Public health aspects of illicit psychoactive drug use

Abstract

Illicit psychoactive drug use and public health: an introduction The misuse of psychoactive drugs is a major public health problem in many countries throughout the world. Nicotine (in the form of tobacco products) and alcohol are the most commonly used and misused psychoactive drugs, and account for the greatest mortal-ity and morbidity related to psychoactive drug use. Since nicotine and alcohol are discussed in Chapters 9.1 and 9.3, this chapter focuses on illicit psychoactive drugs, in particular opiates such as heroin, cocaine, and amphetamine-type stimulants (ATS), which cause major public health problems even if they are not of the magnitude of the problems caused by nicotine and alcohol. The United Nations Office on Drugs and Crime (UNODC) compiles annual estimates of the prevalence of the use of various illicit psychoactive drugs (UNODC 2012) and assesses trends over time. In the most recent World Drug Report published in 2012, the UNODC estimated that in 2010, between 3.4 and 6.6 per cent of the adult population (persons aged 15–64) used an illicit drug in the previous year. Of these, some 10–13 per cent of drug users were considered to be problem users with drug dependence and/ or drug-use disorders. With respect to the use of specific illicit drugs, the UNODC (2012) estimated that cannabis was by far the most commonly used drug, with 2.6–6.0 per cent of adults (120–420 million adults) having used it in the previous year, followed by opioids, cocaine, and ATS that were each used by approximately 0.5 per cent of adults (35 million). These estimates have been relatively stable over the previous 5 years. The Global Burden of Disease project recently estimated the numbers of deaths and of disability-adjusted life years (DALYs) lost attributable to illicit drug use for 1990 and 2010. Attributable deaths increased from 68,577 in 1990 to 157,805 in 2010 (Lim et al. 2012). DALYs also increased substantially during the same period, from 15,171,000 to 23,810,000. Men suffered much greater effects than women; in 2010, there were 109,420 deaths attributable to drug use among men and 48,365 deaths among women. Deaths and DALYs attributable to drug use were quite modest compared to deaths and DALYs attributable to tobacco smoking and alcohol use. For the 2010 analysis, there were 5,695,349 deaths attributable to tobacco smoking and 4,860,168 deaths attributable to alcohol use. Similar to the effects of drug use, the effects of tobacco smoking and alcohol use were much greater among men than women. Despite the modest numbers of adults who use illicit drugs, they generate many costs to society, including lost productivity, increased disability and deaths, disruption of family and other social relationships, and costs of increased law enforcement and incarceration. This chapter will focus on health-related aspects of illicit drug use. Approximately 0.5–