2.

1 Understanding the extent

and nature of drug use

Globally, UNODC estimates that between 155 and 250 tion rather than merely the trends for individual drugs.
million people, or 3.5% to 5.7% of the population aged This information helps to discern the extent to which
15-64, had used illicit substances at least once in the market dynamics (availability, purity and price) have
previous year. Cannabis users comprise the largest temporarily influenced the use, compared to results of
number of illicit drug users (129-190 million people). long-term efforts such as comprehensive prevention
Amphetamine-type stimulants are the second most com- programmes and other interventions to address the drug
monly used illicit drugs, followed by opiates and cocaine. use situation.
However, in terms of harm associated with use, opiates
would be ranked at the top. To illustrate, long-term trends in use of different drugs
and overall drug use are presented for the United States
A comprehensive understanding of the extent of the of America, the United Kingdom, Australia and Spain
drug use problem requires a review of several indicators where trend data over a longer period of time is availa-
– the magnitude of drug use measured by prevalence ble. Although short-term changes and trends might be
(lifetime, annual, past 30 days) in the general popula- observed in the use of different drugs, long-term trends
tion, the potential of problem drug use as measured by suggest that the magnitude of the core of the problem
drug use among young people, and costs and conse- does not change considerably in a few years. Indeed, to
quences of drug use measured by treatment demand, impact the drug use situation, long-term interventions
drug-related morbidity and mortality. Additionally, to for prevention of drug use and drug dependence treat-
understand the dynamics of drug use in a country or ment and care, along with supply reduction efforts, are
region, it is important to look at the overall drug situa- required.

Fig. 92: Illicit drug use at the global level, 2008

Source: UNODC

Number of people who inject drugs

aged 15-64 years : 11-21 million persons

Number of "problem drug users"

aged 15-64 years : 16-38 million persons

Number of people who have used drugs

at least once in the past year aged
15-64 years : 155-250 million persons

Total number of people aged 15-64 years

in 2008: 4,396 million persons

123
World Drug Report 2010

Fig. 93: United States: Dependence on or Fig. 94: US: Types of drug use in the past year
abuse of drugs in the past year among among persons aged 12 and older,
persons aged 12 or older, 2002-2008* 2000-2008
* The difference between the estimates was only statistically significant Source: Substance Abuse and Mental Health Services Adminis-
for opioid painkillers in 2003/2004 and 2008. tration, Results from the 2000-2008 National Survey on Drug
Source: Substance Abuse and Mental Health Services Adminis- Use and Health: National Findings, Office of Applied Studies,
tration, Results from the 2000-2008 National Survey on Drug US Department of Health and Human Services
Use and Health: National Findings, Office of Applied Studies,
US Department of Health and Human Services 16.0 14.9 14.7 14.5
14.4 14.5 14.4 14.2
8 7.3 14.0 12.6
7.1 7 7
6.8 6.8 6.9

Annual prevalence (%)

7 11.0 11.0 10.6 10.6
12.0 10.4 10.3 10.1 10.3
Numbers in millions

6 9.3
10.0
4.5 8.3
5 4.3 4.2 4.2 4.2
4.1 3.9 8.0
4
6.0 4.9 4.7 4.9 5.1 5.0 4.8
4.7
3 3.7
1.5 1.4+ 1.4+ 1.5 1.6 1.7 1.7 4.0 2.9 2.5 2.5
2 2.5 2.4 2.3 2.3
1.9 2.1
1 1.7 1.6 2.0 1.5
1.5 1.5 1.6 1.5 1.4 0.8
0.9
0 0.0 0.0 0.2
2002 2003 2004 2005 2006 2007 2008 2000 2001 2002 2003 2004 2005 2006 2007 2008
Illic it drugs Marijuana Any Illicit Drug Marijuana and Hashish
C oc aine Opioids pain relievers Cocaine Heroin
Ecstasy Pain Relievers
+ difference between this es timate and 2008 es timate is s tatis tically
s ignificant at .05 level

Fig. 95: UK: drug use trends among population Fig. 96: Australia: drug use trends among
aged 16-59, 2000-2008/2009 population aged 14 and over, 1991-2007
Source: Hoare J, Home Office Statistical Bulletin, Drug Misuse Source: Australia, National Campaign Against Drug Abuse
Declared: Findings from the 2008/09 British Crime Survey, Household Surveys 1991, 1993, National Drug Strategy
England and Wales, Home Office, UK July 2009 Household Survey 1995, 1996, 2001, 2004 and 2007

12 25
10.9 10.8
10.5 10.6 22
9.7
10
8.7 20
8.2 17 16.9
7.66 7.9
Annual prevalence (%)

Annual prevalence (%)

8 15.3 15.3
17.9
14
15 13.4

6 13.7
12.7 13.1 12.9
10 11.3
4
3 9.1
2.5 2.4 2.6 2.4 5.2
2 2 2.1 2
5 3.5 3.1 3.1
2 2.2 2 2 1.6 1.8 3.5
1.8 1.8 1.5 1.8 2.6 1.7 3.7
2.1
2.1 1.6 1.6 1.2 2 3.2 2.5
1.5 1.4 1.3 1.3 1 1.1
0 0.3 0.1 0
0.4 0.2
2001/02

