UsoDrogasAmericas ENG-22Table A2.6: Past year and past month prevalence of tobacco use in general population by age group. Table A2.7: Lifetime, past year and past month prevalence

2015 Report onDrug Use

in the Americas2 0 1 5

Inter-American Drug Abuse Control Commission - CICADSecretariat for Multidimensional SecurityOrganization of American States - OAS

OAS Cataloging-in-Publication Data

Inter-American Drug Abuse Control Commission.Report on drug use in the Americas, 2015. p.209 ; cm. (OAS. Official Records Series ; OEA/Ser.L) ISBN 978-0-8270-6373-01. Drug abuse--America. 2. Drugs--America. 3. Drinking of alcoholic beverages--America.4. Inhalant abuse--America. I. Title. II. Inter-American Observatory on Drugs.III. Inter-American Drug Use Data System. IV. Series.OEA/Ser.L/XIV.6.6 2015

ISBN 978-0-8270-6373-0

R e p o r t o n D r u g U s e i n t h e A m e r i c a s : : 2 0 1 5 | 3

Report on Drug Use in the Americas 2015

Organization of American States Secretariat on Multidimensional Security Inter‐American Drug Abuse Control Commission Inter‐American Observatory on Drugs Washington, D.C.

4 | O A S ‐ C I C A D


Editorial Team

This publication was developed by the Inter‐American Observatory on Drugs (OID) of CICAD, with active

contributions from: Marya Hynes, Pernell Clarke, Graciela Ahumada, Francisco Cumsille, Maria Demarco, Ana

María Lemos and Tiffany Barry of the OID, Juan Carlos Araneda (UNODC,CICAD Staff Associate) and Leticia

Keuroglian (Fellow at CICAD from the Junta Nacional de Drogas de Uruguay).

Acknowledgements

Special thanks to the National Observatories on Drugs from the OAS member states, and in particular to those

responsible for their function. This report would not have been possible without the support from these

organizations.

We would also like to thank the members of the Latin American Drug Research Network (REDLA): Maria Elena

Alvarado of the University of Chile, Julio Bejarano of the Institute on Alcoholism and Drug Dependence (IAFA)

of Costa Rica, Fernando Salazar of Cayetano Heredia University of Peru and Jorge Villatoro of the Ramón de la

Fuente Múñiz National Psychiatry Institute of Mexico.

To Alejandro Ahumada for his invaluable contrubution for the editing and Graphic Design1 in this report.

1 Cover map designed by Freepik.com

6 | O A S ‐ C I C A D


Table of Contents

Prologue .................................................................................................................................................................................. 15

Executive summary and conclusions ...................................................................................................................................... 16

INTRODUCTION ....................................................................................................................................................................... 21

A hemisphere of diversity ........................................................................................................................... 21

Objectives ................................................................................................................................................... 23

Methodology .............................................................................................................................................. 24

SOURCES OF INFORMATION: SCOPE AND LIMITATIONS ........................................................................................................ 28

Secondary school students ......................................................................................................................... 28

General population ..................................................................................................................................... 28

University students ..................................................................................................................................... 29

Trend data .................................................................................................................................................. 29

Comparability of the information ............................................................................................................... 30

ORGANIZATION OF THE REPORT: DIMENSIONS AND CHAPTERS ............................................................................................ 30

CHAPTER 1: A L C O H O L ............................................................................................................................................... 33

Introduction .............................................................................................................................................................. 33

Alcohol use among the secondary school population .............................................................................................. 33

Binge drinking .............................................................................................................................. 37

Trends in the secondary school population ................................................................................. 39

Alcohol use in the general population ...................................................................................................................... 41

High risk or hazardous drinking .................................................................................................... 43

Trends in the general population ................................................................................................. 44

Alcohol use among university students .................................................................................................................... 45

CHAPTER 2: T O B A C C O .............................................................................................................................................. 48

Introduction .............................................................................................................................................................. 48

Use of tobacco in the secondary school students .................................................................................................... 49

Trends in tobacco consumption in the secondary school students ............................................. 52

Use of tobacco in the general population .................................................................................... 56

Trends in tobacco consumption in the general population ......................................................... 58

Tobacco use among university students ...................................................................................... 61

CHAPTER 3: M A R I J U A N A ...................................................................................................................................... 62

Introduction .............................................................................................................................................................. 62

Secondary school students ....................................................................................................................................... 62

Indicators of marijuana use .......................................................................................................... 62

Trends among secondary school students ................................................................................... 66

8 | O A S ‐ C I C A D

Perception of risk ......................................................................................................................... 69

Perception of ease of access and offers of marijuana .................................................................. 70

General population ................................................................................................................................................... 72

Indicators of use ........................................................................................................................... 72


Perception of high risk of marijuana use ...................................................................................... 76

Ease of access and offers of marijuana ........................................................................................ 77

University students ................................................................................................................................................... 78


Trends among university students ............................................................................................... 79

Perception of high risk .................................................................................................................. 79

Perception of ease of access and offers of marijuana .................................................................. 80

CHAPTER 4: I N H A L A N T S ........................................................................................................................................ 81

Introduction .............................................................................................................................................................. 81

Secondary school students ....................................................................................................................................... 81


Trends among secondary school students ................................................................................... 86

Perception of risk ......................................................................................................................... 87

General population ................................................................................................................................................... 88




University students ................................................................................................................................................... 91


Trends among university students ............................................................................................... 92


CHAPTER 5: C O C A I N E A N D S M O K A B L E C O C A I N E ......................................................................... 94

COCAINE .................................................................................................................................................................... 95

Introduction ................................................................................................................................................ 95

Secondary school students ......................................................................................................................... 95

Indicators of use ............................................................................................................. 95

Trends among secondary school students ..................................................................... 99

Perception of risk ......................................................................................................... 102

Perception of ease of access to cocaine and offers of cocaine .................................... 103

General population ................................................................................................................................... 105

Indicators on use .......................................................................................................... 105


Trends in the general population ................................................................................. 107


Perception of ease of access and offers of cocaine ..................................................... 109

University students ................................................................................................................................... 110

Indicators of use........................................................................................................... 110

Trends among university students ............................................................................... 111


Ease of access to cocaine and offers of cocaine .......................................................... 113

COCAINE BASE PASTE ............................................................................................................................................. 114

Introduction .............................................................................................................................................. 114

Secondary school students ....................................................................................................................... 115


Trends among secondary school students ................................................................... 116


Perception of ease of access and offers of cocaine base paste ................................... 118



Trends in the general population ................................................................................. 121


Perception of ease of access to and offers of cocaine base paste ............................... 122

University students ................................................................................................................................... 123



Perception of ease of access and offers of cocaine base paste ................................... 125

CRACK ..................................................................................................................................................................... 126

Introduction .............................................................................................................................................. 126

Secondary school students ....................................................................................................................... 126


CHAPTER 6: A M P H E T A M I N E ‐ T Y P E S T I M U L A N T S ...................................................................... 130

Introduction ............................................................................................................................................................ 130

Amphetamines group ................................................................................................................. 130

Ecstasy‐type substances ............................................................................................................. 131

“Ecstasy” use among secondary school students ...................................................................... 132

Trends in “ecstasy” use among secondary school students ...................................................... 136

Perception of high risk among secondary school students ........................................................ 138

Perception of ease of access to “ecstasy” among secondary school students .......................... 139

10 | O A S ‐ C I C A D

Offers of “ecstasy” to secondary school students ...................................................................... 140

Use of “ecstasy” in the general population ................................................................................ 141

Perception of high risk among the general population .............................................................. 142

Perception of ease of access among the general population..................................................... 143

Offers of “ecstasy” among the general population .................................................................... 143

“Ecstasy” use among university students ................................................................................... 144

University students, comparative data ...................................................................................... 144

Perception of high risk among university students .................................................................... 145

Perception of ease of access among university students ........................................................... 146

Offers of “ecstasy” to university students .................................................................................. 147

CHAPTER 7: N E W P S Y C H O A C T I V E S U B S T A N C E S A N D O T H E R

E M E R G I N G D R U G S I N T H E R E G I O N .............................................................................. 148

NEW PSYCHOACTIVE SUBSTANCES ......................................................................................................................... 148

NPS mimic the effects of controlled substances ........................................................................ 148

North America: a large market for new psychoactive substances ............................................. 149

The appearance of new psychoactive substances in Central and South America ..................... 151

NPS and LSD market ................................................................................................................... 153

Compounds of the NBOMe series are reported in the region ................................................... 153

An emerging market for plant‐based substances ....................................................................... 154

HEROIN .................................................................................................................................................................... 156

USE OF PHARMACEUTICALS WITHOUT A MEDICAL PRESCRIPTION........................................................................ 158

OPIATES AND OPIOIDS ............................................................................................................................................ 162

Global context ............................................................................................................................ 162

Opiates and opioids .................................................................................................................... 163

Opioids........................................................................................................................................ 163

Opioid use among students ........................................................................................................ 165

Fentanyl ...................................................................................................................................... 166

References ............................................................................................................................................................................. 168


List of tables

Tables can be found in appendix pages 171 ‐209

Table A1.1: Lifetime, past year and past month prevalence of alcohol use among secondary school students.

Table A1.2: Past year and past month prevalence of alcohol use among secondary school students by sex.

Table A1.3: Past year and past month prevalence of alcohol use among secondary school students by grade.

Table A1.4: Lifetime, past year and past month prevalence of alcohol use among the general population.

Table A1.5: Past year and past month prevalence of alcohol use among the general population by sex.

Table A1.6: Past year and past month prevalence of alcohol use among the general population by age group.

Table A1.7: Lifetime, past year and past month prevalence of alcohol use among university students.

Table A1.8: Past year and past month prevalence of alcohol use among university students by sex.

Table A1.9: Binge drinking among secondary school students by sex and grades.

Table A1.10: Percent of university students with signs of high risk or hazardous alcohol use as a proportion of past year consumers by sex, years 2009 and 2012.

Table A1.11: Percent of university students with signs of alcohol dependence as a proportion of past year users by sex, years 2009 and 2012.

Table A2.1: Lifetime past year and past month prevalence of tobacco use in the secondary school population.

Table A2.2: Past year and past month prevalence of tobacco use among secondary school students by sex.

Table A2.3: Past year and past month prevalence of tobacco use among secondary school students by grade.

Table A2.4: Lifetime, past year and past month prevalence of tobacco use in general population.

Table A2.5: Past year and past month prevalence of tobacco use in general population by sex.

Table A2.6: Past year and past month prevalence of tobacco use in general population by age group.

Table A2.7: Lifetime, past year and past month prevalence of tobacco use among university students.

Table A2.8: Past year and past month prevalence of tobacco use among university students by sex.

Table A2.9: Perception of high risk of smoking cigarettes frequently in secondary school population by sex.

Table A3.1: Lifetime, past year and past month prevalence of marijuana use in the secondary school population.

Table A3.2: Lifetime, and past year prevalence of marijuana use among secondary school students by sex.

Table A3.3: Lifetime, and past year prevalence of marijuana use among secondary school students by grade.

Table A3.4: Lifetime, past year and past month prevalence of marijuana use in general population.

Table A3.5: Lifetime and past year prevalence of marijuana use among the general population by sex.

Table A3.6: Lifetime and past year prevalence of marijuana use among the general population by age group.

Table A3.7: Lifetime, past year and past month prevalence of marijuana use among university students.

Table A3.8: Lifetime, and past year prevalence of marijuana use among university students by sex.

Table A3.9: Perception of high risk of using marijuana sometimes in secondary school population by sex.

Table A3.10: Perception of high risk of using marijuana frequently in secondary school population by sex.

Table A3.11: Perception of high risk of using marijuana sometimes in general population by sex.

Table A3.12: Perception of high risk of using marijuana frequently in general population by sex.

12 | O A S ‐ C I C A D

Table A3.13: Perception of high risk of using marijuana sometimes among university students by sex.

Table A3.14: Perception of high risk of using marijuana frequently among university students by sex.

Table A3.15: Perception of ease of access and percentage of direct offers (past year and past month) of marijuana in secondary school population.

Table A3.16: Perception of ease of access and percentage of direct offers (past year and past month) of marijuana among university students.

Table A4.1: Lifetime, past year and past month prevalence of inhalants use in the secondary school population.

Table A4.2: Lifetime and past year prevalence of inhalants use among secondary school students by sex.

