Drug Abuse in the Global Village
Spain
EXTENT, PATTERNS AND TRENDS IN DRUG ABUSE
Extent of Drug Abuse
Cannabis is the most abused drug in Spain. According to survey research, the annual prevalence of cannabis abuse is estimated to be 5% for the population over 15 years of age (U.N. 1991). Cocaine is the next most prevalent drug abused, with annual prevalence of about 2 per cent. Annual abuse of amphetamines, both medical and non-medical, is estimated at about 1 per cent. The reliability of these estimates are limited, according to the reply to the Annual Reports Questionnaire (U.N. 1991).
Estimates of prevalence of heroin abuse reported for selected areas, are 0.38-0.44 per cent in Barcelona in 1989 and 0.24 per cent in Navarre in 1990. The incidence of heroin consumption, according to survey research, is low and subject to limited reliability (U.N. 1993).
According to survey research, the estimated annual consumption of prescription drugs is about 7 per cent, most are likely to be benzodiazepines, according to U.N. reports. Consumption without medical prescription, that is, illicit abuse, was not reported (U.N. 1991).
Abuser Characteristics
About four in every five opiate or cocaine abusers are males, while women abusers constitute 12-20 per cent of the cocaine abusers, 18-23 per cent of the heroin abusers and 28-30 per cent of the cannabis abusers. Cocaine is most prevalent among abusers 20-39 years of age and cannabis among those aged 15-25 years. According to research among drug abusers, heroin abuse is most prevalent among city dwellers, those 20 to 34 years of age and those with low educational level (Ministry of Health and Consumption 1991, 1992; U.N. 1989; U.N. 1990; Ministry of Justice and Interior 1993).
The average age of patients treated for the first time in 1991, for heroin and cocaine dependence is 25.7 and 26.6 years of age, respectively. The average age of patients with previous treatment record is 27.3 and 28 years of age, respectively. In 1991, 81 per cent of all the patients in opiates substitution treatment, were males and the average age was 30, while females comprised 19 per cent and their average age was 28 (Ministry of Justice and Interior 1993).
Regional Variations
Southern Spain (Andalucia) is where cannabis is consumed most frequently among adolescents and among adults (Cami 1992).
Of the 14,479 AIDS cases reported among intravenous drug users (IDU), most cases were reported in the self governing regions of Catalonia (about 532 per million), of Madrid (about 709 per million), and of the Basque region (about 739 per million), where the most important urban and industrial nuclei are situated (Ministry of Justice and Interior 1993).
Trends
According to U.N. reports in 1991, there has been a decrease in the abuse of cannabis, amphetamines and hallucinogens (LSD) during the last decade (U.N. 1991). Subsequent reports, in 1993, suggest a large increase in the abuse of MDMA ("extasy"), some increase in cocaine consumption, and some decrease in the consumption of opiates and cannabis (U.N. 1993).
An increase in the average age of heroin abusers is attributed to the observation that initiation into the abuse of heroin among youth has decreased (Ministry of Health and Consumption 1991, 1992). The average age for drug consumption for patients in treatment centres continues to increase from 24.9 in 1987 to 27.2 in 1993 (Ministry of Justice and Interior 1993).
In the period from 1981 to 1985, 31.4 per cent of the heroin abusers admitted to treatment had consumed cocaine in the 30 days preceding treatment. This figure rose to 42.8 per cent in 1987, and up to 51.5 per cent in 1991 and has subsequently decreased to 45.6 in 1992 and 44.1 in 1993 (Ministry of Justice and Interior 1993).
Robberies and armed robberies in pharmacies reported to the police increased from 5 cases in the 1975 to 1,900 cases in 1979, falling to 281 cases in 1990 (Cami 1992).
The practice of injection is decreasing rapidly, while smoking and inhaling are increasing among heroin abusers. The rate of people treated for the first time for whom the most frequent mode of intake is intravenous has decreased from 50.3 per cent in 1991 to 37.8 per cent in 1993 (Ministry of Health and Consumption 1992; U.N. 1993).
According to the State Information Drug System (SEIT), the number of deaths related to drug consumption in six cities in Spain has increased from 1983 (82 cases) to 1991 (579 cases), and decreased in 1992 (556 cases). Data from the Police, also, suggest a similar trend, an increase from 1983 (93 cases) to 1990 (667 cases), and a slight decrease to 809 cases in 1991 (Ministry of Health and Consumption 1992).
Seizures of "extasy" have increased from 187 tablets in 1987, 22,165 tablets in 1991 to 274,420 tablets in 1993 (Ministry of Justice and Interior 1993).
Mode of Intake
Heroin is usually injected, cocaine sniffed, and other opiates are ingested (U.N. 1993).
