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 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

By European Union Drugs Agency (EUDA).

This report explores the intricate relationship between economic recessions and illicit drug use through an in-depth scoping review of the literature. Unravelling complexities among demographics and drug types, this analysis sheds light on potential impacts of economic downturns, suggesting that young and already socioeconomically vulnerable population groups appear to be most affected during economic downturns. Among young adults, several studies indicate that the use of cannabis may increase during economic downturns. In addition, there are indications that transitioning to more problematic patterns of drug use, such as from smoking or snorting to injecting, may also increase during times of economic turmoil.

Luxembourg: Publications Office of the European Union., 2024. 60p.

By: Steven Teutsch, Yasmin Hurd, and Elizabeth Boyle

The landscape of cannabis legalization in the United States has been changing dramatically. Cannabis is now available throughout the United States, with policies that vary significantly in terms of public health protection. In most states, legalization occurred through ballot initiatives and public ad campaigns often financed by wealthy donors. Voters acknowledged cannabis’s widespread use, its large illegal market, the criminalization of seemingly minor infractions, and discrimination in enforcement. Today, changes in the classification of cannabis under the federal Controlled Substances Act are pending, as is a possible change in the definition of “hemp.” These sweeping changes are occurring when many of the health consequences of cannabinoids remain quite uncertain. And those changes are coupled with a disturbing legacy of discrimination during the “war on drugs,” with associated devastating consequences for individuals and communities of color in particular. The legalization of an increasingly powerful intoxicating drug has necessitated a greater fusion of public health and drug policy in the states.

In the face of this complexity, how, then, is one to assess the consequences of the changes in cannabis policy for public health and social equity? This was the charge to the Committee on the Public Health Consequences of Changes in the Cannabis Landscape. The 2017 report of the National Academies of Sciences, Engineering, and Medicine, The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research, focuses on the health effects and potential therapeutic benefits of cannabis, noting the paucity of high-quality studies on its health effects. Regrettably, little has changed in this regard since that report was published, and scant to no research exists on the explosion of new cannabis and cannabinoid products. The present report focuses on the public health consequences of cannabis policies that have not been examined by the National Academies.

States have received little federal guidance on how to proceed regarding the health impact of cannabis on the public and communities. Other than two memoranda deferring to states, the federal government has been noticeably missing from this dialogue. Yet cannabis can cause real harms, as multiple investigators, families, and various groups attested to our committee. The tools of public health—assessment, policy development, and assurance—can provide the critical health information decision-makers need to protect the public health and make amends for past cannabis-related inequities, but those tools are only slowly being applied.

With legalization by states now widespread, it is time to ask about its impact, especially given the large variation in state policies. These natural experiments provide a rich but very complex set of experiences for analysis, but these policies are all of relatively recent vintage. Consequently, available products, use patterns, and markets have not yet stabilized. Facing these challenges, the committee reviewed what is known about these policies, formulated recommendations where possible, and delineated a path forward. With a strong commitment to policy research and the application of traditional public health tools, we fully anticipate that better and more consistent policies will unfold.

This report would not have been possible without the deep expertise, wide range of perspectives, and strong commitment of all the committee members. Elizabeth Boyle, study director, and her National Academies colleagues, Khala Hurst-Beatty, Alexandra McKay, and Mia Saltrelli, labored long and hard to tie together all the disparate pieces of this report. We are deeply grateful to all of them. Lastly, we want to express our appreciation to our sponsors, the Centers for Disease Control and Prevention and the National Institutes of Health, without whose vision this study would not have been possible.

The National Academies Press 2024

By Thomas Hofmarcher, Anne Leppänen, Anna Månsdotter, Joakim Strandberg, Anders Håkansson

Background: Illegal drug use is a public health concern with far-reaching consequences for people who use them and for society. In Sweden, the reported use of illegal drugs has been growing and the number of drug-induced deaths is among the highest in Europe. The aim of this study was to provide a comprehensive and up-to-date estimation of the societal costs of illegal drug use in Sweden, relying as much as possible on registry and administrative data. Methods: A prevalence-based cost-of-illness study of illegal drug use in Sweden in 2020 was conducted. A societal approach was chosen and included direct costs (such as costs of health care, social services, and the criminal justice system), indirect costs (such as lost productivity due to unemployment and drug-induced death), and intangible costs (such as reduced quality of life among people who use drugs and their family members). Costs were estimated by combining registry, administrative, and survey data with unit cost data. Results: The estimated societal costs of illegal drug use were 3.7 billion euros in 2020. This corresponded to 355 euros per capita and 0.78 % of the gross domestic product. The direct and intangible costs were of similar sizes, each contributing to approximately 40 % of total costs, whereas indirect costs contributed to approximately 20 %. The largest individual cost components were reduced quality of life among people who use drugs and costs of the criminal justice system. Conclusion: Illegal drug use has a negative impact on the societal aim to create good and equitable health in Sweden. The findings call for evidence-based prevention of drug use and treatment for those addicted. It is important to address the co-morbidity of mental ill-health and drug dependence, to develop low-threshold services and measures for early prevention among children and young adults, as well as to evaluate laws and regulations connected to illegal drug use.

International Journal of Drug Policy, Volume 123, January 2024, 104259

By The United Nations Office on Drugs and Crime

Restrictions on movement imposed by govern- ments across the world due to the COVID-19 pandemic have had an impact on the trafficking of substandard and falsified medical products. Interpol and the World Customs Organization (WCO) reported that seizures of substandard and falsified medical products, including person- al protective equipment (PPE), increased for the first time in March 2020. The emergence of trafficking in PPE signals a significant shift in organized criminal group behaviour that is directly attributable to the COVID-19 pandemic, which has brought huge demand for medical products such as PPE over a relatively short period of time. It is foreseeable that, with the evolution of COVID-19 and developments in medicinal treatments and/or the repurposing of existing medicines, criminal behaviour will shift from trafficking in PPE to the development and delivery of a COVID-19 vaccine. Furthermore, cyberattacks on critical infrastructure involved in addressing the pandemic are likely to continue in the form of online scams aimed at health procurement authorities. Challenges in pandemic preparedness, ranging from weak regulatory and legal frameworks to the prevention of the manufacturing and trafficking of substandard and falsified products and cyber security shortcomings, were evident before COVID-19, but the pandemic has exacerbated them and it will be difficult to make significant improvements in the immediate short term. The report concludes that crime targeting COVID-19 medical products will become more focused with significantly greater risks to pub- lic health as the containment phase of the pan- demic passes to the treatment and prevention stages.

Vienna: UNODC Research and Trend Analysis Branch. 2020. 31p