions for treatment for cocaine and cannabis (Fig. 5.2).
"The profile of the admissions for treatment have undergone some noticeable changes over the course of time, the low levels of admissions for heroin currently remaining stable and a rise being noted in the number of admissions for cocaine and cannabis.
"Regarding the relative importance of each drug in 2010 within the total number of admissions for treatment for psychoactive substance abuse or dependence, Figure 5.3 shows cocaine to be the illicit drug having been the cause of the largest number of admissions for treatment (41.4% of all), followed by opiates (34.3%) and cannabis (21%). Focusing solely on the data for those individuals admitted for the first time in their lives (first admissions), there are even greater differences in favour of cocaine. In this case, cocaine is the drug having been the cause of more first admissions (45.3%), followed by cannabis (32.3%) and opiates (18.2%) (Fig. 5.3)"

"In Spain, the methadone maintenance programmes provided care for 81,022 patients in 2010, meaning a 4.12% rise compared to the 77,811 in 2009.

"These treatments were carried out in a total of 2,526 methadone-prescribing or methadone-dispensing facilities.

"As far as the location of these facilities is concerned, 50.59% are located in a specific drug dependence treatment centre, 10.62% at prisons, 8.23% at hospitals, 8.09% in mobile units, another 8.09% at mental health centres, 7.65% at health centres, 3.73% in pharmacies and 3% in other facilities.

"Also worthy of special mention is the fact that Buprenorphine+Naloxone (Suboxone®) having recently been included as one of the National Health Service benefits, having made the use thereof affordable in a patient profile stabilised on methadone, at low doses and good progress.

"In Spain, Suboxone® is a medicine subject to special medical prescription (psychotropic) and to restricted medical prescription, classified as a substance of hospital diagnosis.

"According to the data furnished (2011) by the Autonomous Communities and Autonomous Cities, a total of 1,350 individuals have been treated with buprenorphine/naloxone (suboxone). This figure is an initial estimate and will therefore have to be revised and updated."

"In Spain, there are different types of centres and resources serving the purpose of preventing drug-related emergencies and reducing drug-related deaths.
"Worthy of special note are the mobile units which go to different places where there are marginal drug users who do not come in to the treatment centres in order to furnish them with socio-sanitary support and prevent drug-related emergencies (outreach programmes). The 30 mobile units that were providing service in 2010 dispensed care for a total of 9,653 users.
"These mobile units also total 8.09% of the methadone-dispensing points. This substance is always prescribed by a qualified professional.
"In short, the mobile units are multipurpose, generally walk-up-access vehicles, the missions of which include: carrying out opiate replacement (methadone) treatments, taking samples, running diagnostic tests, providing first aid and preventing or aiding in drug use-related emergencies, as well as taking action in cases of danger of drug-related deaths."

"As is well-known, the shared use of needles and at-risk sexual practices contribute to spreading different infectious diseases.
"On the other hand, different research studies have revealed that the persons who inject themselves with drugs change their at-risk practices if they are provided with training and counselling, as well as the necessary tools for putting more hygienic behaviours into practice. This is the reason why many countries (including Spain) are stepping up those interventions making it possible to contact injecting drug users for the purpose of trying to modify the risky behaviours for their own health and that of those around them.
"In Spain, the harm reduction programmes mentioned above are involved in the prevention and treatment of infectious diseases by way of the care provided to patients who are active drug users who come into these programmes.
"Of special interest in this regard are the needle and syringe exchange and dispensing programmes, as well as the dispensing of sanitary kits (these kits usually include, in addition to a needle and syringe, disinfectant liquid, condoms, etc.) which are carried out in both outreach programmes as well as in more institutionalized centres and resources.
"These programmes offered for the injecting drug user population for the purpose of reducing, insofar as possible, the risk of transmissible infections associated with the shared or simply unhygienic use of the injecting material.
"Similarly, these programmes also afford the possibility of making early HBV and HBC diagnosis, HAV and HBV vaccinations and carrying out overdose prevention measures. In 2010, the needle and syringe exchange programmes dispensed 2,672,324 needles and syringes through 1,029 exchange points."

