By European Union Drugs Agency (EUDA)

The European Drug Report 2025: Trends and Developments presents the EUDA’s latest analysis of the drug situation in Europe. Focusing on illicit drug use, related harms and drug supply, the report provides a comprehensive set of national data across these themes, as well as on specialist drug treatment and key harm reduction interventions

This report is based on information provided to the EUDA by the EU Member States, the candidate country Türkiye, and Norway, in an annual reporting process. The purpose of the current report is to provide an overview and summary of the European drug situation up to the end of 2024. All grouping, aggregates and labels therefore reflect the situation based on the available data in 2024 in respect to the composition of the European Union and the countries participating in the EUDA’s reporting exercises. However, not all data will cover the full period. Due to the time needed to compile and submit data, many of the annual national data sets included here are from the reference year January to December 2023. Analysis of trends is based only on those countries providing sufficient data to describe changes over the period specified. The reader should also be aware that monitoring patterns and trends in a hidden and stigmatised behaviour such as drug use is both practically and methodologically challenging. For this reason, multiple sources of data are used for the purposes of analysis in this report. Although considerable improvements can be noted, both nationally and in respect to what is possible to achieve in a European-level analysis, the methodological difficulties in this area must be acknowledged. Caution is therefore required in interpretation, in particular when countries are compared on any single measure. Caveats relating to the data are to be found in the online Statistical Bulletin 2025 , which contains detailed information on methodology, qualifications on analysis and comments on the limitations in the information set available. Information is also available there on the methods and data used for European-level estimates, where interpolation may be used :

PortugalEuropean Union Drugs Agency (EUDA); 2025 355p

By Jin A, Darzi AJ, Dargham A, Liddar N, Bozorgi S, Sohrevardi S, Zhang M, Torabiardakani K, Couban RJ, Khalili M, Busse JW, Sadeghirad B.

Background: Increasing legalization of recreational cannabis and availability of cannabinoid products has resulted in expanded use, which is associated with adverse effects including concerns over increased risk of motor vehicle collision (MVC). We aimed to explore the association between cannabis consumption and MVC.

Methods: We searched MEDLINE, EMBASE, CINAHL, Cochrane library, SCOPUS, PsycInfo, Web of Science, TRID from inception to November 2024. We included studies assessing the association between cannabis consumption on MVC fatalities, any injuries, and culpability/unsafe driving actions. Pairs of reviewers independently screened search results, extracted data, and assessed risk of bias. We used a DerSimonian and Laird random-effects model for all meta-analyses and the GRADE approach to assess the certainty of evidence.

Results: We included 31 studies with 328,388 individuals. Low certainty evidence suggests that cannabis consumption may be associated with an increased risk of MVC fatality (8 studies, OR 1.55, 95% CI: 1.20 to 1.98) with an absolute risk increase (ARI) of 14 more deaths per 100,000 MVC's. Low certainty evidence from 9 case-control studies suggests cannabis consumption may be associated with an increased risk of injury due to MVC (OR 2.00, [95% CI: 1.31-3.07]; absolute risk increase of 6.8%). We are uncertain about the association of cannabis consumption with MVC culpability/unsafe driving action as the evidence was only very low certainty.

Conclusions: Low certainty evidence suggests that cannabis consumption may increase risk of MVC fatality and risk of injury from MVC. The association between cannabis use and risk of unsafe driving is uncertain.

Int J Drug Policy. 2025 Aug;142:104832. doi: 10.1016/j.drugpo.2025.104832. Epub 2025 May 13. PMID: 40367728.

By Katrien Luyten

The EU is an important market for illicit drugs (hereinafter referred to as drugs), both in terms of consumption and production. An estimated 29% of European adults aged 15-65 have used drugs at least once in their lifetime, the majority of them being men. Cannabis remains by far the most used drug, followed by cocaine, MDMA (ecstasy or molly) and amphetamines. Drugs have been claiming an increasing number of lives in the EU since 2012, but their impact goes far beyond the harm caused by their use. The drugs market is the largest criminal market in the EU, with an estimated minimum retail value of €30 billion per year in the EU alone. Over a third of the organised crime groups active in the EU are involved in the trade in drugs, which, besides generating massive criminal profits and inflicting substantial harm, incites associated violence. Drug markets furthermore have links with wider criminal activity, including terrorism; they have a negative impact on the legal economy and communities, cause environmental damage and can fuel corruption and undermine governance. Drugs have been trafficked into and through the EU for decades, but they are also increasingly produced in the EU, for both local and global markets, asis the case for cannabis and synthetic drugs such as amphetamines. In fact, the trade in synthetic drugs in the EU is unique compared to other substances,as the production of these drugs and new psychoactive substances in most cases takes place in the EU. In 2021, around 1million seizures of drugs were reported in the EU-27 plus Norway and Türkiye. Although the EU Member States carry the primary responsibility for developing their drug policy and legislation, cross-border cooperation is paramount in the fight against drugs. With the problem constantly expanding in scale and complexity, the EU has been increasingly active since the early 1990s, particularly with respect to law enforcement, health-related issues and the detection and risk assessment of new psychoactive substances. This is an update of a briefing published in September 2021.