2002/03

2003/04

2004/05

2005/06

2006/07

2007/08

2008/09
2000

1991 1993 1995 1998 2001 2004 2007

Cannabis
Pain killers and analgesics
Cocaine Ecstasy
Heroin
Opiates Amphetamine
Methamphetamine
Cannabis
Cocaine
Ecstasy
Any illicit drug

124
 2. Drug statistics and trends Understanding the extent and nature of drug use

Fig. 97: Spain: drug use trends among Fig. 98: Europe: Estimated trends in overall
population aged 15-64, 1995-2007/08 problem drug use in selected
countries from where data was
Source: UNODC and EMCDDA
available (2002-2007), rate per 1,000
12 population aged 15-64
Source: EMCDDA – Statistical Bulletin 2009
11.3 11.2
10 10.1 10
8.64

Prevalence (rate per 1000 population)

9.7 9 8.3
7.6 8.08
Annual prevalence (%)

7.81 7.99
8 7 8
7.3
7 6.2
5.8 5.7
6 6 6.1
4.9 4.9
5 4.8 4.7
3.1 4.02 5.38 4.5
4 2.6 3.0 4.2
2.7 4 4 4.37
4.14 4.14
1.9 1.7 1.6 3 2.47 2.5
2.65
2 1.9 1.2 2.7 2.09
2
1.1 0.9 1.2 1.75
1 1.91 1.5
1.34
0 0.5 0.6 0.6 0.1
0.5 0.3 0
1995

1997

1999

2001

2003

2005/06

2007/08

2002 2003 2004 2005 2006 2007

C zec h R epublic Germany
Cannabis Cocaine
Greec e Italy
Amphetamine Ecstasy
C yprus Malta
Opiate
Aus tria S lovakia

Problem drug use taking behaviours were particularly associated with

severe problems and as such merit the attention of poli-
At the core of drug use lie the problem drug users; those cymakers. The document further elaborated that high-
that might be regular or frequent users of the substances,
risk consumption included information on the number
considered dependent or injecting and who would have
of drug injectors, estimates of daily users and those who
faced social and health consequences as a result of their
are dependent. One challenge in measuring problem
drug use. Information on problem drug users from a
drug users or high-risk drug consumption is that most
policy and programme planning perspective is impor-
of these behaviours are hidden and have low prevalence.
tant as this drives the need and nature of the services
Therefore, they are poorly covered by general popula-
required to address the diverse needs for treatment and
tion estimates. Specific methods are required to gather
care of drug dependent persons.
information on such behaviours.
Lack of a global standard definition Out of the 110 Member States who responded to the
of a problem drug user
2008 ARQ on the extent and pattern of drug use, only
One of the main challenges for UNODC remains the 24 reported information on problem drug use. The
compilation of data reported by Member States and definitions and methods of calculation differ from coun-
their comparability across countries and regions. The try to country. One country in Africa defines problem
Commission on Narcotics Drugs in its forty-third ses- drug use as “drug users who constitute social harm and
sion in 2000 endorsed the paper on 'Drug information insecurity and drug users who relapse after rehabilitation.”2
systems: principles, structures and indicators'1 – also In North America, the DSM-IV3 defines the criteria for
known as the 'Lisbon Consensus Document'. The docu- illicit drug dependence or abuse, while one country in
ment outlines the set of core epidemiological indicators Asia only considers heroin injectors as problem drug
to monitor the drug abuse situation, against which users. The European Monitoring Centre for Drugs and
Member States could report their respective situations Drug Addiction (EMCDDA), in its efforts to compile
through the Annual Reports Questionnaire (ARQ). One comparable information on problem drug use, defines it
of the core indicators in the paper was ‘high-risk drug as “injecting drug use or long duration/regular use of
consumption’. The assumption was that some drug-
2 ARQ: Nigeria 2008.
1 Drug information systems: principles, structures and indicators (E/ 3 American Psychiatric Association, Diagnostic and Statistical Manual
CN.7/2000/CRP.3). on Mental Disorders (see Box in cocaine market chapter).