"The objectives of the drug consumption facilities are:
"- To offer a target population comprised of intravenous drug users outside of the care-providing circuits preventive-educational interventions, emergency care and referral to other resources.
"- To reduce the most frequent infections, the transmission of HIV and viral hepatitis.
"- To identify emerging disorders.
"- To reduce the number and consequences (mortality) of acute drug reactions.
"- To facilitate access to the socio-sanitary networks.
"- To lighten the social impact of intravenous drug use in public areas.
"- To facilitate sterile materials, help for hygiene, food, first-aid, vaccines, etc.
"The fact that they can inject themselves at these facilities is, although important, neither the main nor the sole reason for their existence. The important thing is that they will be able to contact professionals able to provide them with advice concerning the existing resources for providing care for their drug addiction and, in any case, improve their living conditions and health while they remain addicted.
"Also, in view of the high degree of marginality of this subgroup of drug addicts, they are offered additional help, such as educational workshops on hygienic intravenous drug use and preventing overdoses.
"In 2010, eight safe injection or 'drug consumption facilities' were operating in the Autonomous Communities of Catalonia (6), Madrid (1) and the Basque Country (1), having provided care for a total of 8,217 injecting drug users. This figure means a 37.4% decrease compared to the 13,124 of 2009, due mainly to the major drop in the figure for the users for whom care was provided at these facilities in Catalonia.
"Also the social emergency centres, which main purpose is to take in the drug-dependent population with the greatest problems regarding marginalization, they provide for their basic needs and put them in touch with other more demanding resources in the care-providing network and were operating in Spain throughout 2010. Specifically, 41 of these centres have provided care for 10,705 users.
"Regarding the harm reduction aspect, these social emergency centres set priorities for the strategies aimed at reducing adverse drug reaction-related deaths as well as the prevalence of HIV infection and other disorders among opiate and cocaine users."

"Apart from the above, the role of the 1,526 pharmacies which have programmes of this type is also fundamental. These pharmacies participate in some cases in dispensing methadone and in other cases in the needle and syringe exchange programmes.
"In any case, one must bear in mind regarding the aforementioned harm reduction programmes which take part in the prevention of drug-related emergencies and in reducing deaths that the users of these programmes may possibly have been provided with care through more than one of these facilities in 2010, it therefore not being possible to add up the total number of users."

"As in previous years, the measure aimed at providing a solution to the drug problem which scored highest is the education provided at schools (backed by 91.8% of the population). The second most highly-supported measure is voluntary drug user treatment (84.9%), followed by police and Customs supervision (84.2%) (Table 2.51 and Fig. 2.50).
"On the contrary, the measures which are considered to be least effective are those regarding legalization. The legalization of all drugs shows a 20.9% support, meaning a 5.3 percentage point rise compared to 2009, although still far from the level encountered ten years ago (27.1%). Support of the legalization of cannabis has been growing since 2007, up to 32.7% of the population found to support cannabis legalization in the last measurement taken. Similarly, the degree of support is not as high as ten years ago (38.5%).
"Similarly, other measures considered to be effective by more than 80% of the citizens are the publicity campaigns (81.0%) and the strict anti-drug laws (80.3%). Hence, the measures considered most highly effective by citizens are the informative measures, voluntary treatment, police control and legal restriction."

Laws & Policies

"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 to its evaluation. The strategy has 14 objectives, including diminishing the use of legal and illegal drugs, to delay the age of initiation of contact with drugs, to guarantee quality assistance, adapted to the needs of all people affected by drug use, to reduce or limit the harm caused to drug users health and to facilitate 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 those responsible for delivering them, as well as the indicators to be used for evaluation and the respective data sources. It is expected to evaluate the National Action Plan 2009–12, the evaluation plan was prepared in 2011.
"Spain also developed a specific action programme against cocaine 2007–10 which was structured around four main areas: coordination, demand reduction, international cooperation and supply control. By the programme’s conclusion at the end of 2010, 520 actions had been undertaken within its framework."

(Implementation of Spain's National Action Plan on Drugs) "Evaluation of the first Action Plan, 2009-2012 was begun in 2011 and continued on into 2012, having now been fully completed, although the results thereof have not as yet been made public.
"In 2011, the Central Government Administration funded 359 programs through the Government Delegation for the National Plan on Drugs, the Delegation having invested 29,974,064 euros in order to put into practice the 2009-2012 Action Plan. The measures involved encompassed all of the Action Plan’s areas of intervention: coordination, reducing the demand (prevention, lowering risk and reducing harm, social integration and assistance), reducing the supply, improving the basic and applied scientific knowledge, training/instruction and international cooperation.
"Regarding implementation at the autonomic level, all of the Autonomous Communities has regional drug dependence-related strategies in place regarding which information has been provided in earlier reports. The new developments in 2011 concerning the Autonomous Community Drug Dependence Strategies and Plans are as follows:
"- The Autonomous Community of Catalonia’s 2011-2015 Health Plan and Master Plan for Mental Health and Addictions. Catalonian Health Department.
"- The Autonomous Community of Galicia’s 2011-2016 Addictive Disorders Plan. Autonomous Community Government of Galicia. Health Ministry.
"- The Autonomous Community of Navarre’s Drug Dependence Plan (Currently II Autonomous Community of Navarre Drug Dependence Plan, 2012-2016. Autonomous Community Government of Navarre.
"- The Autonomous Community of the Basque Country’s VI Drug Dependence Plan, 2011-2015. Autonomous Community of the Basque Country."