Brussels: EPRS | European Parliamentary Research Service , 2023.. 12p.

By Li Li, Anke Hoeffler, and Teresa Artho

Background: Switzerland is a high-income country with low rates of fatal and nonfatal violence. Possibly due to these low prevalence rates, the costs of violence to Swiss society have received relatively little attention. Objective: This report aims to establish the prevalence rates of homicide and assaults (both physical and sexual) in Switzerland and assess their related tangible and intangible costs. Furthermore, it aims to estimate the economic cost of violence in Switzerland while specifically delving into the economic impact of domestic violence and intimate partner violence (IPV). Methods: We employ a comprehensive approach to categorize violence-related costs into three categories: (1) tangible direct costs; (2) tangible indirect costs; and (3) intangible costs. Within each category, we further classify costs based on the outcome of injuries, distinguishing between fatal and nonfatal violence. To estimate these costs, we use official crime data from the Federal Statistical Office for homicide and assaults. Recognizing the issue of underreporting in physical and sexual assault offenses, victimization surveys are employed to estimate the number of unreported cases. In the absence of Swiss data on the cost of injuries, the Centers for Disease Control and Prevention (CDC) provides estimates on medical costs, work loss costs, and the value of a statistical life (VSL)/quality of life loss costs. To ensure comparability, violence types are mapped, and costs are adjusted for purchasing power parity between the US and Switzerland. We also make adjustments to reflect the relative size of medical spending between the two countries. For comparison, we use prevalence rates of physical assault from Gallup. Using the same methodology, we also estimate the costs of domestic violence and IPV. Results: Our estimates suggest that the economic cost of violence in Switzerland is about USD 66.3 billion, equivalent to 8.3 percent of the country’s GDP, according to Swiss data. However, the costs could be as high as USD 73.4 billion, representing 9.2 percent of GDP, based on the Gallup World Poll data. Further, domestic violence alone accounts for at least 4.4 percent of Swiss GDP, while IPV accounts for at least 3.2 percent. Conclusions: Despite low Swiss prevalence rates of violence, the estimated costs of said violence are high. However, there is considerable uncertainty regarding our estimates due to missing Swiss data on medical and criminal justice costs, as well as the severity of injuries due to assault.

New York: NYU Center on International Cooperation, 2023. 36p

By Andrés Fernández Arauz , and Camelie Ilie

Costa Rica faces an unprecedented challenge in the form of escalating violence concentrated within specific regions of the country. This report delves into the country's administrative divisions, shedding light on its eighty-two cantons, where critical security data is localized. Recent statistics up to September 2023 underline a concerning situation. While violence in Costa Rica remains lower than the regional average for Latin America, it is the country in the region where violence has grown the most since 1995. Levels of intentional homicide have surpassed the threshold of 10 per 100,000 people, which makes it an epidemic in the country according to the World Health Organization’s classification. Moreover, while violence remains a localized issue, the number of cantons surpassing ten homicides per 100,000 inhabitants has increased, especially in coastal and border regions Much of this increase can be attributed to organized crime and the proliferation of illegal weapons, which is made clear by the fact that the cantons that saw the most increase in violence are territories through which the entry and transit of drugs occur in the region. Beyond homicide, non-lethal assault and intimate partner violence are issues that have their own effects in society. While official statistics put the rate of assault at less than one percent, survey data shows the number to be close to 4 percent, and evenly spread between men and women. Intimate partner violence affects 7 percent of adult women, and has increased over the last few years. These statistics add to a diminishing perception of safety, with 65 percent of the population reporting feeling that the country is not safe. For women, the feeling of unsafety is even higher, with 73 percent of female respondents expressing that they feel a high likelihood of being assaulted, compared to 57 percent of male respondents. Specific recommendations are delineated to counter these challenges. First, a thorough reevaluation and update of previous social programs is imperative. This evaluation should delve deep into identifying flaws in the existing programs. Such scrutiny enables timely corrections and reveals valuable lessons to be gleaned from previous work. Second, a regional focus for targeted interventions is proposed. By channeling efforts into the six cantons witnessing the steepest rise in homicides, particularly those strategically located along coasts and borders, Costa Rica can address the problems at their source. These areas often serve as primary entry points for drug trafficking, requiring concentrated and specialized interventions. Finally, an integrated strategy involving local, national, and international stakeholders is emphasized. Present programs often lack alignment and coordination to address recent violence patterns, emphasizing the need for cohesive collaboration. This strategy should foster a cooperative spirit between local governments, ensuring harmonized and effective efforts. These joint initiatives can significantly curb violence in specific cantons by integrating local insights with national expertise

