The epidemiology of illicit drug use in Spain
Multiple drug use
Author: M. E. RODRÍGUEZ, M. D. ANGLIN
Pages: 67 to 74
Creation Date: 1987/01/01
M. D. ANGLIN Department of Psychiatry, University of California, Los Angeles, California, United States of America
On the basis of a review of the available information, this article summarizes the situation, patterns and trends in respect of the use of cannabis, heroin and other opiates, cocaine, amphetamines, hallucinogens and inhalants, as well as multiple drug use. The review clearly shows that since the early 1980s there has been an increasing trend in the use of drugs, particularly heroin and cannabis. Drug use predominantly affects young people. The use of two or more drugs simultaneously or successively, often involving alcohol, is reported as the most common pattern of drug use among youth. Drug use has become incorporated into the current youth culture, with all the individual, social and economic implications this engenders. The average age of users at first use of inhalants was 16.3 years, cannabis 17.5 years, hallucinogens 18.8 years, cocaine 20.6 years and amphetamines 23.5 years.
This article reviews the available information on drug use, particularly the findings of the various studies that have been conducted in Spain. The reviewed information indicates that before 1965 little information about drugs and their use was known in Spain. The only groups that were affected were either those few who had become addicted to medication (iatrogenic dependence) or a small number of soldiers who spent their military service in Africa, becoming addicted there to griffa, a product of cannabis. Another very small group of users were those who occasionally smoked cannabis resin (hashish), either as an element of high society partying or to give a modern cast to some exclusive youth meetings. From 1965 to 1977, the youth movement, which advocated drug abuse as part of the search for socio-cultural alternatives, spread over much of Europe, introducing new cultural beliefs, life-style behaviours, and contemporary art and music currents, while the phenomenon itself only began to take place in Spain. In fact, an increasing spread of drug use in Spain occurred 10 years later. Then, for each drug, the evolutionary process of its use differed depending largely on the role a given drug played in the youth culture and on its availability. Other factors, such as a high proportion of unemployed youth and increased amounts of leisure time, also played a role in the occurrence of drug use.
Until the 1970s, the illicit drug traffic in Spain was characterized by minor offences of a transitory and occasional nature. In the late 1970s, the illicit drug market acquired a continuous, permanent and professionalized character. The problems of the illicit traffic and drug abuse in Spain have become especially evident since 1977. As examples, the amount of cannabis confiscated was 5,474 kilograms in 1977 and 16,920 kilograms in 1982; the figures for cocaine were 14 kilograms in 1977 and 125 kilograms in 1982, and for heroin 151 grams in 1977 and 71 kilograms in 1982 [ 1] . In order to have a real idea of the amount of these drugs existing in the illicit market in Spain, these figures have been estimated as 10 per cent of the total.
Considering the amount of money needed to maintain the consumption of these drugs, it is easy to understand the reasons why the number of property crime offences in Spain is considered as an indirect indicator of the progression of drug abuse. It has recently been estimated that 60 per cent of robberies in Spain are used to finance drug addiction [ 1] . As a more direct example, in Madrid and the surrounding area, the number of robberies of pharmacies in 1975 were five, while in 1981 the figure was 1,900 and 892 in 1983. The decrease in 1983 could be due to the better security measures applied by the pharmacies [ 2] .
The most significant and serious point concerning the use of drugs in Spain is the current young age of most users. The available data collected from several studies show that the illegal use of drugs has become incorporated into the current youth culture, with all the individual, social and economical implications this engenders.
The following text summarizes the available information on drug use by substance.
Cannabis has reached every single city and village throughout Spain. Some illegal cannabis plantations have been found in Spain, although they are not large and are usually cultivated for personal use.
The national survey conducted in 1980 showed that 20 per cent of the population older than 12 years had at some time in their lives tried hashish and 5 per cent used it on a more regular basis [ 3] . In the 15-17 age group 41.5 per cent of the males and 13.4 per cent of the females reported use of cannabis in their lifetime, while in the 18-20 and the 21-24 age groups 42.9 per cent of the males and 9.6 per cent of the females reported such use [ 3] . The 1984 national statistics on youth (the 14-24 age group) estimated that cannabis was offered to 70 per cent of the young people and that between 30 and 40 per cent of youth had ever tried the drug, 10 per cent used it frequently and 3 per cent very frequently and in significant quantity [ 4] .