"The law on protection of citizens’ security (1992) considers drug consumption in public, as well as illicit possession, as a serious order offence 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 foresees that the execution of the fine can be suspended if the person freely attends an official drug treatment programme. For trafficking, the Spanish law lays down penalties in line with the seriousness of the health damages associated to 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 reach up to 20 years and three months in prison, with such long terms reserved for cases with aggravating circumstances. When no such circumstances exist, those who have committed the crime can be sentenced to prison for one to three years if the drugs do not cause serious health damage, and, in line with the amendments enacted in 2010, for up to six years when they do. The new provision of the Penal Code leaves up to the courts possibility to impose sentences lesser degree in case of no aggravating circumstances exist and diversifies the applicable prison sentences for a conduct committed within criminal organisation based on the role of a person in a such entity. In all cases, a fine is also imposed.
"With regard to emerging new psychoactive substances, Ketamine was brought under control in Spain in 2010, but Mephedrone and Tapentadol in 2011. In 2011, a procedure was adopted allowing to classify new psychoactive substances as narcotic drugs at national level.

"A brief description is provided in following of the characteristics of these resources:
"Social emergency centers: The main purpose of these centers is to take in the population of drug?dependent individuals who have greater problems of social exclusion, to tend to their basic needs and to put this population in contact with other more demanding resources in the care?providing network.
"Mobile units. Mobile units are generally multi?purpose, open?access vehicles, the main functions of which are: to perform treatments with opiate substitution treatments (methadone), take samples and conduct diagnostic tests and provide first?aid.
"Pharmacies. Given the vast network of pharmacies in Spain, this is a highly useful resource when those affected by drug use can take recourse to a pharmacy.
"Safe injection rooms. Safe injection rooms, as they are also called, provide care and healthcare advice, sterile injection material and areas for self?injection and personal hygiene. In no case is any type of illegal drug facilitated, nor is any illegal drug administered on the part of healthcare personnel manning the room."

"In Spain, the legal framework of the methadone maintenance programmes (MMPs) is regulated by way of the Royal Decree of January 19, 1990 and Royal Decree 5/1996. The legislative framework regulates the methadone-dispensing facilities in the different Autonomous Communities and Autonomous Cities and specifies that, in each one thereof, there shall be a Commission for the accreditation of the centres and services which take care of carrying out these programmes.
"As mentioned in other reports, a growing number of opiate-dependent (especially heroin-dependent) individuals in our country have been progressively joining substitution programmes from 1990."

(Spain And International Drug Law Enforcement) "Spain enjoyed excellent bilateral and multilateral law enforcement cooperation with international partners in 2013. Cooperation on EU operations in the Mediterranean improved, and EU funds are being used to construct an EU command and control center to oversee maritime operations. Spain is a member of the European multilateral Maritime Analysis and Operation Centre – Narcotics. Spain also provides 22 law enforcement liaisons to three EU operational platforms in Senegal, Ghana, and Colombia. Spain’s law enforcement cooperation with Latin American governments further improved, and U.S. law enforcement agencies maintained strong working relationships with Spanish police services, resulting in multiple significant cocaine seizures in 2013. In a joint operation with the U.S. Drug Enforcement Administration, authorities seized 575 kilograms of cocaine and arrested 74 suspected traffickers."

"Through the different Ministerial Departments, the Central Government has invested a Budget of 136,649,268 euros, a total of 24,215,000 euros thereof having come from the Fund of Assets Seized for Illicit drug Trafficking or other related Offenses. This Fund has been operating since 1996 and is replenished by the cash and the goods seized as a result of final, non-appealable court decisions in proceedings for drug trafficking and other related offenses.
"Of these 136,649,268 euros falling to the different Ministries, the Ministry of Health, Social Policy and Equality transferred to the Autonomous Communities and Autonomous Cities the amount of 28,296,000 euros to be managed directly thereby.
"In addition to this sum, the Autonomous Community Administrations have invested a total of 289,029,636 euros charged against their own budgets, thus meaning that, in all, the aforementioned Autonomous Community Administrations have managed 317,325,636 euros for carrying out programmes and activities related to the prevention, providing care, social reintegration and research in drug dependencies. All of which is in terms of the authorities which the Constitution and the central and autonomous community legislation attributes to the Autonomous Communities and Autonomous Cities in regard to drug dependencies.
"Thus, in all, the total amount invested by the Central Government and the Autonomous Communities and Autonomous Cities in carrying out the drug policies totalled 425,678,904 euros in 2010. This figure means a 1.62% decrease compared to the amount invested in 2009 (432,703,103 euros). This figure of 425,678,904 euros can be broken down as follows:
"- Budgeting contributed by the Central Government: 136,649,268 euros (this sum including 28,296,000 euros which the Central Government transferred to the Autonomous Communities and Autonomous Cities).
"- Budgeting contributed by the Autonomous Communities and Autonomous Cities: 289,029,636."