New York: NYU Center on International Cooperation, 2023. 46p.

By Lisa Cameron, Jennifer Seager, Manisha Shah

We examine the impact of criminalizing sex work, exploiting an event in which local officials unexpectedly criminalized sex work in one district in East Java, Indonesia, but not in neighboring districts. We collect data from female sex workers and their clients before and after the change. We find that criminalization increases sexually transmitted infections among female sex workers by 58 percent, measured by biological tests. This is driven by decreased condom access and use. We also find evidence that criminalization decreases earnings among women who left sex work due to criminalization, and decreases their ability to meet their children's school expenses while increasing the likelihood that children begin working to supplement household income. While criminalization has the potential to improve population STI outcomes if the market shrinks permanently, we show that five years post-criminalization the market has rebounded and the probability of STI transmission within the general population is likely to have increased.

Working Paper 27846

Cambridge, MA: National Bureau of Economic Research, 2020. 52p.

By Nicole Kravitz-Wirtz,  Angela Bruns , Amanda J Aubel , Xiaoya Zhang , Shani A Buggs

Understanding the burden of gun violence among youth is a public health imperative. While most estimates are based on direct and witnessed victimization, living nearby gun violence incidents may be consequential too. Yet detailed information about these broader experiences of violence is lacking. We use data on a population-based cohort of youth merged with incident-level data on deadly gun violence to assess the prevalence and intensity of community exposure to gun homicides across cross-classified categories of exposure distance and recency, overall and by race/ethnicity, household poverty, and neighborhood disadvantage. In total, 2–18% of youth resided within 600 m of a gun homicide occurring in the past 14–365 days. These percentages were 3–25% for incidents within 800 m and 5–37% for those within a 1300-m radius. Black and Latinx youth were 3–7 times more likely, depending on the exposure radius, to experience a past-year gun homicide than white youth and on average experienced incidents more recently and closer to home. Household poverty contributed to exposure inequities, but disproportionate residence in disadvantaged neighborhoods was especially consequential: for all racial/ethnic groups, the difference in the probability of exposure between youth in low vs high poverty households was approximately 5–10 percentage points, while the difference between youth residing in low vs high disadvantage neighborhoods was approximately 50 percentage points. Given well-documented consequences of gun violence exposure on health, these more comprehensive estimates underscore the importance of supportive strategies not only for individual victims but entire communities in the aftermath of gun violence.

J Urban Health, 2022 Jun 7, 16p.

