2024 UNODC World Drug Report highlights, brief reflections.

The World Drug Report (WDR) is published by the United Nations Office on Drugs and Crime (UNODC) (United Nations Office on Drugs and Crime, 2023).  It serves to collate data received from United Nations member states which enables the presentation of trends in production, trafficking and use of illicit substance substances across the globe, while also shedding light on patterns of use of licit substances that may have a harmful impact on health and wellbeing. The report is released annually and as technology advances and new ways of collecting and aggregating data arise, the richness of the data interface continues to evolve.  More recent versions of the World Drug Report provide for interactive engagement with the 2024 WDR (accessible at https://www.unodc.org/unodc/en/data-and-analysis/wdr2024-drug-market-trends.html) allowing for exploration of narratives and topics of interest according to regions of interest (United Nations Office on Drugs and Crime, 2024).   Core to our approach to addressing substance use disorders are 1) a recognition of intersectionality, which refers to the overlapping impact of factors causing discrimination and disadvantage for at-risk populations in ways that further compound poorer health outcomes and access to services; and 2) to pursue intersectorality in policy and practice in recognition of the wide ranging and overlapping causality and effect of substance use (Mereish & Bradford, 2014; Parker et al., 2021; Walters et al., 2023).  The WDR goes beyond sharing trends and statistics but goes further to engage social and economic considerations on a region by region and substance by substance.

The 2022 WDR (United Nations Office on Drugs and Crime, 2022) unpacked some of the public health impact that was being seen following legalization of cannabis, in addition to impacts on safety, drug markets and criminal justice readiness.  Cannabis, alongside opioids, contributed significantly to drug use disorders and treatment demand.  Opioids contributed most significantly to drug-related deaths, and continue to do so in 2024, once again highlighting the need for training in overdose dose prevention and continued efforts to make available pharmaceutical agents to prevent death. The report indicated that the greater health harms were associated with the use of licit substances such as tobacco (most harms) and alcohol (second highest proportion of harms), and that drug use in general, while falling below tobacco and alcohol substance use in health harms resulted in a significant 5% of all substance-related mortality.  The 2022 report also highlighted the underrepresentation of women in drug treatment while women were noted to engage in fairly similar levels of non-medical use of pharmaceutical agents and amphetamines as men.  Men remained the larger proportion of drug users in general, while the youth were noted to be engaging more aggressively in drug use at important development periods more likely to result in lifelong harms including poor socioeconomic outcomes resulting from poor scholastic achievement. An important takeaway from the 2022 WDR was an alarm bell regarding increased global manufacture, trafficking and use of cocaine, important trends for practitioners to be aware of.

The 2023 WDR highlighted the impact of substance use disorders on vulnerable populations and raised awareness of the importance of incorporating strategies for the monitoring of public health impacts of changes in regulation and expanded research into new currently less understood psychoactive medications (United Nations Office on Drugs and Crime, 2023).  People who (PWID) drugs remain a population of concern, being 35 times more likely to be exposed to HIV infection and 23% of new Hepatitis infections being related to unsafe injecting practices, further increasing the likelihood of mortality.  Following on from the 2022 WDR reflections on women being under-represented in treatment, the 2023 WDR contextualised that while women are less likely to be engaged in drug use, they are more likely to progress to drug use disorder at a faster rate than men, and that despite this, significant barriers exist for women to access treatment services. Some of these barriers include the burden of women’s social roles in the backdrop of limited support and resources, increased social stigma and a greater likelihood to belong to other vulnerable groups, such as survivors of trauma.  With the backdrop of instability and conflict in many parts of the world, the 2023 WDR reported a high vulnerability of displaced communities and those exposed to conflict to drug use, as a result of a higher likelihood of exposure to social and mental health problems.  Opioids were noted to remain a significant contributor to the global burden of disease, continuing to contribute remarkably to treatment demand (38% of drug treatment) and to mortality (69% of deaths).  The 2023 WDR focussed on the growing threat of synthetic drugs and raised awareness of the evolution of drug markets and trafficking networks.  The impact of  synthetic cannabinoids, while concerning remained uncertain as data remains limited.  The report warned that the non-medical use of Ketamine could become more prevalent in some areas, including Western Europe, the Middle East and parts of Asia, North Africa and Oceania.  New Psychoactive Substances continue to increase, with 1184 total substances being identified by 2022, an increase from the total of 1165 identified by 2021.  On a lighter note, the 2023 WDR indicated some success with innovative treatment strategies such as those taking advantage of developments in telehealth, while cautioning that some communities are not yet well placed to rely on these technologies.  The promise of psychedelics for mental health disorders has for the most part outstripped the development of best practice and clinical guidance.  The 2023 WDR warns that the burden of getting all of these in place alongside the time needed for scientific rigor may drive the market underground and result in some increased risk of unsafe use.

