Drug disorders major growing public concern in Caribbean—PAHO study

A new study re­leased by the Pan Amer­i­can Health Or­ga­ni­za­tion (PA­HO) has found that drug use dis­or­ders are a ma­jor and grow­ing pub­lic health prob­lem in the Amer­i­c­as, in­clud­ing the Caribbean.

It said that drug use is among the top 10 risk fac­tors con­tribut­ing to all-cause mor­tal­i­ty and dis­abil­i­ty in the re­gion.

PA­HO said that in 2021, an es­ti­mat­ed 17.7 mil­lion peo­ple in the Amer­i­c­as were liv­ing with a drug use dis­or­der, re­sult­ing in near­ly 78,000 deaths di­rect­ly at­trib­ut­able to these dis­or­ders, rep­re­sent­ing a mor­tal­i­ty rate four times high­er than the glob­al av­er­age.

The new study, based on analy­ses of da­ta from the Glob­al Bur­den of Dis­ease 2021, re­vealed that drug use dis­or­ders are pri­mar­i­ly un­der­pinned by opi­oid use and dis­pro­por­tion­ate­ly af­fect young men.

Opi­oid use dis­or­ders ac­count­ed for more than 75 per cent of all drug use dis­or­der–re­lat­ed deaths. Dis­abil­i­ty-ad­just­ed life years (DALYs) linked to drug use dis­or­ders near­ly tripled be­tween 2000 and 2021, in­creas­ing at an av­er­age rate of al­most five per cent per year. Young adults, par­tic­u­lar­ly men, ex­pe­ri­enced the high­est bur­den, while deaths among women al­so in­creased, rais­ing ad­di­tion­al con­cern.

“Drug use dis­or­ders are a pre­ventable and treat­able pub­lic health prob­lem, yet they are tak­ing an in­creas­ing toll on fam­i­lies and com­mu­ni­ties across our re­gion,” said PA­HO Di­rec­tor Dr. Jar­bas Bar­bosa.

“Coun­tries must ur­gent­ly scale up ev­i­dence-based pre­ven­tion, treat­ment, and harm re­duc­tion ser­vices—es­pe­cial­ly for young peo­ple and those at high­er risk.”

PA­HO said that the land­scape of drug use dis­or­ders varies sig­nif­i­cant­ly across the re­gion. In North Amer­i­ca, the study high­lights a sharp in­crease in dis­or­ders re­lat­ed to opi­oids—par­tic­u­lar­ly high­ly po­tent syn­thet­ic opi­oids such as fen­tanyl—as well as am­phet­a­mines.

In con­trast, the main con­trib­u­tors to drug use dis­or­ders in the Caribbean, Cen­tral Amer­i­ca, and South Amer­i­ca over the past decade have been cannabis and co­caine use.

The au­thors es­ti­mate that 145,515 all-cause deaths in the Amer­i­c­as in 2021 re­sult­ed from con­di­tions such as opi­oid over­dose, liv­er can­cer, cir­rho­sis, and sui­cide at­trib­ut­able to drug use.

This places drug use among the top 10 risk fac­tors con­tribut­ing to mor­tal­i­ty and dis­abil­i­ty in the re­gion, along­side high blood pres­sure, high body-mass in­dex, di­etary risks, and to­bac­co use.

PA­HO said sig­nif­i­cant in­creas­es in opi­oid and am­phet­a­mine use dis­or­ders were ob­served dur­ing the COVID-19 pan­dem­ic. It said cri­sis-re­lat­ed stress, dis­rup­tions in health ser­vices, and so­cial iso­la­tion may have in­ten­si­fied ex­ist­ing vul­ner­a­bil­i­ties and con­tributed to the in­crease in drug-re­lat­ed deaths dur­ing this pe­ri­od.

PA­HO said that the study’s find­ings un­der­score crit­i­cal gaps in pre­ven­tion, ac­cess to treat­ment, and harm re­duc­tion ser­vices across the Amer­i­c­as.

It is urg­ing coun­tries to strength­en drug pre­ven­tion pro­grams tar­get­ing youth and high-risk pop­u­la­tions; ex­pand ac­cess to treat­ment and harm re­duc­tion, in­clud­ing med­ica­tion-as­sist­ed treat­ment for opi­oid use dis­or­ders; in­te­grate sub­stance use ser­vices in­to pri­ma­ry health care and com­mu­ni­ty-based ser­vices; im­prove sur­veil­lance and da­ta sys­tems to de­tect emerg­ing trends, par­tic­u­lar­ly those in­volv­ing syn­thet­ic opi­oids and com­bined drug use; and en­sure gen­der-re­spon­sive ap­proach­es, giv­en the grow­ing bur­den among women.

PA­HO said tools such as the Al­co­hol Use Dis­or­ders Iden­ti­fi­ca­tion Test (AU­DIT) and the Al­co­hol, Smok­ing and Sub­stance In­volve­ment Screen­ing Test (AS­SIST), de­vel­oped by the World Health Or­ga­ni­za­tion (WHO), are rec­og­nized as cost-ef­fec­tive strate­gies to re­duce harm and close the treat­ment gap.

“We must place men­tal health and sub­stance use care at the cen­tre of our health sys­tems,” said Dr. Re­na­to Oliveira E Souza, chief of the Men­tal Health and Sub­stance Use Unit at PA­HO.

“Com­mu­ni­ty-based, peo­ple-cen­tred ser­vices, sup­port­ed by strong pub­lic health lead­er­ship and na­tion­al strate­gies in­formed by epi­demi­o­log­i­cal pat­terns, can re­verse these trends and save thou­sands of lives across the Amer­i­c­as.” —WASH­ING­TON (CMC)