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

"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)."

"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)."

"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 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 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."

"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."

"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."

"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."

"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 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."

"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."

"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."

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."

"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."