125
World Drug Report 2010

Drug use – nature and typology Different kinds of adverse childhood experiences, such as
self-reported supervision neglect, physical neglect, physi-
Scientific evidence indicates that the drug use is a result
cal assault and contact sexual abuse, have been reported
of a complex multifactorial interaction between repeated
in association with adolescent cigarette, alcohol, cannabis
exposure to drugs, and biological and environmental fac-
and inhalant use, as well as violent behaviour.2
tors. In recent years, the biopsychosocial model has rec-
ognized drug dependence as a multifaceted problem Epidemiological data also show a frequent association
requiring the expertise of many disciplines. A health sci- between stress-related disorders such as post traumatic
ences multidisciplinary approach can be applied to stress disorder (PTSD) and substance use disorder. Stud-
research, prevention and treatment of drug use. ies have examined the association between traumatic
exposure, PTSD and substance use that have shown early
Recreational onset of marijuana and heroin use, while alcohol depend-
Some forms of drug use are associated with recreational ence and opiate dependence were each associated with
settings or specific sub-populations, for example, ecstasy exposure to a traumatic event.3
use, which is found more among young people and asso-
ciated with particular lifestyle and events (parties, night- Psychiatric disorders
clubs and dance events) seen in many affluent societies.
Also among those who use drugs in recreational settings, Further studies have shown that individuals with lifetime
a significant proportion could be induced to substance mental disorder were three times more likely than others
abuse with the purpose of coping with anxiety, poor to be dependent on substances. Patients suffering from
emotional skills, poor capacity to manage stressful stim- bipolar disorders (manic-depressive disorders) are more
uli and difficult environmental situations, poor engage- likely to be using psychoactive substances compared with
ment in school and lack of vocational skills. those suffering from unipolar major depression.4 On the
other hand, use of psycho-stimulants such as ampheta-
Society, family, life experience mine or cocaine and cannabis can also induce psychotic-
like symptoms in users.
Use of opiates, cocaine, amphetamine and metham-
phetamine, and those injecting, account for a substantial
proportion of dependent or problem drug users (however
defined). These drug users also tend to be more chronic
users, with associated psychiatric and medical co-mor- 1 Gerra G. et al., “Childhood neglect and parental care perception in
bidities, and are either stigmatized or come from margin- cocaine addicts: Relation with psychiatric symptoms and biologi-
cal correlates,” Neuroscience and Biobehavioral Reviews, 33 (2009)
alized segments of society. Many studies have shown a 601-610.
strong association between poverty, social exclusion and 2 Hussey J.M., Chang J.J. and Kotch J.B., “Child maltreatment in
problem drug use. the United States: prevalence, risk factors, and adolescent health
consequences”, Pediatrics, September 2006, 118(3):933-942.
Studies also suggest the possibility that childhood experi- 3 Gerra G., Somaini L., Zaimovic A., Gerra M L., Maremmani I.,
ences of neglect and poor parent-child attachment may Amore M. and Ciccocioppo R., Developmental Traumatic Experi-
partially contribute to a complex neurobiological derange- ences, PTSD and Substance Abuse Vulnerability: The Neuroobiologi-
cal Link, Neurobiology of Post Traumatic Stress Disorder, June
ment and dopamine system dysfunctions, playing a cru- 2010 ISBN: 978-1-61668-851-6.
cial role in susceptibility to addictive and affective 4 World Health Organization Neuroscience of psychoactive substance
disorders.1 use and dependence, Geneva 2004.

opioids, cocaine and/or amphetamines.”4 The broad The global number of problem drug users is stable
scope and differences in defining and understanding
problem drug use in different regions signifies the need Based on the global estimates of cannabis, opiate, cocaine
for setting common parameters, based on an already and amphetamine-type stimulant users, and using the
acceptable definition or criterion, for example, DSM-IV relative risk coefficient,5 it is estimated that in 2008,
or ICD – 10 (WHO International Classification of there were between 16 and 38 million problem drug
Diseases – Revision 10), for determining, reporting and users (between 10%-15% of estimated drug users) in the
comparing the extent of harmful or high risk drug use world. The broad range of the estimate reflects the
at global level. uncertainties in the available data globally.

5 The relative risk coefficient takes opiates as the index drug and cal-
4 EMCDDA Guidelines for Estimating the Incidence of Problem Drug culates the coefficient for treatment, injecting drug use, toxicity and
Use, February 2008. deaths.

126
 2. Drug statistics and trends Understanding the extent and nature of drug use

Fig. 99: Europe: Estimates of problem drug use (rate per 1,000 population aged 15-64)*
* The methods for estimation of problem drug users differ between countries, but include capture/recapture, treatment multiplier, police multiplier,
et cetera.
Source: EMCDDA, Statistical bulletin 2009: Problem drug use population, 2009

12

10

0
Greece

Sweden
Germany*

France
Slovakia

Malta

Denmark
Czech Rep.