Table A4.3: Lifetime and past year prevalence of inhalants use among secondary school students by grade.

Table A4.4: Lifetime, past year and past month prevalence of inhalants use in general population.

Table A4.5: Lifetime, past year and past month prevalence of inhalants use among university students.

Table A4.6: Perception of high risk of using inhalants sometimes in secondary school population by sex.

Table A4.7: Perception of high risk of using inhalants frequently in secondary school population by sex.

Table A4.8: Perception of high risk of using inhalants sometimes and frequently in general population by sex.

Table A4.9: Perception of high risk of using inhalants sometimes and frequently among university students.

Table A5.1: Lifetime, past year and past month prevalence of cocaine use in the secondary school population.

Table A5.2: Lifetime and past year prevalence of cocaine use among secondary school students by sex.

Table A5.3: Lifetime and past year prevalence of cocaine use among secondary school students by grade.

Table A5.4: Lifetime, past year and past month prevalence of cocaine use in general population.

Table A5.5: Lifetime and past year prevalence of cocaine use among the general population by sex.

Table A5.6: Lifetime and past year prevalence of cocaine use among the general population by age group.

Table A5.7: Lifetime, past year and past month prevalence of cocaine use among university students.

Table A5.8: Lifetime and past year prevalence of cocaine use among university students by sex.

Table A5.9: Perception of high risk of using cocaine sometimes in secondary school population by sex.

Table A5.10: Perception of high risk of using cocaine frequently in secondary school population by sex.

Table A5.11: Perception of high risk of using cocaine sometimes in general population by sex.

Table A5.12: Perception of high risk of using cocaine frequently in general population by sex.

Table A5.13: Perception of high risk of using cocaine sometimes among university students by sex.

Table A5.14: Perception of high risk of using cocaine frequently among university students by sex.

Table A5.15: Perception of ease of access and percentage of direct offers (past year and past month) of cocaine in secondary school population.

Table A5.16: Perception of ease of access and percentage of direct offers (past year and past month) of cocaine among university students.

Table A5.17: Lifetime, past year and past month prevalence of cocaine base paste use in the secondary school population.

Table A5.18: Lifetime and past year prevalence of cocaine base paste use among secondary school students by sex.

Table A5.19: Lifetime and past year prevalence of cocaine base paste use among secondary school students by grade.

Table A5.20: Lifetime, past year and past month prevalence of cocaine base paste use in general population.

Table A5.21: Lifetime, past year and past month prevalence of cocaine base paste use among university students.

Table A5.22: Perception of high risk of smoking cocaine base past sometimes in secondary school population by sex.


Table A5.23: Perception of high risk of smoking cocaine base paste frequently in secondary school population by sex.

Table A5.24: Perception of high risk of using cocaine base paste sometimes in general population by sex.

Table A5.25: Perception of high risk of using cocaine base paste frequently in general population by sex.

Table A5.26: Perception of high risk of using cocaine base paste sometimes among university students by sex.

Table A5.27: Perception of high risk of using cocaine base paste frequently among university students by sex.

Table A5.28: Perception of ease of access and percentage of direct offers (past year and past month) of cocaine base paste in secondary school population.

Table A5.29: Lifetime, past year and past month prevalence of crack use in the secondary school population.

Table A5.30: Lifetime and past year prevalence of crack use among secondary school students by sex.

Table A5.31: Lifetime, past year and past month prevalence of crack use in general population.

Table A6.1: Lifetime, past year and past month prevalence of “ecstasy” in use in the secondary school population.

Table A6.2: Lifetime and past year prevalence of “ecstasy” use among secondary school students by sex.

Table A6.3: Lifetime and past year prevalence of “ecstasy” use among secondary school students by grade.

Table A6.4: Lifetime, past year and past month prevalence of “ecstasy” use in general population.

Table A6.5: Lifetime, past year and past month prevalence of “ecstasy” use among university students.

Table A6.6: Lifetime and past year prevalence of “ecstasy” use among university students by sex.

Table A6.7: Perception of high risk of using “ecstasy” sometimes in secondary school population by sex.

Table A6.8: Perception of high risk of using “ecstasy” frequently in secondary school population by sex.

Table A6.9: Perception of high risk of using “ecstasy” sometimes in general population by sex.

Table A6.10: Perception of high risk of using “ecstasy” frequently in general population by sex.

Table A6.11: Perception of high risk of using “ecstasy” sometimes among university students by sex.

Table A6.12: Perception of high risk of using “ecstasy” a frequently among university students by sex.

Table A6.13: Perception of ease of access and percentage of direct offers (past year and past month) of “ecstasy” in secondary school population.

Table A6.14: Perception of ease of access and percentage of direct offers (past year and past month) of “ecstasy” among general population.

Table A6.15: Perception of ease of access and percentage of direct offers (past year and past month) of “ecstasy” among university students.

Tabla A7.1: Lifetime, past year and past month prevalence of stimulant pharmaceutical use without a medical prescription in the secondary school population.

Tabla A7.2: Past year prevalence of stimulant pharmaceutical use without a medical prescription in the secondary school population by sex.

Tabla A7.3: Lifetime, past year and past month prevalence of tranquilizers pharmaceutical use without a medical prescription in the secondary school population.

Tabla A7.4: Past year prevalence of tranquilizers pharmaceutical use without a medical prescription in the secondary school population by sex.

14 | O A S ‐ C I C A D


Prologue It is a great pleasure to present the second edition of the Report on Drug Use in the Americas, 2015. CICAD’s Hemispheric Drug Strategy provides very clearly for the design of national drug policies which are evidence‐based, with the further stipulation that such evidence, whenever possible, should allow for the comparison of data among countries. Until recently, it has simply not been possible to undertake such comparisons, due to the absence of available data. Many member states lacked the human, institutional and financial resources to conduct drug epidemiology studies on a regular basis, as well as qualitative studies among others. Knowledge should be the basis on which to build good policies on drugs. The dedicated work of the Inter‐American Observatory on Drugs (OID), led by Dr. Francisco Cumsille and his committed team of researchers, has been an essential element in strengthening the capacity of our member states to gather and analyze the evidence needed to construct effective drug policies. For more than a decade, the OID has been fully committed to working in partnership with member states to bolster the web of national observatories and academic researchers active in the drug field. The proof of that commitment can be found in this very comprehensive and timely report. CICAD’s commissioners are currently in the process of negotiating a new Plan of Action for 2016‐2020, to support the second phase of implementation of the Hemispheric Drug Strategy 2010. OAS Ministers specifically mandated that this plan of action be drafted taking into account all available evidence. This report will provide an extensive set of information and analysis that should support the efforts of member states with the support of the Executive Secretariat to craft this new Plan of Action. While hemispheric countries have come a long way in their efforts to generate and analyze drug data, there are still many challenges ahead. Several states need to develop and analyze data on a local or municipal basis in order to shape community based initiatives that take into account local realities. Additional research into youth drug use patterns is urgently needed, to confirm trends in age of initiation and perception of risk which are outlined in this report. Drug observatories need to be further strengthened, and they need to develop or improve national drug information networks that support their information gathering and dissemination efforts. Academic research into drug topics needs to become a higher priority at universities throughout the hemisphere. We are working on all these areas through the OID, but political commitments by our member states will be essential if we are to put into effect these valuable reforms. We very much hope that this publication can support the member states of the CICAD to better understand the hemispheric situation as well as their own drug consumption challenges and how they fit in with broader trends in the hemisphere.

Ambassador Paul Simons Executive Secretary

Inter‐American Drug Abuse Control Commission

16 | O A S ‐ C I C A D

Executive summary and conclusions

This Report on Drug Use in the Americas 2015 provides an overview of the use of psychoactive substances

hemisphere‐wide and subregionally. It draws on information provided to CICAD by the OAS member states.

The three main sources of information were: national studies among secondary school students, general

population studies, and surveys of university students. These studies reported on rates of use of the principal

psychoactive substances, namely, tobacco, alcohol, inhalants, marijuana, cocaines and “ecstasy”, as well as on

the abuse of alcohol among secondary school students. We looked at other comparable factors, which have to

do with perceptions about the ease with which drugs can be obtained, and the number of times respondents

received offers in the past year to buy or try marijuana, cocaine, cocaine base paste, “ecstasy” and other

amphetamine‐type stimulants. We examined the perceived risk among different population groups of the

occasional or frequent use of these substances, as indicating the degree of rejection or acceptability of the use

of those drugs, and the possible impact of people’s perceptions on the rates of use. Some information is also

included on heroin and pharmaceuticals, and finally, the report reviews the current situation with regard to

new psychoactive substances.

The report itself is organized according to psychoactive substance. However, this executive summary looks at

three subjects that are particularly relevant to the development of drug policies: use of drugs at an early age

and factors associated with that use, trends in drug use, and emerging themes in the region. Before we begin

to analyze these issues in detail, it is important again to stress the wide differences between countries in terms

of drug use. There is no single pattern: there are variations throughout the hemisphere, just as there are

variations between countries in each subregion. This reinforces the point that national policies on drug use

should be specific to the particular realities of each country.

The first point that emerges from the information we have available and that is presented in this report is the

use of drugs at an early age (this information is drawn primarily from studies among secondary school

students). There is abundant evidence about the risks and consequences of the use of drugs at a young age,

and this should therefore be an area of top priority. The report shows that in twenty‐three of the twenty‐nine

countries that have information on secondary school students (generally between the ages of 13 and 17), 20%

or more of the students reported that they had drunk an alcoholic beverage in the month prior to the study,

and that in fourteen countries, this figure is over 30%. In seventeen countries, the rate of past month use of

alcohol among eighth grade students (aged around 13) was over 15%, and more than 25% in seven countries.

An important issue is the problem use of alcohol. It has been clearly established that any level of drug use

among adolescents is, in and of itself, problematic in terms of the bio psychosocial risks involved, as discussed

in this report. Bearing this in mind, if we look at the pattern of alcohol use among secondary school students in

the hemisphere, the data show that the 50% or more who said that they had drunk alcohol in the past month

reported an episode of binge drinking (that is, they had drunk five or more drinks on a single occasion in the

two weeks prior to the survey). This means that one out of two students who used alcohol in the past month

had at least one episode of binge drinking in the two weeks prior to the survey in question. The general

population studies in some of the countries that have information available show that between 5% and 22% of

those who drank alcohol in the past year show signs of problem use of alcohol.


Like all of the psychoactive substances, there are major differences throughout the region in the use of tobacco

among secondary school students. In nine of the twenty‐eight countries that have information available, the

prevalence of past month use is less than 5%, while the rate is over 10% in six other countries. The proportion

of secondary school students in the Caribbean who smoke is substantially lower than in the other subregions.

Two countries, both in South America, have rates of tobacco use among eighth graders of over 10%. We

cannot fail to mention that in the United States, the use of electronic cigarettes among secondary school

students is higher than their rates of tobacco use.

The prevalence of marijuana use in the past year differs considerably from country to country, ranging from

less than 5% in some countries to over 20% in others. In eleven of the thirty‐one countries for which we have

information, past year prevalence was over 15%. Among eighth grade students, the prevalence of past year use

was in excess of 15% in eight countries. The differences between countries in levels of marijuana use are also

seen in other facets of the problem: for example, the perception of the high risk of the occasional use of

marijuana ranges from 10% to 70% of secondary school students; the perception of ease of access varies from

less than 5% to more than 60% (in other words, in one country, six out of ten students say that it would be easy

for them to obtain marijuana). Lastly, in some countries, more than 20% of students report that they were

offered marijuana to buy or try during the year prior to the survey. There is evidence that these factors are

associated with drug use: in those countries where prevalence rates are high, the perceived high risk of the

occasional use of marijuana tends to be low while at the same time, the perception of ease of access is high

and there were also a considerable number of episodes of direct offers of marijuana to students.

This report also looks at the use of inhalants. The definition of inhalant is a challenge for drug researchers: the

term covers a broad range of chemical substances used for different purposes and in most cases sold legally,

and have differing degrees of psychoactive and pharmacological effects. Prevalence of past year use of

inhalants ranges from 0.5% to 11%. Inhalant use has been found at a young age, with lifetime prevalence rates

of over 10% among eighth grade students in some countries. When we look at prevalence rates by sex, we see,

principally in the Caribbean, that inhalant use among female students is more widespread than among males.

