A regional framework for action on substance use and public health.

Substance use is a public health problem worldwide. According to United Nations Office on Drugs and Crime (UNODC) estimates, there has been an increase of more than 10% over recent years in cannabis use in 9 countries in the Region; while the prevalence of opiate use in Afghanistan, the Islamic Republic of Iran and Pakistan is among the highest in the world. The estimated prevalence for drug dependence in the North Africa and Middle East region is 0.29%, which is 1.3 times higher than the global prevalence (1). Emergencies and civil unrest are known as important factors in the exacerbation of the situation (2). At an international level increasing attention is being paid to adopting a more public health-oriented approach. This was highlighted in the outcome document of the United Nations General Assembly Special Session on Drugs (UNGASS) in 2016, which called for a balanced approach between law enforcement and the health sector to counter the world drug problem and inclusion of substance use targets under the health goal of the 2015 Sustainable Development Goals (SDGs) agenda (3,4). The Eastern Mediterranean Region (EMR) faces particular challenges in implementing the operational recommendations of the UNGASS 2016 outcome document and reporting on the SDG targets. It comprises 22 economically diverse countries, with their own cultures and characteristics. A substantial number of these countries are experiencing insecurity, war and humanitarian crisis. In complex humanitarian situations, there is attrition in the capacity of the health and social systems to respond to the increased needs and demands. Since different countries in the Region are at varying stages of development, including the development of their mental health systems, WHO Regional office for the Eastern Mediterranean (EMRO) has devised a classification of countries into three groups that are similar in terms of their population health outcomes, health system performance and level of health expenditure. This facilitates a more meaningful comparison between countries, and for recommendations appropriate to countries’ current levels of health system and socio-economic development (5). The Substance Use Atlas 2015 is designed to collect information and report on the agreed upon indicators and targets (6). The current iteration of the Atlas includes contributions from all countries of the Region and provides data on the status of substance use services and will serve as a benchmark to monitor progress. The key findings from the Substance Use Atlas as pertains to EMR countries indicate that (5):