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WORLD DRUG REPORT: Demand for cocaine

HEISENBERG

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Demand for cocaine.

In 2019, roughly 20 million people worldwide (range: 17–25 million), or 0.4 per cent of the adult population aged 15–64 (range: 0.3 per cent–0.5 per cent), had used cocaine in the past year. A high prevalence of cocaine use is estimated in Oceania (mainly for the subregion Australia and New Zealand, where it is 2.7 per cent), North America (2.1 per cent), Western and Central Europe (1.4 per cent) and South and Central America (nearly 1.0. per cent). The estimated extent of cocaine use in other subregions is far below the global average, although the availability of data is limited.

Between 2010 and 2019, the estimated prevalence of past-year cocaine use remained fairly stable, at about 0.4 per cent, but population growth led to an increase of 22 per cent in the number of people who had used cocaine in the past year. These estimates and global trends should be interpreted with caution, however, given the intrinsic limitations of general population surveys and since only a limited number of countries provide new estimates every year. Cocaine use varies greatly across subregions and regions, and the error margins are too wide to allow conclusions to be drawn about a statistically significant increase in cocaine use in the past decade.

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HEISENBERG

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Cocaine use in Africa.

In Africa, in 2019, between 500,000 and 4.3 million people (best estimate: nearly 2 million people), or between 0.1 and 0.6 per cent (midpoint: 0.3 per cent) of the adult population, were estimated to have used cocaine in the past year. Although recent data from surveys among the general population are not available in the region, qualitative information reported by Member States indicated that, over the period 2015–2019, there was an increase in the use of cocaine in 11 of the 16 countries that reported such trends.

In North Africa, past-year prevalence of cocaine use among the adult population in 2019 was estimated to be the same as the regional average (0.3 per cent), with fewer than 500,000 past-year users. Cocaine use among adolescents aged 15–17 in the subregion ranges between 0.2 per cent, in Tunisia, and 0.8 per cent, in Egypt, with a higher prevalence of use reported among boys than among girls.

Cocaine use in West and Central Africa is commonly reported among people seeking treatment for drug use disorders. A significant increase in the number of people entering drug treatment with cocaine as their primary drug of concern was observed in the subregion over the period 2014–2017: notwithstanding the differences in drug treatment systems and the extent to which drug treatment reporting was developed in a country over that period, the number of people treated for cocaine use disorders in countries in West and Central Africa increased from less than 100 in 2014 to 800, or nearly 2 per 1,000,000 people, in 2017.

In South Africa, the number of people admitted to treatment for cocaine-related problems has remained consistently low across the different reporting sites in the country, but cocaine is often reported as a secondary sub-stance of use among patients in drug treatment. In 2019, between 2 and 5 per cent of people entering drug treatment reported cocaine as a primary or secondary drug of use in South Africa. By comparison, in 2014, between 3 and 10 per cent of patients in treatment reported cocaine as a primary or secondary drug of concern.


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HEISENBERG

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Cocaine use in Asia.
Cocaine use in Asia is minimal in terms of annual prevalence (ranging between 0.05 and 0.08 per cent of the adult population) but, in 2019,between 1.6 and 2.6 million people had used the drug in the past year. Recent data on the extent of cocaine use are not available from most countries in Asia, but in those for which data are available, cocaine use remains quite low. For example, in 2019, roughly 50,000 people in Indonesia (0.03 per cent of the adult population) and 32,500 people in Thailand (0.07 per cent of the adult population) were estimated to have used cocaine in the past year. In India, about 0.2 per cent of men and 0.01 per cent of women aged 10–75, an estimated 1 million people in total, reported past-year cocaine use in 2018.

Mixed trends in cocaine use in South America.

In South America, nearly 3 million people, or 1 per cent of the population aged 15–64, were estimated to be past-year cocaine users in 2019. In Central America, the prevalence of cocaine use is comparable with that in South America, with almost 1 per cent of the adult population (about 300,000 people) estimated to be past-year cocaine users in 2019. The prevalence of past-year cocaine use in the Caribbean is lower, at an estimated 0.6 per cent in 2019, or 180,000 past-year cocaine users among the adult population.