In the case of inhalants, unlike other substances, there is no clear association between the perceived high risk

of occasional use and the rate of use.

As for substances derived from coca leaf, for the purposes of this report we divide them into three types:

cocaine hydrochloride, cocaine base paste (also known as paco or basuco in Spanish) and crack. While the use

of cocaine hydrochloride is fairly even across the hemisphere, the use of cocaine base paste is concentrated

mostly in South America, while crack is found more often in Central America, North America and the

Caribbean. In eight out of thirty countries, prevalence of the use of cocaine in the past year among secondary

school students was 2% or more. However, in two countries, the rates were less than 0.5%. Average rates of

use of cocaine among secondary school students were higher in South America than in the other subregions.

In a large majority of those countries that have information on the subject, the perceived high risk of the

occasional use of cocaine was less than 50%, and sometimes under 30% in a number of countries. Secondary

school students’ perceptions about ease of access to cocaine varied considerably among countries, with

percentages ranging from 4% to over 20%. The situation was similar with direct offers of cocaine in the past

year, with lows of less than 2% and a high of 8%. Again, these three indicators are associated with levels of use:

countries with high prevalence rates have low percentages of perceived high risk and high percentages of

18 | O A S ‐ C I C A D

perceived ease of access to cocaine, and also large proportions of students who were directly offered cocaine.

The use of cocaine base paste is concentrated for the most part in the countries of the Southern Cone, where

the prevalence of lifetime use among secondary school students ranges from 0.8% to 4.3%, whereas past year

use ranges from 0.5% to 2.2%. A matter of grave concern is that unlike other psychoactive substances, the use

of cocaine base paste is generally higher among eighth graders than among older students, if we use past year

prevalence as the indicator. The perception among secondary school students that the occasional use of

cocaine base paste involves high risk runs between 50% and 25%. In a number of the countries that have

information, 15% of students see it as easy to obtain cocaine base paste, while offers during the past year were

made to 6% in one country. As to the use of crack, the information available about secondary school students

(from all of the Caribbean countries, four in South America, five in Central America, and the United States in

North America) shows that the highest prevalence rates, of over 1.5%, are found in a number of Caribbean

countries. The lowest levels of use hover around 0.5%.

There are major differences among the subregions with respect to Amphetamine‐Type Stimulants (ATS), chiefly

in the case of methamphetamine, use of which is conspicuously higher in the United States than in the rest of

North America, which in turn, has higher rates of use than other subregions. “Ecstasy” is the ATS most

frequently used in the countries of Latin America, and also in the Americas as a whole. Lifetime use of ATS

among secondary school students ranges from 0.2% to 7.6%. There is great concern over the use of “ecstasy”

at a very young age among secondary school students in some countries. It is not associated with any

subregion in particular, but rather with the overall rates of use in specific countries, in some of which, the rate

of use is over 2% among eighth grade students. In almost all countries, no more than 50% of students perceive

the occasional use of ATS as being of high risk, while just over 10% in several countries view ATS as being easy

to obtain. More than 5% of students in some countries say they have received direct offers of ATS.

It is also important for us to analyze trends in the use of psychoactive substances. In those countries that have

comparable studies that enable us to speak of trends, we see that past month use of alcohol among secondary

school students was stable in a number of countries (Argentina, Chile and Costa Rica), with a downward trend

in others (Peru, United States and Uruguay). Something similar occurred in the countries of the Caribbean:

when we compare two points in time, a decline in alcohol use was observed in more than half of the countries,

while there was an increase in a few countries. Among the general population, we observe that alcohol use has

stabilized in Argentina, Uruguay and the United States, with a decline in Peru and Chile in recent years.

With regard to the use of tobacco, we should note that there was a systematic decline in almost all of the

countries, both among the general population and among secondary school students, with a significant

decrease in new cases. It is very probable that this decline is tracking prevention policies, information on the

harm caused by smoking, and the introduction of non‐smoking areas in a large majority of the countries in

recent years.

Trends in marijuana use among secondary school students over time are different although increases in use are

more common. Thus, in Argentina, Chile, Uruguay, Costa Rica and ten Caribbean countries, we see an increase

in past year use. On the other hand, in the United States, which saw a systematic increase between 2007 and

2013, marijuana use fell slightly in 2014, while in Peru, it stabilized at low rates. Something similar occurred in

the general population studies, where there was also an increase in rates of marijuana use in most of the


countries that have data series. Lastly, in all of the countries that are members of the Andean Community,

there was an increase in the use of marijuana among university students between 2009 and 2012.

Trends in the use of inhalants among secondary school students vary among countries: while there was an

increase in use in Argentina, Chile and most of the countries of the Caribbean, inhalant use in Uruguay and

Peru remained stable.

Trends in cocaine use are also quite varied. Among secondary school students, while Argentina and Chile

showed a rise in the levels of cocaine use, we see that rates in Costa Rica and Peru stabilized. In the United

States, there has been a systematic reduction in use since 1999. As for the Caribbean, in ten of the eleven

countries for which we have information, there was an increase in the prevalence of past year use of cocaine.

The general population studies show a systematic decrease in the United States, stabilization in Peru and

Colombia, an increase in Uruguay, and stabilization in Argentina and Chile in recent years, preceded by

significant declines in each country. As for trends in the use of cocaine base paste among secondary school

students in those countries of South America that have data series, the constant is stability in all of them, but

on the other hand, trends among the general population do not show a clear pattern over time.

The overall picture regarding the use of “ecstasy” among secondary school students is not clear: it is largely

stable, but with two countries where there is a clear upward trend. In three countries of the Andean

Community, university students showed an increase in “ecstasy” use while there was a decline in one country.

Again, we note that the situation see for a number of the substances examined above is similar: high levels of

drug use in those countries where a small percentage of the population perceived any risk in use, where many

people thought the substances were easy to obtain and where there were larger numbers of offers to buy or

try the substances.

We look lastly at emerging themes in the region, which may be summarized as follows: in recent years, the

illicit drug market has been characterized by the appearance of a number of new psychoactive substances

(NPS), which often have chemical and/or pharmacological properties that are similar to those of controlled

substances. Their variety has never been as great as it is now, and their emergence has triggered the

establishment of early warning systems. In the Western Hemisphere, Canada and the United States reported

the highest volume of NPS, but between 2008 and 2014, some countries in Latin America also reported finding

NPS in their territories. Information on the use of these substances is still relatively limited: in the United

States, it was found that 5.8% of twelfth grade students reported that they had used synthetic cannabinoids

during the past year, trending down with respect to 2011. Surveys conducted in Canada of 7th and 12th grade

students during school year 2012‐2013 found high rates of past month use of Salvia divinorum (2%), synthetic

cannabinoids (1.4%), bath salts (0.6%) and benzylpiperazine (0.5%). In the countries of Latin America, there

was evidence of the use of plant‐based substances, ketamine, synthetic cannabinoids and phenethylamines. A

number of these NPS mimic the effects of controlled substances and are sold on the illicit market. The

implications for public policies on this emerging trend are many, and they pose challenges that go beyond the

question of their use and the potential harm to health to other issues such as legislation, policies on supply

control, forensics and trafficking in precursors.

20 | O A S ‐ C I C A D

Until only a few years ago, the use of heroin appeared to be concentrated in the countries of North America.

However, this has been changing recently and some countries of Latin America and the Caribbean have

identified episodes of heroin use and an unusual demand for treatment for heroin use. History suggests that

the challenges for policies on heroin are significant, and may at time require substantive changes. We should

also mention other opioids such as methadone, buprenorphine, oxycodone, tramadol and others that have an

effect similar to that of morphine; in countries like the United States, these drugs are generating a substantial

demand for treatment. While in 2002, there were fewer than 50,000 new episodes of treatment for these

drugs—a figure much lower than cocaine‐ by 2012, that number had tripled and was larger than the episodes

of treatment demand for cocaine, representing nearly 10% of all episodes of demand for treatment in that

year.

In light of all that we have said above, the first conclusion we may draw from this report is that there is a high

level of drug use among adolescents in the hemisphere, and a very low perceived risk of the occasional use of

drugs—which raises questions as to how well public policies on the prevention of substance use among

adolescents have operated thus far. But it is also important to note that the high levels of drug use in the

countries appear to be associated with a high level of perceived ease of access to drugs as well as significant

volumes of drugs offered to adolescents, all of which pose another challenge for policies to control the supply

of drugs.

A second point that should be made here is that although there are few countries in Latin America and the

Caribbean that are today reporting heroin use, CICAD considers that it is a problem that is still in its infancy and

therefore must be monitored closely, and that a comprehensive approach must be taken in order to prevent it

from developing further in the future. In addition, the appearance of new psychoactive substances poses a

challenge for policy makers, not only in the area of demand reduction but also in supply control: the

emergence of NPS has changed traditional patterns of illicit drug production by simplifying procedures to such

an extent that NPS may potentially be produced anywhere in any country. Lastly, it should be noted that a well‐

designed public policy, correctly implemented and having clear criteria for evaluation requires relevant, up‐to‐

date information that is both qualitative and quantitative. Although progress has been made in this area,

additional efforts are still needed in many countries, for the new challenges posed by the drug problem

demand more and better information on which the member states can base their responses.


INTRODUCTION

A hemisphere of diversity

Talking about “the drug problem”, the 2013 Analytical Report by the OAS1 said that:

All experience the problem, albeit in different ways. And the same is true of countries, wherein

the problem manifests itself in different ways depending on their particular circumstances.

Degrees of economic development, institutional structures, and political priorities all vary from

one country in our region to another, as do drug use patterns, health issues, and the impact of

organized criminal activities associated with the problem. The reality is that our countries feel

and live in very different ways the “Drug Problem,” which can even take on different forms

within a country; for example, in rural as opposed to urban areas.

This is not just because of the diversity among each country of the Hemisphere, but because the

problem itself comprises different manifestations. These also have varying impacts on our

countries….

The countries and subregions of the hemisphere (North America, Central America, the Caribbean and South

America) are different and at the same time similar: their languages, history of emancipation, pre‐Colombian

cultures, the size of their populations and territories, and the historical and social processes that went to make

up the social, economic and political/policy structures that we now see in the Western Hemisphere. However,

beyond the similarities, there is unquestionable diversity in the hemisphere and between and within the

subregions. This diversity is important when we try to understand social phenomena such as patterns of the

use and abuse of psychoactive substances.

In terms of population, the countries of the Americas taken together had an estimated population of 954

million in 2014,ii representing approximately 13.3% of the world population. In terms of territory, it is the

second largest continent on the planet after Asia, occupying a large part of the Western Hemisphere, with a

total surface area of 42,549,000 sq. km².

Geographically, the hemisphere can be divided into four areas: North America, Central America, South America

and the Caribbean. This report will consider the following countries as making up these subregions: North

America (Canada, United States and Mexico), Central America (Belize, Costa Rica, El Salvador, Guatemala,

Honduras, Nicaragua and Panama), the Caribbean (Antigua and Barbuda, Bahamas, Barbados, Dominica,

Dominican Republic, Grenada, Haiti, Jamaica, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the

Grenadines, and Trinidad and Tobago) and in South America (Argentina, Brazil, the Plurinational State of

ii For the countries of Latin America and the Caribbean, the data are taken from the Statistical Yearbook of Latin America and the Caribbean, 2013, Economic Commission for Latin America and the Caribbean (ECLAC/United Nations). The source of the data on the United States is the Bureau of the Census, 2013. Data on Canada and worldwide data are from the United Nations, Department of Economic and Social Affairs, Population Division.

22 | O A S ‐ C I C A D

Bolivia, Chile, Colombia, Ecuador, Guyana, Paraguay, Peru, Suriname, Uruguay and the Bolivarian Republic of

Venezuela).

Demographic weight of the subregions of the Americas. Estimated population, 2014

North America has 49.5% of the hemisphere’s population, and includes the country with the largest population,

the United States, with slightly more than 316 million inhabitants.

South America is second in terms of population, representing 43% of the total population of the hemisphere,

with slightly more than 409 million inhabitants in twelve countries. Brazil, with more than 200 million people,

represents almost 50% of this subregion. Central America has a total population of 45.7 million, or 4.8% of the

total population of the hemisphere. There are seven countries in Central America, but one third of the total

Central American population is in Guatemala, which has 15.7 million inhabitants.

