Drug use is a worldwide phenomenon, and drug use occurs in almost every country. The three main drugs of use are cannabis, opiates, and cocaine.
Alcohol consumption causes death and disability relatively early in life. In the age group 20 – 39 years approximately 25% of the total deaths are alcohol-attributable.
Alcohol is a psychoactive substance with dependence-producing properties that has been widely used in many cultures for centuries. The harmful use of alcohol causes a large disease, social and economic burden in societies. The harmful use of alcohol ranks among the top five risk factors for disease, disability and death throughout the world. Harmful use of alcohol accounts for 5.9% of all deaths worldwide. Despite the large health, social and economic burden associated with harmful use of alcohol, it has remained a relatively low priority in public policy.
Opiates and opioids top the list of problem drugs that cause the most burden of disease and drug-related deaths worldwide. For the third consecutive year, Afghanistan, which has the world’s largest opium poppy cultivation, saw an increase in the area under cultivation (from 154,000 hectares in 2012 to 209,000 hectares in 2013).
An emerging phenomenon among opioid-dependent drug users in the United States of America is that synthetic opioids are being replaced with heroin, driven by the increased availability of heroin in parts of the United States, and lesser costs to regular users to maintain their dependency. Further, the reformulation of one of the main prescription pharmaceuticals abused, OxyContin, now makes it more difficult to snort or inject it.
The emergence of potentially more harmful behaviour, including the abuse of opioids such as fentanyl, has been noted among opioid-dependent persons in Estonia, Finland and the United States. It has been observed that opioid users may alternate between pharmaceutical and/ or prescription opioids and heroin, depending on which substance is more available, accessible and cheaper in the market.
The most problematic use of cocaine is in the Americas. In North America, cocaine use has been declining since 2006, partly due to a sustained shortage. However, more recently, a slight increase in prevalence has been observed in the United States, as has an increase in maritime seizures.
In South America, cocaine consumption and trafficking have become more prominent, particularly in Brazil due to factors including its geographical location and a large urban population. In Western and Central Europe, the second largest market after the Americas, indicators of overall supply suggest a possible rebound in the availability of cocaine; retail purity has increased in some countries with sizable consumer markets. On the other hand, they do not show an increase in demand. There has even been a decline in cocaine use in some of the countries that have had higher levels of use.
Although the general public may perceive cannabis to be the least harmful illicit drug, there has been a noticeable increase in the number of persons seeking treatment for cannabis use disorders over the past decade, particularly in the Americas, Oceania and Europe.
Manufacture of methamphetamine in North America expanded once again, with a large increase in the number of methamphetamine laboratories reported dismantled in the United States and Mexico.
Of the total of 144 tons of amphetamine-type stimulants seized globally, half were seized in North America and a quarter in East and South-East Asia. Large quantities of amphetamine seizures continue to be reported in the Middle East, in particular in Jordan, Saudi Arabia and the Syrian Arab Republic.
The misuse of prescription stimulants or medications for attention-deficit hyperactivity disorder (ADHD) is not uncommon, although only a few countries report any prevalence of misuse among the general and youth population. Although misuse of prescription stimulants in other regions is not negligible, such abuse is reported mainly by countries in North and South America.
New psychoactive substances and web-based marketplaces
While the Internet continues to be used as a means of drug trafficking and illicit trade in precursor chemicals, use of the so-called “dark net” has been growing. The “dark net” constitutes a virtual marketplace, which is inaccessible by web search, and where it is difficult for law enforcement authorities to identify website owners and users, as their identities remain hidden by means of sophisticated concealment methods. That makes the “dark net” a safe haven for buyers and sellers of illicit drugs, who trade principally in a digital currency (Bitcoin).
The dismantling of one prominent “dark net” site, the “Silk Road”, uncovered that the site had approximately $1.2 billion worth of total revenue from two to five years of operations.
Finally, the proliferation of new psychoactive substances continues to pose a challenge, with the number of new psychoactive substances (348 such substances in December 2013, up from 251 in July 2012) clearly exceeding the number of psychoactive substances controlled at the international level (234 substances).
People who inject drugs
Unsafe injecting drug use can have very serious health implications due to the high risks of the transmission of blood-borne infections such as HIV, as well as hepatitis B and hepatitis C, contracted by sharing of contaminated injecting equipment. The Joint United Nations Programme on HIV/AIDS (UNAIDS) reports that the number of new cases of HIV among people who inject drugs (PWID) remains high, constituting up to 40 per cent of new infections in some countries and resulting in a major public health challenge.1