On an ISSUP Webinar on 30 July 2024, Ms Giovanna Campello , Chief of UNODC Prevention, Treatment & Rehabilitation Section presented highlights from the 2024 WDR . The Afghan opiate market has contracted significantly (by 95% from 2022 to 2023). While the local impact has been clear (strangled production and higher prices), the global impact is yet to be seen, particularly as it relates to the demand for opiate treatment services and the extent to which people who use shift to alternative drugs once a shortage starts to impact their access to opiates. The increase in cocaine supply is noted to have resulted in expanded markets in Western Central and South-Eastern Europe, as indicated by treatment demand data, while treatment demand data in  traditional transit areas in West and North Africa are indicating an increase in cocaine use likely as a result of the spillover of product being trafficked from Latin America to Europe.  Similarly, heroine trafficked from South-West Asia to Europe via Southern and east Africa is seen to be penetrating local markets along with other substances already destined for these markets, such as methamphetamine.  All these dynamics serve to exacerbate the challenges already posed by significant burden related to cannabis use in these regions.  Other concerns in Africa are Tramadol, Cocaine and drug mixtures such as nyaope, karkoubi and kush.  Synthetic drugs pose a looming threat, with cheaper and shorter production requirements, and non-reliance on geography. The potential harms are also unquantified as the ingredients may be inconsistent and remain poorly understood.   Already there is an increase in the use of amphetamine and methamphetamine in Western, Central and South-Eastern Europe as indicated by wastewater analysis.  A major concern with in the use of synthetic drugs is the link to risky sexual behaviours, with a higher risk for sexually transmitted infections including HIV and viral hepatitis.  As pre-empted by the 2023 WDR, Ketamine seizures are indeed indicating an increase in some regions, the non-medical use of which is associated with significant harms for chronic users.  Ms Campello indicated that the 20% increase in drug use in 2022 compared to the past decade is in part due to global population growth.  The 2024 WDR indicates the persistent increased risk of HIV and Hepatic C amongst PWID, a population whose needs must be intentionally incorporated into care and service planning.  The report indicates that the number if people in treatment is decreasing while treatment gap continues to widen, affecting Low and Middle Income Countries (LMIC) and women particularly, which is especially concerning considering the transition in Africa from trafficking route to market as discussed above.  The report cautions that the higher levels of cannabis use amongst adolescents than amongst adults is particularly concerning in context of vaping which is becoming increasingly common. The report reiterates the special needs of populations such as the homeless, that are at greater risk of the effects of drug use, suggesting that interventions must be designed to be responsive to their specific needs while being mindful of the stigma and social exclusion they face.  Ms Campello highlighted some of the challenges with accumulating data on the state of prevention services worldwide, a gap that must be addressed to map what is a key area in addressing drug demand reduction.

The webinar presented by Ms Campello and moderated by Goodman Sibeko may be viewed here: https://www.issup.net/knowledge-share/resources/2024-07/highlights-2024-unodc-world-drug-report

References

• Mereish, E. H., & Bradford, J. B. (2014). Intersecting identities and substance use problems: Sexual orientation, gender, race, and lifetime substance use problems. Journal of Studies on Alcohol and Drugs, 75(1). https://doi.org/10.15288/jsad.2014.75.179
• Parker, M. A., Cordoba-Grueso, W. S., Streck, J. M., Goodwin, R. D., & Weinberger, A. H. (2021). Intersectionality of serious psychological distress, cigarette smoking, and substance use disorders in the United States: 2008–2018. Drug and Alcohol Dependence, 228. https://doi.org/10.1016/j.drugalcdep.2021.109095
• United Nations Office on Drugs and Crime. (2023). Online World Drug Report 2023 - Latest data and trend analysis. https://www.unodc.org/unodc/en/data-and-analysis/wdr-2023-online-segment.html
• Walters, S. M., Kerr, J., Cano, M., Earnshaw, V., & Link, B. (2023). Intersectional Stigma as a Fundamental Cause of Health Disparities: A Case Study of How Drug Use Stigma Intersecting With Racism and Xenophobia Creates Health Inequities for Black and Hispanic Persons Who Use Drugs Over Time. Stigma and Health, 8(3). https://doi.org/10.1037/sah0000426
• United Nations Office on Drugs and Crime. (2022). World Drug Report 2022. https://www.unodc.org/unodc/en/data-and-analysis/world-drug-report-2022.html
• United Nations Office on Drugs and Crime. (2023). World Drug Report 2023. https://www.unodc.org/unodc/en/data-and-analysis/world-drug-report-2023.html
• United Nations Office on Drugs and Crime. (2024). World Drug Report 2024 - Drug market patterns and trends. https://www.unodc.org/unodc/en/data-and-analysis/wdr2024-drug-market-trends.html