Columbia University Mailman School of Public Health, 722 W 168(th) St, New York NY 10032 USA.
Columbia University Mailman School of Public Health, 722 W 168(th) St, New York NY 10032 USA.
Int J Drug Policy. 2022 Oct;108:103810. doi: 10.1016/j.drugpo.2022.103810. Epub 2022 Aug 5.
In the context of changing cannabis and other drug policy and regulation, concerns may arise regarding drug treatment access and use. We assessed cannabis/cocaine-related dependence and treatment in Argentina, Chile, and Uruguay.
Nationally representative cross-sectional household surveys of people ages 15-64 in Argentina (4 surveys, 2006-2017), Chile (7 surveys, 2006-2018), and Uruguay (4 surveys, 2006-2018) were harmonized. We estimated weighted prevalences of cannabis or cocaine-related (cocaine or cocaine paste) dependence, based on meeting 3+ past-year ICD-10 dependence criteria. We estimated weighted prevalences of past-year alcohol/drug treatment use (Argentina, Chile) or use/seeking (Uruguay) among people with past-year cannabis/cocaine-related dependence. We tested model-based prevalence trends over time and described individual-level treatment correlates by country.
Cannabis/cocaine dependence prevalence increased in the region starting in 2010-2011, driven by cannabis dependence. Adjusted cannabis dependence prevalence increased from 0.7% in 2010 to 1.5% in 2017 in Argentina (aPD=0.8, 95% CI= 0.3, 1.2), from 0.8% in 2010 to 2.8% in 2018 in Chile (aPD=2.0, 95% CI= 1.4, 2.6), and from 1.4% in 2011 to 2.4% in 2018 in Uruguay (aPD=0.9, 95% CI= 0.2, 1.6). Cocaine-related dependence increased in Uruguay, decreased in Argentina, and remained stable in Chile. Among people with past-year cannabis/cocaine dependence, average alcohol/drug treatment use prevalence was 15.3% in Argentina and 6.0% in Chile, while treatment use/seeking was 14.7% in Uruguay. Alcohol/drug treatment prevalence was lower among people with cannabis dependence than cocaine-related dependence. Treatment correlates included older ages in all countries and male sex in Argentina only.
Alcohol/drug treatment use among people with cannabis/cocaine-related dependence remained low, signaling an ongoing treatment gap in the context of growing cannabis dependence prevalence in the region. Additional resources may be needed to increase treatment access and uptake. Future studies should assess contributors of low treatment use, including perceived need, stigma, and service availability.
在大麻和其他药物政策和法规不断变化的背景下，人们可能会对药物治疗的可及性和使用产生担忧。我们评估了阿根廷、智利和乌拉圭的大麻/可卡因相关依赖和治疗情况。
对阿根廷（4 项调查，2006-2017 年）、智利（7 项调查，2006-2018 年）和乌拉圭（4 项调查，2006-2018 年）的 15-64 岁人群进行了全国代表性的横断面家庭调查。我们根据满足 ICD-10 依赖标准 3+个过去年份，估计了大麻或可卡因相关（可卡因或可卡因糊剂）依赖的加权流行率。我们估计了过去一年有大麻/可卡因相关依赖的人在过去一年中使用酒精/药物治疗（阿根廷、智利）或使用/寻求（乌拉圭）的加权流行率。我们测试了随时间变化的基于模型的流行趋势，并按国家描述了个体水平的治疗相关性。
从 2010-2011 年开始，该地区的大麻/可卡因依赖流行率开始上升，这主要是由大麻依赖驱动的。调整后的大麻依赖流行率从 2010 年的 0.7%上升到 2017 年的 1.5%，在阿根廷（aPD=0.8，95%CI=0.3，1.2），从 2010 年的 0.8%上升到 2018 年的 2.8%，在智利（aPD=2.0，95%CI=1.4，2.6），从 2011 年的 1.4%上升到 2018 年的 2.4%，在乌拉圭（aPD=0.9，95%CI=0.2，1.6）。可卡因相关依赖在乌拉圭增加，在阿根廷减少，在智利保持稳定。在过去一年有大麻/可卡因依赖的人中，阿根廷的平均酒精/药物治疗使用率为 15.3%，智利为 6.0%，而乌拉圭的治疗使用率/寻求率为 14.7%。与可卡因相关依赖相比，大麻依赖患者的酒精/药物治疗使用率较低。在所有国家中，年龄较大和仅在阿根廷为男性与治疗相关。
在该地区大麻依赖流行率不断上升的情况下，大麻/可卡因相关依赖患者的酒精/药物治疗使用率仍然较低，表明治疗差距仍然存在。可能需要更多资源来增加治疗的可及性和采用率。未来的研究应评估低治疗使用率的原因，包括感知需求、污名和服务提供。
