title: Global burden of disease attributable to illicit drug use and dependence: findings from the Global Burden of Disease Study 2010.
abstract: BACKGROUND
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  Australian National Health and Medical Research Council, Australian Government Department of Health and Ageing, Bill & Melinda Gates Foundation.
authors.affiliation: 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. Electronic address: l.degenhardt@unsw.edu.au.
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
authors.forename: Harvey A
authors.initials: HA
authors.lastname: Whiteford
authors.forename: Alize J
authors.initials: AJ
authors.lastname: Ferrari
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Baxter
authors.forename: Fiona J
authors.initials: FJ
authors.lastname: Charlson
authors.forename: Wayne D
authors.initials: WD
authors.lastname: Hall
authors.forename: Greg
authors.initials: G
authors.lastname: Freedman
authors.forename: Roy
authors.initials: R
authors.lastname: Burstein
authors.forename: Nicole
authors.initials: N
authors.lastname: Johns
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Engell
authors.forename: Abraham
authors.initials: A
authors.lastname: Flaxman
authors.forename: Christopher J L
authors.initials: CJ
authors.lastname: Murray
authors.forename: Theo
authors.initials: T
authors.lastname: Vos
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D014943:Global Health; D006801:Humans; D007223:Infant; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D055815:Young Adult