The 1985 national survey showed that 21.3 per cent of the population older than 12 years had used cannabis at some time in their lives, 14.3 per cent in the six months before the survey and 12.2 per cent in the month before the survey [ 5] . The proportion of the population using cannabis more than two times per week was 6.1 per cent, while 2.8 per cent used it between two and six times a week and 3.3 per cent at least once a day. If the last three categories are considered as regular users, then it was estimated that in 1980 there were 1,759,000 such users and 1,824,000 in 1985 [ 5] . The 1985 national survey revealed that the average age at first cannabis use was 17.5 years [ 5] .
Several studies of high school students suggest that the proportion of cannabis users in different areas of Spain are similar. A study in Mallorca showed that 28.7 per cent of the students had some contact with marijuana: 14 per cent had used it at some time in their lives, 12 per cent occasionally, 2.6 per cent several times per week and 0.5 per cent daily. This study demonstrated a strong relationship between smoking marijuana and heavy tobacco smoking [ 6] . In a study conducted in Valencia the results were similar: 27.6 per cent of the students had smoked some variety of cannabis [ 7] .
A comparison of the results reported by several surveys conducted among university students at different times show the evolution of cannabis use. A survey conducted in Cadiz in 1970 revealed that the proportion of those who had at some time smoked griffa was 4.8 per cent [ 8] . A survey conducted in Valencia in 1975 reported that 12 per cent of the sample had used hashish, 10 per cent marijuana and 10 per cent griffa [ 9] . The sample surveys in Barcelona showed that 9.6 per cent of the respondents had smoked cannabis derivatives in 1974 [ 10] , 22 per cent in 1978 [ 11] and 20 per cent in 1984 [ 12] .
Until 1978, heroin was illegally imported into Spain from France for a small number of consumers. As a consequence of the dismantling of the so-called "French connection" and the destruction of illicit heroin laboratories in France and Italy, such laboratories emerged in neighbouring countries including Spain. The establishment of illicit laboratories in Spain was one of the factors most conducive to the increase in the availability of heroin in the country [ 13] . In the last few years, contrary to what occurred before, most of heroin coming to the illicit market in Spain has been consumed in the country.
Heroin abuse, although a relatively new phenomenon, has been increasing rapidly, achieving epidemic characteristics, predominantly among youth. The first reported cases of heroin abuse appeared in the mid-1970s, while the current heroin epidemic commenced at the beginning of the 1980s. The national 1980 survey showed that 2 per cent of the population older than 12 years used heroin sporadically and 0.3 per cent daily or at least three times a week. The percentage of the respondents who used heroin at some time in their lives was 2.9 per cent in the 15-17 age group, 4.5 per cent in the 18-20 age group and 3.3 per cent in the 21-24 age group [ 3] . The 1984 national statistics on youth estimated that 5 per cent of young people had used heroin at some time in their lives, with less than 2 per cent having had intravenous use, and less than 0.5 per cent being regular users of opiates [ 4] . It was estimated that 40,000 to 60,000 young people used opiates at least occasionally, and 80,000 to 120,000 had even tried heroin one or more times [ 4] .
The 1985 national survey showed that 1.8 per cent of the population older than 12 years had used heroin at some time in their lives, 1.1 per cent in the six months before the survey and 0.9 per cent in the month before the survey [ 5] . Among the respondents, 0.07 per cent used heroin two to six times per week and 0.34 per cent at least once a day [ 5] . The higher rates of heroin use were found in Euskadi, Madrid, Cataluna and Navarra [ 5] . The comparison of the results of the two national surveys shows that the number of regular heroin users increased by 58.2 per cent from 1980 to 1985.
With regard to the gender of users, the study conducted among students in the geographical area of Gijon in 1981 showed that 5.8 per cent of the males and 1.1 per cent of the females used opiates [ 14] .
Consecutive studies among university students have demonstrated the proportion of students involved in the use of opiates. The 1974 survey in Barcelona showed that 0.8 per cent of medical students had used opiates [ 15] . The average rate of heroin use found among students of the various universities in Spain was 0.6 per cent in 1978 [ 11] . In 1984, 1.2 per cent of the interviewed students in Barcelona admitted to having tried heroin at some time in their lives. No significant differences were found between the genders [ 12] .
