Visualizing the persistent burden of illicit drugs

Teenagers using drugs in an abandoned structure in St. Petersburg. Flickr, Artem

The War on Drugs has failed, a blue-ribbon panel of experts has concluded, and has actually made things worse.

“The international drug control regime is broken,” wrote Fernando Henrique Cardoso, the former President of Brazil, in the introduction to the Global Commission on Drug Policy’s recent report, Taking Control: Pathways to Drug Policies That Work.

The commission is composed of former presidents, prime ministers and presidential cabinet members as well as others such as former UN Secretary General Kofi Annan, Virgin Group founder Richard Branson, and former Executive Director of the Global Fund Michel Kazatchkine.

The drug policy report attests that the War on Drugs has failed and has led to increased violence and health problems associated with drug use. In the report, the Commission proposes a variety of recommendations, including shifting from punitive drug control policies to approaches focused on harm reduction and treatment. Instead of imprisonment, the commissioners recommend devising strategies to reduce participation in drug manufacturing and sales, such as programs aimed at expanding economic opportunities, and encouraging experimentation in legal regulation of drugs that are currently illegal.

Rates of death from drug use disorders, 2010 (both sexes, age-standardized, deaths per 100,000) 

IHME Drug War

Note: Trends shown in this map have been adjusted for differences in ages and population size across countries. To access this data visualization online, visit http://ihmeuw.org/2ayd. Source: Global Burden of Disease Study 2010.

The report explains that restrictive drug policies raise the risk of death from overdoses and other complications with drug use. As an example, it notes that there were over 20,000 deaths from overdoses of illicit drugs in the US in 2010.

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The map above shows death rates from drug use disorders around the world from the Global Burden of Disease (GBD) Study 2010. Drug use disorders include intoxication, withdrawal, dependence, psychotic disorder and other health problems caused by the use of opioids, cocaine, amphetamine, cannabis, and other drugs.

The US stands out as one of the countries with the highest rates of deaths from drug use disorders in the world, along with Russia, Norway, South Africa, and Equatorial Guinea. Deaths from drug use in the US, estimated to be 5.94 per 100,000, are much higher than in the Netherlands (0.84 deaths per 100,000), a country known for its harm-reduction approach to illicit drugs.

The Commission’s report describes Russia’s “preference for criminalizing users,” noting that needle exchange programs are heavily restricted and opioid substitution treatment is prohibited. According to UNAIDS, intravenous drug use is the main driver of the HIV epidemic in Russia. While deaths from HIV declined globally, in Russia they increased at an annual rate of 8.7% between 2000 and 2013

Rates of death from HIV, Russia, 1990-2013

IHMEHIVRussia

Note: The green shading around the line represents the uncertainty interval, which is the range of possible estimates of deaths in a given year. Source: “Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.”

In Latin America, drug-gang-fuelled violence contributes to sky-high homicide rates. The next screen grab below shows homicide death rates in Latin America and the Caribbean compared to other regions of the world.

Death rates from interpersonal violence by region, 2010

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IHMEdrugwar2

Note: Trends shown in this map have been adjusted for differences in ages and population size across regions. To access this data visualization online, visit http://ihmeuw.org/2awr. Source: Global Burden of Disease Study 2010.

The Global Commission on Drug Policy’s report cites estimates that, since the scale-up of the war on drugs in Mexico in 2006, 60,000 to 100,000 lives have been lost as a result of drug-related violence.

The New York Times profiled the struggle of families in Honduras whose children, some younger than 10, have been murdered by drug gangs. According to the Times and many other recent reports, violence from the drug trade has been a major factor driving thousands of unaccompanied children from Honduras, Guatemala, and El Salvador to cross into the US illegally.

The following screen grab shows how Guatemala and El Salvador had the greatest homicide death rates in Central America in 2010 according to the GBD study.

IHMEdrugwar3

Note: Trends shown in this map have been adjusted for differences in ages and population size across countries. To access this data visualization online, visithttp://ihmeuw.org/2ay6. Source: Global Burden of Disease Study 2010.

A UN General Assembly Special Session on the issue of global drug policy is scheduled for 2016. Legalization and regulation of marijuana in Uruguay and in Colorado and Washington State in the US, as well as a new law in New Zealand that permits the production and sale of novel psychoactive substances, may be harbingers of a shifting mentality in the war on drugs. At the same time, the statistics showing the negative health impacts caused by illicit drugs illustrate just how many challenges remain in combating this persistent problem.

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About Author

Katie Leach-Kemon

Katherine (Katie) Leach-Kemon is a policy translation specialist at the Institute for Health Metrics and Evaluation (IHME). Katie specializes in two of IHME's research areas, the Global Burden of Disease and health financing. Katie has helped produce IHME's Financing Global Health report since it was first published in 2009. She received an MPH from the University of Washington and served as a Peace Corps volunteer in Niger. Her work has been published in The Lancet, Health Affairs, and the Journal of the American Medical Association. You can follow her on Twitter @kleachkemon.