World Drug Report 2020

Presented in six separate booklets, the World Drug Report 2020 provides a wealth of information and analysis to support the international community in implementing operational recommendations on a number of commitments made by Member States

Key elements

(Excerpt from preface by Ghada Waly, UNODC Executive Director)

• 269 million people used drugs in 2018, up 30 per cent from 2009
• 6 million people suffer from drug use disorders globally
• 1 out of 8 people who need drug-related treatment receive it
• While 1 out of 3 drug users is a woman, only 1 out of 5 people in treatment is a woman
• Seizures of amphetamines quadrupled between 2009 and 2018
• More than 80% of the world’s population are deprived of access to controlled drugs for pain relief and other essential medical uses

Impact of Covid-19

The measures implemented to prevent the spread of Covid-19 have affected all aspects of the illegal drug markets, from production and trafficking to use.

Drug supply shortages can go together with an overall decrease in consumption (for example, of drugs that are mostly consumed in recreational settings such as bars and clubs) but may also, especially in the case of heroin, lead to the consumption of harmful domestically produced substances, as well as more harmful patterns of drug use by people with drug use disorders.

The impact of the pandemic on drug markets is unknown and hard to predict in the long run, but it could be far-reaching. Drug markets could be disrupted by the economic downturn and associated lockdowns. Rising unemployment and lack of opportunities will make it more likely that poor and disadvantaged people engage in harmful patterns of drug use, suffer drug use disorders and turn to illicit activities linked to drugs – either production or transport. And drug trafficking organizations are likely to exploit the situation by providing services to the vulnerable and boosting their ranks with new recruits. With Governments less able to respond, these shifts could quickly take root and become the new reality for many communities.

• Position Statement of the CSFD on Covid-19
• Statement by the UN expert on the right to health
• Addiction Services Are Essential Services

Market growth

Drug use around the world has been on the rise, in terms of both overall numbers and the proportion of the world’s population that uses drugs. In 2009, the estimated 210 million users represented 4.8 per cent of global population aged 15‒64, compared with the estimated 269 million users in 2018, or 5.3 per cent of the population.

The global drug market is expanding and more complex – Source: World Drug Report 2020

Over the past two decades, drug use increased far more rapidly in developing countries than in developed countries. This partly reflects differences in overall population growth over the same period – 7 per cent in developed countries and 28 per cent in developing countries – but also the faster growth of the young population in developing countries. Adolescents and young adults account for the largest share of those using drugs. While that age group grew by 16 per cent in developing countries over the period 2000–2018, it declined by 10 per cent in developed countries.

Worldwide, drug use is more widespread in developed countries than in developing countries. Drugs such as cocaine are even more firmly associated with the wealthier parts of the world. Likewise, within countries, the wealthier sectors of society have a higher prevalence of drug use. But the transition to drug use disorders is more prevalent among people with a lower socioeconomic status. Data from a handful of countries suggest an association between harmful patterns of drug use and disorders and low income. Those patterns seem to be less common among wealthier sections of society.

Increased complexity

Drug markets are becoming increasingly complex. Plant-based substances such as cannabis, cocaine and heroin have been joined by hundreds of synthetic drugs, many not under international control. There has also been a rapid rise in the non-medical use of pharmaceutical drugs.

Roughly 500 new psychoactive substances are found on the national markets of Member States each year. Currently, most of those are stimulants, followed by synthetic cannabinoid receptor agonists and a smaller number of opioids. However, while the overall number of NPS has stabilized, the proportions have changed. Opioid NPS accounted for just 2 per cent of the number of NPS identified in 2014 but by 2018 that figure had risen to 9 per cent.

Opioid NPS, many of them fentanyl analogues, have proved both potent and harmful, fuelling overdose deaths in North America and to a lesser extent in other regions.

Individual NPS hardly ever establish their own significant market. However, evidence from Europe suggests synthetic cannabinoids are a significant problem among marginalized sections of society such as the homeless and prison inmates.