The twelve countries of the Caribbean subregion that are included in this report have a total population of 26.2

million, or 2.7% of the population of the hemisphere. The Dominican Republic and Haiti each has more than 10

million inhabitants, followed by Jamaica and Trinidad and Tobago, which have 2.7 and 1.3 million respectively.

The weight of some countries within their subregion impacts on subregional averages as we examine the

indicators that describe the problem of the use of psychoactive substances at the subregional level. It is for

that reason that we look first at each country, and then examine the data for the subregion as a whole.

It is also important to consider the variations in the countries’ demographic structures,2 since worldwide, the

highest levels of the use of almost all psychoactive substances, and particularly illicit drugs, are found among

young people aged 15‐34.

In North and South America and the Caribbean, we have countries that have smaller percentages of young

people, ranging from 27% to 30% of the total population, namely, the United States, Barbados, Uruguay and

Antigua and Barbuda.

49.5

43

4.8 2.7

North America

South America

Central America

Caribbean


In the Caribbean, the percentages of young people in Grenada and Haiti are 39.3% and 36.7% respectively. In

Central America, more than one third of the population of all countries is young, and within the subregion,

young people make up more than 36% of the total population of Nicaragua, Honduras, Belize and El Salvador.

Another important indicator is the percentage of the urban population of each country, since general

population studies and many national studies of secondary school students refer to the urban population.

University students are also part of the urban population. This does not mean that the problems of substance

use are concentrated only in urban areas—to the contrary, we know that there is also significant use of some

substances in rural areas.

Urbanization is part of the process of countries’ modernization and industrialization. It was a characteristic of

the twentieth century and continues in the twenty‐first, when economic growth was the driver of urbanization,

the impact of which has involved many social, economic and cultural contradictions and complexities.

National figures on percentages of the urban population do not fully reflect the demographics in the countries’

states and provinces, but they do give an idea of the overall process. For the purposes of the present report,

the level of urbanization of the countries and subregions is important in that it has a major impact on people’s

daily lives, their cultural behaviors and the organization of their labor markets.

Estimates of the proportion of the urban population of the countries of the hemisphere in 20103 show

important differences between countries: some have more than 90% of their population living in urban areas

(Argentina, Uruguay and Venezuela, for example), while others have urban populations of less than 20%

(Trinidad and Tobago and Saint Lucia).

Many of the countries have national studies of drug use among secondary school students, who are generally

aged 13‐17, and it is therefore useful to know the secondary school matriculation rates in each country.

In ten of the twenty‐three countries that have information,4 the net enrolment ratio is over 80%, and as high as

86%. In five countries, between 70% and 77% of school age adolescents are in some form of educational

establishment. Only one country has a matriculation rate of less than 50%.

Objectives

The present report on drug use in the Americas 2015 gives an overview of the use of psychoactive substances

in the hemisphere and its subregions: alcohol, tobacco, marijuana, cocaines, inhalants, amphetamine‐type

stimulants, new psychoactive substances, and heroin, opiates and opioids, and pharmaceuticals without medial

prescription. This information is drawn largely from three sources: national studies of secondary school

students, general population studies, and surveys among university students in each country. We also describe

alcohol abuse among secondary school students, and their perceptions of the risk of the occasional and

frequent use of psychoactive substances, which are indications of the extent of rejection or acceptance of drug

use among particular groups, as well as their possible impact on rates of use. Other comparable factors looked

at here have to do with perceived ease of access to particular psychoactive substances, as well as numbers of

24 | O A S ‐ C I C A D

direct offers of marijuana, cocaine, cocaine base paste and “ecstasy” received in the past year by the particular

population analyzed.

Therefore, the objectives are to:

Estimate the extent and characteristics of the use in the hemisphere of alcohol, tobacco, marijuana,

cocaines, inhalants, amphetamine‐type stimulants, stimulants and tranquilizers without medical

prescription, by looking at their prevalence among secondary school students, the general population

and university students.

Provide a regional overview of the situation with regard to new psychoactive substances.

Update the situation of heroin use in the region.

Assess for different population groups the relationship between the use of psychoactive substances

and the perception of the high risk of the occasional and frequent use of those substances.

Assess the relationship between the use of marijuana, cocaine, cocaine base paste and “ecstasy” and

the perceived ease of access to them, as well as the numbers of direct offers of these substances

received by secondary school students, the general population and university students.

Look at trends in drug use among the different population groups as monitored by each country.

Provide information that will lead to a better understanding of substance use to inform decisions about

drug policy.

Methodology

The data in this report were provided to CICAD’s Inter‐American Observatory on Drugs (OID/CICAD) by the

National Observatories on Drugs of the National Drug Commissions. These data are taken from studies

available up to January 2015. Information on Canada was provided to CICAD by the Controlled Substances and

Tobacco Directorate of Health Canada. The U.S. data on secondary school students were taken from the 2014

Monitoring the Future report, and supplemented by information from the National Institute on Drug Abuse

(NIDA), while general population data were calculated using the database of the National Survey on Drug Use

and Health, 2013 of the Substance Abuse and Mental Health Services Administration (SAMHSA). Other

information, mainly on trends, was obtained directly from reports posted on the web sites of the

corresponding National Observatories on Drugs.

To the extent possible, in addition to country‐level information, estimates were also made for each of the

hemisphere’s four subregions. We also include overall estimates for the region as a whole.

The country studies referenced in this report were as follows:


Country National Observatory National Commission

Secondary school students

General population

University students

Year of the most recent study available

Antigua and Barbuda

Office of National Drug and Money Laundering Control Policy (ONDCP)

2013

Argentina

Argentine Observatory on Drugs, Secretariat of Programming for the Prevention of Drug Addiction and the Fight Against Narcotrafficking (SEDRONAR)

2011 2011

Bahamas National Anti Drug Secretariat (NDS) 2011

Barbados National Council on Substance Abuse (NCSA)

2013 2006

Belize National Drug Abuse Control Council Ministry of Health (NDACC)

2013 2005

Bolivia (Plurinational State of)

Bolivian Observatory on Drugs, National Council on the Fight Against Illicit Drug Trafficking (CONALTID)

2008 2014 2012

Brazil Brazilian Observatory of Information on Drugs (OBID), National Secretariat on Drug Policy (SENAD)

2010 2005 2010

Canada Controlled Substances and Tobacco Directorate, Health Canada.

2010/11 2012

Chile

Chilean Observatory on Drugs, National Service for the Prevention and Rehabilitation of Drug and Alcohol Consumption (SENDA)

2013 2012

Colombia Colombian Observatory on Drugs, Ministry of Justice and Law

2011 2013 2012

Costa Rica Costa Rican Observatory on Drugs, Costa Rican Institute on Drugs (ICD)

2012 2010

26 | O A S ‐ C I C A D

Country National Observatory – National Commission


General population

University students


Dominica National Drug Abuse Prevention Unit, Ministry of Health (NDPU)

2011

Dominican Rep. Dominican Observatory on Drugs, National Council on Drugs (CND)

2008 2010

Ecuador

Ecuadorian Observatory on Drugs, National Council on the Control of Narcotic and Psychotropic Substances (CONSEP)

2012 2013 2012

El Salvador Salvadorian Observatory on Drugs, National Antidrug Commission (CNA)

2008 2014 2012

Grenada Drug Control Secretariat 2013

Guyana Ministry of Home Affairs 2013

Haiti Haitian Observatory on Drugs, National Commission for the Fight Against Drugs (CONALD)

2014

Honduras Honduran Observatory on Drugs 2005

Jamaica Direction of Information and Research, National Council on Drug Abuse (NCDA)

2013

Mexico Observatory on Tobacco, Alcohol and other Drugs, National Commission against Addiction (CONADIC)

2011

Panama

Panamanian Observatory on Drugs, National Commission for the Study and Prevention of Crime Related to Drugs (CONAPRED)

2008

Paraguay Paraguayan Observatory on Drugs (OPD), National Antidrug Secretariat (SENAD)

2005 2003

Peru Peruvian Observatory on Drugs, DEVIDA

2012 2010 2012

Saint Kitts and Nevis

National Council on Drug Abuse Prevention

2013

Saint Vincent and the Grenadines

Ministry of Health and the Environment

2013

Saint Lucia Substance Abuse Advisory Council Secretariat

2013


Country National Observatory – National Commission


General population

University students


Suriname National Drugs Council (NAR), Bureau of National Security

2006 2007

Trinidad and Tobago

National Drug Council (NDC), National Alcohol and Drug Prevention Program Secretariat (NADAPP)

2013

United States National Office on Drug Control Policy (ONDCP), and National Institute on Drug Abuse (NIDA)

2014 2013

Uruguay Uruguayan Observatory on Drugs, National Drug Council (JND)

2014 2011

Venezuela (Bolivarian Republic of)

Venezuelan Observatory on Drugs, National Antidrug Office (ONA)

2009 2011 2014

28 | O A S ‐ C I C A D

SOURCES OF INFORMATION: SCOPE AND LIMITATIONS


The data on the use of psychoactive substances analyzed in this report are taken from national studies on

secondary school students in the 8th, 10th and 12th grades (or equivalent in each country) corresponding to

ages 13, 15 and 17. In the case of Venezuela, the data correspond to students in grades 7 through 12. In the

case of Brazil, since the 2010 survey in that country included students aged 10‐19 in 27 State capitals, the

OID/CICAD recalculated the data—with the authorization of the National Drug Policy Secretariat (SENAD)‐‐to

consider only the 13‐18 year age group.

Generally speaking, the studies are national in scope (covering the main cities) and the questions about

substance use, binge drinking, perception of high risk, perception of ease of access and offers of substances

received are comparable among the countries analyzed. The methodologies for drawing the samples and the

collection of the information based on self‐administered surveys are similar among countries.

Some information is available for thirty‐one countries, including the United States and Canada in North

America (up to the publication of the present report, Mexico did not have national studies among secondary

school students); Belize, Costa Rica, El Salvador, Honduras and Panama in Central America; Argentina, Bolivia

(Plurinational State of), Brazil, Chile, Colombia, Ecuador, Guyana, Paraguay, Peru, Suriname, Uruguay and

Venezuela (Bolivarian Republic of) in South America, and twelve countries in the Caribbean (Antigua and

Barbuda, Bahamas, Barbados, Dominica, the Dominican Republic, Grenada, Haiti, Jamaica, Saint Kitts and

Nevis, Saint Lucia, Saint Vincent and the Grenadines and Trinidad and Tobago). We were thus able to calculate

rates of use at the subregional level.

However, when we analyze subregional data, we must bear in mind the weight of the large countries in each

subregion, such as the United States in North America and Brazil in South America, since they greatly impact

the subregional average. In order to calculate subregional indicators, only those countries whose studies were

from 2010 or later were included, and therefore, Bolivia, Dominican Republic, El Salvador, Honduras, Panama,

Paraguay, Suriname and Venezuela were omitted from the regional averages.

Information presented in this report on the perception of risk is based on a module of questions on student

perceptions of certain drug taking behaviors. In the English speaking Caribbean, the question asks students

about the ‘perception of harmfulness to health’ while in Spanish speaking countries in Latin America the

question asks about ‘perception of risk’. Even though these questions are not strictly the same, they attempt to

measure similar concepts and data from the two regions suggest that the results are similar. For the purposes

of this report, the results on perception of risk are treated as comparable.

General population

The information on the general population is drawn from national studies among people aged 12‐64, while

Argentina’s data are on 16‐65 year olds, Uruguay, ages 15‐65, and Canada, ages 15‐64. While the United States


defines the general population as 12 years and older, for the purposes of this report, the population was

adjusted to ages 12‐64, and it is on that population that the indicators are presented. The questions designed

to measure rates of prevalence, perception of high risk, ease of access and offers of substances are similar

among countries.

In all the countries, these general population studies used a household survey methodology, with random

selection of the one respondent per household and the application of the questionnaire in a private interview.

The sample designs are national in scope and cover urban populations in different proportions for each

country.

Information is available from nineteen countries as described in the table above: the three in North America,

three in Central America, eleven in South America, and only two from the Caribbean. Therefore, subregional

data are not calculated for the indicators on use among the general population.