The study of the prevalence and characteristics of heroin use is difficult because of the illegality of such use. At present, there are few available studies in Spain with reliable methodologies that can gather accurate data on heroin use and related problems. For this reason, some of the indirect indicators, which show the consequences of the problem, are presented below in an attempt to achieve a more realistic view of the problem. One example of this is the number of heroin addicts admitted to one of the main hospitals in Valencia for liver disease. There had been no admission for heroin addiction to that hospital before 1980, while there were 15 admissions in 1980, 24 in 1982 and 19 during the first nine months of 1984 [ 16] .
The number of reported deaths caused by heroin overdose was 34 in 1981, 48 in 1982, 93 in 1983, 150 in 1984 and 142 in 1985. It is important to bear in mind that those figures correspond to official records and that, due to the general underreporting of deaths associated with drug abuse, the actual number should probably be higher. The number of emergency room visits associated with heroin abuse recorded by the Hospital del Mar, Barcelona, was 7 in 1980, 44 in 1981, 233 in 1982, 796 in 1983, and 2,562 in 1984 17, [ 18] .
The number of patient visits to specific treatment centers for heroin addiction can also indicate the level of such addiction. For example, the Hospital del Mar reported 29 such visits in 1981, 369 in 1982, 1,502 in 1983, and 1,988 in 1984 [ 19] . The patients were mainly in the 19-21 age group. The figures on new admissions for heroin addiction to four out-patient treatment centres in Barcelona were 7 in 1981, 569 in 1982, and 1,150 in 1983 [ 20] .
The increasing numbers of heroin seizures, the amount of heroin seized and the number of heroin-related offences are consistent with other direct and indirect indicators showing the increasing trend of heroin abuse in Spain.
Sources differ in their assessment in how much cocaine has been seized in Spain during the last few years, but all of them agree that the increase has been enormous. After 1977, the illegal drug-trafficking organizations have used Spain as the entry and distribution point for much of the cocaine sold in Europe. In 1981, the illicit trade in cocaine became a profitable business on the illicit market in Spain itself. At present, a great deal of the cocaine coming into the illicit market in Spain is intended for domestic consumption.
With the now abundant quantities of cocaine available on the illicit market in Spain the drug is distributed to artistic and other high-level society circles, especially in Barcelona and Madrid [ 21] . The use of cocaine confers status. Detailed data about patterns of cocaine use are not fully available, but it is known that its use is mostly occasional or sporadic and that regular users are at present a small minority.
The 1980 national survey indicated that 3.5 per cent of the population older than 12 years had tried cocaine and that 2 per cent used it on a more regular basis. Cocaine consumption by young people was more widespread. The percentage of young people who used or tried cocaine at some time in their lives was 15.8 per cent in the 15-17 age group, 10.2 per cent in the 18-20 age group and 10.9 per cent in 21-24 age group [ 3] . The 1984 national statistics about youth estimated that 5 per cent of young people had tried cocaine and that the proportion of regular users was insignificant [ 4] . The national 1985 survey showed that 3.7 per cent of the population older than 12 years had used cocaine at some time in their lives, 1.8 per cent in the six months before the survey and 1.4 per cent in the month before the survey. The survey showed that the proportion of regular cocaine users was 0.28 per cent of the population (0.18 per cent using cocaine between two and six times per week and 0.10 per cent using it at least once a day) [ 5] .
The number of regular users in 1980 was estimated to be 52,500 and 83,000 in 1985. The average age of cocaine users at first use was 20.6 years [ 5] .
The use of cocaine among high school students is considered to be quite low, although 2.5 per cent of the students had tried it according to a recent study [ 7] . A study in the Asturian region showed that 2.4 per cent of the students (3.1 per cent of the males and i.4 per cent of the females) had used cocaine. The respondents in this study were in the 14-24 age group [ 14] .
A study conducted in Barcelona in 1984 revealed that 1 to 3 per cent of the students (4.6 per cent of the males and 1.6 per cent of the females) used cocaine at some time in their lives [ 12] . Although the sporadic use of cocaine is more often found among young people, it appears that its regular use is initiated at a later age (after 20 years) than the regular use of other drugs [ 22] .