By Vanda Felbab-Brown 

Over the past several decades, the U.S. opioid epidemic has spanned four phases:  Oversupply of prescription opioids in the 1990s.. A significant increase in heroin supply and use in the 2000s.  A supply-driven explosion of fentanyl use after 2012.  Most recently, polydrug use, with fentanyl mixed into/with all kinds of drugs. Since fentanyl entered the U.S. illegal drug market, more than a million people in the United States have died of opioid overdose. The costs of fentanyl use go beyond the tragic deaths and drug-use-related morbidity, however. In addition to having significant implications for public health and the economy, the fentanyl crisis intersects in many ways with U.S. foreign policy. U.S. overdose deaths began declining in 2023. But there is little certainty as to which domestic or foreign-policy interventions have been crucial drivers. The wider availability of overdose-reversal medication is fundamental, as is expanded access to evidence-based treatment. It is also possible that the Biden administration’s actions toward international supply from Mexico and China are contributing to this reduction in overdose deaths: since the start of 2024, China has become more active in suppressing the flow of precursor chemicals, and Mexican cartels, perhaps purposefully, are now trafficking a less lethal version of fentanyl. A wide array of policy measures as well as structural factors outside of policy control could be cumulatively and interactively reducing mortality. The fact that the declines in mortality are not uniform across U.S. ethnic, racial, and social groups or geographic areas suggests the importance of access to medication for overdose reversal and the treatment of opioid use disorder, as well as the influence of structural factors. There is strong bipartisan support for preserving access to medication-based treatments. But crucially, access depends on medical insurance coverage, such as that provided through Medicaid and the Affordable Care Act. There are strong ideological divides about the financing and structure of the U.S. insurance industry as well as other aspects of drug policy. On February 1, President Donald Trump imposed a 25% tariff on imports from Mexico and Canada and a 10% tariff on imports from China until each country stops the flow of fentanyl (as well as migrants, in the cases of Mexico and Canada).1 He gave all three countries a month-long reprieve before implementing the tariffs in March to see if they satisfied his counternarcotics demands. Canada adopted a robust package of anti-fentanyl measures. Mexico too tried to appease the United States through a set of law enforcement actions, though it held out on perhaps the most important form of cooperation—expanding the presence and mandates of U.S. law enforcement agents in Mexico to levels at least approaching those enjoyed during the Felipe Calderón administration. Unlike Mexico or Canada, China did not take any further counternarcotics actions and instead responded with counter-tariffs of its own, even as Trump threatened to add additional tariffs on imports from China of up to 60%.2 On March 4, 2025, Trump dismissed Canada’s and Mexico’s law enforcement actions as inadequate, implementing the 25% tariffs. He also added an additional 10% tariff on China, meaning the second Trump administration has now placed a 20% tariff on Chinese goods.3 Apart from increasing the cost of goods for U.S. customers and driving up inflation, these tariffs will have complex effects on anti-fentanyl cooperation. Any large U.S. tariffs on China will likely eviscerate Beijing’s cooperation with the United States, resetting the diplomatic clock  back to the bargaining of 2018 and noncooperation of 2021-2023. As crucial as it is to induce the government of Mexico to start robustly and systematically acting against Mexican criminal groups, whose power has grown enormously and threatens the Mexican state, Mexican society, and U.S. interests, Mexico has no capacity to halt the flow of fentanyl. Mixing the issues of migration and fentanyl risks Mexico appeasing the United States principally on migration while placating it with inadequate anti-fentanyl actions. Further, U.S. military action in Mexico, which has been threatened by Republican politicians close to Trump, would yield no sustained weakening of Mexican criminal groups or fentanyl flows. It would, however, poison the political atmosphere in Mexico and hinder its meaningful cooperation with the United States. Strong law enforcement cooperation with Canada is crucial. Canada has been facing law enforcement challenges, such as the expansion of Mexican and Asian organized crime groups and money laundering operations in Canada. But disregarding the domestic and collaborative law enforcement efforts Canada has put on the table is capricious. At home, Trump’s favored approach, which renews focus on imprisoning users and drug dealers, and dramatically toughening penalties for the latter, would be ineffective and counterproductive. And while providing treatment is very important, the dramatic effect of treatment modality on effectiveness cannot be overlooked. Approaches to treatment should be designed based on evidence, not ideology.

Washington, DC: Brookings Institute, 2025. 49p.

By Dan Werb, dwerb@health.u HaeSeung Sung ∙ Yingbo Naa ∙ Indhu Rammohana ∙ Jolene Eeuwesa ∙ Ashly Smoke∙  Akwasi Owusu-Bempah, Thomas Kerr,g, and Mohammad Karamouzian

  Background Supervised consumption services (SCS) are effective at preventing overdose mortality. However, their effect on public safety remains contested. We investigated homicide rates in areas near SCS in Toronto. Methods We classified coroner-reported fatal shootings and stabbings (January 1st, 2010 to September 30th 2023) by geographic zone: within 500 m (‘near’), between 500 m and 3 km (‘far’), and beyond 3 km of an SCS (‘out’). We then used Poisson regression to calculate the rate ratio (RR) across zones 18, 36, 48, and 60 months pre vs. post SCS implementation. Finally, we compared spatial homicide incidence prior to and after the date of the implementation of each SCS using interrupted time series (ITS). Findings Overall, 956 homicides occurred, and 590 (62%) were fatal shootings and stabbings. There was no meaningful change in the rate of fatal shootings and stabbings within 3 kms of SCS (near and far zones) after their implementation. However, between 48 and 60 months pos-implementation, we detected an increase in out zones. In an ITS analysis, we observed a reduction in the monthly incidence in near zones and an increase in out zones. Interpretation SCS implementation was not associated with increased homicide rates; instead, we observed a reduction in monthly incidence near SCS. These results may inform drug market activity responses that optimize community health and safety.