In 1991, the main route of drug administration for abusers entering prisons was intravenous (67.7 per cent for heroin, 26.7 per cent for other opiates and 60.1 per cent for cocaine), followed by smoking for heroin (26,1 per cent), oral for other opiates (59.7 per cent) and sniffing for cocaine (21.6 per cent) (Ministry of Health and Consumption 1991). Approximately 30.2 per cent of the people who entered prison in 1993 were IDUs. IDU among those re-entering prison was 43.8 per cent. Among IDUs who entered prison for the first time in 1993, around 30.2 per cent were infected with HIV. The percentage of IDUs among persons entering prison for the first time has decreased from 26.4 per cent in 1992 to 20.8 per cent in 1993 (Ministry of Justice and Interior 1993).
The effect of AIDS has radically modified the attitude of IDUs. Injection among dependent heroin abusers in treatment between 1981 and 1985 decreased from 87 per cent to 62.4 per cent in 1991 (Ministry of Health and Consumption 1991). U.N. 1993 confirms these trends (U.N. 1993).
COSTS AND CONSEQUENCES OF ABUSE
According to the National Register of AIDS cases (Registro Nacional de Casos de SIDA), by the end of 1993, 14,479 AIDS cases were IDU related. This represents 63.9 per cent of all the AIDS cases diagnosed, by the end of 1993. Spain surpasses Italy, Switzerland and France in the number of drug related AIDS cases per million (Ministry of Health Consumption 1991, 1992; Ministry of Justice and Interior 1993).
The number of AIDS cases among IDUs increased from 1 case in 1982 to 2,588 cases in 1991, peaking at 2,592 cases in 1992, followed by a decrease to 1,938 cases in 1993 (Ministry of Justice and Interior 1993).
By the end of 1993, the highest rate of accumulated cases of AIDS per million were in the Basque region and in the self-governing regions of Madrid and Catalonia (Ministry of Justice and Interior 1993).
The total number of deaths caused by opiates or cocaine for 1993 was 653, according to SEIT (most of them males) (U.N. 1993).
Mortality due to acute reaction to opiates or cocaine abuse in six large Spanish cities increased from 82 cases in 1983 to 579 cases in 1991. In over 90 per cent of death cases, among those admitted to treatment, traces of morphine or other metabolical products derived from heroin were found, according to SEIT. In many cases, benzodiazepines were also found; thus, supporting the hypothesis that benzodiazepines can increase the risk in heroin overdose, according to Spanish reports (Ministry of Health and Consumption 1991, 1992; Ministry of Justice and Interior 1993).
Since 1991, the peak year for deaths due to acute reaction from opiates or cocaine, the rate has been decreasing, from 556 deaths in 1992 to 442 in 1993 (U.N. 1993).
NATIONAL RESPONSES TO DRUG ABUSE
National Strategy
Since 1985, drug related activities are coordinated in a National Plan, chaired by the Ministry of Health. An inter ministerial group, with the participation of various ministries, sets policy and programme guidelines to tackle emerging problems. At the self governing regions level, the Sectorial Conference coordinates regional activities (Spain 1991).
Structure of National Drug Control Organs
The central government unit responsible for liaison and coordination of national drug control policy is the Plan Nacional sobre Drogas (National Plan for Drugs) within the Ministry of Interior. The Ministry of Health and Consumption acts as competent authority for the issuance of import and export authorizations.
LEGAL, ADMINISTRATIVE AND OTHER ACTION
TAKEN TO IMPLEMENT THE INTERNATIONAL
DRUG CONTROL TREATIES**
Treaty Adherence
Spain is party to the 1961 Convention on Narcotic Drugs, as amended by the 1972 Protocol, the 1971 Convention on Psychotropic Drugs, and the 1988 Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substance.
Measures Taken with Respect to Drug Control
Recently enacted laws and regulations:
In December 1993, a law was enacted on measures to prevent money-laundering, including drug-related money-laundering. It requires banks and other financial institutions to keep records on the identity of their clients and to cooperate with the enforcement services by informing them of any suspicious transactions made in that regard. A Commission on Prevention of Money Laundering and other monetary offenses under the authority of the Secretary of State was created to oversee and coordinate implementation of the law. In December 1992, a modification of the penal code and the law of criminal prosecution was enacted which integrates the normative provisions of the 1988 Convention into the judicial system. Spain has concluded agreements on mutual legal assistance and mutual assistance with respect to customs matters and on demand reduction with the United States. Likewise, a mutual legal assistance agreement has been concluded with Chile and agreements on maritime cooperation and extradition with France.
Licensing system for manufacture, trade and distribution:
There is a government-controlled licensing system. Several narcotic drugs and psychotropic substances were reported being manufactured in 1993.
