World-wide global drug dependence analysis shows opioid abuse is greatest threat of death and illness

‘Big 4’ Journal Highlights – The Lancet – by Bruce Sylvester – Opioid dependence leads in causing death and illness among all illicitly used drugs, researchers report. The results of the Global Burden of Disease Study 2010 appeared online in The Lancet on August 28, 2013.

Professor Louisa Degenhardt, University of New South Wales, Australia led researchers in Australia and the US in a comprehensive search and analysis of available data on the prevalence and effects of amphetamines, cannabis, cocaine, and opioids.  MDMA (ecstasy) and hallucinogens like LSD, were not included.

For all illicit drugs studied, dependent persons were largely male, 64% each for cannabis and amphetamines, and 70% each for opioids and cocaine.  For all drugs, dependence and disease burden were highest among males aged 20 – 29 years.

They found that the burden of death and disease in the most-affected countries (high-income countries like the USA, UK, and Australia) was 20 times greater than in the least-affected countries.

Highest cocaine dependence was found in North America and Latin America.  Among areas with the highest levels of opioid dependence were Australasia and Western Europe.

The UK, USA, South Africa, and Australia all had particularly high  burdens of death and illness due to illicit drug dependence.

Cannabis was the most commonly used illicit drug worldwide. But the prevalence of cannabis dependence (13.0 million people worldwide) was lower than amphetamines (17.2 million) and opioids (15.5 million).

Notably, the highest burden of disease was associated with opioid dependence, followed by amphetamine dependence, and injection drug use as a risk factor for blood-borne viruses (hepatitis B, C, and HIV).

Cannabis and cocaine dependence had lower rates of disease burden, due to the smaller dependent populations and lower levels of disability associated with these drugs.

The researchers examined trends over time. Disability and illness caused by the four drugs increased by over 50% between 1990 and 2010.  About 22% of the increase appears to be due to increasing prevalence of drug-use disorders, particularly opioid dependence.  Of about 78,000 deaths in 2010 attributed to drug-use disorders, 55% were estimated to be due to opioid dependence.

The researchers estimated that illicit drug dependence contributes to just under 1% of the global burden of death and illness. But illicit drug use causes comparatively more burden per person.

Degenhardt said, “…. our results clearly show that illicit drug use is an important contributor to the global disease burden, and we now have the first global picture of this cause of health loss. Moreover, much can be done to reduce this burden. Although we have fewer means of responding to some causes of burden, such as cocaine and amphetamine dependence, well-evaluated and effective interventions can substantially reduce two major causes of burden— opioid dependence and injecting drug use. The challenge will be to deliver these efficiently and on a scale needed to have an effect on a population level.”