MODULE 2- EPIDEMIOLOGY OF DRUG USE IN THE AMERICAS Part Two- Drug Policy and Public Health MODULE 2- EPIDEMIOLOGY OF DRUG USE IN THE AMERICAS This module describes the epidemiology of drug use in the Americas, comparing it to drug use worldwide and looking at trends over time as well as within specific population groups. Pan American Health Organization

Learning Objectives Upon completion of this module you will be able to: Describe drug use epidemiology in the Americas Upon completion of this module you will be able to describe the epidemiology of drug in the Americas. Pan American Health Organization

Drug Use in the Americas At least 4.4 million men and 1.2 million women afflicted by drug use disorders Annually, 1.7 million men and 400,000 women are affected, often in their most productive years of life Impact on the health care systems of many countries in the Region Drug-related disorders more common in the developed countries of the Americas Health burden falls disproportionately on low- and middle-income countries At least 4.4 million men and 1.2 million women in Latin America and the Caribbean are afflicted by drug use disorders—including drug dependence and other ailments—at some point in their lives. Annually, 1.7 million men and 400,000 women are affected. Drug use disorders have a significant impact on the health care systems of many countries in the Region and on the health and disability profiles of men in their most productive years of life. Although drug-related disorders are more common in the developed countries of the Americas, the health burden falls disproportionately on low- and middle-income countries, where programs for treatment and prevention are often unavailable or unaffordable. Pan American Health Organization

A review of the published literature on drug epidemiology in Latin America and the Caribbean was published by PAHO in 2009 and provides a good overview of the situation. The main findings and are presented in this module, with updated information where possible. Pan American Health Organization

Cannabis: Illicit drug with highest levels of use North America Prevalence rate (15-64 yrs) 10.7% above the global average. 20% of all cannabis users in the world v.s. 7% share of global population. Use increase: USA annual prevalence (12+ yrs): 10.1% (2007) → 11.3% (2009) South America, the Caribbean and Central America Prevalence rate (15-64 yrs): South America: 2.9%-3.0% The Caribbean: 1.6%-7.6% Central America: 2.2%-2.5% 5% of all cannabis users Cannabis is the illicit drug with the highest levels of use in North and South America, the Caribbean and Central America. The prevalence rate for persons over age 15 is 10.7%, which is above the global average. One out of 5 all cannabis users in the world reside in North America while its population represents only 7% of the world’s population. In the USA annual prevalence increased from 10.1% in 2007 to 11.3% in 2009. In other parts of the Americas, prevalence ranges from 1.6% to 7.6%, with the highest rates reported from the Caribbean nations. Pan American Health Organization

Cocaine North America South America, Central America and the Caribbean Prevalence rate (15-64 yrs): 1.9% Global average: 0.4% 1/3 of all cocaine users globally Use decline USA annual prevalence (15-64 yrs): 3.0% (2006) → 2.4% (2009). Canada annual prevalence (15-64 yrs): 2.3% (2004) → 1.4% (2009). South America, Central America and the Caribbean Prevalence rate (15-64 yrs): 0.9%-1.0% (above global average) 1/6 of all cocaine users globally Use stabilization at the higher levels Main problem drug: 50% of all drug-related treatment demand Cocaine is the substance most associated with medical harm and treatment demand in the Americas. It became widely available in North America in the 1970s and in Europe in the 1980s. “Crack” or smokeable cocaine was being used in Peru in the 1970s. It came to the US in 1985, Canada in 1986 and in European countries somewhat later. Prevalence rates for lifetime use of cocaine are typically one to three percent in developed countries, with higher rates in the US and the producer countries, such as Peru, Columbia, Bolivia and Brazil. In North America, approximately 1.9% of the population aged 15 to 64 reports having used cocaine at least once in their lifetime. This represents one-third of the cocaine users in the world. Prevalence rates are highest in the USA. In South America, Central America and the Caribbean, prevalence is close to 1% of the population above age 15, which represents 50% of all treatment demand in these countries. In Mexico and Brazil the use of cocaine shows a steady increase. Pan American Health Organization