Control system:
(i) Prescription requirement: There is a prescription requirement for supply or dispensation of preparations containing narcotic drugs and psychotropic substances.
(ii) Warnings on packages: Preparations containing narcotic drugs or psychotropic substances carry a symbol which indicates the special nature of the contents but there are no warnings to safeguard the user of those preparations on the packages themselves.
(iii) Control of non-treaty substances, if any: None reported.
(iv) Other administrative measures: In 1993, the National Plan of Drugs was moved from the Ministry of Health and Consumption to the Ministry of Interior, within the framework of restructuring the latter Ministry. It was also decided to grant financial aid to non-profit state entities who develop programmes that are in accordance with the priorities set by the National Plan. In July 1993, a resolution was adopted by the Undersecretary of Social Affairs calling for support and subsidies to assist non-governmental organizations in implementing their programmes.
Social Measures
Penal sanctions related to social measures: In 1990, courts applied measures of treatment, education, after-care, rehabilitation or social reintegration for a drug-related offence both as an alternative and in addition to conviction or punishment. For 1989 and 1991, courts applied those measures only as an alternative to conviction or punishment. No data supplied for 1993.
Other social measures: In 1992, the development of a treatment programme for prisoners continued.
DEMAND REDUCTION ACTIVITIES
Primary Prevention
The media is used in drug prevention extensively. Media activities were varied and consisted of 715 television programmes, 10,500 radio programmes, 1,550 newspaper ads, 50 videos, thousands of posters, brochures, pamphlets, letters, calendars, as well as activities in theaters, and music festivals in 1991 (U.N. 1993). Press offices in every government department supply information to the media. Collaboration also exists between the media and health professionals, NGOs through training programmes (U.N. 1993).
A prevention programme of the Ministry of Education and Science operates in schools since 1987. It focuses on training teachers, developing education projects and coordinating with other prevention agencies (NGOs or local or regional administrations). During 1990-1991, 134 projects were carried out in 187 different educational centres, which involved 1,713 teachers, 2,054 parents and over 33,000 students (Ministry of Health and Consumption 1991). In 1993, 307 prevention programmes were carried out with the schools. About 5,614 activities took place, involving 97,298 persons (including teachers, parents, students, and persons from different associations) (Ministry of Justice and Interior 1993). Drug education has become part of the curricula of primary and secondary schools, starting from 1991 (U.N. 1993). Since 1987, the Ministry of Education has been carrying out a training programme, having appointed regional coordinators to promote courses for teachers and parents. They are offering a range of classroom activities concerned with tobacco, alcohol and other drugs (Spain 1991).
Community-wide prevention activities are being developed with youth organizations, neighborhoods, prisons and Army Forces, all following healthy lifestyle themes. Messages to prevent risks associated with needle sharing and unsafe safe sexual behavior have been inserted in community campaigns. Syringes are available in pharmacies without prescription. No needle exchange programmes have been put into practice (Spain 1991).
In 1993, the first Private Sector Conference on Drug Abuse in the Workplace was held in Seville, with the participation of representatives of private business, NGO's and international organizations including UNDCP (U.N. 1993).
Treatment and Rehabilitation
Rehabilitation policy is based on a holistic approach and voluntary participation. Most treatment and rehabilitation programmes are provided in state health services, which include detoxification, personal counselling and support, educational and vocational programmes and contacts with other health and social agencies. Some of the services are provided on an outpatient basis. Programmes aim to abstinence, but drug maintenance programmes are also provided. Most programmes are free of charge (U.N. 1993).
Resources for treatment and rehabilitation have increased since 1985. A total of 369 outpatient centres offer detoxification programmes, health education, psychotherapeutic support and links with vocational training and employment agencies run by a multidisciplinary staff. There were 120 residential facilities in 1989, half of them totally or partially publicly funded. In 1989 there were 48 hospital detoxification units, with 208 beds (Spain 1991).
The number of people admitted to treatment centres increased, mainly due to more available treatment space. In 1987, 10,338 drug dependent abusers were admitted for treatment in Spain, of which 97 per cent were heroin abusers, 1 per cent were abusers of other opiates, and 2 per cent were cocaine abusers. In 1993, the total number of patients treated rose to 39,033, of which 94.9 per cent were heroin abusers, 4.4 per cent were cocaine abusers, and 0.7 per cent were other opiates abusers (Ministry of Health and Consumption 1991; Ministry of Justice and Interior 1993). About 56.9 per cent of the people admitted to treatment due to abuse or dependence of opiates or cocaine during 1993 were admitted for the first time in their lives; in 1991 this rate was of 51.1 per cent (Ministry of Justice and Interior 1993).
According to a 1993 report, there are 776 treatment facilities in Spain, including 84 non-hospital residential units, 452 state health care services, 50 specialized detoxification facilities, 124 facilities within prisons, and 66 other facilities (U.N. 1993).