The Lancet Regional Health – Americas, Volume 43, 2025. 101022

By European Union Agency for Fundamental Rights, FRA; European Institute for Gender Equality

  This report presents, for the first time, selected key results of the EU gender-based violence survey based on data from all 27 Member States. Across the EU-27, 114 023 women were interviewed about their experiences. The report focuses on the prevalence of various forms of violence against women in the EU. The EU gender-based violence survey also collected specific data about women’s experiences of violence, including on the consequences of violence and contacts with different services that provide assistance to victims, as survivors of violence. Data on both the prevalence of violence and the consequences of violence will be analysed in detail in the survey report that Eurostat, FRA and EIGE will publish in 2025. In this report, the results are presented in four chapters, starting with the overall prevalence of physical violence or threats and/or sexual violence by any perpetrator. This is followed by two chapters that focus on violence perpetrated by women’s intimate partners and by other people (non-partners). The fourth chapter examines women’s experiences of sexual harassment at work. Finally, the report includes an annex that summarises the survey data collection methodology  

Vienna: FRA 2024. 48p.

By Dean J. Connolly, Santino Coduri-Fulford c, Katherine Macdonald , Gail GilchristLuke Muschialli

Sexualised drug use (SDU) is a highly prevalent phenomenon of increasing public health significance in communities of men who have sex with men (MSM). This prospectively registered PRISMA-ScR-adherent systematic scoping review examines the current state of knowledge surrounding violence amongst MSM in the context of SDU. A broad search was conducted across four databases, with no restrictions. Studies citing or cited by all database-identified records retained for full-text review were retrieved and screened. Three journals were hand searched across the past five years, and three searches were conducted on Google Scholar. In addition, 13 key opinion leaders were contacted via email to request any additional published or unpublished data. The twentyeight studies included in the final synthesis reported mostly qualitative data from geographically diverse nonrepresentative samples, predominantly relating to sexual violence with other typologies seldom investigated or reported. Although quantitative data were limited, sexual violence appeared common in this context and was directly associated with impaired mental health and suicidality. Some participants reported first- or second-hand accounts of non-consensual administration of incapacitating doses of GHB/GBL to men who were subsequently raped. This was frequently perpetrated by men whose age, status, or financial privilege afforded them power over their victims. While reports from some participants suggested context-specific blurring of the lines of consent, a few quotes demonstrated a dearth of knowledge surrounding the centrality of consent in lawful sex. Given the historical denigration of MSM, any efforts to further investigate or address this issue must be community-led.

International Journal of Drug Policy

Volume 136, February 2025, 104706

By Ingrid Diane Johnson

Purpose: How victims of violence against women (VAW) label their experiences and selves can be important for help-seeking, but descriptive research on the prevalence of experience- and self-labels among VAW victims is limited. This study sought to fll some of the gaps in this quantitative literature using new measurement tools. Method: The current study used quantitative survey data from a weighted sample of 1694 community-based women in Alaska who had experienced VAW (determined using behaviorally specific items) to measure the prevalence of a variety of labels these victims could apply to their experiences and selves. Results Generally, victims of specific forms of violence had minimal agreement on the terms they used to label their experiences. The most commonly endorsed label was 28.5% of those who had experienced alcohol or drug involved sexual assault applying the label rape to their experiences. Across all victims, the most commonly endorsed self-label was survivor, with one-quarter to one-third endorsing this label, depending on the subsample. Roughly one-tenth used the self-label victim across all subsamples. Conclusion: VAW service providers should consider labels used to promote services and how to increase awareness about which behaviors constitute VAW; policymakers should improve the accessibility of healthcare so that labeling oneself or one’s experiences in a certain way is not a prerequisite of help-seeking; and researchers should continue exploring how to measure experience- and self-labels with minimal priming of participants and greater specificity to the actual experiences with violence.

