NEW YORK - For the first time since its conception, this year the World Drug Report consists of two products, a web-based element and a set of booklets. The latest global, regional and subregional estimates of and trends in drug demand and supply are presented in a user-friendly, interactive online segment by The United Nations Office on Drugs and Crime (UNODC).

While Special points of interest include key takeaways and policy implications, booklet 1 takes the form of an executive summary based on analysis of the key findings of the online segment and the thematic booklet 2 and the conclusions that can be drawn from them.

In addition to providing an in-depth analysis of key developments and emerging trends in selected drug markets, including in countries currently experiencing conflict, booklet 2 focuses on a number of other contemporary issues related to drugs.

EXECUTIVE SUMMARY

Drug use continues to be high worldwide. In 2021, 1 in every 17 people aged 15–64 in the world had used a drug in the past 12 months.

The estimated number of users grew from 240 million in 2011 to 296 million in 2021 (5.8 per cent of the global pop-ulation aged 15–64). This is a 23 per cent increase, partly due to population growth.Cannabis continues to be the most used drug, with an estimated 219 million users (4.3 per cent of the global adult population) in 2021.

Use of the drug is increasing and although globally cannabis users are mostly men (about 70 per cent), the gender divide is reducing in some subregions; women account for 42 per cent of cannabis users in North America.It is estimated that in 2021, 36 million people had used amphetamines, 22 million had used cocaine and 20 million had used “ecstasy”-type substances in the past year.

The proportion of female users is higher in the case of amphetamine-type stimulants (45 per cent of users are women) and non-medical use of pharmaceuticals (between 45 and 49 per cent of users are women), whereas the highest share of men is found in users of opiates (75 per cent) and cocaine (73 per cent).

Opioids continue to be the group of substances with the highest contribution to severe drug-related harm, including fatal overdoses. An estimated 60 million people engaged in non-medical opioid use in 2021, 31.5 million of whom used opiates (mainly heroin).

Different drugs pose different burdens on health and health-care systems. Most drug use disorders are related to cannabis and opioids, which are also the drugs that lead most people to seek drug treatment, but opioids remain the most lethal drug.

Among all countries that ranked the drugs leading to drug use disorders, the majority (46 per cent of countries) reported cannabis in first place, 31 per cent of countries reported opioids in first place, mainly heroin, whereas amphetamine-type stimulants, in particular methamphetamine, were reported in first place by 13 per cent of countries.

The ranking in each country is determined mainly by two factors: prevalence of use and dependence potential.

There are clear regional differences in the primary drug reported by people entering drug treatment: in most of Europe and most of the subregions of Asia, opioids are the most frequent primary drug of people in drug treatment, whereas in Latin America it is cocaine, in parts of Africa it is cannabis, and in East and South-East Asia it is methamphetamine.Opioids remain, however, the leading cause of deaths in fatal overdoses.

Opioids accounted for nearly 70 per cent of the 128,000 deaths attributed to drug use dis-orders in 2019. Opioid use disorders also accounted for the majority (71 per cent of the 18 million healthy years of life lost owing to premature death and disability in 2019.

An estimated 13.2 million people were injecting drugs in 2021. This estimate is 18 per cent higher than in 2020 (11.2 million). This increase is due to newly available estimates in the United States of America and in some other countries.

Eastern Europe (1.3 per cent of the adult population) and North America (1.0 per cent) remain the two subregions with the highest estimated prevalence of people who inject drugs, and, in absolute terms, North America now has the highest number of indi-viduals that report injecting drugs, ahead of East and South-East Asia.

The risk of acquiring HIV is 35 times higher for those who inject drugs than for those who do not inject drugs. The joint UNODC, WHO, UNAIDS and World Bank global estimate for people who inject drugs living with HIV is nearly 12 per cent, so 1.6 million people (1 in every 8 people) injecting drugs is living with HIV.

South-West Asia (29.3 per cent) and Eastern Europe (25.4 per cent) are the two subregions with the highest prevalence of HIV among people who inject drugs.Injecting drug use continues to be an important facilitating driver of the global epi-demic of hepatitis C, with WHO estimating that 23 per cent of new hepatitis C infections are attributable to unsafe drug injection.

Based on the joint UNODC, WHO, UNAIDS and World Bank global estimates, every second person injecting drugs is living with hepatitis C (an estimated 6.6 million people). Overall, liver diseases attributed to hepatitis C account for more than half the deaths attributed to the use of drugs. In the decade 2010–2019 there was a 13 per cent increase in the number of healthy years of life lost due to disability and premature death caused by liver disease attributed to hepatitis C among people who use and inject drugs.

As is the case with the use of drugs, there are more men than women injecting drugs. Men are 5 times more likely than women to inject drugs (based on limited data from 18 countries), whereas women who inject drugs are 1.2 times more likely than men to be living with HIV (based on data from 58 countries). Women who inject drugs are likely to have a male intimate partner who initiated them into drug use; they are also likely to ask their male partner to inject them.

