The World Drug Report puts a strong focus on the situation of people with drug dependence and that of drug treatment services
An estimated 39.5 million people worldwide were suffering from drug use disorders in 2021, but only one in five people with drug use disorders received treatment – Source: World Drug Report 2023 UNODC/United Nations
Each year the World Drug Report provides the latest data on global and subregional estimates and trends in drug demand and supply. However, it is not only about counting with data, the World Drug Report (WDR) also includes takeaways and policy implications, in-depth analysis of key developments and emerging trends and contemporary issues related to drugs.
Dianova decided to zoom in some of the aspects highlighted in the WDR 2023 that link directly to the situation of people in drug treatment and the provision of drug treatment services as to get the bigger picture of the reality of the field of treatment. Below you will find text that comes directly from WDR.
Setting the scene on drugs, drug use disorders and drug treatment
Drug use continues to be high worldwide. In 2021, 1 in every 17 people aged 15–64 in the world had used a drug in the past 12 months (representing 5.8 per cent of the global population aged 15–64). The estimated number of users grew a 23 per cent from 2011 to 2021, partly due to population growth. An estimated 39.5 million people worldwide were suffering from drug use disorders in 2021, seeing an increase from previous years. Only 1 in 5 people with drug use disorders received drug treatment.
People who use drugs, 2021 – Women among people who use drugs, 2021 – Source: World Drug Report 2023 UNODC
Different drugs pose different burdens on health and health-care systems. Most drug use disorders are related to cannabis and opioids, which are also the drugs that lead most people to seek drug treatment, but opioids remain the most lethal drugs. There are clear regional differences in the primary drug reported by people entering drug treatment: in most of Europe and most of the subregions of Asia, opioids are the most frequent primary drug of people in drug treatment, whereas in Latin America it is cocaine, in parts of Africa it is cannabis, and in East and South-East Asia it is methamphetamine
Drug use is also particularly harmful to young people. In some regions, young people are more severely affected by substance use disorder. In fact, in South America, more than half of those in drug treatment are under 25 years old. In Africa, 70 per cent are under 35.
Inequalities, disparities, public health and human rights
Inequality and social and economic disparities continue to drive and be driven by the drug phenomenon, threating public health and human rights. Focusing on the field of treatment, the WDR sheds light on the following:
The demand for treating drug-related disorders remains largely unmet and disparities in access persist. COVID causes setbacks in the service provision
An estimated 39.5 million people worldwide were suffering from drug use disorders in 2021, but only one in five people with drug use disorders received treatment, with large disparities across regions and in the type and quality of treatment received. Not all forms of treatment respect human rights or are evidence-based.
Women in treatment, 2021 – People under 25 years old in treatment, 2021 – Source: Word Drug Report 2023, UNODC
The Covid-19 pandemic has aggravated the treatment gap. Most countries that reported treatment delivery aggregates to UNODC before and after the pandemic noted a decline of about a 40 per cent in the number of persons in drug treatment between the periods 2018–2019 and 2020–2021, with further declines within the period of 2020 to 2021.
Women face barriers in accessing drug treatment services
Barriers in accessing treatment are multiple but women are most affected. Women who use drugs tend to progress to drug use disorders faster than men but they continue to be underrepresented in drug treatment. This gap is particularly high for women who use amphetamine-type stimulants. Almost 1 in 2 users of amphetamine-type stimulants is a woman but only 1 in 4 people in treatment is a woman.
Overall, the lowest proportions of women in drug-related treatment are in Asia and Africa and the highest proportions are in the subregions of Australia and New Zealand as well as in North America.
Service innovations during the COVID-19 pandemic have increased access to drug treatment for some population groups
Innovations in drug service provision included the use of telehealth (for example, the use of telephone lines and online communication tools) and of various strategies to ensure access to medication and sterile injecting equipment (for example, increased number of take-home dosages, delivery of medication or sterile equipment), among others. Studies evaluating the impact of such strategies are beginning to emerge, mostly in high-income countries, and so far, early results have been rather positive: patients are more likely to remain in treatment, the services cater to new clients, patients report greater levels of satisfaction, and programmes were able to save resources while overcoming traditional barriers to treatment such as childcare or work commitments, transportation challenges and even stigma.