With nearly 1.5 million people who used cocaine and “crack” cocaine in the past year in 2016, or 1.0 per cent of the population aged 15–64, Brazil appears to be the largest cocaine market in South America. However, an earlier household survey, implemented in 2012, had estimated that past-year prevalence of “crack” cocaine and cocaine in Brazil was 2.2 per cent of the adult population.

Argentina, Bolivia (Plurinational State of), Chile, Colombia and Uruguay, the countries in South America with recent information on drug use, report mixed trends in the use of cocaine among the general population. In Argentina in 2017, 1.5 per cent of the population (2.4 per cent of males and 0.7 per cent of females) aged 12–65 had used cocaine in the past year. The highest preva-lence of past-year cocaine use (3 per cent) was reported among people aged 18–24 and, to a lesser extent, among people aged 25–49. Cocaine base paste was estimated to have been used by 0.1 per cent of the general popula-tion in the past year, mainly by men and people aged 25–34. However, this is difficult to estimate since people who use cocaine base paste are usually from socially marginalized groups, which are not well captured by household surveys. Over the period 2010–2017, the prevalence of cocaine use nearly doubled in Argentina: in 2010, 0.8 per cent of the adult population were estimated to be past-year cocaine users; the increase in cocaine use was greater among women than among men, and greater among adults aged 35–49 than among any other age group.

In 2018 in the Plurinational State of Bolivia, about 0.6 per cent of the population aged 15–64 were estimated to have used cocaine in the past year and 0.2 per cent to have used cocaine base paste. The past-year use of cocaine and cocaine base paste have both increased since the last national survey in 2014, but the increase in the past-year use of cocaine base paste was more pronounced than that of cocaine. Cocaine use in the country was more frequent among men than women and, by age group, more frequent among those aged 16–24 than in other age groups; it was also more frequent among middle-income groups (high-middle- and middle-income groups) than low-income groups. The use of cocaine base paste was reported to be more common among low-income groups, however.

In Uruguay, the past-year prevalence of cocaine use was reported to be 2 per cent of the adult population in 2018, a rate that had remained stable since 2011. In 2018, the past-year use of cocaine in Uruguay was higher among men than among women and, by age group, higher among people aged 26–35. About 7 per cent of past-year cocaine users reported that they “sometimes” used the drug weekly, and 1 per cent reported that they used it daily. Nevertheless, almost 43 per cent of past-year cocaine users in that country were considered to be suffering from cocaine use disorders. In 2018, there were an estimated 8,800 regular users (about 4 people per 1,000 population aged 15–64) of cocaine base paste in Uruguay, which is considerably lower than the previous estimate of 14,000 regular users, in 2012. The comparison of two studies, which used respondent-driven sampling to survey regular users of cocaine base paste in 2012 and 2018, found that there has been a decline in the use of the substance among young adults. However, the pro-portion of older users – those in the age group 36–45 and older – has increased considerably, suggesting that an ageing cohort of users who initiated use at the age of about 18, over the period 2002–2004, may have continued to use coca paste (pasta básica de cocaína) over the years. The use of coca paste (pasta básica de cocaína) is reportedly common among socially marginalized population groups, in particular the homeless and people living in shelters, and among those with a low level of education (less than primary level).
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HEISENBERG

