Bulgarian school pupils reported higher than average (35 countries) levels of lifetime use for six of the eight key substances studied, including cannabis, illicit drugs other than cannabis and new psychoactive substances.
Lifetime cannabis use increased substantially between 1999 and 2003, but has remained relatively stable since then.
Bulgarian pupils reported one of the highest rates of lifetime cannabis use among the ESPAD countries.
For results reported for the last 30 days, cigarette use, alcohol use and heavy episodic drinking also exceeded the ESPAD average. However, the results showed that levels of lifetime use of inhalants and non-prescription use of tranquillisers or sedatives were slightly below the ESPAD average.
Studies among university students conducted in 2006-14 also indicate relatively stable levels of cannabis consumption among young adults over this period.
Recent data on high-risk drug use in Bulgaria are limited, the centre said.
In general, problem drug use in Bulgaria is linked to the use of opioids (primarily heroin) and injecting drug use.
Data from specialised treatment centres indicate that heroin remains the primary substance used by a large proportion of first-time treatment clients, although a reduction in the proportion of first-time entrants seeking help primarily for heroin use has been noted since 2009.
Injecting remains a common mode of heroin use in Bulgaria, although the proportion of heroin users who inject is decreasing.
In Bulgaria, it is estimated that approximately 0.2 per cent of 15- to 64-year-olds have used cannabis daily or almost daily in the past 30 days, based on data from the 2012 general population survey.
In the past three years, the prevalence of injecting-related HIV has been rather stable, with approximately one in 10 new HIV cases registered in Bulgaria associated with this transmission route, the report said.
Hepatitis C virus (HCV) infection is the most common drug-related infection in Bulgaria. In 2016, as in the previous year, subnational estimates suggest that approximately 6 out of 10 drug treatment clients in Sofia were HCV positive. The prevalence of HIV infection among this group was about three per cent. About four per cent of those tested had a positive test for chronic hepatitis B virus infection (positive HBsAg).
According to data from the National Centre of Public Health and Analyses (NCPHA), a total of 2781 people sought medical aid in emergency care centres as a result of drug dependency in 2016.
Data on drug-related emergencies are also available at individual facility level. The Centre for Emergency Medical Aid of Sofia reported 496 emergency cases related to illicit drug use (including abstinence syndrome), of which 109 cases were related to overdose with an illicit substance.
The toxicology clinic in Pirogov Hospital in Sofia reported 227 emergency clients in 2016, one third of whom required assistance because of cannabis use, followed by those who sought help as a result of amphetamine, cocaine, heroin and methadone use.
Since 2017, one emergency department in a hospital in Sofia has participated in the European Drug Emergencies Network (Euro-DEN Plus) project, which was established in 2013 to monitor acute drug toxicity in sentinel centres across Europe.
Drug-induced deaths are deaths that can be attributed directly to the use of illicit drugs (i.e. poisonings and overdoses). The general mortality register reported a decline in drug-induced deaths for 2008-14, with some stabilisation at low levels in recent years. All but four of the victims in 2016 were male. The mean age at the time of death was 38 years.
The drug-induced mortality rate among adults (aged 15-64) was 4.47 deaths per million in 2016, which is lower than the most recent European average of 21.8 deaths per million.
Bulgaria, which is situated on the Balkan route, is considered a transit country for illicit drugs, with trafficking activity shaped by supply and demand in Western European and Middle Eastern countries, the report said.
In addition, the cultivation of cannabis, which is mainly carried out indoors, and some production of synthetic stimulants are consistently reported. The available information suggests that cannabis grown in Bulgaria may also be smuggled to other EU countries. Amphetamines are reported to be the main stimulants produced, albeit at a small scale and for domestic use.
Cannabis products are the most frequently seized drugs in Bulgaria, followed by heroin.
However, the amounts of substances that are seized fluctuate from year to year and, in 2016, herbal cannabis and cannabis resin, heroin, cocaine and amphetamine were seized in quantities that were higher than those reported in 2015.
New psychoactive substances (NPS) continue to be seized in Bulgaria. In 2016, a total of 15 NPS were detected in Bulgaria for the first time, most of which were synthetic cannabinoids, the EMCCDA said.