Primary drug of people in treatment, 2021 – Source: WDR 2023 – UNODC
Unequal access to services exacerbate inequality in treatment provision
Although innovations in service provision that started during the pandemic appear to have resulted in early benefits, challenges remain due to the digital divide, especially in low-income countries and in certain marginalized populations that are hard to reach, including the homeless and injecting drug users.
Other marginalized groups, such as those with a history of incarceration, people displaced by humanitarian emergencies and sex workers, face other barriers in accessing services. Moreover, use of drugs by marginalized populations may be more intense, putting them at greater risk to continued harms, relapse and other related health outcomes.
Interconnection of drug use disorder and mental health conditions
Drug use disorders and other mental health conditions are closely interconnected: mental health conditions increase the risk of developing drug use disorders, and drugs pose the risk of exacerbating mental health problems if taken outside medical supervision. With an estimated one in eight people globally living with a diagnosed mental health condition, the need to address mental health issues in drug use prevention and treatment has increasingly become a priority.
Forcibly displaced populations suffer an elevated vulnerability to mental health and substance use disorders that should be addressed.
By mid-2022, the number of people who had been forcibly displaced worldwide had exceeded 100 million, which was more than double the nearly 43 million who were forcibly displaced a decade earlier. People who are forcibly displaced are likely to suffer elevated levels of social and mental health problems, as well as an increased vulnerability to substance use disorders. Among displaced populations, the initiation of, or transition to, harmful use of substances is complex. The extent and pattern of substance use is not necessarily dissimilar from that of the general population, but it often needs to be addressed in the context of limited health infrastructures and constrained social and economic resources. Availability and accessibility of mental health services, including drug treatment services, remain a challenge for displaced people, who may face stigma and discrimination when accessing local services.
People who inject drugs, 2021 – People with drug use disorders, 2021 – Source: WDR 2023 – UNODC
Possible responses identified by the WDR 2023
Reducing inequalities and the gap in access to treatment and comprehensive services to minimize the adverse public health and social consequences of drug use in a continuum of care for people who use drugs, especially vulnerable and marginalized populations, is critical.
- Large-scale drug-use prevention initiatives that are school-, family- and community-based are needed to reduce the risk of increasing drug use disorders, in particular in view of the current high prevalence level of mental health conditions. Higher socioeconomic groups have shown a greater propensity to initiate drug use than lower socioeconomic groups but it is the lower socioeconomic groups that pay the higher price, as they are more likely to suffer from drug use disorders.
- In order to be effective, the approach to treatment service provision must be voluntary and based on human rights. As the drug phenomenon continues to evolve, Member States will need to redouble efforts to ensure access to quality services that are shown to reduce drug use disorders, both globally and nationally and across all subpopulations.
- Reducing stigma faced by people who use drugs will make drug-related treatment and interventions more accessible and effective for people who need such services. Gains have been made during the pandemic to reduce barriers in accessing services, which have shown promise in attracting and retaining patients.
- Given the disproportionate levels of harm and the large gap in accessing services experienced by certain populations who use drugs most intensively, additional effort is needed to design and implement policies and programmes addressing the specific needs of populations. It is important to tailor programmes to individuals experiencing homelessness, sex workers, those suffering from trauma and others who face barriers in accessing services, including people with additional mental health comorbidities, those currently and formerly incarcerated and women who are pregnant.
- The importance of addressing mental health in efforts to prevent as well as treat drug use disorders needs to be given greater priority. Current scientific research and clinical trials involving psychedelics indicate their potential for treating some mental health conditions, but medical supervision is a critical component to ensuring their benefits while limiting harms.
- The record high number of displaced persons requires far greater investment in providing drug-use prevention initiatives and drug-related treatment and services to minimize the adverse public health and social consequences in a continuum of care in humanitarian settings.
- Political and financial commitments are needed to scale up interventions that address structural and economic inequalities, harmful sociocultural norms, gender-based inequalities and gender-based violence that drive HIV and hepatitis epidemics among people who use drugs.
Proportion of women among drug users and in people in drug treatment, 2021 – Source: WDR 2023 – UNODC