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Cocaine use in North America remains high.
In North America, an estimated 2.1 per cent of the adult population, or 6.9 million people, were estimated to have used cocaine in the past year in 2019. In Canada, past-year prevalence of cocaine use in 2017 was estimated to be 2.5 per cent of the adult population, an estimate which had increased from 1.5 per cent in 2015. Cocaine use in Mexico is much lower than in Canada and the United States, and was estimated to be 0.8 per cent of the population aged 12–65 in 2016.
In 2019 in the United States, 5.5 million people, or 2.0 per cent of the population aged 12 and older, had used cocaine in the past year. As a long-term trend, past-year use of cocaine reached a low in 2011 but increased thereafter and stabilized at a high level from 2016.
Cocaine use in the United States is highest among young people (aged 18–25), with a past-year prevalence of 5.3 per cent in 2019. The prevalence of use of “crack” cocaine is much lower, with 778,000 people, or 0.3 per cent of the population aged 12 and older, reporting use of the substance in the past year. Among adults aged 18 and older, comparatively higher “crack” cocaine use is reported among those aged 26 and older. Generally, cocaine use is more common among socially integrated cocaine users, whereas cocaine injecting and use of “crack” cocaine is more common among socially marginalized groups of users.
Among the 5.5 million people in the Unites States who had used cocaine in the past year in 2019, nearly 2 million (0.7 per cent of the population aged 12 and older) were estimated to have used the drug on average of 5.5. days in the past month. Among past-month users, 8.8 per cent (175,000 people) were estimated to be daily or near-daily users of cocaine.
In addition to overdose deaths attributed to opioid use in the United States, those attributed to cocaine use have also been increasing, in particular since 2014: over the period 2010–2019, the number of overdose deaths attributed to cocaine use increased nearly fourfold. How-ever, this increase is attributed to a large extent to deaths that also involved an opioid, most notably synthetic opioids (fentanyls). In 2019, of the total 15,883 overdose deaths attributed to cocaine, 75 per cent involved an opioid, mostly fentanyls. While it is not known if the deaths were the result of the concomitant, sequential or inadvertent use of the two drugs, there have been reports of cocaine being either mixed inadvertently with fentanyls or adulterated with fentanyls in the United States.

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Indications of increasing cocaine use in Western and Central Europe.

In 2019, an estimated 5 million people in Europe, or about 0.9 per cent of the population aged 15–64, had used cocaine in the past year. However, cocaine use is much higher in Western and Central Europe than in Eastern and South-Eastern Europe (0.3 per cent, or 580,000 users).

In 2019 in Western and Central Europe, 1.4 per cent, or 4.4 million people aged 15–64, were estimated to have used cocaine in the past year. Many countries in the subregion, especially those with a high prevalence of cocaine use, such as England and Wales, Germany and Italy, have reported an increase in cocaine use in their recent surveys, while others have reported stable trends at high levels.

The use of “crack” cocaine, although still uncommon, is reported in some countries in the subregion. In France, the number of high risk “crack” cocaine users was estimated at 43,916 in 2018, an increase from the 7,520 estimated in 2010, while the number of people reported in treatment for “crack” cocaine in the country doubled, from 3,388 in 2010 to 6,921 in 2018. In England, the prevalence of crack cocaine was estimated at 5.10 per 1,000 population aged 15–64 in the period 2016–2017, which represents a stabilization after the increasing trend observed in the fiscal years 2011/12 (4.8 per 1000 population) and 2013/14 (5.2 per 1000 population). In England, “crack” cocaine was the primary drug of use of 7.6 per cent of people entering treatment for drug use disorders in 2018, and it was the most common secondary sub-stance reported among people in drug treatment.

There is also evidence of an overall increase in the avail-ability of high-purity cocaine, which has increased each year since 2009. In 2018, cocaine purity in the European Union was considered to be at its highest level for a decade; the average purity of cocaine at the retail level varied between 23 and 87 per cent across the European Union in 2018, however, with half of the countries reporting an average purity of between 53 and 69 per cent.

According to the latest school survey, conducted in 32 countries in Europe in 2019, 1.9 per cent of students aged 15–16 reported cocaine use and about 1 per cent reported using “crack” cocaine in their lifetime, an estimate that has remained unchanged since 2011.

The overall increase in cocaine use in Europe is also con-firmed in estimates of cocaine consumption from wastewater analysis; findings from 147 cities indicate an increase since 2011, becoming more pronounced after 2015. This analysis shows that cocaine consumption varies considerably across the region, ranging from less than 1 mg to more than 700 mg of benzoylecgonine (cocaine metabolite) per 100,000 inhabitants in 2020. Above-average per capita consumption was reported in cities in Western and Central Europe (notably in Belgium, France, the Netherlands, Spain, Switzerland and the United Kingdom). Below-average per capita consumption of cocaine was reported in cities in Northern Europe (notably in Finland and Sweden), Central Europe (Czechia) and South Eastern Europe (Bulgaria, Romania and Serbia). Based on this analysis, cocaine consumption declined slightly in 2020, however, which was more marked in small cities (population of 100,000 or less) than in middle-sized cities (population between 100,000 and less than 1 million) and hardly noticeable in large cities (population of 1 million or more) in Europe.