Latvia*

Portugal*
Hungary

Poland

Slovenia
Austria

Spain*
Cyprus

Italy

UK
Finland

In Europe, the prevalence rate of problem drug users Europe (1.5%) and Australia and New Zealand (1.03%)
varies between 2.7 in Greece and 9.0 in UK as rate per have a high prevalence of injecting drug use. In absolute
1,000 population aged 15-64. The United Kingdom, numbers, East Europe has one of the highest numbers of
Italy and Spain are on the higher end of the range, injecting drug users. In East Europe most of the injectors
whereas Greece, Germany and Hungary are countries are using opiates, while in Australia and New Zealand,
with low rates of problem drug use. methamphetamine is the main substance being injected.
In the United States, 7 million people - or 2.8% of the Gap in provision of services to problem drug users
population aged 12 and older - were considered sub-
The estimate of the global number of problem drug
stance dependent, abusing illicit substances in 2008.
users provides the range of the number of people who
Cannabis was the illicit substance with the highest rate
need assistance to address their drug problems, includ-
of past year dependence, followed by pain relievers (opi-
ing treatment of drug dependence and care. Comparing
oids) and cocaine.6 In Canada, 2.7% of the population this with the number of people who are in treatment
aged 15 and older were reported to have experienced at provides the magnitude of the unmet need for treatment
least one type of harm in the past year due to illicit drug of illicit drug use. Notwithstanding the gap in reporting
use. ‘Harm’ in the Canadian reports is classified as harm and coverage of services, Member States reported that
to physical health, or in the social, employment and between 42% (in South America) and 5% (in Africa) of
legal spheres.7 problem drug users were treated in the previous year. It
Injecting drug users (IDU) can be estimated that globally, between 12% and 30%
of problem drug users had received treatment in the past
Among the most problematic drug users are those who year, which means that between 11 million and 33.5
inject drugs. The last available estimate of the global million problem drug users in the world have an unmet
number of IDU remains the one developed by the need for treatment interventions.
UNODC/UNAIDS reference group in 2008, which
During the High-level Segment of the Commission on
estimated that there are 15.9 million people who inject
Narcotic Drugs in 2009, Member States adopted a Polit-
drugs (between 11 – 21.2 million).8 Of these, 3 million ical Declaration and Plan of Action. The Plan of Action
may be living with HIV (range 0.5-5.5 million). East called for Member States to ensure that access to drug
treatment is affordable, culturally appropriate and based
6 Substance Abuse and Mental Health Services Administration, Results on scientific evidence, and that drug dependence care
from the 2008 National Survey on Drug Use and Health: National
Findings, US Department of Health and Health Services, Office of services are included in the health care systems. It also
Applied Studies. called for the need to develop a comprehensive treat-
7 Health Canada, Canadian Alcohol and Drug Use Monitoring Survey: ment system offering a wide range of integrated pharma-
Summary of Results for 2008. cological (such as detoxification and opioid agonist and
8 Mathers B.M., Degenhardt L., Ali H., Wiessing L., Hickman M., antagonist maintenance) and psychosocial (such as
Mattick RP., et al. “HIV prevention, treatment and care services fro
people who inject drugs a systematic review of global, regional and counselling, cognitive behavioural therapy and social
national coverage,”The Lancet, 2010; 375(9719:1014-28). support) interventions based on scientific evidence and

127
World Drug Report 2010

focused on the process of rehabilitation, recovery and

social reintegration.9 Assessment of the services
The costs for the delivery of evidence-based treatment is provided to injecting drug users
seen to be much lower than the indirect costs caused by to respond to HIV
untreated drug dependence (prisons, unemployment,
law enforcement and health consequences). Research The morbidity and mortality associated with injecting
indicates that spending on treatment produces savings drug use (IDU) is a global public health issue. Of par-
in terms of a reduction in the number of crime victims, ticular significance is the spread of HIV between people
as well as reduced expenditures for the criminal justice who inject drugs, through the sharing of injecting equip-
system. At a minimum there was a 3:1 savings rate, and ment, and through sexual transmission to the wider
when a broader calculation of costs associated with population.
crime, health and social productivity was taken into Responding to IDU is an essential component of the
account, the rate of savings to investment rose to 13:1. global response to HIV. During the 2009 High-level
These savings can improve disadvantaged situations Segment of the Commission on Narcotic Drugs and in
where opportunities for education, employment and other forums, countries and UN agencies centrally
social welfare are undermined, and increase possibilities involved in the HIV response for injecting drug users -
for families to recover battered economies, thus facilitat- UNODC, WHO and UNAIDS - endorsed a compre-
ing social and economic development.10 hensive package of interventions that are necessary to
prevent and control HIV among IDUs.1 These include:
Fig. 100: Unmet need for treatment needle and syringe programmes (NSP); opioid substitu-
interventions, 2008 tion therapy (OST) and other drug treatment modali-
ties; HIV testing and counselling; antiretroviral therapy
Source: UNODC
for HIV (ART); targeted information and education for
Number of people who have used drugs at least once IDUs; prevention and treatment of viral hepatitis, sexu-
in the past year aged 15-64 years: 155-250 million ally transmitted diseases and tuberculosis; and condom
Number of problem drug users distribution programmes.
aged 15-64: 16-38 million
NSPs provide clean injecting equipment to IDUs; a
crucial way to reduce injecting risk, and a contact point
for providing health information to IDUs. These exist
in 82 of the 151 countries where injecting drug use is
known to occur. Only 7.5% (range 5.4%-11.5%) of
IDUs worldwide are estimated to have accessed an NSP
in a 12-month period. Globally, 22 clean syringes are
estimated to be distributed per IDU in a year, meaning
most injections worldwide occur with used injecting
equipment.
Long acting opioid maintenance therapy, or opioid sub-
stitution programmes (OST) have been introduced in
71 countries, but remain absent in many where the
prevalence of opioid injection is high. It is estimated
that globally there are only 8 (range 6-12) OST recipi-
ents for every 100 IDUs, suggesting coverage of only a
small proportion of IDUs who might benefit from this
treatment for drug dependence.

Number of problem drug users aged 15-64 ART is important not only for treating IDUs who have
who did not receive treatment: 11-33.5 million contracted HIV, but also in preventing HIV transmis-
sion.2 From the limited data available, it is estimated

9 UNODC, Political Declaration and Plan of Action on International

Cooperation Towards an Integrated and Balanced Strategy to Counter the 1 WHO/UNODC,UNAIDS, WHO, UNODC, UNAIDS Techni-
World Drug Problem, High-level segment, Commission on Narcotic cal Guide for countries to set targets for universal access to HIV
Drugs, Vienna, 11-12 March 2009 prevention, treatment and care for injecting drug users, Geneva,
2008.
10 UNODC and WHO, Principles of Drug Dependence Treatment:
Discussion Paper , March 2008, also see Gossop M, Marsden J and 2 Degenhardt L., Mathers B.M., Vickerman P., Hickman M.,
Stewart D, The National Treatment Outcome Research Study: After 5 Rhodes T., Latkin C., “HIV prevention for people who inject
years – Changes in substance use, health and criminal behaviour during drugs: Why individual, structural, and combination approaches
the five years after intake, National Addiction Centre, London 2001.

