Care for people who use drugs

For all the excellence of the Spanish National Health System, care for people who use drugs remains an area in need of improvement.

What we are up against:

• Poor integration: the specialist addiction units set up in the 1980s were never brought into the public health network. Running in parallel, they are hard to coordinate with other services (mental health, primary and hospital care, and so on).
• Barriers to communication: there is a serious lack of knowledge about drugs among health professionals. That, together with prejudice, stops patients speaking openly about their drug-related concerns.
• Stigmatisation of drug use: any use of a substance is framed as potentially pathological and as the step before an addictive disorder.
• No specialist training: Spain has no specific, accredited, nationally recognised training pathway for the addictions field (nothing equivalent to the MIR or PIR residency programmes).
• Stability and quality at risk: funding for many private and publicly contracted services is variable and changeable, and subject to shifting municipal or regional policy. According to official figures, the availability and quality of treatment services vary widely.
• Little political interest: care for people who use drugs is neither a political priority nor an electoral asset. Nor does it draw the same public empathy as other at-risk minorities or particularly vulnerable groups.
• The global context: the global drug policy framework is not built on scientific criteria. Its consequences for public health are severe, and they fall hardest on people who use controlled substances.

Against that backdrop, this service is distinguished by:

Comprehensive, personalised care: care that takes in the physical, psychological, social and emotional, with treatment or intervention plans designed around each person’s needs.

Grounded in scientific evidence: no moral assessments or judgements. Built on proven psychotherapeutic methods (motivational interviewing, cognitive behavioural therapy, contingency management).

Rational use of medication: psychiatric medicines (antidepressants, anxiolytics and the like) are not used to mask symptoms indefinitely. They should be used on an individual basis, as a temporary complement to psychotherapeutic support.

The principles behind this treatment

The person who uses drugs is the protagonist of their own process. People who use drugs must be treated in line with current law on the rights to autonomy, confidentiality and active participation in their treatment.

Cultural and social factors matter and must be taken into account. Differences in lifestyle, belief and attitude deserve respect.

Different patterns of use carry different potential risks. For some people abstinence is the only reasonable option. For others it is possible to work on responsible-use and harm-reduction strategies.