Journal of Family Violence (2024) 39:421–433

By The United Office on Drugs and Crime

  In the Sahel countries and their neighbours, the high prevalence of infectious diseases, including malaria, coupled with challenges in terms of the availability and affordability of and access to healthcare, creates an environment in which the demand for medical products and services is not fully met through formal channels. The disparity between the demand for and supply of regulated pharmaceutical products leaves room for trafficking, provides an incentive for the involvement of organized criminal groups and fuels the ongoing threat to public safety and public health in the Sahel countries. Between January 2017 and December 2021, at least 605 tons of different medical products were seized in West Africa during international operations.  While there are no reliable estimates of the overall quantities of medical products that are trafficked in different ways and forms in the Sahel countries, studies point to a percentage of substandard and falsified medicines in the medical market of between 19 and 50 per cent. Some 40 per cent of the substandard and falsified medical products reported in the Sahel countries between 2013 and 2021 was discovered in the regulated supply chain. Just as regulated medical products can be diverted, illicitly manufactured medical products can find their way into authorized pharmaceutical outlets, which shows how much the regulated (legal) and unregulated (illicit) supply chains are interconnected. The Sahel countries rely heavily on imports of medical products because their pharmaceutical industries are still in the early stages of development. Of total pharmaceutical expenditure in sub-Saharan Africa in 2019, imports represented as much as 70 to 90 per cent (roughly 14 billion United States dollars ($)). Medical products diverted from the legal supply chain often originate in the main exporting countries of medical products to the Sahel countries, in particular Belgium and France, and to a lesser extent China and India. Others are manufactured in neighbouring countries, including in North Africa and the Gulf of Guinea. The seaports in the Gulf of Guinea, Conakry (Guinea), Tema (Ghana), Lomé (Togo), Cotonou (Benin) and Apapa (Nigeria) can be identified as major entry points for medical products destined for the Sahel countries. Trafficking by air, using postal shipments or carried out by commercial air passengers, is employed for smuggling smaller quantities of medical products. Once in West Africa, trafficked medical products reach the Sahel countries through smugglers who follow traditional trafficking routes using buses, trucks and private cars. Investigations have revealed the involvement of a wide range of opportunistic actors in trafficking in medical products in the Sahel countries, from employees of pharmaceutical companies, public officials, law enforcement officers and health agency workers to street vendors, all motivated by potential financial gain. Despite terrorist groups and non-state armed groups being commonly associated with trafficking in medical products in the Sahel, most reported cases in the region show that the involvement of such groups is limited and mainly revolves around consuming medical products or levying "taxes" on them in the areas under their control. In sub-Saharan Africa, as many as 267,000 deaths per year are linked to falsified and substandard antimalarial medicines. In addition, up to 169,271 are linked to falsified and substandard antibiotics used to treat severe pneumonia in children.     

Vienna: UNODC, 2022. 28p.

By Ulla D. Berg, and Sebastian K. León

Each year the United States government detains and deports hundreds of thousands of people who prior to their removal are held in confinement for an average of 55 days. The short and long-term effects of the coronavirus pandemic on migrant detention and deportation continue to be evaluated in real time, including how we can best study it. This paper provides a timely analysis on the relationship between immigration enforcement and confinement, public health emergencies, and ethnographic methods. It makes two contributions. The first is methodological and focuses on the challenges and opportunities of ethnographic methods in carceral settings when pandemic-related protocols have raised additional challenges to conventional in-person prison ethnography. The second contribution is empirical and documents how we adapted ethnographic methods to an interdisciplinary research design and to the exigencies of the pandemic to study the spread of the coronavirus in four immigrant detention facilities in New Jersey, USA.

EthnographyVolume 25, Issue 3, September 2024, Pages 314-334

By Godwin Omokhagbo Emmanuel, Folahanmi Tomiwa Akinsolu , Olunike Rebecca Abodunrin,

Oliver Chukwujekwu Ezechi

ntroduction

Substance use is a growing public health concern in West Africa, contributing to significant morbidity, mortality, and socioeconomic challenges. Despite the increasing prevalence, comprehensive data on the patterns and factors influencing substance use in the region remain limited. This systematic review and meta-analysis aim to synthesize existing research on the prevalence and patterns of substance use in West Africa, providing critical insights for developing targeted interventions and policies.

Methodology

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] guidelines. A systematic search was performed across four major databases [PubMed, Web of Science, CINAHL, and Scopus] from January 2000 to June 2024. A total of 22 studies involving 43,145 participants met the inclusion criteria. Multiple reviewers performed data extraction and quality assessment independently, and a random-effects meta-analysis was used to estimate the pooled prevalence of various substances. Sensitivity analysis was conducted using a leave-one-out approach to evaluate the influence of individual studies on the overall prevalence.