128
World Drug Report 2010

in some regions. The contribution of cannabis to treat-

ment demand is increasing in Europe, South America
Effective treatment for heroin and Oceania, while admissions for synthetic opiates in
and crack dependence: UK North America sharply increased in the last few years,
Drug Treatment Monitoring compensating for decreased admissions for heroin. In
System Outcomes Study Group Europe, the admissions for stimulants (cocaine and
amphetamine-type stimulants) and cannabis have also
In the United Kingdom, using data from the national increased over time, in parallel with a decline in admis-
Drug Treatment Monitoring System, a prospective sions for opiates.
cohort study looked at treatment outcomes of 14,656
heroin and crack addicts. The effectiveness of treat- Interpreting trends in treatment demand data is chal-
ment was assessed from changes in the days of heroin lenging as patterns and trends over time can reflect a
or crack cocaine use or both in the 28 days before the mixture of factors, such as:
start of treatment and in the 28 days before the study s the development and improved coverage of drug
review. treatment reporting systems;
The study shows that the first six months of pharma- s statistical artefacts, for example, resulting from
cological or psychosocial treatment is associated with different countries reporting in a region in different
reduced heroin and crack cocaine use, but the effec- time periods (notably in Africa);
tiveness of pharmacological treatment is less pro-
s changing patterns of consumption including
nounced for users of both drugs.
prevalence, frequency of drug use and the typical
Source: Marsden J, Eastwood B, et al, Effectiveness of amounts used on each occasion;
community treatments for heroin and crack cocaine addic-
tion in England: a prospective, in-treatment cohort study s prevention measures and the availability, accessibility
and utilization of treatment services;
s response of the criminal justice system to drug
Trends in the main drugs of concern in problem offenders, such as compulsory treatment as an
drug users as indicated by treatment demand alternative to imprisonment.
An analysis of the number of treatment services pro- Opiates main problem drug by far in Europe and
vided in a country according to the main drug for admis- Asia, but declining in Oceania
sion can provide information on the drugs that are most
problematic in terms of health and social consequences Opiates are clearly the main problem drug as indicated
and need for intervention. by treatment demand over the past 10 years in Europe
(with at least 55% of demand) and Asia (consistently
The treatment demand data presented here cover the more than 60% of demand).
10-year period from the late 1990s to 2008. Data for all
but 2008 were published in the World Drug Report 2000 Opiates have also increased their contribution in Africa
(for 1997/1998, labelled as the late 1990s) and WDR from 8% (late 1990s) to 20% (2008). While there has
2005 through 2009 (for the years 2003 to 2007, or been an increase in opiate-related treatment in Africa
latest year available at the time of publication). over the last decade, the strong increase is, however, to
some extent, a statistical artefact as previous treatment
The data show that there is generally, in each region, a data (dating back more than 10 years) were removed and
clear, and over the past 10 years consistent, drug type could not be replaced as no new data were forthcoming.
that dominates treatment. This suggests marked regional Therefore, data from smaller island countries - such as
differences in the drugs that affect problem drug users. Mauritius or the Seychelles, where the proportion of
Indeed, in the last decade, the primary drug for treat- opiate treatment has historically been very high - con-
ment has remained cannabis in Africa, cocaine in South tribute more to the treatment demand for opiates in
America and opiates in Asia and Europe. The two nota- Africa.
ble exceptions are: 1) North America, where a dominant
drug for treatment demand does not emerge, and rather, Opiate-related treatment has recently exhibited a large
the percentage breakdown of drugs has become more increase in North America, from 10% (2006) to 23%
uniform over time, and 2) Oceania, which has experi- (2008), reflecting the rising abuse of synthetic opioids,
enced over time one of the biggest changes in the pri- and are possibly starting to emerge in South America.
mary treatment drug from opiates to cannabis. Oceania has experienced a striking decline in the contri-
bution of opiates to treatment demand from 66% (late
The changes observed over the last decade in the contri- 1990s) to 26% (2008), in line with the severe heroin
bution that each drug has made to treatment admissions shortage of 2001 in Australia which convinced many
suggest an ongoing diversification of problem drug users heroin addicts to give up their habit.

