We’re all aware of the opioid issue currently ravaging America, Canada, and beyond. How does this affect the countries of South America? And what other drug issues go on in that region? A recent report highlights South America, and the drugs within, including which drugs are most problematic of the following: amphetamines, cannabis, cocaine, and opioids; and where these problems occur.
What report?
The report, called Burden of disease due to amphetamines, cannabis, cocaine, and opioid use disorders in South America, 1990–2019: a systematic analysis of the Global Burden of Disease Study 2019, was published in January, 2023, in The Lancet Psychiatry. As per the name, the paper seeks to investigate the “burden of disease attributable to amphetamine use disorder, cannabis use disorder (CAD), cocaine use disorder, and opioid use disorder (OUD) in South America from 1990 to 2019, on the basis of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.”
In order to gather and assess this information on South America and the main drugs of use, the investigators used data from the Global Burden of Disease 2019, only, to estimate these measuring points in connection to the above mentioned use disorders: “incidence, prevalence, mortality, years of life lost (YLL), years of life lived with disability (YLD), and disability-adjusted life-years (DALYs) due to substance use disorders.”
The report looks at the12 countries on the continent of South America for drugs issues: Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Guyana, Paraguay, Peru, Suriname, Uruguay, and Venezuela. The collected data went through modelling by use of standardized tools, like the “Cause of Death Ensemble model, spatio-temporal Gaussian process regression, and disease modelling meta-regression.”
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Estimates were created from the data for the different aforementioned categories; with breakdowns for sex of users, location, and the years of use. It makes comparisons by gender, location, and year; as well as regional and global approximations. Obviously, not every Latin American country is involved, meaning Mexico, the countries of Central America, and island nations are not included in this examination.
Findings of the report about South America and drugs
Amphetamine
According to the 2019 data, Peru has the highest prevalence of amphetamine use disorder per 100,000 people in terms of DALY numbers. When looking at years of life living with the disability (YLD), amphetamine rates were stable for the most part in the 10-year period, showing the highest numbers in Peru, Paraguay, and Uruguay. Paraguay showed some of the highest levels of the drug disorder.
The countries with the highest amphetamine use disorder rates in terms of overall years of life lost (YLL) per 100,000 during the given time period, were Suriname and Peru. In the former this rate increased from 2010 to 2019, while in the latter, it did show a decrease within those same years.
Some countries did show decreases in the annual presence of use disorders related to this drug during the given time period. These include: Venezuela, Brazil, Colombia, Peru, Chile, and Surinam. If you’ll notice, Peru and Surinam, which have some of the bigger issues with the drug, also have a decrease in numbers, indicating a lessening of the issue.
Cannabis
When it came to cannabis use disorder DALY information, there was a stable rate in South America between 1990-2019; with the exceptions of both Chile and Colombia. These two countries had the highest rates in 2019, for DALY numbers.
In terms of years lived with the disorder, cannabis rates retained stability in all included countries except Chile and Colombia. The highest rates of CAD were in Chile, Colombia, Guyana, and Suriname. However, there was no YLL scores, implying cannabis of all the drugs, was not associated with years lost.
Countries that saw a decrease in cannabis use disorder annually during this time, were Venezuela, Brazil, and Uruguay. It was pointed out by the authors that there was no increase in burden from CAD in Uruguay, the only country within this region to allow recreational use.
Opioid
Opioid use disorder numbers increased per 100,000 between 2009-2019 in both Brazil and Peru. In 2019, those countries had the highest rates on the continent; 82 and 70, respectively in terms of DALY numbers.
YLD rates for opioids did increase in most of the South American countries, but went up the highest amount in Brazil. In Brazil, YLD rates went from 52 to 80, between the years 1990-2019. It had the highest rise of South America.
For opioids, the highest YLL rates belonged to Chile and Uruguay between 2000-2019. The former scored 11·6, while the latter came in at 10·9. Though Ecuador also showed very high rates for opioid use disorder in general.
Countries that saw an annual decrease in OUD, were Venezuela and Bolivia. Overall, while OUD showed up less than other substance abuse disorders, it showed the highest amount of burden of any drug for those who were classified with the disorder. That makes sense as opioids cause the largest death rate, pretty much anywhere there’s an industry.
Cocaine
The 2019 numbers show it was Brazil with the highest levels of cocaine use disorder, with a DALY rate of 45 per 100,000. This is nearly a full double from 1990 numbers.
In terms of YLD rates, the four countries with the highest amounts, were Argentina, Uruguay, Chile, and Brazil; which all saw increases between 1990-2010, but then a decrease from 2010-2019. Overall, Argentina was a hot spot for cocaine use disorder.
For YLL rates related to cocaine use disorder, Brazil had the highest scores. And the numbers for that country greatly increased between 1990-2019, going from 3·7 to 18·1.
For countries that showed an annual decrease in use disorders for this drug, there were Colombia and Peru. Overall, the burden of cocaine use disorder decreased over time.
