National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
Lancet. 2013 Nov 9;382(9904):1564-74. doi: 10.1016/S0140-6736(13)61530-5. Epub 2013 Aug 29.
No systematic attempts have been made to estimate the global and regional prevalence of amphetamine, cannabis, cocaine, and opioid dependence, and quantify their burden. We aimed to assess the prevalence and burden of drug dependence, as measured in years of life lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs).
We conducted systematic reviews of the epidemiology of drug dependence, and analysed results with Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) Bayesian meta-regression technique (DisMod-MR) to estimate population-level prevalence of dependence and use. GBD 2010 calculated new disability weights by use of representative community surveys and an internet-based survey. We combined estimates of dependence with disability weights to calculate prevalent YLDs, YLLs, and DALYs, and estimated YLDs, YLLs, and DALYs attributable to drug use as a risk factor for other health outcomes.
Illicit drug dependence directly accounted for 20·0 million DALYs (95% UI 15·3-25·4 million) in 2010, accounting for 0·8% (0·6-1·0) of global all-cause DALYs. Worldwide, more people were dependent on opioids and amphetamines than other drugs. Opioid dependence was the largest contributor to the direct burden of DALYs (9·2 million, 95% UI 7·1-11·4). The proportion of all-cause DALYs attributed to drug dependence was 20 times higher in some regions than others, with an increased proportion of burden in countries with the highest incomes. Injecting drug use as a risk factor for HIV accounted for 2·1 million DALYs (95% UI 1·1-3·6 million) and as a risk factor for hepatitis C accounted for 502,000 DALYs (286,000-891,000). Suicide as a risk of amphetamine dependence accounted for 854,000 DALYs (291,000-1,791,000), as a risk of opioid dependence for 671,000 DALYs (329,000-1,730,000), and as a risk of cocaine dependence for 324,000 DALYs (109,000-682,000). Countries with the highest rate of burden (>650 DALYs per 100,000 population) included the USA, UK, Russia, and Australia.
Illicit drug use is an important contributor to the global burden of disease. Efficient strategies to reduce disease burden of opioid dependence and injecting drug use, such as delivery of opioid substitution treatment and needle and syringe programmes, are needed to reduce this burden at a population scale.
Australian National Health and Medical Research Council, Australian Government Department of Health and Ageing, Bill & Melinda Gates Foundation.
目前尚无系统方法用于评估全球和区域安非他命、大麻、可卡因和阿片类药物依赖的流行率，并量化其负担。我们旨在评估药物依赖的流行率和负担，其衡量标准是残疾造成的生命年（YLDs）、生命损失年（YLLs）和伤残调整生命年（DALYs）。
我们对药物依赖的流行病学进行了系统评价，并使用全球疾病、伤害和危险因素研究 2010 年（GBD 2010）贝叶斯荟萃回归技术（DisMod-MR）分析结果，以估计依赖人群的流行率和使用情况。GBD 2010 利用代表性社区调查和基于互联网的调查计算了新的残疾权重。我们将依赖估计值与残疾权重相结合，计算出流行的 YLDs、YLLs 和 DALYs，并估计了药物使用作为其他健康结果的风险因素而导致的 YLDs、YLLs 和 DALYs。
2010 年，非法药物依赖直接导致 2000 万残疾生命年（95%UI 1530 万至 2540 万），占全球所有原因残疾生命年的 0.8%（0.6%至 1.0%）。全世界，依赖阿片类药物和安非他命的人数多于其他药物。阿片类药物依赖是 DALYs 直接负担的最大贡献者（920 万，95%UI 710 万至 1140 万）。一些地区的所有原因 DALYs 归因于药物依赖的比例是其他地区的 20 倍，收入最高的国家的负担比例更高。将注射吸毒作为艾滋病毒的风险因素，占 210 万残疾生命年（95%UI 110 万至 360 万），作为丙型肝炎的风险因素占 50.2 万残疾生命年（28.6 万至 89.1 万）。将安非他命依赖作为自杀的风险因素，占 85.4 万残疾生命年（29.1 万至 179.1 万），将阿片类药物依赖作为自杀的风险因素，占 67.1 万残疾生命年（32.9 万至 173 万），将可卡因依赖作为自杀的风险因素，占 32.4 万残疾生命年（10.9 万至 68.2 万）。负担率最高的国家（>650 残疾生命年/每 10 万人）包括美国、英国、俄罗斯和澳大利亚。
非法药物使用是全球疾病负担的一个重要因素。需要有效的策略来减轻阿片类药物依赖和注射吸毒的疾病负担，例如提供阿片类药物替代治疗和针具计划，以在人群中降低这一负担。
澳大利亚国家卫生与医学研究理事会、澳大利亚联邦卫生部、比尔及梅琳达·盖茨基金会。