University students

With respect to studies among university students, information is available from seven countries. In four of

these, which are part of the Andean Community (Bolivia, Colombia, Ecuador and Peru), the studies were

conducted using the same methodology (on‐line data collection on the basis of national samples and random

selection of students) and were part of the same Andean Community project in 2012 and 2009. In addition, El

Salvador (2012) used the same methodology as the Andean countries and information is also available from

Brazil (2010) and Venezuela (2014), although using a different methodology.

Trend data

For the three populations analyzed, trend data were used from those countries that have at least three

comparable studies that have been published. These data were obtained from the corresponding National

Observatories on Drugs or equivalent. This was the case with studies among secondary school students in

Argentina (2001‐2011)5, Chile (2001‐2013)6, Peru (2005‐2012)7, Costa Rica (2006‐2012)8, Uruguay (2003‐2014)9

and the United States (1991‐2013)10. Exceptionally, data from Mexico City (1989‐2012)11 were also included

because of the very long period of time over which substance use has been monitored. Comparable data from

general population studies were included from Argentina (2004‐2011) 12, Chile (1994‐2012)13, Mexico (2002‐

2011)14, Peru (1998‐2010)15, United States (2002‐2013)16 and Uruguay (2001‐2011)17.

Also included in this report are data from the comparable studies conducted among secondary school students

in the countries of the Caribbean: the information from the initial studies conducted in 2009 or before and the

studies from 2011‐2014 is homogeneous and covers the subregion as a whole. We also include comparative

data from equivalent general population studies in Colombia (2008 and 2013) and from secondary school

studies among ages 10‐19 and older in Brazil (2004 and 2010).

This report covers a significant body of information that allows us to analyze levels of substance use, use at an

early age, and some selected risk and protection factors in the hemisphere. This attempt to identify trends and

problems has its limitations. We are fully aware that in order to give a full account of the drug problem and the

30 | O A S ‐ C I C A D

problem of substance abuse itself, more information and analysis is needed, as well as sources of information

and studies that are complementary.

A number of countries of the hemisphere have moved forward in this direction and have developed lines of

research that allow them to examine drug‐related mortality and morbidity, episodes of violence and the

commission of crimes, domestic violence, street violence and self‐inflicted violence. They are also conducting

qualitative studies that explore and describe the complex world of the social representations associated with

the use and abuse of psychoactive substances, as well as qualitative and quantitative studies among the so‐

called hidden populations, to estimate the extent and specific patterns of drug use.

Further research is being carried out to examine the impact that the countries’ regulatory and legal systems

have on the human rights of substance users and on the stigmatization and criminalization of users.

Indicators on the supply of drugs, such as seizures, trafficking routes, and the production and diversion of

chemical precursors, need to be incorporated into a more comprehensive and explanatory report. It is also

absolutely necessary that progress be made in analyzing the chemical compositions of drugs, their purity and

the quantities and types of adulterants and diluents that are used in preparation and that impact the harms

caused by these substances.

In short, this effort to present the information is merely the tip of the iceberg in terms of some very complex

and rapidly changing problems.

Comparability of the information

Although all the studies have the same reference population (apart from the exceptions discussed above), the

same methodologies were used to draw the samples and collect the information, and the same questions were

asked in order to estimate the indicators selected for the present report, the data are not strictly comparable.

To make them strictly comparable, the populations ought to have been standardized and the samples adjusted

accordingly, and the studies carried out under conditions of strict comparability.

ORGANIZATION OF THE REPORT: DIMENSIONS AND CHAPTERS

In order to provide as much information as possible, while at the same time making the topics understandable

in a readable narrative, this report is organized on the basis of the different psychoactive substances. Thus,

each chapter brings together the data, descriptions and analysis of each substance in the following order:

alcohol, tobacco, marijuana, inhalants, cocaines (cocaine hydrochloride, cocaine base paste and crack),

amphetamine‐type stimulants and other emerging themes.

We look first at levels of use of each psychoactive substance by lifetime prevalence, past 12 months (past year,

also occasionally referred to as “recent use” in this report) and past 30 days (past month, also referred to as


“current use”). In order to examine substance use at a young age, we analyze the prevalence of use among 8th

grade students as reported in the studies on secondary school students. We have also emphasized adolescents

(aged 12‐17) and young adults (aged 18‐34) in the general population studies, since these are the age groups in

which there is the highest level of drug use worldwide.

The information on each of the countries is organized by subregion. The purpose is not to provide a ranking,

but rather to allow each country to see itself within its own subregion, and to look at each subregion in relation

to the others.

Second, we include variables that might provide information on drug use that were found in the

epidemiological studies underlying this report, and that are fairly comparable and available in all of the studies

and all of the countries (secondary school students, general population and university students). While these

variables cannot pretend to explain or be determinant of substance use, most of the time they are associated

with drug use. These indicators are the perception of the high risk of occasional and frequent use, the

perception of ease of access to marijuana, cocaine, cocaine base paste and “ecstasy”, and offers received of

each of these substances.

Opinions were asked about the perceived risk of occasional drug use, and frequent drug use. While the

information available covers a broad range of responses, from high risk, moderate risk, and no risk to “don’t

know”, the high‐risk view was selected for the present report. The percentage of the population that sees drug

use as high risk would, from the point of view of the perceived harm, be less likely to use drugs—although,

according to international evidence, they are not immune to drug use.

The information on the perception of ease of access analyses the responses that speak to how easy it is, from a

subjective point of view, to obtain certain drugs.

The answers to the question “have you been offered drugs at any time in the past year or past month, whether

to buy or try?” are an objective measure of the percentages of the population that received direct offers of

drugs, assuming that greater availability would produce a greater risk of using a particular psychoactive

substance.

These two indicators are both related to access to drugs. The difference between them is that the former, the

perceived ease of access, like any perception, comes from a variety of different sources and may be influenced

by the environment, the media or the person’s own experience. On the other hand, the indicator on direct

offers of substances refers to a concrete event that the respondent actually experienced, that is, over a

particular period of time, he or she received an offer of the particular drug.

For each of these three dimensions (perception of high risk, perception of ease of access, and offers received),

we analyze its association with rates of substance use, in an effort to gain a better understanding of the

phenomenon of drug use in the hemisphere.

Third, we look at trends in drug use based on available information from the countries, as detailed above.

This report is organized as follows:

32 | O A S ‐ C I C A D

An Executive Summary provides a rapid overview of the major topics by chapter, and the principal conclusions

and recommendations drawn from the findings.

Separate chapters on each psychoactive substance give the data and analyses as described above.

The Appendix contains tables on each psychoactive substance, giving details about lifetime, past year and past

month prevalence rates from studies among secondary school students, general population and university

students; past year prevalence by sex and grade among secondary school students; past year prevalence by sex

and age group in the general population; the distribution of opinions about the perceived high risk of

occasional and frequent use, the perception of ease of access and offers of drugs received, among the three

populations analyzed.


CHAPTER 1: A L C O H O L

Introduction Alcohol is one of the most commonly used psychoactive substances worldwide. It is of particular concern in

the Americas, where the per capita consumption is estimated to be 30% higher than the global average.18

Although the majority of people who consume alcohol never develop a problem, science indicates that the

earlier individuals begin using alcohol, the more likely they are to develop hazardous drinking behavior, and

alcohol‐related diseases over time. Alcohol represents one of the most important risks to health, particularly

in low and middle income countries of the Americas and is linked to both the incidence of disease as well as to

the impact of a disease in the body. Indeed, alcohol use is the primary factor behind more than sixty types of

illnesses and injuries and is responsible for approximately 2.5 million deaths per year worldwide. 19 Alcohol use

is also linked to a variety of social problems.20,21 It is strongly associated with domestic violence, child neglect

and abuse, crime and criminal behavior.22,23,24,25,26,27,28

Adolescents are a particularly vulnerable group due to their stage of development. Research indicates that

initiating alcohol use prior to age 15 is associated with an increased risk for alcohol related problems in

adulthood.29,30 Hence any alcohol consumption in this population is considered high risk behavior and further

associated with other high risk behaviors such as drinking and driving, tobacco use and early sexual behavior.

Indeed, given that alcohol is a controlled substance in every country in the hemisphere, any alcohol use among

people below the legal drinking age should be considered misuse.

Alcohol use among the secondary school population There appears to be a broad range of drinking behavior across the Americas. In five South American and

Caribbean countries, more than 75% of secondary school students have used alcohol at some point in their

lifetime, while in El Salvador and Venezuela, slightly over 30% have experimented with alcohol.

There is a broad range of past year prevalence of alcohol use among secondary school students in South

America, from less than 20% to almost 70%. Over 50% of secondary school students in Antigua, Argentina,

Barbados, Chile, Colombia, Dominica, Grenada, Paraguay, Saint Vincent and the Grenadines, Saint Lucia,

Suriname and Uruguay have used alcohol during the past year. Bahamas, Belize, Canada, Jamaica, St. Kitts,

Trinidad and Tobago, and the United States have past year prevalence of between 40% and 50%. The lowest

rates, at about 20% or less, can be found in Ecuador, El Salvador and Venezuela.

In this chapter, we will use past month prevalence as the primary indicator for alcohol use in each population.

The past month prevalence shows a broad range across the hemisphere from less than 10% to over 50%. In

Graph 1‐1, we can observe that five countries have past month prevalence of alcohol use among secondary

school students of over 40%. These numbers suggest that in many of the member states alcohol is easily

accessed by this population.

34 | O A S ‐ C I C A D

Graph 1‐1: Past month prevalence of alcohol consumption among secondary school students in the Americas

Adolescence is considered to be a critical risk period for the initiation of alcohol use.31 Studies indicate that

beginning alcohol and other substance use in early adolescence (ages 12‐14) 32 is associated with greater

likelihood of abuse or dependence over time than for those who initiate alcohol use during adulthood. Indeed,

research indicates that the earlier a person begins using alcohol, the greater the risk over time for a variety of

adverse health effects.

In Graph 1‐2, we can see that in Argentina, Colombia and St. Vincent, nearly half of all secondary school

students have used alcohol during the past month.

Graph 1‐2: Past month prevalence of alcohol among secondary school students by sub‐region

05

101520253035404550

S.Lucia (2013)

S.Vincent‐Grenadines (2013)

Antigua‐Barbuda (2013)

Dominica (2011)

Grenada (2013)

Dominican

Rep

. (2008)

Barbados (2013)

Trinidad

‐Tobago (2013)

Baham

as (2011)

S.Kitts‐Nevis(2013)

Jamaica (2013)

Haiti (2014)

Prevalence (%)

0

10

20

30

40

50

60

United

States (2014)

Belize (2013)

Costa Rica (2012)

Panam

a (2008)

Honduras (2005)

El Salvador (2008)

Colombia (2011)

Argentina (2011)

Paraguay (2005)

Uruguay (2014)

Surinam

e (2006)

Chile (2013)

Bolivia (2008)

Ven

ezuela (2009)

Guyana (2013)

Peru (2012)

Ecuador (2012)

S. Vincent‐Grenadines…

S. Lucia (2013)


Dominica (2011)

Grenada (2013)

Dominican

Rep

. (2008)

Barbados (2013)

Trinidad

‐Tobago (2013)

Baham

as (2011)

S. Kitts‐Nevis (2013)

Jamaica (2013)

Hait i (2014)

Prevalence (%)


Of the twenty‐nine countries on this chart, fourteen show past month prevalence of alcohol use among

secondary school students exceeding 30%. The lowest past month prevalence for this population are found in

Honduras at 12.7%, Peru and El Salvador both have past month prevalence at close to 12%, and Ecuador at

about 7%.

Graph 1‐3 shows alcohol use among eighth graders, who are the youngest age group in the secondary school surveys.

Graph 1‐3: Past month prevalence of alcohol use among secondary

school students in eighth grade by country and by sub‐region

In Argentina, Colombia and Saint Vincent, at least 30% of secondary school students in the eighth grade have

consumed alcohol within the past thirty days. In more than half of the countries shown, at least 15% of eighth

graders have consumed alcohol within the last month. Such early regular use of alcohol in this population

highlights the need for special focus on prevention and early intervention.

Alcohol use among secondary school students rises rapidly across age groups (Graph 1‐4). In the United States,

Panama, Ecuador, Peru, Chile, Barbados and the Dominican Republic, past month alcohol use tripled between

the 8th and 12th grades. In twenty of the countries, past month alcohol use more than doubled between the 8th

and 12th grades.