Amphetamines and amphetamine-like substances, which can stimulate the central nervous system, are present in a large number of pharmaceutical products. A medical prescription is required to buy them. Since 1981, pharmacists have been required to be more restrictive in making available these products.
The 1980 national survey showed that approximately 6 per cent of the population older than 12 years used amphetamines sporadically, while 0.4 per cent were regular consumers [ 3] . The proportion of users was much higher among young people than among adults: 15.8 per cent of people in the 15-17 age group had tried amphetamines, 10.2 per cent in the 18-20 age group and 10.9 per cent in the 21-24 age group [ 3] .
A study in the northern area of the country found that 10.9 per cent of the adolescents and young people were amphetamine users (14.8 per cent of the males and 5.7 per cent of the females) [ 14] .
The 1984 statistics about youth indicated that 15 per cent of young people had tried amphetamines, males more often and with greater frequency. It was estimated that between 18 and 28 per cent of amphetamine users were abusing these substances [ 4] . The 1985 national survey showed that 11.3 per cent of the population older than 12 years had tried amphetamines at some time in their lives, 4.9 per cent in the six months before the survey and 3.7 per cent in the month before the survey. The proportion of regular amphetamine users was estimated to be 1.9 per cent in 1985, 0.8 per cent using them between 2 and 6 times per week and 1.1 per cent at least once a day [ 5] . The average age of amphetamine users at first use was 23.5 years in 1985.
The 1985 study among high school students in Valencia demonstrated that 12.2 per cent of them had used amphetamines at some time in their lives [ 7] . According to a survey conducted at several Spanish universities, on average 20 per cent of medical students used amphetamines at some time in their lives [ 11] . In a school of elementary teachers, where almost all students were women, the figure was 8.8 per cent. In most cases, the use among students was related to preparation for examinations. The proportion of those using amphetamines regularly was much smaller, ranging from less than 1 per cent to 1.4 per cent [ 11] .
The 1980 national survey revealed that 2.6 per cent of the population older than 12 years had tried LSD. A higher proportion of young people, predominantly males, experimented with it: 5.3 per cent in the 15-17 age group, 7.7 per cent in the 18-20 age group, and 5.5 per cent in the 21-24 age group [ 3] . The average age of the users of hallucinogenic substances at first use was 18.8 years. The 1985 national survey showed that 4.4 per cent of the population older than 12 years had used hallucinogens at some time in their lives, 2.1 per cent in the six months before the survey and 1.5 per cent in the month before the survey [ 5] . As many as 3.4 per cent of the high school students surveyed had tried hallucinogenic drugs such as LSD [ 7] .
In 1984, it was estimated that approximately 3 per cent of the population less than 18 years old had tried inhalants [ 4] , while the results of the 1985 national survey showed that 2 per cent of the population older than 12 years had used these products at some time in their lives, 0.7 per cent in the six months before the survey and 0.4 per cent in the month before the survey. A small percentage (0.07 per cent) of the population were regular users. The average age of inhalant users at first use was 16.3 years [ 5] .
The proportion of high school students in Valencia having ever tried inhalants was 5.3 per cent [ 7] . A survey conducted at several universities revealed that 1.5 per cent of the students had ever used inhalants [ 11] . In general, inhalant users are mainly males between 10 and 20 years of age, although it is not unusual to find eight-year-old users. The users usually come from lower socio-economic strata of the population who live in poor settlements outside big cities. Their home environment is often unstable. The users of inhalants usually present difficulties for adaptation at school resulting in major learning problems.
The available information indicates that multiple drug use is the most common pattern of drug use among young people. According to the estimate made in 1984, between 40,000 and 60,000 young people suffered from problems related to the dependence on one or more substances. Between 800,000 and 1,200,000 people used two or more substances, either simultaneously or successively [ 4] .
In northern Spain, a 1980 study estimated that 0.6 per cent of the population used two substances and 0.4 per cent three substances regularly [ 23] . Alcohol and tobacco were not included among the substances. When alcohol was studied, it clearly showed that the rate of cannabis use was higher among alcohol users.
Multiple drug use with its unpredictable consequences is a particular problem. The experimentation with two or more substances is frequently the main step in the move towards devastating drug addiction.
