48. Illicit Opiate Abuse
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Editors/Authors: Wayne Hall, Chris Doran, Louisa Degenhardt, and Donald Shepard
Disease / Condition
Illicit Opiate Abuse
Maternal & Neonatal Conditions
Illicit opiate use, especially injected drugs, contributes to premature mortality and morbidity in many developed and developing societies. The economic costs of illicit drug use are substantial. Fatal overdoses and HIV/AIDS resulting from sharing dirty needles and injecting equipment are major contributors to mortality and morbidity. Illicit opioid use accounted for 0.7 percent of global disability–adjusted life years in 2000.
An estimated 15.3 million people, or 0.4 percent of the world population ages 15 to 64, used illicit opioids in 2002, with more than half using heroin and the rest using opium or diverted pharmaceuticals such as buprenorphine, methadone, or morphine.
The most popular interventions for illicit opioid dependence in many developed societies have been law enforcement efforts to interdict the drug supply and enforce legal sanctions against drug use. One consequence has been that illicit opioid users have been exposed to the least effective intervention: imprisonment for drug or property offenses.
The most effective intervention to reduce blood–borne virus infection resulting from illicit drug injections is provision of clean injecting equipment to users. This intervention has been widely supported in developed countries, but less so in developing countries. In addition, vaccinations are effective against hepatitis B.
In treatment settings, the most popular interventions have been detoxification and drug–free treatment, which has proven the least productive in retaining opioid–dependent people in treatment. Opioid agonists have a niche role in treatment of opioid dependence, especially if their efficacy improves with development of long–acting injectable forms of the drug.
Click on the links below to read the full text.
- Nature, Causes, and Health Consequences of Illicit Opioid Use
- Contribution of Opioid Dependence to the Global Burden of Disease
- Interventions for Illicit Opioid Dependence
- Relevance to Developing Countries
- Research and Development
- Conclusions: Promises and Pitfalls
- Annex 48.A: Prevalence of Use, Adverse Health Effects of and Interventions for Cannabis, Cocaine, Amphetamines, and MDMA Use and Dependence