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Review
. 2019 Nov 2;394(10209):1652-1667.
doi: 10.1016/S0140-6736(19)32230-5. Epub 2019 Oct 23.

Responding to global stimulant use: challenges and opportunities

Michael Farrell  1 , Natasha K Martin  2 , Emily Stockings  3 , Annick Bórquez  4 , Javier A Cepeda  5 , Louisa Degenhardt  3 , Robert Ali  6 , Lucy Thi Tran  3 , Jürgen Rehm  7 , Marta Torrens  8 , Steve Shoptaw  9 , Rebecca McKetin  3
Affiliations
Review

Responding to global stimulant use: challenges and opportunities

Michael Farrell et al. Lancet. .

Erratum in

  • Department of Error.
    [No authors listed] [No authors listed] Lancet. 2019 Nov 16;394(10211):1806. doi: 10.1016/S0140-6736(19)32723-0. Lancet. 2019. PMID: 31741454 No abstract available.

Abstract

We did a global review to synthesise data on the prevalence, harms, and interventions for stimulant use, focusing specifically on the use of cocaine and amphetamines. Modelling estimated the effect of cocaine and amphetamine use on mortality, suicidality, and blood borne virus incidence. The estimated global prevalence of cocaine use was 0·4% and amphetamine use was 0·7%, with dependence affecting 16% of people who used cocaine and 11% of those who used amphetamine. Stimulant use was associated with elevated mortality, increased incidence of HIV and hepatitis C infection, poor mental health (suicidality, psychosis, depression, and violence), and increased risk of cardiovascular events. No effective pharmacotherapies are available that reduce stimulant use, and the available psychosocial interventions (except for contingency management) had a weak overall effect. Generic approaches can address mental health and blood borne virus infection risk if better tailored to mitigate the harms associated with stimulant use. Substantial and sustained investment is needed to develop more effective interventions to reduce stimulant use.

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Conflict of interest statement

Declaration of interests

MF and LD have received investigator-initiated untied educational grants for studies of opioid medications in Australia from Indivior, Mundipharma, and Seqirus. RA has received untied educational grants from Reckitt Benckiser/Indivior and Mundipharma for studies of opioid substitution and agonist medication treatments in Australia. NKM has received unrestricted research grants to her university from Gilead and Merck unrelated to this work. MT has received educational grants in Spain from Gilead, Merck Sharp & Dohme, Servier, and Lundbeck unrelated to this work. JR has received educational grants from Lundbeck GmbH. SS has received clinical supplies from Alkermes and Medicinova for randomised trials outside of the submitted work. ES, AB, JAC, LTT, and RM report no competing interests.

Figures

Figure 1:
Figure 1:. Prevalence of (A) cocaine and (B) amphetamine use and estimated age-standardised prevalence of (C) cocaine and (D) amphetamine dependence per 100 000 population
Drug use data from the UN Office on Drugs and Crime World Drug Report 2018. For methods used to generate these estimates see appendix p 8. Drug dependence data from the Global Burden of Disease study 2017. For methods used to generate these estimates see appendix p 12. No prevalence estimates have been reported by the UN Office on Drugs and Crime for grey countries. Amphetamines estimates include use of prescription stimulants.
Figure 1:
Figure 1:. Prevalence of (A) cocaine and (B) amphetamine use and estimated age-standardised prevalence of (C) cocaine and (D) amphetamine dependence per 100 000 population
Drug use data from the UN Office on Drugs and Crime World Drug Report 2018. For methods used to generate these estimates see appendix p 8. Drug dependence data from the Global Burden of Disease study 2017. For methods used to generate these estimates see appendix p 12. No prevalence estimates have been reported by the UN Office on Drugs and Crime for grey countries. Amphetamines estimates include use of prescription stimulants.
Figure 2:
Figure 2:. Fraction of regional all-cause deaths associated with cocaine and amphetamine dependence in 2017
For methods used to generate these estimates see appendix p 27.
See this image and copyright information in PMC

References

    1. Peacock A, Bruno R, Gisev N, et al. New psychoactive substances: challenges for drug surveillance, control, and public health responses. Lancet 2019; published online October 23 10.1016/S0140-6736(19)32231-7. - DOI - PubMed
    1. International Narcotics Control Board 2010. Report of the International Narcotics Control Board on the availability of internationally controlled drugs: ensuring adequate access for medical and scientific purposes New York NY: United Nations, 2011.
    1. Grinspoon L, Bakalar JB. Coca and cocaine as medicines: an historical review. J Ethnopharmacol 1981; 3: 149–59. - PubMed
    1. Byck R Cocaine papers. New York, NY: Stonehill, 1974.
    1. UN Office on Drugs and Crime. World drug report 2018 2018. https://www.unodc.org/wdr2018/ (accessed Sept 23, 2019).

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