Alcohol use, alcohol use disorder and heavy episodic drinking in the Eastern Mediterranean region: A systematic review.

BACKGROUND AND AMS: Despite the evident public health impact, the extent and patterns of alcohol use in the Eastern Mediterranean countries remain understudied. The latest estimation for the last 12-month use of alcohol in the region was 2.9% in 2016 by the World Health Organization. We reviewed the main indicators for alcohol consumption in the region since 2010. METHODS: We systematically searched on-line databases until September 2023, together with other global and regional sources for studies on the adult general population (aged ≥ 15 years) and young general populations (aged < 18 years) and studies on the treatment-seeking individuals with substance use in Eastern Mediterranean countries. Studies were included from 22 countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, United Arab Emirates and Yemen. RESULTS: A total of 148 were included (n = 95 on the prevalence of alcohol use, n = 46 on the prevalence of alcohol use disorder, regular use and heavy episodic drinking, n = 35 on alcohol use pattern among people who use substances and one report on alcohol per capita consumption, n = 29 had data for more than one category). The pooled prevalence of the last 12-month alcohol use in the adult general population was 9.5% [95% confidence interval (CI) = 6.4-13.7] among males, 2.8% (95% CI = 1.3-5.5\) among females and 6.2% (95% CI = 3.9-9.6) in both sexes in the region, with notable subregional variations. Data on the prevalence of alcohol use disorder and heavy drinking were limited to several countries, with heterogeneous indicators. The pooled estimate of alcohol as the primary substance of use among treatment-seeking people who used substances was 16.9% (95% CI = 8.8-26.9). CONCLUSIONS: More than 30 million adults in the Eastern Mediterranean region used alcohol in the last 12 months, with a prevalence of 6.2%. This is far fewer than the global estimate of 43% of the population aged 15 years and above, but is approximately two times more than the previous estimate (2.9%), reported by the World Health Organization in 2016, which might show an increasing trend.

Prevalence of injecting drug use and HIV, hepatitis B, and hepatitis C in people who inject drugs in the Eastern Mediterranean region: a systematic review and meta-analysis.

BACKGROUND: Considerable disease burden is attributed to injecting drug use (IDU). This regional systematic review and meta-analysis aimed to assess the prevalence of IDU and the characteristics of people who inject drugs in the 22 countries of the WHO Eastern Mediterranean region. METHODS: We conducted a systematic review and meta-analysis on the prevalence of IDU, estimation of the population size of people who inject drugs, the characteristics of people who inject drugs, commonly injected drugs, the prevalence of HIV, hepatitis C virus, and hepatitis B virus in people who inject drugs, and opioid agonist treatment and needle and syringe programme services. We searched PubMed, Web of Science, Scopus, Embase, and the Index Medicus for the Eastern Mediterranean Region for documents published between Jan 1, 2010, and April 17, 2022, with no language restrictions. We also searched government reports, civil society information, and UN websites and databases for grey literature published between Jan 1, 2010, and April 17, 2022. Documents were eligible if they reported or estimated an indicator of interest, or reported enough data to permit calculation of the indicator. We extracted data from the eligible documents and calculated national and regional estimates. FINDINGS: We identified 38 283 documents and included 201 documents in the systematic review. A total of 115 documents were included for the four outcomes for which meta-analyses were performed. The number of people who inject drugs was estimated as 864 597 (95% CI 641 909-1 205 255), amounting to a prevalence of 20·0 per 10 000 adults (95% CI 14·9-27·9) in the region. Among people who inject drugs, the prevalence of HIV was estimated as 19·22% (95% CI 12·86-26·36), hepatitis C virus as 44·82% (29·32-61·16), and hepatitis B virus as 2·66% (0·84-7·26). Countries varied greatly regarding the variables of interest and the availability of relevant data. Nine countries provided needle and syringe programme services and seven countries provided opioid agonist treatment services, mostly with very low, low, or unclear coverage. INTERPRETATION: The prevalence of IDU in the Eastern Mediterranean region is lower than the global mean, particularly among women. The HIV infection rate is higher than the global mean, and the hepatitis C virus infection rate is lower than the global mean. Harm-reduction services are underdeveloped. Data collection on IDU and provision of services need improvement in the region. FUNDING: World Health Organization. TRANSLATIONS: For the Arabic, Farsi and French translations of the abstract see Supplementary Materials section.

Drug use, drug use disorders, and treatment services in the Eastern Mediterranean region: a systematic review.

Drug use is an increasing global public health concern. We reviewed the prevalence and patterns of drug use, drug use disorders, and the extent of treatment services in 21 countries and one territory in the Eastern Mediterranean region from 2010 to 2022. Online databases were systematically searched on April 17, 2022, along with other sources for grey literature. The extracted data were analysed and used for synthesis at the country, subregional, and regional levels. The prevalence of drug use is higher in the Eastern Mediterranean region than global estimates, with cannabis, opium, khat, and tramadol among the main drugs used in the region. Data on the prevalence of drug use disorders were scarce and heterogeneous. Treatment facilities for drug use disorders are available in most countries, but opioid agonist treatment exists in only seven countries. There is a need to expand evidence-based and cost-effective care. Limited data exist, especially regarding drug use disorders, treatment coverage, and drug use among women and young people.

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

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. Emergencies and civil unrest are known as important factors in the exacerbation of the situation.