0

5

10

15

20

25

30

35

40

45United

States (2014)

Belize (2013)

Honduras (2005)

Costa Rica (2012)

Panam

a (2008)

El Salvador (2008)

Colombia (2011)

Argentina (2011)

Paraguay (2005)

Surinam

e (2006)

Uruguay (2014)

Bolivia (2008)

Chile (2013)

Ven

ezuela (2009)

Guyana (2013)

Peru (2012)

Ecuador (2012)

S. Vincent‐Grenadines (2013)

S. Lucia (2013)


Dominica (2011)

Grenada (2013)

Haiti (2014)


Dominican

Rep

. (2008)

Trinidad

‐Tobago (2013)

Baham

as (2011)

Jamaica (2013)

Barbados (2013)

Prevalence(%

)

36 | O A S ‐ C I C A D

Graph 1‐4: Ratio of increase in past month alcohol use from 8th grade to 12th grade secondary school students

Taking the weighted mean of alcohol use among students in South America (Table 1‐1), using recent data (2010

and later), the average past month use was over 35% in South America. Note that the range for South America

is very broad, from about 7% in Ecuador to just over 50% in Colombia. Although the range of past month

prevalence is the same for the hemisphere as a whole, the weighted average past month prevalence for South

America is significantly higher than in the hemisphere.

Table 1‐1: Weighted average of past month prevalence of alcohol use among secondary school students by subregion and total hemisphere, using data from 2010 or later

Region/subregion Past month Minimum value‐Maximum value

South America 35.76 7.3 ‐ 50.18

The Caribbean 24.78 22.9 ‐ 47.06

Hemisphere 26.76 7.3 ‐ 50.18

* Only countries with information from 2010 and later are included. Weighted means are not available for North America and Central America.

In the Caribbean, the range of past month prevalence is smaller; however the weighted average is slightly

lower than the weighted average for the hemisphere. In the case of the Caribbean, it is also important to note

that the weighted mean is strongly influenced by Jamaica and Haiti, which have much larger populations than

the other islands.

When we look at alcohol use by sex among secondary school students (Graph 1‐5), we see that in the majority

of countries, alcohol use between boys and girls is similar.

0

1

2

3

4

5

United

States (2014)

Panam

a (2008)

El Salvador (2008)

Costa Rica (2012)

Haiti (2014)

Belize (2013)

Honduras (2005)

Ecuador (2012)

Peru (2012)

Chile (2013)

Ven

ezuela (2009)

Uruguay (2014)

Bolivia (2008)

Argentina (2011)

Paraguay (2015)

Surinam

e (2006)

Guyana (2013)

Colombia (2011)

Barbados (2013)

Dominican

Rep

. (2008)

Baham

as (2011)

Trinidad

‐Tobago (2013)

Grenada (2013)

Jamaica (2013)

Dominica (2011)



S. Lucia (2013)


Ratio


Graph 1‐5: Past month prevalence of alcohol use among secondary

school students by sex, country and sub region

In Belize, Costa Rica, El Salvador, Argentina, Colombia, Paraguay, Uruguay, Chile, Ecuador, Guyana, Peru, Saint

Vincent, Grenada, Barbados, Saint Kitts and Nevis and Jamaica, the prevalence of use between males and

females are practically the same. The largest difference was found in Haiti, where the proportion of boys that

consumed alcohol in the past month is almost twice as much as girls.

It is interesting to note that in seven countries, although past month prevalence for boys and girls was similar,

the prevalence among girls is marginally higher than among boys in the United States, Antigua, Bahamas,

Dominica, Dominican Republic, St. Lucia and Trinidad and Tobago.

Binge drinking

Importantly, the countries in the hemisphere apply slightly different definitions of binge drinking. In countries

that apply the SIDUC methodology, binge drinking is defined as the proportion of students who consumed

alcohol during the past month who also reported consuming five drinks or more on a single occasion during the

two weeks prior to the survey. This differs from both Canada and the United States, where binge drinking

among adolescents is defined as four drinks for females and five drinks for males on a single occasion.

In addition, while the SIDUC methodology calculates binge drinking as a proportion of all past month users, the

United States and Canada use slightly different measures: the United States measures binge drinking among

high school students as a proportion of all students, while Canada measures binge drinking as a proportion of

past year users. Hence, in their respective contexts, the United States estimates that approximately 12.5% of

male high school students and 10.9% of female high school students engaged in binge drinking in the year prior

to the survey (Monitoring the Future, 2014), while Canada estimates that approximately 38.6% of male and

35.2% of female students who consumed alcohol during the year prior to the survey binge drank.

0

10

20

30

40

50

60

United

States (2014)

Panam

a (2008)

Costa Rica (2012)

Honduras (2005)

El Salvador (2008)

Argentina (2011)

Colombia (2011)

Surinam

e (2006)

Paraguay (2005)

Uruguay (2014)

Chile (2013)

Bolivia (2008)

Guyana (2013)

Ven

ezuela (2009)

Peru (2012)

Ecuador (2012)


S. Lucia (2013)


Grenada (2013)

Belize (2013)

Dominica (2011)

Barbados (2013)

Haiti (2014)

Dominican

Rep

. (2008)

S. Kitts (2013)

Trinidad

‐Tobago (2013)

Baham

as (2011)

Jamaica (2013)

Prevalence(%

)Males Females

38 | O A S ‐ C I C A D

Graph 1‐6 shows binge drinking rates among secondary school students who reported having consumed

alcohol at some time during the 30 days prior to the survey.

Graph 1‐6: Binge drinking among past‐month users, secondary school

students in Latin America and the Caribbean.

Binge drinking rates ranged between just under 50% to just below 70%. In South America we see that In

Argentina, Chile, Guyana, Peru, Suriname and Uruguay, binge drinking is between 60% and 70% of past month

users. Nearly all the Caribbean countries show binge drinking rates of between 40%‐60% of past month users.

In other words, in nearly every country presented, one out of every two students who drank alcohol during the

past month also reported at least one binge drinking episode in the two weeks prior to the survey.

If we look at binge drinking in a slightly different context, other patterns emerge. Taking only the population

who consumed alcohol during the past thirty days (Graph 1‐7), we see that regardless of prevalence in the

countries, binge drinking among past month alcohol users ranges consistently between about 50% and 70%.

Graph 1‐7: Association between binge drinking as a proportion of past month

users and past month prevalence (each point represents an individual country).

0

10

20

30

40

50

60

70

80

0

10

20

30

40

50

60

70

80

0 10 20 30 40 50 60

past month prevalence

Binge drinking/

past month users


This implies that binge drinking may be independent from the overall prevalence of alcohol use among

secondary school students, and is more concentrated among the higher risk adolescents.

Nevertheless, if we look at binge drinking as a proportion of the entire secondary school population, we can

see that as the prevalence of alcohol increases, the proportion of students that reported binge drinking also

increases (Graph 1‐8). This may be an important point for policy makers when considering resource

distribution for prevention and early intervention.

Graph 1‐8: Association between binge drinking as a proportion of the entire population

and past month prevalence (each point represents an individual country)

Trends in the secondary school population

The trends in alcohol use among secondary school students vary by country. In Argentina, Chile and Costa Rica,

past month prevalence of alcohol use among secondary school students appears to be stable over time. In the

United States, Peru and Uruguay, alcohol use among secondary school students appears to be decreasing.

Graph 1‐9: Past month prevalence of alcohol use among secondary school students in

Argentina, 2001‐2011

Graph 1‐10 Past month prevalence of alcohol use among secondary school students in

Chile, 2001‐2013

0

5

10

15

20

25

30

35

0 10 20 30 40 50 60

Binge drinking / en

tire population

past month prevalence

50.3

40.7

60.1

46.749.7

0

10

20

30

40

50

60

70

2001 2005 2007 2009 2011

Prevalence (%)

38.9

38.7 43.3

38.1

35.5

34.7

35.6

0

10

20

30

40

50

60

70

2001 2003 2005 2007 2009 2011 2013

Prevalence (%)

40 | O A S ‐ C I C A D


Costa Rica, 2006‐2012

Graph 1‐12: Past year prevalence of alcohol use among secondary school students in

Peru, 2005‐2012


Uruguay, 2008‐2014

Graph 1‐14: Past month prevalence of alcohol use among secondary school students in the

United States, 1991‐2013

Mexico has trend data for secondary school students in Mexico City only. According to these data, past month

alcohol use has risen steadily from 30.1% in 1997 to 40.1% in 2012.

Although we do not have trend data from every country in the hemisphere, several countries have two data

points that are worth mentioning. In Colombia, the two school surveys carried in 2008 and 2013 showed an

increase in past month prevalence among secondary school students from 33.8% to 35.8%.33 In Guyana, past

month prevalence decreased from 38.2% in 2007 to 16.5% in 2013.

Graph 1‐15 shows past month prevalence among secondary school students in the Caribbean subregion.

18.921.7 20.1

0

10

20

30

40

50

60

70

2006 2009 2012

Prevalence (%)

39.9

29.924.5

19.7

0

10

20

30

40

50

60

70

2005 2007 2009 2012

Prevalence (%)

55.951.4

54.3 52.748.2

38.7

0

10

20

30

40

50

60

70

2003 2005 2007 2009 2011 2014

Prevalence (%)

38.4

37.6 38.8

37.4

36.6

33.3

32.9

31

28.1

26.8

25.9

22.6

0

10

20

30

40

50

60

70

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

Prevalence (%)


Graph 1‐15: Past month prevalence of alcohol use among secondary school students

In these countries, past month prevalence of alcohol use decreased for every country except Antigua and

Barbuda and Saint Vincent.

Alcohol use in the general population The following section describes data on alcohol taken from general population studies. In the countries that

use the SIDUC methodology, the general population covers the 12‐64 age group. However, data from some

countries cover slightly different populations, which may affect the prevalence. In Argentina, the general

population is defined as ages 16‐65, in Uruguay ages 15 to 65, while in Canada the general population is

defined as age 15‐64 years. The United States defines the general population as age 12 and over; however, for

purposes of this report, the United States provided data for ages 12‐64 years of age.

There is a great deal of diversity in alcohol consumption across the hemisphere. Lifetime prevalence ranges

from less than 40% in Costa Rica to over 90% in Uruguay. Past year prevalence of alcohol is between 50% and

60% in Mexico, Peru, Venezuela, Barbados, Chile, Dominican Republic, Colombia and Bolivia, with rates just

below 50% in both Brazil and Suriname (Table A1.4 Appendix). Over 65% of the general population in

Argentina, Canada, Paraguay, United States and Uruguay consumed alcohol in the past year, while less than

40% of the population consumed alcohol during the past year in Belize, Ecuador, Costa Rica and El Salvador.

The lowest past year prevalence was found in El Salvador at 18%.

Graph 1‐16 shows the wide range of alcohol use among the general population during the past thirty days.

0

10

20

30

40

50

60

70

Antigua‐Barbuda

Baham

as

Barbados

Belize

Dominica

Grenada

Haiti

Jamaica

S. Kitts‐Nevis

S. Vincent‐Grenadines

S. Lucia

Trinidad

‐Tobago

Prevalence (%)

2009 or before 2011‐2014

42 | O A S ‐ C I C A D

Graph 1‐16: Past month prevalence of alcohol use in the general population by country

and subregion.iii

Past month prevalence ranges from less than 10% in El Salvador to over 60% in Canada. In the majority of

countries shown, we see that at least three in ten people in the general population drink alcohol on a monthly

basis.

When we look at alcohol use in the general population (Graph 1‐17) by age group, we see that the highest

levels of use across the hemisphere are found in the adult population aged 18‐34.

