Addiction Medicine: an Important Field for Public Health

The abuse of illegal drugs is one of the greatest challenges that the world is facing today. Occurring in all countries, from the richest to the poorest, it is a problem that involves all groups and, increasingly, all ages, fuelling global crime, corruption and terrorism, generating unimaginable wealth for the few and limitless harm for the many, costing millions of lives and threatening the very sustainability of communities the world over. 1 This year marks the one hundredth anniversary of the ratification of the first international treaty on drug dependence: the Opium Convention at The Hague. 1 However, the world is still haunted by the continued abuse of drugs. According to the United Nations Office of Drug Control, estimates of illicit drug use range from 149 to 271 million people worldwide and are associated with 200,000 premature deaths. 2 Society has been trying to deal with this problem for over a hundred years but today the abuse of illegal drugs remains an enormous challenge and there is a frighteningly high social price to pay. 3 The problem now seems to be taking on a new dimension with an increase in the non-medical use of prescription pharmaceuticals, particularly opioid pain medications. The prevalence of non-medical use of prescription medications may soon surpass illicit drug use. 4 In the United States, only marijuana surpasses prescription pain medications as the first substance for initiation of illicit drug use. 5 Although illicit drug use is a prevalent and disturbing global problem , the most widely used drugs are alcohol and tobacco. The harmful use of alcohol is responsible for 2.5 million deaths annually and is identified as the third largest risk factor for premature mortality, disability , and health problems. 6 According to the World Health Organization (WHO) tobacco is used by 1 billion people, 80% living in low and middle-income countries. Tobacco consumption causes the death of nearly 6 million people each year, 600,000 of whom are killed by secondhand passive smoking. 7 Family members, friends, co-workers, and community members from different regions and countries experiencing the visible and devastating social consequences of drug abuse and dependence may conclude that there is no solution to addiction and it remains a social or moral problem. 8 Such assumptions dictate that solutions lie in restricting supply, interdiction, and incarceration of the user. As a social problem , there is no role for either medical treatment …