130
 2. Drug statistics and trends Understanding the extent and nature of drug use

Fig. 101: Regional patterns and trends in main problem drugs as reflected in treatment demand
Sources: UNODC, Annual Reports Questionnaire Data/DELTA and National Government Reports

80% 80%
Europe Africa
70% 70%

60% 60%

50% 50%

40% 40%

30% 30%

20% 20%

10% 10%

#
0% 0%
Late 1990s 2003 2004 2005 2006 2007 2008 Late 1990s 2003 2004 2005 2006 2007 2008
(2000) (2005) (2006) (2007) (2008) (2009) (2010) (2000) (2005) (2006) (2007) (2008) (2009) (2010)

Year* (WDR publication) Year* (WDR publication)

Cocaine Cannabis Opiates ATS Cocaine Cannabis Opiates ATS

80% 80%
North America South America
70% 70%

60% 60%

50% 50%

40% 40%

30% 30%

20% 20%

10% 10%

0% 0%
Late 1990s 2003 2004 2005 2006 2007 2008 Late 1990s 2003 2004 2005 2006 2007 2008
(2000) (2005) (2006) (2007) (2008) (2009) (2010) (2000) (2005) (2006) (2007) (2008) (2009) (2010)

Year* (WDR publication) Year* (WDR publication)

Cocaine Cannabis Opiates ATS Cocaine Cannabis Opiates ATS

80% 80%

Asia Oceania
70% 70%

60% 60%

50% 50%

40% 40%

30% 30%

20% 20%

10% 10%

0% 0%
Late 1990s 2003 2004 2005 2006 2007 2008 Late 1990s 2003 2004 2005 2006 2007 2008
(2000) (2005) (2006) (2007) (2008) (2009) (2010) (2000) (2005) (2006) (2007) (2008) (2009) (2010)
Year* (WDR publication) Year* (WDR publication)

Cocaine Cannabis Opiates ATS Cocaine Cannabis Opiates ATS

Notes: Percentages are unweighted means of treatment demand in reporting countries.

An 'Other drugs' category is not included and so totals may not add up to 100%. Alternatively, polydrug use may increase totals beyond 100%.
Number of countries reporting treatment demand data: Europe (30 to 45); Africa (15 to 41); North America (3); South America (21 to 26);
Asia (27 to 43); Oceania (1 or 2).
* year specified or latest year available at time of WDR publication.
# Treatment data dating back more than 10 years were removed from the 2008 estimates and therefore caution should be taken in comparing the
data from 2008 with previous years.

131
World Drug Report 2010

Synthetic opioids are increasingly linked with Fig. 102: Treatment admissions for opiates,
problem drug use in North America 1997-2007 (North America)
Treatment demand data from the United States of Note: Percent of admissions excluding alcohol.
America11 and Canada12 both show an increase of prob- Source: Office of Applied Studies, Substance Abuse and
Mental Health Services Administration, Treatment Episode
lem drug users linked to the use of synthetic opioids/ Data Set (TEDS)
prescription medicine and a decline in the heroin-related
problem users. In the United States, admissions where United States of America
35 400,000
opiates were the primary drug of concern increased by
34% between 1997 and 2007 (typically representing 30 350,000

Number of admissions
29-32% of demand for treatment, excluding alcohol).
300,000
Heroin is still the major contributor to the treatment 25
demand for opioids, but this has become less marked 250,000
20

Percent
with the steady increase in demand for treatment for 200,000
synthetic opioids. The contribution of heroin to opioid 15
150,000
admissions has continually declined from 94% (1997)
10
to 73% (2007), with the number of admissions for 100,000
heroin starting to decline in 2002. In contrast, the 5 50,000
number of admissions for other opiates/synthetic opio-
ids has increased from 16,274 to 90,516 (more than 0 0

1997
1998
1999
2000
2001

2002
2003
2004
2005
2006
2007
450%) between 1997 and 2007, from contributing just
6% of opioid admissions in 1997 to 27% in 2007. A
Opiates
similar situation is found in Canada. Treatment demand
for prescription opioids has been greater than for heroin/
Percent admissions
{ Heroin
Other opiates/synthetics
opium over the past few years, and it is still increasing. Opiates
Treatment demand data from Ontario show that the
number of admissions for opioids increased 55%
Number admissions
{ Heroin
Other opiates/synthetics
between 2004/2005 and 2008/2009, or from 14.7% to
18.5% of all drug treatment demand (excluding alcohol
and tobacco). This increase is attributable to the 68% Fig. 103: Treatment admissions for opiates,
2004-2009 (North America)
rise in admissions for prescription opioids/codeine
(heroin/opium admissions actually declined 5%). The Note: Percent of admissions excluding alcohol, tobacco and
not specified.
contribution of prescription opioids/codeine to all Source: Substance Abuse Statistical Tables, DATIS, Centre for
admissions (excluding alcohol and tobacco) has increased Addiction & Mental Health, July 2009
from 12.1% to 16.5%, while the heroin/opium contri-
bution has declined from 2.6% to 2.0%. Canada (Ontario only)
20 25,000
Cannabis is an increasingly problematic drug 18
Although it is the world’s most widely used drug, can- 16 20,000
Number of admissions

nabis is often thought to be the least harmful and of 14

little interest to public health, in spite of the fact that
Percent

12 15,000
evidence in recent years has shown that the use of can-
10
nabis can create remarkable levels of harm. Data on
8 10,000
treatment demand for cannabis and medical research
have pointed to the potentially severe health conse- 6
quences of cannabis use. 4 5,000

The most probable adverse effects of cannabis use 2

include dependency, increased risk of motor vehicle 0 0
2004/05 2005/06 2006/07 2007/08 2008/09
accidents, impaired respiratory function, cardiovascular
disease and adverse effects of regular use on adolescent Opiates
psychosocial development and mental health.13 The Percent admissions
{ Heroin/Opium
Prescription opioids/codeine
Opiates
11 Office of Applied Studies, Substance Abuse and Mental Health Serv-
ices Administration, Treatment Episode Data Set (TEDS).
Number admissions
{ Heroin/Opium
Prescription opioids/codeine
12 Substance Abuse Statistical Tables, DATIS Centre for Addiction &
Mental Health, July 2009.
13 Hall W., and Degenhardt, L., “Adverse health effects of non-medical
cannabis use,” The Lancet, Volume 374, Issue 9698, Pages 1383 - 1391, 17 October 2009.