Policy changes and changing trends

Canada, Uruguay and 11 jurisdictions in the United States allow the manufacture and sale of cannabis products for non-medical use.

In most of those jurisdictions, cannabis use has risen since its legalization, although the same trend was observed in other jurisdictions where non-medical use of cannabis was not legalized.

Global seizures of cannabis herb fell to their lowest level in two decades in 2018 – a slump driven by declines in North America, where seizures have fallen by 84 per cent in the last 10 years. By contrast, seizures almost doubled in the rest of the world over the same period. The pattern of seizures suggests policies aimed at liberalizing cannabis markets have played a key role in the decline.

Disadvantaged face harm from legal and illicit drug markets

Medicines for pain relief are unequally distributed across regions. More than 90 per cent of all pharmaceutical opioids available for medical consumption were in high-income countries in 2018.

Some 50 per cent were in North America, 40 per cent in Europe, and a further 2 per cent in Oceania. Those countries are home to about 12 per cent of the global population. Low and middle income countries, which are home to 88 per cent of the global population, are estimated to consume less than 10 per cent of pharmaceutical opioids.

Some 35.6 million people suffered from drug use disorders in 2018. Poverty, limited education and social marginalization may increase the risk of drug use disorders and exacerbate the consequences. This is borne out by studies in high-income countries, where an individual’s adverse socioeconomic trajectory – not just their status at a single point in time – is also associated with risk of drug use disorders.

For people with drugs use disorders, the availability of and access to drug treatment services remains limited at the global level – only one in eight receives drug treatment each year. And, while one in three drug users is a woman, women continue to account for only one in five people in treatment for drug use disorders.

Latest trends

Number of past-year users in millions, 2018 – Source: World Drug Report 2020

An estimated 192 million people used cannabis in 2018, making it the most used drug globally. In comparison, 58 million people used opioids in 2018.

But that lower number of users belies the harm associated with opioids. This group of substances accounted for 66 per cent of the estimated 167,000 deaths related to drug use disorders in 2017 and 50 per cent of the 42 million lost due to disability or early death, attributed to drug use.

In West, Central and North Africa, the opioid crisis is fuelled by tramadol; in North America, by fentanyls. Although those sub-regions have little in common in terms of economics, demographics or general patterns of drug use, both are struggling with an opioid crisis fuelled by substances that are easy to access and cheap to produce.

In North America, the use of synthetic opioids such as fentanyl has fuelled two decades of increases in opioid overdose deaths. In 2018, fentanyls were implicated in two thirds of the 67,367 overdose deaths registered in the United States. Canada, too, has reported similar findings, though with lower numbers. The overdose deaths attributed to fentanyls are partly driven by the unpredictability of their potency as found in illicit drug markets.

In West, Central and North Africa, the market for non-medical use of tramadol has grown considerably. An increasing number of people with tramadol use disorders are entering treatment in the region.

The stimulant scene is dominated by cocaine and methamphetamine, and use of both substances is rising in their main markets. Some 19 million people used cocaine in 2018, fuelled by the drug’s popularity in North America and Western Europe. Roughly 27 million people used amphetamines that same year, methamphetamine being the most used ATS in South-East Asia.

Some 11.3 million people are estimated to have injected drugs in 2018, a practice that accounts for roughly 10 per cent of HIV infections worldwide. More than 1 million people who inject drugs are living with HIV and 5.5 million are living with hepatitis C.

Opioid shortages caused by COVID-19 restrictions could lead to users substituting with more readily available substances such as alcohol or benzodiazepines, or to mixing with synthetic drugs. More harmful patterns of use may emerge as some users switch to injecting, or to more frequent injecting.

The financial downturn and social distancing rules could also have a double impact on people who inject drugs. In addition to being more vulnerable to COVID-19 infection and complications from the disease because they have compromised immune systems, they are also likely to face problems in accessing treatment and other services from under pressure health providers.