F. Lazaro, "La droga en España: momento actual (I)", Policia Española, July-August 1983, pp. 50-51.002
Resumen Estadístico de la Evolución del Tráfico Ilícito de Drogas en España (Madrid, Brigada Central de Estupefacientes, Gabinete de estudio, informacion y coordinación, 1982), annex 1.003
EDIS-Caritas Nacional, "La población española ante las drogas", Revista de Documentación Social, vol. 42, 1981.004
D. Comas, Informe Sobre el Uso de Drogas por Parte de la Juventud Española (Madrid, Ministry of Culture, 1984).005
Avance de Resultados Generales del Estudio Sobre Consumo de Drogas en España (Madrid, Equipo de lnvestigacion Sociologica EDIS, 1985).006
A. Calafat and others, "Consumo de alcohol, tabaco y otras drogas entre estudiantes de enseñanza media y formación profesional de Mallorca", Drogalcohol. vol. 7, No. 3 (1982), pp. 117-126.007
M. A. Torres Hernández, M. S. Gisbert Grifo and J. A. Gisbert Calabuig, "El consumo de drogas de abuso en la población estudiantil de Bachillerato Superior de la Provincia de Valencia", Drogalcohol, vol. 10, No. 1 (1985), pp. 15-20.008
A. Calcedo, "Uso y abuso de psicoestimulantes y otras drogas en el medio universitario a propósito de una encuesta", Actas Luso-Españolas de Neurologia Psiquiatría, vol. 30, No. 3 (1971), pp. 129-150.009
V. Carbonell, "Los universitarios valencianos y el uso de drogas", Drogalcohol, vol. 3, 1978, p. 20.010
J. R. Laporte and others, "Caffeine, tobacco, alcohol and drug consumption among medical students in Barcelona", European Journal of Clinical Pharmacology, vol. 11, 1977, p. 499.011
Grupo Universitario Multicéntrico, "Consumo de drogas en el medio universitario", Medicina Clinica, vol. 75, 1980, pp. 317-326.012
J. Cami and M. E. Rodríguez, Estudi Sobre el Consum de Drogues Entre els Estudiants de Medicina de les Universitats Catalanes (Barcelona, Generalitat de Catalunya, 1985).013
"Aprehensiones realizadas por la Guardia Civil en 1983", Interdroga, Boletín Informativo de la Comision lnterministerial para el Estudio de los Problemas Derivados del Consumo de Drogas, vol. 3, 1983.014
R. Hinojal Fonseca and others, "Estudio del consumo de drogas en adolescentes de un área asturiana: Gijón", Medicina Clínica, vol. 80, No. 3 (1983), pp. 108-111.015
J. Laporte and others, "Consumo de drogas de uso no medico entre los estudiantes de Medicina de Barcelona", Comunicación al Segundo Congreso Nacional de la Asociación Española de Farmacólogos, Cádiz, 1976.016
J. A. del Olmo and others, "Enfermedad hepática en el área de Valencia", Gastroenterologia y Hepatologia, vol. 7, No. 8 (1984), pp. 405-410.017
J. Cami and others, "Heroína: nueva causa de urgencias toxicológicas", Medicina Clínica, vol. 82, No. 1 (1984), pp. 1-4.018
F. Alvarez and others, "Urgencias toxicológicas", 1984 (unpublished).019
Memoria de Actividades Servicio de Toxicomanias (Barcelona, Hospital del Mar, 1984).020
S. de Torres, Demanda Asistencial Derivada de la Heroinomania (Barcelona, Hospital del Mar, 1984).021
R. Herren, "La coca 'chic' lleg a España", Cambio, vol. 16, No. 695 (1985), pp. 112-119.022
F. Marquinez and others, Estudio Epidemiológico Directo Sobre Consumo de Alcohol Tabaco y Otras Drogas en la Población General de Vizcaya (Bilbao, Departamento de Estudios de Sanidad y Seguridad Social, 1980).023
F. Marquinez and others, Investigación Epidemiológica Aplicada a la Prevención y Tratamiento de las Toxicomanías en la Provincia de Vizcaya (Bilbao, Departamento de Estudios de Sanidad y Seguridad Social, 1980).