Gender
When looking at male vs female, DALY numbers were consistently higher for men for each drug use disorder, and for all locations, except Paraguay. In totality, men caused more burden through use than females, with the biggest differences in use with cocaine and cannabis. Though males still caused more burden with amphetamine use disorders, the difference between the two was smaller. When it came to opioids, the rates were the same
For both genders, opioids caused the highest rate DALYs. The only exceptions for this were Argentina, which had higher DALY rates for cocaine use disorder in males; and in Paraguay, where among females, amphetamine use damage was higher.
Cannabis use disorder DALY rates were the lowest in all locations, for both men and women.
Does this report have conflicts of interest?
Well, for one thing, the entire study was funded by the Bill & Melinda Gates Foundation. The Gates foundation is actually a private organization that doesn’t have to please anything or anyone but the three trustees of the company, Bill Gates, his wife Melinda, and Warren Buffet. The terms ‘non-profit’ and ‘not-for-profit’ are actually a little confusing here; and while most tend to think such organizations aren’t privately funded, and privately held; this is mistaken.
This foundation doesn’t need any kind of public approval, or to show that its making progress. The IRS can’t do much, and there’s no way to know how tax-exempt funds are used, or if there are conflicts of interest in research. The Gates Foundation is known for doing all kinds of things in third world countries, and a lot of it isn’t very good. As this study focuses primarily on third world countries, and the organization has so many dealings in such places, this entire study could be nothing more than a marketing ploy to get involved.
Then consider what’s actually being measured – use disorders. Should we really consider cannabis a use disorder if it doesn’t show damage in DALY scores or years lost? Has cannabis been fingered for ruining lives? And for that matter, all of these ‘disorders’ have no medical definition or diagnosis. Meaning, it’s a doctor who decides if someone fits a classification, and this means going on personal opinion, which can vary greatly between doctors. What if a doctor simply doesn’t like weed? Then maybe recreational use, gets diagnosed as a use disorder. Use, and use disorder are two separate things. Any research based off psychiatric diagnoses without a medical reference, should be questioned in my opinion.
The study ended by saying “Programmes for amphetamine use disorder, CAD, and OUD management should be improved.” If cannabis isn’t hurting anyone, and is seeing a lessening of restriction all over the world, do we need to worry about systems to deal with it? That sentence puts cannabis in a category with opioids, the drugs that take out close to a 100,000 people a year in the US. That’s putting together one drug which has shown few-to-no negative consequences (and positive benefits), with the drugs that cause the most damage; and then saying they need comparable measures for monitoring and control.
In fact, the report goes on to say, “Countries in South America should improve monitoring of substance use disorders, including regular surveys to provide more accurate data on which to base policy decisions.” Isn’t that the kind of thing the Gates Foundation loves doing? Looking for problems and setting up programs for the misfortunate in third world countries? And hasn’t the third world suffered enough from the ‘advice’ and interference of rich American entities?
Let’s not forget that Bill Gates was one of the biggest pushers of vaccines for covid-19; and while I don’t care to get into opinions on vaccines, there is a point, which should never be forsaken. Gates was pushing a Johnson & Johnson vaccines, as in, the same company that has the biggest payouts to make from global opioid lawsuits, accounting for multi-billions and counting. Whether you agree with vaccines or not isn’t the point, not paying attention to this essential risk-assessment is dangerous at its very best.
Why would anyone take a medication from a company that has so clearly and repeatedly shown its lack of regard for humanity? If you’re super into pharmaceuticals, this probably won’t get through to you, but its actually not a statement on vaccines, but on being able to trust the companies that make them. And that is a big deal, especially in light of the opioid lawsuits. The Gates Foundation had no problem with this conflict of interest. And while the same can technically be said for people taking the vaccine, the reality, is that very few understand this connection. I have yet to find one vaccinated person who does. But Bill Gates and his foundation, absolutely do.
So how accurate is this research? It’s hard to say. A report like this could be used for the foundation itself to set up shop in some areas. Or maybe it’s an honest look at drugs in South America. The issue of integrity in research, both related to cannabis and beyond, is not to be ignored; so just because a study comes out, doesn’t mean for a second that it shouldn’t be questioned.
Plus, as long as cannabis is included, and put in the same category as opioids, information is automatically off. This has never made sense, and won’t ever. And for those that keep classifying it this way, do we really want their opinions on issues of drug use disorders, or anything else? In fact, the biggest takeaway of this entire study, is that while amphetamine and cocaine have gone down in their damage overall, and cannabis never caused anything substantial, the one big thing, is the rise of opioid use. All over the continent. And that’s an American pharmaceutical-company started issue, that’s now spread to South America.
Conclusion
Drug use damage certainly exist, but its not the same thing for all drugs, even if the same terminology is applied. While this paper is interesting in assessing some aspects of South America and the drugs of abuse therein; there are a lot of issues with the definition of these disorders, who would decide such diagnoses, and most of all, who funded the report. I say, get the important points out of it…like that even in South America, opioid use is rising (that part is wildly important!) And take the rest with a grain of salt.
Oh, and one other thing…where was alcohol in all this?
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