More than 90 per cent of drug related treatment admissions and the emergencies registered by SEIT are related to heroin consumption (Ministry of Justice and Interior 1993).
SUPPLY REDUCTION ACTIVITIES
In December 1992, Spain passed special narcotics legislation to comply with EU directives. To combat money laundering, Spanish banks instituted a policy of requiring identification from persons depositing currency in excess of $10,000 (INCSR 1993).
A newly established "Civil Guard of the sea" is expected to strengthen Spain's maritime surveillance capabilities, as it grows from 13 to 77 vessels and its personnel, from 338 to 2,245 by 1995 (INCSR 1993).
Arrests, Convictions and Types of Offenses
In 1993, 30,163 persons were arrested for illicit drug trafficking, compared to 11,446 in 1984. Most of the arrests were cannabis and opiate related (43 per cent and 36 per cent respectively). Cocaine related arrests accounted for 13 per cent of the total arrests (Ministry of Justice and Interior 1993). Possession of drugs for personal consumption is not illegal in Spain (Cami 1992).
Seizures
In 1993, 160,169 kg of cannabis (and its derivatives) were seized, compared to 11,400 kg in 1980. There has also been an increase in cocaine seizures, from 58 kg in 1980, up to 5,350 kg in 1993. The amount of heroin seized increased, significantly, through the years, but had a slight drop from 1990 to 1993. It increased from 6 kg in 1980 to 886 kg in 1990 and dropped to 604 kg in 1993 (Ministry of Justice and Interior 1993).
During 1992, Spain was the EU country where the largest quantities of cannabis and cocaine were seized and the fourth in terms of heroin seizures, after Germany, Italy, and Holland. The amount of seizures and arrests in 1993 was reported stable as compared to 1992 (Ministry of Justice and Interior 1993).
Supply Source of Drugs
Most of the cannabis available in Spain originates from North Africa. It is transported to Spain by sea for trafficking to other European countries. Most of the cocaine available in Spain, originates in South America and reaches Spain by air and sea (Plan Nacional 1992).
The U.S. Drug Enforcement Administration estimates that roughly 55 per cent of the cocaine destined for the European market, largely from the Cali and Medellin cartels, flows through the Iberian Peninsula. Spain also is a transit point for heroin from Asia (INCSR 1993). In general, it is estimated that international organizations that introduce heroin into Spain prefer to do so by land, through the Balkans and Central Europe (Ministry of Health and Consumption 1992). A smaller but growing amount of heroin comes via maritime routes from Lebanon (INCSR 1993).
References and Notes
A computerized network (State Information Drug System (SEIT)), established in 1987, collects indirect indicators on drug abuse from the whole country with 17 gathering points and a central unit for synthesis. It provides an annual report which contains figures on drug treatment demands and emergency episodes due to drug related problems (Spain 1991).
U.N. 1989, 1990, 1991, 1993. Replies to the UNDCP "Annual Reports Questionnaires" for the years 1989, 1990, 1991, and 1993.
Cami 1992. Cami J, Barrio G. "Drug Consumption in Spain: Trends, Implications and Policies". In: Conference on American and European Drug Policies: Comparative Perspectives. Ed. by The Rand Corporation, Washington, 1992, in press.
INCSR 1993. International Narcotics Control Strategy Report. April 1993.
Ministry of Health and Consumption 1991, 1992. Ministry of Health and Consumption Memoria 1991 and 1992, Plan Nacional Sobre Drogas. Delegacion del Gobierno para el Plan Nacional Sobre Drogas. Ministerio de Sanidad y Consumo.
Ministry of Justice and Interior 1993. Plan Nacional Sobre Drogas, Memoria 1993. Delegacion del Gobierno para el Plan Nacional sobre Drogas. Ministerio de Justicia e Interior.
Plan Nacional 1992. Nota Informativa Sobre la Situacion de Espana en Materia de Drogas, con Especial Referencia al Ultimo Trimestre de 1991. Plan Nacional Sobre Drogas, Delegacion del Gobierno para el Plan Nacional Sobre Drogas, 1992.
Spain 1991. First Pan European Ministerial Conference on Co-operation on Illicit Drug Abuse Problems. National Report of Spain. Co-operation Group to Combat Drug Abuse and Illicit Trafficking in Drugs (POMPIDOU GROUP). Council of Europe, 1991.
Notes:
** The Legal, Administrative and Other Action Taken to Implement the International Drug Control Treaties section was prepared by the Secretariat of the Commission on Narcotic Drugs based on Annual Reports Questionnaires for the years 1989-91, 1993, Informe de situaciףn y memoria de actividades, 1992 edita por el Ministerio de Sanidad y Consumo.