Graph 1‐17: Past month prevalence of alcohol use in the general population

by age groups 12‐17, 18‐34 and 35‐64,by country and subregioniv

iii Argentina: population aged 16‐64, Canada: population aged 15‐64, and Uruguay: population aged 15‐65 iv Argentina: population aged 16‐64, Canada : population aged 15‐64, and Uruguay: population aged 15‐65

0

10

20

30

40

50

60

70

Canada (2012)

United

States (2013)

Mexico (2011)

Costa Rica (2010)

El Salvador (2014)

Uruguay (2011)

Argentina (2011)

Paraguay (2003)

Chile (2012)

Brazil (2005)

Bolivia (2014)

Colombia (2013)

Ven

ezuela (2011)

Surinam

e (2007)

Peru (2010)

Ecuador (2013)

Barbados (2006)

Dominican

Rep

. (2010)

Belize (2005)

Prevalence(%

)

0

10

20

30

40

50

60

70

80

Canada (2012)

United

States (2013)

Belize (2005)

Costa Rica (2010)

El Salvador (2014)

Argentina (2011)

Bolivia (2007)

Uruguay (2011)

Paraguay (2003)

Chile (2012)

Colombia (2013)

Surinam

e (2007)

Peru (2010)

Ecuador (2013)

Dominican

Rep

. (2010)

Barbados (2006)

Prevalence(%

)

12 to 17 18 to 34 35 to 64


Nevertheless, there are significant levels of regular alcohol use among minors in nearly every country. In

Argentina, upwards of 40% of people between the ages of 16‐17 consume alcohol at least once a month. In

Uruguay, almost 52% of 15‐18 year olds consumed alcohol in the past month. Given the issues associated with

early drinking, any alcohol consumption among this age group should be a matter of concern.

Although Mexico is not included in this graph because it does not have data for each age group, the past month

prevalence among 12‐17 year‐olds in Mexico was 14.5%. For all other countries included in this analysis, the

past month prevalence of alcohol use is 20% or less. Indeed, in Costa Rica, El Salvador, Bolivia, and Ecuador the

rate for this group is less than 5%.

However, the results in the 12 to 17 age group should be interpreted with some caution. The past month

prevalence of alcohol use in Uruguay (48.7%), Argentina (40.6%) and Canada (24.6%) appear to be significantly

higher than the other countries, but this may be explained in part by the fact that the actual age ranges

represented in these countries do not correspond exactly with the 12 to 17 year olds in the other countries.

High risk or hazardous drinking

According to the World Health Organizaiton (WHO), hazardous drinking is defined as a pattern of alcohol

consumption that increases the risk of harmful consequences for the user or others. Hazardous drinking

behavior increases the risk of harm to either the user or others, although the user may not be diagnosed with

an alcohol related disorder.

Several member states apply screening tools to measure hazardous drinking behavior. The following graph

shows data taken from four South American countries that measure hazardous drinking behavior in their

household surveys. Argentina, Chile, Colombia and Uruguay apply the Alcohol Use Disorders Identification

Test (AUDIT)34 self‐report version in their general population surveys.

In the general population, hazardous drinking does not rise proportionately with prevalence. Graph 1‐18

shows the levels of hazardous alcohol use in four South American countries.

Graph 1‐18: Past year prevalence and hazardous alcohol use among past year users

in the general population

0

10

20

30

40

50

60

70

80

Argentina (2011) Chile (2012) Colombia (2013) Uruguay (2011)

Prevalence (%)

Past Year Prevalence Hazardous use

44 | O A S ‐ C I C A D

Uruguay shows the highest past year prevalence but has the lowest rates of hazardous use. In Colombia, more

than 20% of people who consumed alcohol during the past year fit the criteria for hazardous use. Indeed,

hazardous use among Colombian males and females is higher than among their counterparts in the other

countries. Argentina shows hazardous use rates just above 10% and in Chile, just below 10%.

Peru carried out a similar study using an instrument known as the Brief Scale on Abnormal Drinking (Escala

Breve de Beber Anormal) 35 to measure problematic use. Peru (2010) estimated that approximately 22% of

males and 8% of females (total 15.8%) in the general population show signs of hazardous drinking according

that scale. According to the National Household Survey 2013, in the United States almost one quarter (22.9%)

of persons age 12 or older binge drank in the 30 days prior to the study. 36 This translates into approximately

60.1 million people.37

Trends in the general population

The majority of countries in the Americas do not have trend data on alcohol use in the general population.

Argentina, United States and Uruguay show stable trends in use over time. Peru shows a notable decline in

past month prevalence from 46.3% in 1998 to 30.5% in 2010, as well as Chile between 2006 and 2012 (from

58.1% to 40.8%).

In Colombia, only two data points are available: 33.85% in 2008 and 35.8% 2013,38 which makes it difficult to

determine a trend.

Graph 1‐19: Past month prevalence of alcohol use among the general population in Argentina, 2004‐2011

Graph 1‐20: Past month prevalence of alcohol use among the general population in

Chile, 1994‐2012

55.452.9 50.3

48.4

54.8

0

10

20

30

40

50

60

2004 2006 2008 2010 2011

Prevalence (%)

40.4 48.1

53

54.4

59.6 57.9

58.1

49.8

40.5

40.8

0

10

20

30

40

50

60

Prevalence (%)


Graph 1‐21: Past month prevalence of alcohol use among

the general population in Uruguay, 2001‐2011

Graph 1‐22: Past month prevalence of alcohol use among

the general population in Peru, 1998‐2010

Graph 1‐23: Past month prevalence of alcohol use in the

general population in the United States, 2002‐2013

Alcohol use among university students Thus far, only five countries in the hemisphere have participated with CICAD in surveys of university students:

Bolivia, Colombia, Ecuador, El Salvador and Peru. Brazil and Venezuela have carried out similar studies using

their own methodologies. The four countries from the Andean subregion participated in a set of surveys

among the university population, an initial survey in 2009 and a second follow up survey in 2012. Although we

do not have enough data points to identify trends, we can observe some changes in drinking prevalence during

this time period. The tables and graphs in this section refer to data on alcohol use among the university

population in the seven Latin American countries. Comparative data are available for the four countries that

have repeated studies.

By the time most teenagers reach the age of majority, they have consumed alcohol at least once in their lives.

Reflected in the data from university populations, where most students are aged 18 and older and have

reached the legal drinking age in their countries, we can observe that more than 60% of university students

53.2 52.455.3

0

10

20

30

40

50

60

2001 2006 2011

Prevalence (%)

46.341.8

34.530.5

0

10

20

30

40

50

60

1998 2002 2006 2010

Prevalence (%)

51

50.1

50.3

51.8 51

51.2

51.6

51.9

51.8

51.8

52.1

52.2

0

10

20

30

40

50

60

Prevalence (%)

46 | O A S ‐ C I C A D

have tried alcohol at least once in their lives. This proportion reaches over 95% in Colombia (Table A1.7

Appendix).

When we look at past month prevalence, we see in Graph 1‐24 that over 60% of university students in Brazil

and Colombia consumed alcohol on a monthly basis, as well as half of university students in Ecuador.

Graph 1‐24: Past month prevalence of alcohol use among university students

in seven countries

Of greater concern among this age group is drinking behavior that is identified as either high risk or hazardous.

High risk drinking can lead to multiple social, medical, financial and other problems, shorten life‐span and lead

to increased mortality from alcohol related accidents (WHO 2001).39 The two graphs below provide

information on the proportion of university students who, according to the AUDIT scale, fit the criteria for high

risk or hazardous drinking behavior.

Graph 1‐25: Proportion of university students who have consumed alcohol during the past year and display signs of high risk or hazardous drinking, 2009 and 2012

Looking at the university students who reported having consumed any alcohol during the past year, we can see

that in each of the four countries in Graph 1‐25, hazardous drinking behavior increased between 2009 and

2012.

When we look at hazardous drinking by sex in Graph 1‐26, we can see that overall, hazardous drinking has

increased among females in every country surveyed, although they still show lower rates than males.

0

10

20

30

40

50

60

70

El Salvador(2012)

Bolivia(2012)

Brazil(2010)

Colombia(2012)

Ecuador(2012)

Peru(2012)

Venezuela(2014)

Prevalence (%)

0

5

10

15

20

25

30

35

40

45

Bolivia Colombia Ecuador Peru

2009

2012


Graph 1‐26 proportion of university students who have consumed alcohol during the past year that display signs of high risk or hazardous drinking, 2009 and 2012, by sex

Hazardous drinking decreased slightly among male students in Colombia and Ecuador, but increased in both

Bolivia and Peru. In the case of Colombia and Ecuador, hazardous drinking decreased among the male

university students, but increased among females in the same time period.

0

10

20

30

40

50

60

Bolivia Colombia Ecuador Peru

Males 2009

males 2012

Females 2009

Females 2012

48 | O A S ‐ C I C A D

CHAPTER 2: T O B A C C O

Introduction Tobacco is a plant that contains an addictive substance known as nicotine that is consumed in all parts of the

world. According to the World Health Organization (WHO), traditional tobacco products such as cigarettes,

cigars, loose tobacco for pipes, snuff, and chewing tobacco are either smoked, snuffed, chewed, or sucked.40

New applications of technology have resulted in the increased popularity of the electronic cigarette (e‐

cigarette) or vaporizers as a means of delivery for nicotine. E‐cigarettes are basically battery operated devices

that contain a cartridge usually filled with nicotine, a flavoring agent, and other chemicals. The device turns this

mixture into a vapor that is then inhaled by the user. In July 2009, the United States Food and Drug

Administration issued a warning about the health risks posed by e‐cigarettes41. The health impacts of using

these devices continue to be studied as their use increases.

The health burden of tobacco is such that the Pan American Health Organization (PAHO) refers to it as an

epidemic.42 Smoking tobacco has been shown to cause cancer and diseases of the lung, and it increases the

risk of heart disease. In a 2013 report, PAHO states that worldwide, 12% of all deaths of adults aged 30 and

over are attributable to tobacco use and exposure to second‐hand smoke, while in the Americas, this figure

increases to 16%. So, the health risks are not only to the users, but also to persons who are exposed to second‐

hand smoke. PAHO estimates that tobacco consumption and exposure to second‐hand smoke kills 6 million

people in the world every year, including about 1 million people in the Americas. The prevalence of tobacco

use varies substantially worldwide for men and women, but in general men are more likely to be users.43

The mortality and morbidity caused by tobacco are largely preventable and it is for this reason that the WHO

Framework Convention on Tobacco Control (FCTC) was adopted in May 2003 and entered into force in

February 2005. The Convention was developed to reduce the supply of and demand for tobacco and tobacco

products. It aims to prevent smoking by young people, prevent exposure to second‐hand smoke, and help

smokers to quit and remain abstinent. In its guidelines for implementation, WHO presents six distinct

interventions which address the provisions of the Convention (WHO, 2013). These are:

Monitor tobacco use and prevention policies

Protect people from tobacco smoke

Offer help to quit tobacco use

Warn about the dangers of tobacco

Enforce bans on tobacco advertising, promotion and sponsorship

Raise taxes on tobacco.

Further to these guidelines, WHO also launched a Global Tobacco Surveillance System in August 2013, which

includes a standard set of 22 key questions to be included in surveys of adults in its member states.

This chapter attempts to present the state of tobacco consumption in the Americas by collating and analyzing

data from three main sources:


General population (household) surveys

Secondary school student surveys

University student surveys

Prevalence figures largely refer to the smoking of manufactured cigarettes and not to other tobacco products

that are consumed in a variety of other ways.

Use of tobacco in the secondary school students Graph 2‐1 shows the past month prevalence of tobacco use among secondary school students in the Americas

in a geographic way where the countries are color coded according to specific ranges of past month tobacco

use. Graph 2‐2 shows the past month prevalence of tobacco use among secondary school students in specific

countries across the Americas. These results show first and foremost that there is a great deal of variation in

the prevalence of tobacco use among the countries included in this analysis. Prevalence values range from

24.5% in Chile to 1.8% in Antigua and Barbuda. Besides Chile, the countries with rates of use higher than 10%

are Argentina (18.7%), Paraguay (14.7%), Bolivia (13.3%), Canada (12.9%) and Colombia (12.5%). On the other

end of the spectrum, the Dominican Republic (1.9%), Bahamas (2.1%), Guyana (2.5%), Saint Kitts and Nevis

(2.6%), Barbados (2.9%), Saint Lucia (3.9%), Jamaica (4.5%) and Panama (4.8%) report rates of use that are less

than 5%. All other countries included in this analysis reported rates between 5% and 10%.

Graph 2‐1: Past month prevalence of tobacco use in the secondary school

population in the Americas

0

1

2

3

4

5

6

7

8

Prevalence (%)

50 | O A S ‐ C I C A D

Graph 2‐2: Past month prevalence of tobacco use in the secondary school population, by subregion

Table 2‐1 shows the past month prevalence of tobacco use by region and for all students overall. The average

prevalence is highest in South America (13.5%) and lowest in the Caribbean (5.1%). It should be noted that the

region with the broadest range of values is South America has values that include or fall between 9.1% and

24.5%. The average for these three regions is 7.1%.