132
 2. Drug statistics and trends Understanding the extent and nature of drug use

rising number of cannabis-related problem drug users is However, reasons for the increase in demand have proved
often not correlated with a similar rise in the overall difficult to identify and EMCDDA recommends further
number of cannabis users, suggesting that the risks asso- research16 to tackle this issue.17
ciated with the use of cannabis have been increasingly
The effect of poly-drug use in the treatment statistics
recognized and diagnosed in recent years. Rising levels
should not be disregarded. While drug treatment seekers
in cannabis potency in many parts of the world (notably
in the past may have been registered almost automati-
in industrialized countries) have also contributed to the
cally for heroin, they may now be more accurately regis-
increased risk of cannabis use.
tered as having cannabis as the primary problem drug
Cannabis is clearly the dominant drug for treatment in while consuming other drugs as well. Moreover, the
Africa with consistently over 60% of demand. Over the increasing complexity of drug use makes it difficult to
past 10 years, cannabis has been making an increasing have a simple characterization of problem drug users
contribution to treatment demand in Europe (more than according to a single drug type. In the context of drug
doubling from 10% to 22%), South America (more than users combining the use of different drugs to get the
doubling from 15% to 40%) and Oceania (more than effect they want to achieve, the use of cannabis becomes
trebling from 13% to stabilize around 47%). Only North potentially more harmful because its effect combined
America has seen a reduction in the contribution of can- with other drugs can be very different from when it is
nabis to treatment demand compared to other drugs. used alone.
Harmful levels of cannabis use on the rise Cocaine is the main problem drug in the Americas,
in Australia but its contribution is declining in North America
Treatment episodes where cannabis was the primary Treatment demand for cocaine is most dominant in the
drug of concern increased in Australia by 34%, from Americas, where coca cultivation is concentrated.
23,826 to 31,864 between 2002 and 2008 alone,14 Cocaine is the main problem drug according to treat-
despite a sharp decline in cannabis use among the gen- ment demand for South America (with more than 50%
eral population. of demand), and where once it appeared to be on the
decline, over the last few years, the situation has stabi-
Possible explanations for the increasing trend in the lized. Although cocaine was the main drug for treatment
problematic use of cannabis and cannabis-related harm in North America in the late 1990s, the cocaine-related
include: increased consumption among older users treatment demand has been declining over the last
reflecting dependence among those who have had a long decade, and was responsible for just 31% of total treat-
history of use that was initiated at a relatively young age; ment demand in 2008. In Europe, the treatment
and the increased availability of cheaper and possibly demand, in contrast, increased from 3% to 10% over
higher potency cannabis. Referrals from the criminal the same period. Cocaine-related treatment demand in
justice system do not seem to have had an influence Africa accounts for less than 10% of the total,18 and in
on the increase in the numbers entering treatment in Asia and Oceania demand is negligible (<1%).
Australia.15
ATS treatment demand is relatively small but not
Contributing factors for increasing treatment unimportant
demand for cannabis in Europe remain uncertain
Asia has the highest percentage of admissions for
Cannabis ranks second for treatment demand at the amphetamine-type stimulants (ATS), where it ranks as
European level and its contribution to drug treatment the second most important drug. In Oceania and North
demand has been steadily increasing. The EMCDDA America, treatment demand for ATS has increased to
has been documenting rising levels of demand for treat- some 20% since the late 1990s. Otherwise, demand for
ment from cannabis-related problems since 1996, but treatment has remained below approximately 10% in
there are wide discrepancies between countries. In 2006, other regions, with a possible recent emergence in South
21% of all European clients and 28% of new clients America. It should be noted that treatment for ATS is
entered treatment with cannabis as the primary drug of often administered differently than for other drugs, and
concern. In Denmark, Germany, France, Hungary and can be easily under-reported.
Turkey the percentage of new clients seeking treatment
for cannabis as the primary drug was greater than 50%.
16 EMCDDA, A cannabis reader: global issues and local experiences,
14 Australian Institute of Health and Welfare (AIHW), Alcohol and other Monograph series 8, Volume 2, Lisbon, 2008.
drug treatment services in Australia 2007–08: report on the national 17 EMCDDA, Annual report on the state of the drugs problem in the
minimum data set, Drug treatment series no. 9, cat. no. HSE 73, European Union and Norway. Cannabis problems in context — under-
Canberra, 2009. standing the increase in European treatment demands, Lisbon, 2004.
15 Roxburgh, A., Hall, W.D., Degenhardt, L., McLaren, J., Black, E., 18 In contrast to the data shown, there are no indications of any decline
Copeland, J., and Mattick, R.P. “The epidemiology of cannabis use in cocaine-related treatment demand in Africa over the last decade.
and cannabis-related harm in Australia 1993–2007,” Addiction, 2010 The lower demand shown is a statistical artefact resulting from the
Mar 12. Pre-publication early view. removal of treatment data dating back more than 10 years.

