What do we know about the extent of cocaine use and dependence? Results of a global systematic review

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Resource Type: Technical Reports

NDARC Technical Report No. 308 (2010)

EXECUTIVE SUMMARY

Aims: Systematically review existing data on the global prevalence of cocaine use and dependence. The aims of this paper are to: (1) describe the available international data on cocaine use and dependence and make broad geographical comparisons; (2) identify priorities for improving the comparability, quality and coverage of such estimates; and (3) establish a baseline for future research to compare geographic changes over time.

Methods: According to an approach being used across searches undertaken for the 2005 Global Burden of Disease project (GBD), a systematic review was undertaken for cocaine dependence and use. Multiple search strategies were used with: a) peer‐reviewed literature searches (1990‐2008) using methods recommended by the Meta‐analysis of Observational Studies in Epidemiology (MOOSE) group; b) systematic searches of online databases; c) Internet searches to find any other evidence of use; d) repeated consultation and feedback from experts around the globe; e) a viral email sent to lists in the HIV and illicit drug fields. Culling and data extraction followed manualised protocols, with in‐built systems of cross‐checking and internal consistency. Data were extracted and graded according to predefined variables and quality scored. This paper reports the most recent and highest graded prevalence estimate for the general population and school population and reports the proportion of coverage of the world's population for use and dependence estimates, general population and school surveys, age and sex specific estimates, and most recent year of estimates.

Results: Evidence and prevalence of cocaine use and dependence were found for 182 countries, covering 98% of the world population aged 15-64 years. More countries reported evidence of cocaine use, rather than estimates of use but these countries accounted for the minority or the world's population. Cocaine use was reported by eighty-six countries. Cocaine use estimates varied widely with the highest estimates in the Americas and Western Europe and the lowest in Asia, Africa and Eastern Europe. Five countries reported the prevalence of cocaine dependence, accounting for 8% of the world's population aged 15 to 64. Cocaine dependence estimates were equal to or less than 1% (lifetime and point prevalence estimates) and were measured with direct assessment methods.

Conclusions: There is evidence of cocaine use occurring throughout the world. However, large gaps in the global literature on the extent of such use and dependence remain. These country specific estimates of cocaine dependence are necessary for future policy and public health strategies, particularly if the harms associated with cocaine dependence are to be addressed.