In 2018, among those entering treatment for cocaine use disorders in the European Union, more than two thirds (79 per cent) reported the use of cocaine in combination with heroin or other opioids. The number of first-time entrants into treatment for cocaine use disorders has also increased in the past few years. Overall, cocaine was cited as the primary drug of concern by 75,000 people entering specialized drug treatment in 2018, of whom nearly half (34,000) were first-time entrants; in 2014, about 60,000 people entered drug treatment services for problems related to cocaine use, of whom less than half (27,000) were first-time entrants. Overall, Italy, Spain and the United Kingdom accounted for almost three quarters of all people treated for cocaine use disorders in specialized drug treatment services in the European Union in 2018.

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HEISENBERG

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In Oceania, cocaine use is on the increase in Australia.

In 2019, an estimated 730,000 people in Oceania, or 2.7 per cent of the population aged 15–64, had used cocaine in the past year.

In New Zealand, recent wastewater analysis showed low levels of cocaine consumption compared with other countries that have established cocaine markets. In the second quarter of 2019, the highest level of cocaine consumption in the country was estimated in Auckland territory (60 mg per day per 1,000 inhabitants); at the national level, 850 g of cocaine were estimated to be consumed per week, suggesting a small user base that likely reflects a low demand for and supply of cocaine. In the second quarter of 2020, cocaine consumption dropped considerably, to a weekly national average of 100 g per 1,000 inhabitants (or nearly 5 mg per day per 1,000 inhabitants), with the highest consumption, 10 mg per day per 1,000 inhabitants, found in Auckland territory. This is approximately 20 times less than the average per capita consumption of cocaine in Europe.

In Australia, the past-year prevalence of cocaine use increased from 2.5 per cent of the population aged 14 and older in 2016 to 4.2 per cent (900,000 people) in 2019. Past-year cocaine use increased across all age groups, except among those aged 14–19. The increase in past-year cocaine use was driven mainly by men in those age groups, but cocaine use among women in their 20s also increased in the same period. The proportion of men in their 20s using cocaine in the past 12 months almost doubled, from 7.3 per cent in 2016 to 14.4 per cent in 2019. Moreover, past-year cocaine use more than doubled independently of education level (with or without 12 years of education) and in all socioeconomic groups. Past-month cocaine use among people who reported cocaine use in the past year also increased, from 10 per cent in 2016 to about 17 per cent in 2019.

The upward trend in cocaine use in Australia is confirmed by data from wastewater analysis. The estimated amount of cocaine consumed per year in Australia has increased considerably since the fiscal year 2016/17, from an estimated 3,057 kg of cocaine consumed in the country during that period to 5,675 kg in the fiscal year 2019/20. The wastewater analyses undertaken across Australia in August 2020 covered 56 per cent of the population, or some 13.2 million inhabitants, and were conducted at 20 wastewater treatment plants in state capitals and 35 regional areas, covering a wide range of catchment population sizes in the country. Overall, cocaine consumption was estimated to be lower at regional sites than in state capitals, although cocaine consumption has increased in all states and territories, most notably Western Australia, where it had started from a relatively low base of consumption compared with other sites.

On average, nearly 600 mg of cocaine per 1,000 population per day was estimated to be consumed in Australia. Cocaine consumption was estimated to be higher in New South Wales than in the rest of the country, but consumption in some sites in Queensland, Victoria and the Australian Cap-ital Territory was also relatively high. The comparison of these findings with those in Europe for 2019 suggests that per capita cocaine consumption based on wastewater analysis was much lower in Australia than in some European countries characterized by high per capita consumption levels, such as Denmark, the Netherlands, Spain and the United Kingdom. While the COVID-19 pandemic has had an initial impact on cocaine consumption in some states and territories in Australia, notably the state capital sites, with the easing of movement restrictions in the latter part of 2020, cocaine consumption appears to have increased sharply in the Australian Capital Territory and Tasmania and returned to its pre-COVID-19 level in New South Wales.
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