As a result, women are more likely to be exposed to higher risk for sexual transmission of infections, also through sex work and their increased vulnerability to abuse from law enforcement officers and intimate partners, and to be the victim of physical assault or rape.

Large inequalities remain in the availability of internationally controlled opioids for medical consumption. Overall, there is a 40-fold difference in the availability of opioids per capita for pain management and palliative care between high-income and low- and middle-income countries. Some 86 per cent of the world’s population live without adequate access to pharmaceutical opioids for pain relief and care.

Nevertheless, some progress has been made in recent years, showing some increases in availability in low- and middle-income countries. Overall progress was also made with regard to the availability of methadone and buprenorphine over the last two decades, two opioids which are used not only as analgesics but also as opioid agonist medication in the treatment of opioid use disorders.

Despite the positive developments there remains an extremely wide diversity in the availability of opioids for medical purposes worldwide. Although a number of countries in North America, Oceania and Western Europe continue to have high levels of availability, most other countries have extremely low levels of availability of opioids for medical purposes, notably countries in Africa and Asia.

An estimated 39.5 million people worldwide were suffering from drug use disorders in 2021, but only 1 in 5 people with drug use disorders received drug treatment. The Covid-19 pandemic has aggravated the treatment gap.

Of the 46 countries regularly reporting to UNODC data on people in drug treatment, about 40 per cent registered a decline in the number of people in drug treatment during the COVID health emergency as compared to previous years. Data for 2021 show further declines.Barriers in accessing treatment are multiple but women are most affected.

Women who use drugs tend to progress to drug use disorders faster than men but they continue to be underrepresented in drug treatment. This gap is particularly high for women who use amphetamine-type stimulants. Almost 1 in 2 users of amphetamine-type stimulants is a woman but only 1 in 4 people in treatment is a woman.

In addition to the family expectations and responsibilities that they face, women may experience further barriers in accessing treatment that include increased fear of legal sanctions, increased social stigma, lack of childcare and fear of losing custody of children while in treatment.

Women who use drugs and are also members of certain population groups, for example, trauma and violence survivors, people with comorbidities, sex workers, prisoners or members of ethnic minorities, face more severe vulnerabilities, including higher levels of stigma and discrimination.

Deaths related to the use of drugs were estimated at about 500,000 in 2019, 17.5 per cent more than in 2009. Liver diseases attributed to hepatitis C are a major cause of drug-related deaths, accounting for more than half of the total number of deaths attributed to the use of drugs. Drug overdoses account for a quarter of drug-related deaths.

Opioids continue to account for the most severe drug-related harm, including fatal overdoses, when used non-medically.

At the global level, two thirds of direct drug- related deaths are due to opioids, and in some subregions the proportion can be as high as three quarters of such deaths.

More men than women die of drug overdose but excess mortality risk in women who use drugs is typically higher than in men (mainly owing to lower mortality rates among women of corresponding age in the general population).

Fortunately, the past decade has seen a decline in deaths attributed to HIV/AIDS among people who use drugs.

n 2021, 5.3 per cent of 15–16-year-olds worldwide (13.5 million individuals) had used cannabis in the past year. The adolescent brain is still developing and drug use can have long-term negative effects. Early drug use initiation can lead to faster development of dependence than in adults and other problems in adulthood.

The use of cannabis among 15–16-year-olds varies by region, from less than 3 per cent in Asia to over 17 per cent in Oceania but in most regions the proportion of adolescents using the drug is higher than in the general population aged 15–64. Similar prevalence in the two age groups was only recorded in Africa, where the population is young, and in the Americas, where until recently use among adoles-cents was higher than that among the general population.

Recent surveys during the coronavirus disease (COVID-19) pandemic from North America have recorded a significant decrease in cannabis use (and the use of some other drugs) among adolescents. This decline may, however, relate to changes in living conditions and drug-use patterns during the COVID-19 pandemic.

The use of new psychoactive substances is generally higher among school students than among the general population. In the long term, however, and where data are available (mainly in high income countries), they show that the use of new psycho-active substances other than ketamine appears to be stable or declining among young people.In South America, more than half of those in drug treatment are under 25 years old and in Africa 70 per cent are under 35

FINDINGS KEY MESSAGE

- One in every 17 people worldwide had used a drug in 2021, 23 per cent more than a decade earlier.

- Opioids continue to be the main drug that impacts the global burden of disease whereas cannabis is reported by a large share of countries as the drug of most concern for drug use disorders.

- New data put the global estimate of people who injected drugs in 2021 at 13.2 million, 18 per cent higher than in 2020.

- Large inequalities remain in the availability of pharmaceutical opioids for medical consumption.

- Barriers to treatment remain, especially for women.

- Liver diseases attributed to hepatitis C are a main cause of drug-related deaths, whereas opioids account for most overdose deaths.

- Young people are more vulnerable to drug use than adults are.

- Drug production and trafficking are exacerbating an array of other criminal economies in the Amazon Basin that have a negative impact on the environment and on communities.

For the full report, visit: https://www.unodc.org/res/WDR-2023/WDR23_Exsum_fin_SP.pdf