133
World Drug Report 2010

Gender and the illicit drug and females is lower among the young population than
markets for the adults.
Male students outnumber females in the use of cocaine
The markets for illicit drugs affect more men than
and cannabis in all European countries. In contrast,
women worldwide, both in terms of use and trafficking
female students more frequently report tranquillizer use
of illicit substances. Data that characterize traffickers of
in virtually all countries and ecstasy use in some coun-
illicit drugs are scarce. In 2009, the Commission on
tries.2
Narcotic Drugs, in its resolution 52/1, stressed the
importance of collecting and analysing data disaggre- A gender gap between the young and older generations
gated by sex and age, and of conducting research on is also apparent in South America. One comparative
gender issues related to drug trafficking, especially the study shows, for example, that in all six analysed coun-
use of women and girls as drug couriers. The Commis- tries, except Argentina, the gender ratio3 of cannabis use
sion called for improved data collection and recom- is lower for students than the adult population, though
mended the undertaking of a gender analysis based on with large variations across countries. Data from Latin
available data. One data source that can be used to gen- America and other parts of the world suggest that the
erate a gender analysis of drug traffickers is the Indi- more advanced the country, the higher the proportion
vidual Drug Seizures Database, where data submitted by of females among drug users.
a limited number of countries (between 30 and 50 from
all regions) report the characteristics of traffickers associ- Fig. 105: Gender ratio in lifetime cannabis
ated with each individual seizure.1 These data show that use, selected South American
the great majority of drug traffickers are men. They also countries
suggest that, irrespective of age, the percentage of female Sources: UNODC/Organization of American States (OAS),
traffickers slightly decreased between 2006 and 2009, Informe subregional sobre uso de drogas en población
reaching between 15% and 20% of detected traffickers escolarizada, segundo estudio conjunto, 2009; UNODC/
OAS, Elementos orientadores para las políticas públicas
in 2009. sobre drogas en la subregion – primero estudio compara-
tivo sobre consumo de drogas y factores asociados en
Fig. 104: Trends in gender distribution of población de 15 a 64 años, 2008
drug traffickers, 2005-2009
9
Source: UNODC Individual Drug Seizures Database 15-64
8
100% Students
7
90%
80% 6
70%
5
60%
4
50%
40% 3
30% 2
20%
1
10%
0% 0
Ecuador

Peru
Argentina

Uruguay
Bolivia

Chile
2005
2006
2007
2008
2009

2005
2006
2007
2008
2009

2005
2006
2007
2008
2009

Age < 25 Age 26 - 45 Age > 45

Female Male

The use of illicit drugs is more balanced between males In general, substance dependence and abuse is also
and females, but it still sees a higher number of men higher for males than females, although in the United
involved. For all drugs, the gender gap between males States an age-specific analysis reveals that in 2008, the
rate of substance dependence was higher for females
(8.2%) than males (7.0%) in the population aged 12 to
1 Data on the gender composition of drug-related arrestees could
also be reported by Member States in the ARQ. However, this
data can hardly be utilized for a gender analysis because very few 2 EMCDDA, A gender perspective on drug use and responding to drug
countries provide the sex-breakdown of the data on arrestees with problems, Lisbon 2006.
little comparability across countries. 3 Ratio of prevalence among males and females.

134
 2. Drug statistics and trends Understanding the extent and nature of drug use

17, while the same rate was almost double for males
(12.0%) than females (6.3%) in the population 18
years and older.4 There are few studies that analyse
gender differences in accessibility of treatment serv-
ices. In 2004 in Europe, there was a ratio of 4:1
between males and females in treatment. The high
ratio (higher than the ratio between male and female
drug users) can be explained by the higher risk of
becoming problem drug users observed for males. At
the same time, according to the EMCDDA, there are
no studies that can provide definitive answers on the
gender distribution of the unmet treatment needs of
problem drug users.5 In many countries where gender
roles are culturally determined and women are not
empowered, gender differences can be reflected in a
lack of access to treatment services which could be
due to: a) higher stigma for women who use drugs
than for men, and/or b) the fact that services do not
cater for women (for example, they do not admit
women or do not cater for the needs of safety and
childcare). An illustrative example of the lack of
accessibility can be found in Afghanistan, where in
2008 there were only three residential drug treat-
ment facilities for women with adjacent child care
and treatment facilities, despite the high level of
heroin and opium use among the female popula-
tion.6

4 Substance Abuse and Mental Health Services Administration,

Results from the 2000 - 2008 National Survey on Drug Use
and Health: National Findings, Office of Applied Studies, US
Department of Health and Human Services.
5 EMCDDA, A gender perspective on drug use and responding to
drug problems, Lisbon, 2006.
6 Report to the US Congress, Report on Progress Toward Security
and Stability in Afghanistan, April 2010.

135