Drug Use Disorders: A Major Public Health Challenge in the Americas

Drug use disorders are consolidating as one of the main public health challenges in the Americas region, ranking among the ten most relevant risk factors for death and disability, according to a recent study published in the Pan American Journal of Public Health. The analysis, based on data from the Global Burden of Disease 2021 study, indicates that 17.7 million people in the region lived with one of these disorders in 2021, with nearly 78,000 deaths directly attributable to this cause. This represents a mortality rate four times higher than the global average. Opioids are the primary trigger of the regional impact. The report identifies that disorders related to opioid use account for more than 75% of deaths associated with these conditions. In North America, the increase is mainly associated with the use of high-potency synthetic opioids, such as fentanyl, as well as amphetamines. In contrast, in Central America, the Caribbean, and South America, the greatest burden falls on the use of cannabis and cocaine, substances that have been the main contributors to the increase observed over the last decade. Beyond directly attributed deaths, the study estimates that 145,515 deaths from any cause in the Americas in 2021 were related to opioid overdoses, cirrhosis, liver cancer, and suicide associated with drug use. This broadened impact explains why these disorders are on par with other high-population-weight factors, such as high blood pressure, overweight and obesity, dietary risks, and tobacco use. During the COVID-19 pandemic, significant increases were recorded in disorders related to opioid and amphetamine use. Additionally, disability-adjusted life years (DALYs) linked to drug use nearly tripled between 2000 and 2021, with an average annual growth close to 5%. The highest burden is concentrated in young men, although the study also documents a sustained increase in deaths among women, which broadens the scope of the problem and presents new challenges for health systems. The behavior of drug use disorders showed significant variations within the region. In this scenario, PAHO urges countries to: strengthen preventive programs aimed at young people and key populations; expand access to treatment, including medication-assisted treatment for opioid use disorders; integrate substance use care into primary care and community services; improve surveillance systems, with an emphasis on synthetic opioids and combined use; adopt gender-sensitive approaches, given the increase observed among women. Tools such as AUDIT (Alcohol Use Disorders Identification Test) and ASSIST (Alcohol, Smoking and Substance Involvement Screening Test), developed by the World Health Organization, are cited as cost-effective strategies to reduce harm and close care gaps. Treating substance use as a health priority. For Renato Oliveira e Souza, head of the Mental Health and Substance Use Unit at PAHO, the approach to drug use must occupy a central place within health systems, with community-based, comprehensive, and person-centered services, backed by health leadership and national strategies aligned with observed patterns. The organization concludes that reversing these trends is possible, provided that prevention, care, and monitoring mechanisms are strengthened, with the goal of reducing the burden of disability and preventing thousands of preventable deaths in the region.