Amphetamine Type Stimulants (ATS) North America Prevalence rate: 1.1% amphetamines/ecstasy (above Global avrg) Use increase: Methamphetamine (12+ yrs): 0.3% (2008) → 0.5% (2009) USA Ecstasy (12+ yrs): 0.9% (2008) → 1.1% (2009) South America, Central America and the Caribbean Mostly linked to diverted prescription stimulants (anorectics or ADHD). High levels of use (2009) in Argentina, Brazil, and Chile Epidemic patterns of illicit amphetamine use have been reported in several countries since the Second World War: in Japan between 1945 and 1954; in the United States during the 1990’s; in Sweden in the 1940s, 1950s and 1960s; and the United Kingdom in the late 1950s and again in the late 1960s. Recently, there has been a pronounced increase in the production and use of amphetamine-type stimulants (or ATS) such as amphetamine and methamphetamine analogues of the MDA-type including MDMA or ecstasy. The prevalence of using amphetamine-type substances, including methamphetamines and ecstasy, is approximately 1.1% in North America and may be increasing in young persons over the age of 12. In the other parts of the region, use of amphetamine-type substances is mainly linked to diverted prescription stimulants (anorectics or stimulants for ADHD). The highest rates in South America are found in Argentina, Brazil and Chile. Pan American Health Organization

Opioids North America South America, Central America and the Caribbean Prevalence rate: 0.4% (opiate abuse in 2009) 2/5 of global opioid users (mainly due to non-medical use of prescription opioids) Opioid use: Increase Opiate use: Stable in recent years South America, Central America and the Caribbean Prescription opioid use more prevalent than heroin use (0.4% vs 0.1%). High prevalence of the non-medical use of prescription opioids: Costa Rica, Brazil, and Chile Heroin became increasingly common in North America and Europe after the 1960s. Increases in heroin use are often cyclical. In the UK there was a “heroin epidemic” in the mid-1980s, resulting in the availability of cheap, high purity heroin from Pakistan. The prevalence of heroin use in the general populations is relatively low, but it causes widespread problems in many countries. The risk of death may be 20 or 30 times higher than in non-drug users. The shared use of injection equipment has caused local, national and regional HIV-1 epidemics. HIV-1 prevalence is high in drug injecting populations in southern Europe, the northeast of the United States, and parts of Asia and South America. While the estimated worldwide production of heroin has more than doubled or even tripled since 1985 (Childress, 1994; UNDCP, 1997), its use in North America has stabilized in recent years. At the same time, the use of opioids (mainly diverted prescription medications) is increasing. Although prevalence rates are less than 1% of the adult population, North America has approximately 40% of the world’s opioid users. In South America, Central America and the Caribbean, prescription opioid use is more prevalent than heroin use. The highest prevalence of the non-medical use of prescription opioids is found in Costa Rica, Brazil and Chile. Pan American Health Organization

Non-medical Use of Prescription Drugs North America USA Prescription drugs ‘psychotherapeutics’ annual prevalence (12+ yrs): 6.4% Pain relievers (opioids-oxycodone): 4.9% Tranquillizers: 2.2% Around 2.2 million people initiated their drug use with pain reliever Canada Prescription opioid misuse: 0.5% (heroin use: 0.36%) Mexico Prescription opioid prevalence (adults): 0.06% Heroin: 0.04% The non-medical use of prescription drugs has become particularly acute in the USA, Canada and Mexico. In the USA, the annual prevalence among those 12 and older is estimated at 6.4%, with pain relievers and tranquillizers accounting for most of the misuse. It is estimated that approximately 2.2 million people initiated their drug use with a pain reliever. This figure is close to the estimated number of people who initiate drug use with cannabis. Pan American Health Organization

OPEN QUESTION What are the most common illicit drugs that cause harms in your country? How do you know? What are the most common illicit drugs that cause harms in your country? How do you know? Pan American Health Organization