Report on drug use in the Americas

Drug use continues to represent a significant problem in the Americas, and one that challenges policy makers at the highest levels. The Inter-American Drug Abuse Control Commission (known by its Spanish language acronym, CICAD), of the Organization of American States (OAS), serves as the preeminent Western Hemisphere forum for policy discussion and hemispheric cooperation on drugs. Along with other responsibilities, the Executive Secretariat of CICAD supports OAS member states by providing an evidencebased picture of the drug problem, both nationally and at the hemispheric level, so that member states can design and implement policies and programs to address the problem.

The Report on Drug Use in the Americas 2019 analyzes current drug use data in the Hemisphere. It features information on the most widely used drugs across the region, organized by drug and by population group, and highlights emerging issues of interest to policy-makers and to the public. The Report draws on data obtained primarily through national surveys using the Inter-American Uniform Drug Use Data System (known by its Spanish language acronym, SIDUC), developed by the CICAD Executive Secretariat.

Findings and recommendations

The Western Hemisphere has a population of approximately one billion people, representing 35 sovereign countries. The region is ethnically, linguistically, economically, and culturally diverse. The drug problems across the Hemisphere are similarly diverse. Despite this diversity, there are a number of common themes regarding drug use.

This report highlights four specific areas of relevance to hemispheric drug policy:

• Early onset of drug use
• Drug use trends
• Changes in drug use by sex
• New challenges for drug policy

Early onset of drug use

As research evidence shows, the younger people begin using drugs, the greater the health risks and other consequences. Prevention programs and other interventions that can delay the age when someone first uses drugs should be accorded high priority.

Analysis of early-onset drug use is based on national secondary school student surveys. This report looks at early-onset use of a variety of licit and illicit substances, including alcohol, tobacco, cannabis, cocaine, and smokable cocaine. All of these substances show some levels of use among eighth graders. Use of any psychoactive substance—including alcohol and tobacco—among secondary school students should be a matter of concern for any country and underscores the need for preventive interventions beginning in early childhood.

Policies to control the sale and use of alcohol and tobacco have had positive results, which could provide critical lessons with regard to policies for other drugs.

Drug use trends

Monitoring trends in drug use is one of the most important ways to evaluate the impacts of drug policies. At the national level, drug trends may rise and fall in specific populations, geographic areas, or by other variables. The evolving nature of drug use makes it difficult to identify any single common trend in drug use across the Hemisphere. Almost every drug analyzed in this report shows variations in trends between countries.

Tobacco appears to be the only substance that is showing systematic decreases in use over time. In the general population, cannabis use is increasing in most countries that have trend data, and about half the countries show increases in cocaine use. In the secondary school population, most countries with trend data available are showing increases in cannabis use, although trends for cocaine are more mixed in this age group.

While it may be difficult to draw region-wide conclusions based on trends in individual countries, the data in this report can call attention to issues of shared concern and can help to inform national policy.

Changes in drug use by sex

Drug use has historically been seen as a male phenomenon, but recent data show that females in some countries are now using certain drugs either at the same, or at higher rates, than males. Non-medical use of prescription drugs, synthetic drugs, and opioids demonstrates how drug use patterns are changing.

Prevalence of tranquilizer use is higher among women than men in almost every country where data are available. This pattern holds true not only in the general population but in the secondary school and university populations as well.

In the case of secondary school students, the prevalence of drug use is much more similar between the sexes for alcohol and inhalants. Similar to the general population, the prevalence of non-medical use of prescription tranquilizers is higher among secondary school girls than boys. In contrast, cocaine and smokable cocaine-type substances tend to be used more by boys than by girls. In a few countries, however, girls use cocaine, cocaine base paste, and crack at higher rates than boys. While boys continue to use tobacco and cannabis at higher rates than girls, we see this gender gap closing in many countries.

New challenges for drug policy

The prevalence of new psychoactive substances (NPS), opioids, and benzodiazepines presents new challenges not only for drug treatment but for public health and drug policies overall. While most of the novel drugs appearing in the Americas have a low prevalence, the potential impact on health is significant. The United States and Canada are experiencing serious epidemics of opioids and NPS, resulting in some of the highest overdose rates in the history of drug use. This is costly, first and foremost in terms of the number of lives lost, but also with respect to the long-term economic impact of the problem in these countries. Signs indicate that the use of such drugs is likely to continue to spread, making them a key point of concern for OAS member states.

Previous OAS reports have highlighted the diversity of the drug problem across the Americas and the challenges this poses for international drug policy. The OAS Report on the Drug Problem in the Americas 2013 noted that this phenomenon has different impacts in different countries and therefore leads to different responses. While risk factors and determinants of drug use may be universal, the manifestation of key factors varies by country, rendering it difficult to prescribe a single set of policy recommendations.

The cross-national analysis presented in this report may be useful for shedding light on the larger context in which each country operates; however, the ability to draw conclusions on the impact of policy across countries is limited, partly because of differences in availability of data but also because of differences in the individual situation of each country and each subregion. For any given country, the data will likely prove most useful in evaluating the impact and implications of its own national drug problems and policies.