Results

The meta-analysis revealed the pooled prevalence rates of alcohol [44%], cannabis [6%], tramadol [30%], codeine [11%], and kolanut [39%]. The analysis identified high heterogeneity across studies [I2 = 98– 99%], reflecting diverse substance use patterns and influencing factors, including peer influence, availability of substances, socioeconomic conditions, and demographic characteristics. Sensitivity analysis indicated that no single study significantly impacted the overall prevalence estimates, confirming the robustness of the findings.

Conclusion

Substance use in West Africa is widespread and influenced by complex factors. The high prevalence of alcohol and tramadol use highlights the urgent need for targeted public health interventions, including stricter regulatory frameworks, community-based prevention programs, and comprehensive public education campaigns. This study provides a critical foundation for developing effective strategies to mitigate the escalating substance use crisis in the region.

PLOS Glob Public Health 4(12): e0004019. https://doi.org/10.1371/journal. pgph.0004019

By Matthew F. Garnett and Arialdi M. Miniño

Drug overdoses are one of the leading causes of injury death in adults and have risen over the past several decades in the United States (1–3). Overdoses involving synthetic opioids (fentanyl, for example) and stimulants (cocaine and methamphetamine, for example) have also risen in the past few years (1). This report presents rates of drug overdose deaths from the National Vital Statistics System over a 20-year period by demographic group and by the type of drugs involved, specifically, opioids and stimulants, with a focus on changes from 2022 to 2023. Key findings Data from the National Vital Statistics System ● The age-adjusted rate of drug overdose deaths increased from 8.9deaths per 100,000 standard population in 2003 to 32.6 in 2022; however, the rate decreased to 31.3 in 2023. ● Rates decreased between 2022 and 2023 for people ages 15–54 and increased for adults age 55 and older. ● From 2022 to 2023, rates decreased for White non-Hispanic people, while rates for other race and Hispanic-origin groups generally stayed the same or increased. ● Between 2022 and 2023, rates declined for deaths involving synthetic opioids other than methadone, heroin, and natural and semisynthetic opioids, while the rate for methadone remained the same. ● From 2022 to 2023, rates increased for deaths involving cocaine by 4.9% (from 8.2 to 8.6) and psychostimulants with abuse potential by 1.9% (10.4 to 10.6)

NCHS Data Brief No. 522, December 2024. 12p.
Hyattsville, MD: National Center for Health Statistics. 2024. DOI: https://dx.doi.org/10.15620/cdc/170565.

By Joseph Friedman, jofriedman@health.uDaniel Ciccarone

Synthetic illicit drugs, such as nitazenes and fentanyls, are becoming commonplace in countries around the world, including in Europe, Australia, and Latin America, which raises concern for overdose crises like those seen in North America. An important dimension of the risk represented by synthetic drugs is the fact that they are increasingly packaged in counterfeit pill form. These pills—often indistinguishable from authentic pharmaceuticals—have substantially widened the scope of populations susceptible to synthetic drug overdose in North America (eg, among adolescents experimenting with pills or tourists from the USA seeking psychoactive medications from pharmacies in Mexico). The non-medical use of diverted prescription medications is relatively more common, and less stigmatised, than the use of powder drugs. Many consumers of counterfeit pills are unaware that they contain synthetic illicit drugs, believe them to be authentic pharmaceuticals, and would be unlikely to consume those drugs knowingly or if in powder form. Given these issues, we recommend the expansion of educational and awareness campaigns, pill testing programmes to help consumers shift demand to safer products, increased monitoring in routine clinical scenarios and overdose death toxicology, and expanding medically managed safer alternatives to counterfeit pill use.\

The Lancet Public Health, Volume 10, Issue 1, e58 - e62 2025.

By Aisha M Abubakar, Rowland G Seymour, Alison Gardner, Imogen Lambert, Rachel Fyson, Nicola Wright

Background

Exploitation poses a significant public health concern. This paper highlights ‘jigsaw pieces’ of statistical evidence, indicating cognitive impairment as a pre- or co-existing factor in exploitation.

Methods

We reviewed English Safeguarding Adults Collection (SAC) data and Safeguarding Adults Reviews (SARs) from 2017 to 22. Data relevant to exploitation and cognitive impairment were analysed using summary statistics and ‘analysis of variance’.

