Drug abuse and public health. A global perspective

During the past 20 years there has been a substantial increase in the data available on the prevalence and consequences of the use of drugs which are liable to abuse. The body of data is sufficiently scientific, comprehensive and global in scope to enable an overall profile of the use patterns of these drugs to be drawn in this review. The studies evaluated include those which surveyed populations of hundreds, thousands, or even more, covering a range of common drugs of abuse and using specified research methods. The data are summarised for North America, Europe, Asia and the West Pacific, Africa and South America. A complex picture has emerged, confounded by an array of factors, which this review does not address in detail, such as youth alienation, the changing role of women and the increasing sophistication of criminal networks. From a global perspective, the evidence reviewed from the various regions indicates that the use of drugs with liability for abuse is widespread and associated with public health and social problems of great magnitude. The major set of problems appears to be related to primary pattern drugs such as alcohol, nicotine, cannabis and the opioids. Cocaine may also be a worldwide threat in view of the problems it has created in some regions. Drug abuse usually starts in adolescence, and both sexes now appear to be involved where in the recent past it was predominantly men who were affected. The concurrent use of multiple substances is now becoming the modal pattern, and drug-related problems correlate with one another and with somatic, psychiatric and social pathology. Opioid use now tends to be via intravenous administration, and the doses of cannabis and cocaine base which are used are increasing. Substances with therapeutic effects on DSM-III-R diagnosable disorders, such as antidepressants and benzodiazepines, require careful consideration by policymakers because the risk:benefit ratio is different to that of primary-pattern intoxicants, especially taking into consideration the broad and proven therapeutic use of these substances and the need for their availability for patients and physicians. In conclusion, the data presented in this review indicate that the scientific description of trends and consequences of drug abuse is an indispensable first step in rational policy making. The review also identifies areas for further study and research.