Drug use disorders remain a prevalent problem globally, yet most countries do not offer evidence-based treatment for these disorders, according to a new database set up by the World Health Organization (WHO) to track the availability of services to prevent and treat substance use disorders. The WHO created the database as part of its effort to expand access to treatment for patients with these disorders (http://www.who.int/gho/substance_abuse/en/index.html). The database contains information on 147 countries—accounting for 88% of the world's population—that have been assessed by the WHO. (Photo credit: WHO) Substance abuse remains prevalent around the globe, but treatment access lags, according to a new database set up by the World Health Organization to track the availability of services to prevent and treat substance use disorders. “Drug dependence is a disorder that can be treated effectively, but unfortunately, the large majority of persons who need it do not have access to treatment,” said Shekhar Saxena, MD, director of the department of mental health and substance abuse at the WHO, in a statement. “The data presented in the new system illustrate the huge gaps that still exist in the area of drug dependence treatment.” Saxena noted, however, that more countries are recognizing the societal and economic benefits of offering treatment for substance abuse. According to the WHO, about 27 million individuals worldwide have severe drug problems, but the prevalence of such disorders varies globally. In some countries, such as the United States and Spain, just under 2% of individuals have substance abuse disorders, while in others, such as Iran and Colombia, more than 3% of the population is affected. Alcohol use disorders are an even greater problem, with countries such as the United States having a prevalence of 5.48%, compared with a prevalence of more than 16% in the Russian Federation. Such disorders have devastating effects on individuals' health and hamper their ability to work and maintain relationships. Additionally, left untreated, these disorders can contribute to huge societal costs from repeated hospitalization and the spread of disease through injection drug use or risky sexual behaviors, which are often associated with substance abuse. Yet the availability of treatment lags in much of the world. According to a statement from Vladimir Poznyak, MD, PhD, coordinator of the management of substance abuse program at the WHO, only 45% of the countries assessed offer medications such as methadone or buprenorphine to patients who are dependent on opioid drugs, and even in countries where such evidence-based treatment is available, only 1 in 5 patients get such treatment. In 2009, the WHO and the United Nations (UN) Office on Drugs and Crime launched a program to help expand access to treatment globally and improve the quality of treatment being offered. Initially, the program focused its efforts on Serbia, Albania, Haiti, and Pakistan but has since expanded to 11 more countries. David Metzger, PhD, scientific director of the Treatment Research Institute in Philadelphia, agreed that access to substance abuse treatment globally is very poor but said that efforts such as the WHO's may boost awareness of this problem and build support for drug treatment. Solving the problem, he said, requires a combination of political will and resources. Recognition that heroin use has driven the epidemic of HIV in many countries has led some groups to work to expand access to medical treatment for opioid dependence in the Russian Federation, central Asia, and southeastern Asia, Metzger noted. In particular, the UN and the Global Fund to Fight AIDS, Tuberculosis and Malaria have invested in expanding methadone treatment programs in these regions. But financial pressure on the Global Fund may mean that individual countries must pick up these costs, he said. Some countries will not be able to afford this. Closer to home, the WHO database includes information on drug abuse in the United States but has incomplete data on drug treatment. Metzger said that the drug treatment system is comparatively well developed here, but there is a need for more efforts in early intervention. Treatment may be easier to access in some other countries, he said, but a broader range of treatment options is available in the United States. He noted, however, that access to the full range of options exists only for those who have the financial resources or health care coverage to pay for it.
JAMA – American Medical Association
Published: Aug 1, 2012
Keywords: drug abuse,world health organization