Results

Despite estimates suggesting cognitive impairments may be prevalent among people experiencing exploitation in England, national datasets miss opportunities to illuminate this issue. Although SAC data include statistics on support needs and various forms of abuse and exploitation, they lack intersectional data. Significant regional variations in recorded safeguarding investigations and potential conflation between abuse and exploitation also suggest data inconsistencies. Increased safeguarding investigations for people who were not previously in contact with services indicate that adults may be ‘slipping through the net’. SARs, although representing serious cases, provide stronger evidence linking cognitive impairment with risks of exploitation.

Conclusions

This study identifies opportunities to collect detailed information on cognitive impairment and exploitation. The extremely limited quantitative evidence-base could be enhanced using existing data channels to build a more robust picture, as well as improve prevention, identification and response efforts for ‘at-risk’ adults.

Journal of Public Health, Volume 46, Issue 4, December 2024, Pages 498–505,

By Lauren J. Tanz; Andrea Stewart, R. Matt Gladden,; Jean Y. Ko, Lauren Owens, Julie O’Donnell

During 2023, approximately 72,000, or nearly seven in 10, drug overdose deaths in the United States were estimated to involve illegally manufactured fentanyls (IMFs). Carfentanil, a fentanyl analog 100 times more potent than fentanyl, has reemerged in the U.S. drug supply. Using CDC’s State Unintentional Drug Overdose Reporting System data, this report describes trends in overdose deaths during January 2021– June 2024, overall and with IMFs detected, by U.S. Census Bureau region, and in deaths with carfentanil detected, in 45 states and the District of Columbia (DC). Numbers of deaths with carfentanil detected by state during January 2023–June 2024 in 49 states and DC are also reported. The number of overdose deaths with IMFs detected declined from 2022 to 2023 in the Northeast (3.2% decline), Midwest (7.8%), and South (2.8%) regions; deaths in the West increased 33.9%. The percentage of deaths with IMFs detected was steady at approximately 70%–80% in the Northeast, Midwest, and South. In contrast, the percentage of deaths with IMFs detected in the West increased from 48.5% during January–March 2021 to 66.5% during April–June 2024. Overdose deaths with carfentanil detected increased approximately sevenfold, from 29 during January–June 2023 to 238 during January–June 2024; during January 2023–June 2024, overdose deaths with carfentanil detected were reported in 37 states. Overdose prevention efforts that address the widespread presence of IMFs, including carfentanil, and can rapidly adapt to other potent opioids in the drug supply might result in lasting reductions in overdose deaths across the entire United States

MMWR | December 5, 2024 | Vol. 73 | No. 48, 7p.

By Tami L. Mark; Benjamin D. Huber

IMPORTANCE: Medicaid programs have expanded coverage of substance use disorder treatment and undertaken many other initiatives to reduce drug overdoses among beneficiaries. However, to date, no information has been published that tracks overdose deaths among the Medicaid population. OBJECTIVE To determine the rate of drug overdose among Medicaid beneficiaries. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, US Centers for Medicare & Medicaid Services data from 2016 to 2020 that linked enrollment and demographic data from all Medicaid beneficiaries in the US with the US Centers for Disease Control and Prevention National Death Index were used to determine the rate of drug overdose death among Medicaid beneficiaries. The Medicaid population rates were compared with those of the total US population, overall and by age and sex. EXPOSURE Participation in the Medicaid program. MAIN OUTCOME Death of a drug overdose. RESULTS In 2020, the drug overdose death rate among Medicaid beneficiaries was 54.6 per 100 000, a rate that was twice as high as the drug overdose rate among all US residents (27.9 per 100 000). In 2020, Medicaid beneficiaries comprised 25.0% of the US population but 48% of all overdose deaths (44 277 of 91 783). For each age and sex group older than 15 years, overdose deaths were higher for the Medicaid population than for the US population, with the greatest difference occurring among adults ages 45 to 64 years. From 2016 to 2020, Medicaid overdose deaths increased by 54%. CONCLUSIONS AND RELEVANCE The results of this study suggest that more research is needed to understand why Medicaid beneficiaries have higher rates of drug overdoses than all US residents. Additionally, research is needed to understand how best to prevent overdoses among Medicaid beneficiaries. The federal government should s

JAMA Health Forum. 2024;5(12):e244365. doi:10.1001/jamahealthforum.2024.4365