Social, economic and health challenges, the desire for pleasure and the need to cope with contemporary realities – combined with increased drug availability – contribute to the use of drugs in the Eastern and Southern Africa region (ESA).

Heroin (an opiate/opioid), cocaine and amphetamine-type stimulants (ATS) are unregulated drugs that contribute to most drug-related harm. About one in ten people who start using a drug will develop dependence. The likelihood of developing dependence is associated with early onset of use, socio-economic challenges and co-occurring mental and physical health conditions. Given the growing population in the region, the consequences of drug dependence for development are likely to be extreme – without appropriate interventions in place.

Decades of scientific research have contributed to a strong evidence base that shows effective interventions mitigate the effects of drug dependence. Effective prevention includes ensuring safe and healthy pregnancies and early childhood development. It entails supporting parenting skills and the educational, emotional and social skills development of adolescents and young adults. Drug use screening and brief interventions are effective in helping prevent progression to drug dependence.

Drug dependence is usually a chronic condition. But it can be treated through a combination of medical and psychosocial interventions. Medical treatment of opioid dependence using opioid substitution therapy (OST) is the recommended intervention. Overdose prevention and management, needle and syringe services, and testing and treatment of HIV, viral hepatitis, sexually transmitted infections (STIs) and tuberculosis (TB) are also integral to comprehensive, effective responses. The return on investment in evidence-based drug prevention, treatment and harm reduction equates to between US$4 and US$12 for each dollar spent. Access to treatment for drug dependence is a universal right for all people. However, globally, only one in six people with drug dependence benefits from such services.