Table 2‐1: Past month prevalence of tobacco use by subregion in the Americas as a whole

Subregion Past month Minimum value‐Maximum value

North America 8.0 8.0 ‐ 12.9

South America 13.8 9.1 ‐ 24.5

The Caribbean 5.1 1.8 ‐ 7.4

Hemisphere 7.1 1.8 ‐ 24.5

*Only countries with information from 2010 and later are included. Weighted means are not available

for North America and Central America

When prevalence rates are analyzed by sex (Table A2.2 Appendix), prevalence among males exceeds that of

females in the vast majority of countries. However, the amount by which male prevalence exceeds female

prevalence varies significantly from country to country. Graph 2‐3 helps to portray these differences more

clearly. In Guyana for example, the prevalence among males is about 3.6 times that of females, while in

Suriname the rate among males is 3.3 times that of females. Saint Vincent and the Grenadines and Argentina

0

5

10

15

20

25

30

Canada (2010/11)

United

States (2014)

El Salvador (2008)

Honduras (2005)

Belize (2013)

Costa Rica (2012)

Panam

a (2008)

Chile (2013)

Argentina (2011)

Paraguay (2005)

Bolivia (2008)

Colombia (2011)

Uruguay (2014)

Peru (2012)

Surinam

e (2006)

Ven

ezuela (2009)

Ecuador (2012)

Dominica (2011)

Trinidad

‐Tobago (2013)


Grenada (2013)

Haiti (2014)

Jamaica (2013)

S. Lucia (2013)

Barbados (2013)

Saint Kitts‐Nevis (2013)

Guyana (2013)

Baham

as (2011)

Dominican

Rep

. (2008)


Prevalence ( %)


with male to female prevalence ratios of 1.04 and 1.1 respectively are the two countries with the smallest

difference in prevalence rates between males and females. The exceptions are Uruguay, Chile, and Antigua and

Barbuda where the prevalence rates among female students are higher than those among male students with

ratios of 0.9, 0.8 and 0.4 respectively.

Graph 2‐3: Ratio of past month prevalence of tobacco use among males to past mont prevalence among females among secondary school studentsv

If we examine the past month prevalence of tobacco use by grade level among secondary school students

(Table A2.3 Appendix), we see great variation when the results are compared across countries and across

grades as obsesrved in other measures. In general, the higher the grade, the higher the prevalence, but there

are four countries, all from the Caribbean, that do not follow this general pattern. In Antigua, Grenada, Saint

Kitts and Nevis and Saint Lucia, prevalence levels do not follow a positive relationship with grade level. In Saint

Lucia and Antigua, the 10th grade students have the lowest prevalence levels while in Saint Kitts and Grenada,

the 12th grade students have the lowest prevalence levels. These patterns could suggest that there may be

issues particular to these countries that influence the behavior of students as they transition from lower to

higher grades. More study would be required to confirm this.

Also of importance is the use of tobacco at a young age. Graph 2‐4 shows the prevalence of tobacco use by

students in the 8th grade of secondary school arranged by subregion. This graph shows that in countries such as

v The ratio of male prevalence to female prevalence will be greater than 1 if the male prevalence value is higher than the value of female prevalence. Conversely, if male prevalence is less than female prevalence, the ratio will be greater than 0 but less than 1. In the graph above, values greater than 1 indicate that male prevalence is higher than female prevalence while values less than 1 indicate that male prevalence is lower than female prevalence.

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

Ratio

52 | O A S ‐ C I C A D

Chile, Argentina, Colombia and Paraguay where levels of tobacco use are higher, there are also higher levels of

tobacco use by students in lower grades. More than 12% of 8th grade students in Chile and Argentina are

current users of tobacco and both of these countries have the two highest overall levels of prevalence among

the countries included in this analysis. What this suggests is that countries where use of tobacco at an early age

is low, overall use in the entire school population is also likely to be low. This is important information for

informing tobacco control policies and programs.

Graph 2‐4: Past month prevalence of tobacco use by secondary school student

in the 8th grade or equivalent, by subregion

Trends in tobacco consumption in the secondary school students

Graphs 2‐5 to 2‐13 show various trends in past month prevalence of tobacco use among secondary school

students in the countries included in this analysis. Without doubt, all of the results demonstrate that to varying

degrees, the use of tobacco is declining. Uruguay shows the steepest decline, followed by Chile and Argentina.

The United States is the country that has the most data available and shows a long and sustained decline from

1996 to 2014. In all cases, these graphs reinforce the point that over the past ten years, there has been a

remarkable decline in the prevalence of tobacco consumption among the secondary school population.

0

2

4

6

8

10

12

14

16

Canada (2010/11)

United

States (2014)

Belize (2013)

El Salvador (2008)

Honduras (2005)

Costa Rica (2012)

Panam

a (2008)

Chile (2013)

Argentina (2011)

Colombia (2011)

Paraguay (2005)

Bolivia (2008)

Surinam

e (2006)

Uruguay (2014)

Peru (2012)

Ecuador (2012)

Guyana (2013)

Grenada (2013)


Dominica (2011)

S. Lucia (2013)

Trinidad

‐Tobago (2013)

Haiti (2014)


Jamaica (2013)

Barbados (2013)


Baham

as (2011)

Dominican

Rep

. (2008)

Prevalence (%)


Graph 2‐5 Past month prevalence of tobacco use among

the Secondary School population in the USA, 1991‐2013

Graph 2‐6: Past month prevalence of tobacco use among

the Secondary School population in Chile, 2001‐2013


the Secondary School population in Uruguay, 2003‐2014


the Secondary School population in Argentina, 2001‐2011


the Secondary School population in Peru, 2005‐2012


the Secondary School population in Barbados, 2002‐2013

24.7 27

17.714.4 12.8

8

0

5

10

15

20

25

30

35

40

45

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

Prevalence (%)

42 41.3

33.1

26.7

0

5

10

15

20

25

30

35

40

45

2001 2003 2005 2007 2009 2011 2013

Prevalence (%)

30.2

24.822

18.413.1

9.2

0

5

10

15

20

25

30

35

40

45

2003 2005 2007 2009 2011 2014

Prevalence (%)

24.822.1 22

19.7 18.7

0

5

10

15

20

25

30

35

40

45

2001 2005 2007 2009 2011

Prevalence (%)

28.5

22.9

17.8

12.8

0

5

10

15

20

25

30

35

40

45

2005 2007 2009 2012

Prevalence (%)

4.56 3.662.91

0

5

10

15

20

25

30

35

40

45

2002 2006 2013

Prevalence (%)

54 | O A S ‐ C I C A D


the Secondary School population in Costa Rica, 2006‐2012


the Secondary School population in Grenada, 2002‐2013


the Secondary School population in Guyana, 2002‐2013

Graph 2‐14 shows a comparison of tobacco use and e‐cigarette use among secondary school students in the

United States. At each grade level, the past month prevalence of e‐cigarettes is higher than that of tobacco. In

the 8th grade and 10th grades, the prevalence of e‐cigarettes is more than twice the value of that for tobacco

(8.7% vs. 4% and 16.2% vs. 7.2% respectively). 2014 was the first year that the annual Monitoring the Future

Study has collected data on e‐cigarettes44 and these results provide some indication that students may be

turning away from manufactured cigarettes in favor of e‐cigarettes. Alternately, new tobacco users may be

using e‐cigarettes as their preferred means of tobacco consumption.

8.5 8.96

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

2006 2009 2012

Prevalence (%)

5.6 5.45 5.390

5

10

15

20

25

30

35

40

45

2002 2005 2013

Prevalence (%)

1.74.13

2.53

0

5

10

15

20

25

30

35

40

45

2002 2007 2013

Prevalence (%)


Graph 2‐14: Past Month Prevalence of Tobacco and E‐Cigarettes among Students in the USA45.

Graph 2‐15 shows the proportion of past month users of tobacco who admit to smoking 20 or more cigarettes

per day for a number of countries from the Caribbean region. These results go beyond simple prevalence to

look more closely at how current smokers actually smoke. Almost 19% of current smokers in Barbados smoke

20 or more cigarettes per day and most likely are daily smokers. On the other end of the scale is Jamaica where

only 6.3% of current smokers indicated that they smoked more than 20 cigarettes per day. Barbados has a

lower level of past month prevalence than five of the countries here, but as the graph shows, a significantly

higher proportion of these users engage in heavy smoking.

Graph 2‐15 – Proportion of Past Month Users who smoke 20 or more cigarettes per day

0

2

4

6

8

10

12

14

16

18

8th Grade 10th Grade 12th Grade

Prevalence (%)

Tabacco E‐Cigarretes

0

2

4

6

8

10

12

14

16

18

20

56 | O A S ‐ C I C A D

Use of tobacco in the general population

Graph 2‐16 shows past month prevalence of tobacco use for the general population in countries where these

data are available. There are fewer countries for which general population data are available than those that

have school population data, but the patterns of use for the countries included here generally reflect similar

patterns of use to secondary school students. Chile once again reports the highest level of prevalence with a

value of almost 34%, followed by Uruguay (31%) and Argentina (28.9%). El Salvador (5%) reports the lowest

prevalence among the countries included in this analysis. The Dominican Republic (7.6%), Ecuador (8.2%) and

Barbados (9.1%) are the other countries that have prevalence levels lower than 10%.

Graph 2‐16. Past Month Prevalence of Tobacco Use in the General Population.vi

When the past month prevalence of tobacco use in the general population is analyzed by sex, the results

indicate that in every country, male prevalence exceeds that of females but that these differences vary greatly

between countries (Table A2.5 Appendix). What these results also show is the relative weight that male

consumption versus female consumption has on the overall prevalence figures. In the case of Suriname for

example, the analysis shows that males have the highest prevalence of tobacco use (38.4%) when compared to

males or females in any of the other countries included in this analysis. At the other end of the spectrum, only

1.7% of females in El Salvador are current users of tobacco.

Graph 2‐17 helps to quantify the differences in prevalence between males and females. In El Salvador, the

country with the lowest overall prevalence rate, the prevalence among males is about 5.4 times that of

females, while in Barbados the rate among males is 4.5 times that of females. On the other hand, in Chile and

Uruguay, which have the highest overall and second highest overall prevalence rates of tobacco use among the

countries in this analysis, the ratio of male to female use are the smallest at around 1.2 each. In most cases,

lower prevalence countries have large gender differences while some higher prevalence countries have

vi Argentina: population aged 16‐64, Canada: population aged 15‐64, and Uruguay: population aged 15‐65

0

5

10

15

20

25

30

35

40

United

States (2013)

Canada (2012)

Mexico (2011)

Costa Rica (2010)

Belize (2005)

El Salvador (2014)

Chile (2012)

Uruguay (2011)

Argentina (2011)

Bolivia (2007)

Surinam

e (2007)

Ven

ezuela (2011)

Brazil (2005)

Paraguay (2003)

Peru (2010)

Colombia (2013)

Ecuador (2013)

Barbados (2006)

Dominican

Rep

. (2010)

Prevalence (%)


relatively smaller gender differences. It is important to note that this pattern does not hold true for all of the

countries here.

Graph 2‐17. Ratio of Past Month Prevalence of Tobacco Use for Males to Past Month Prevalence of Tobacco Use for

Females in the General Population.vii

Graph 2‐18. Past Month Prevalence of Tobacco Use in the General Population by age groups 12 to 17viii and 18 to 34 by country ordered by sub‐region.ix

vii Argentina: population aged 16‐64, Canada : population aged 15‐64, and Uruguay: population aged 15‐65 viii Canada and Uruguay 15 to 17, Argentina 16 to 17 ix Argentina: population aged 16‐64, Canada : population aged 15‐64, and Uruguay: population aged 15‐65

0

1

2

3

4

5

6

Ratio

0

5

10

15

20

25

30

35

40

45

Prevalence (%)

12 to 17 18 to 34

58 | O A S ‐ C I C A D

Graph 2‐18 presents the prevalence of tobacco use by the age groups 12 to 17 and 18 to 34. In each country

represented here, the prevalence of tobacco use is considerably higher in the older age group when compared

to use by the younger age group. The graph also shows that use in the younger age group varies significantly

among the countries included in this analysis, from a low of 0.6% in the Dominican Republic to a high of 19.0%

in Argentina. Uruguay (14.4%) and Chile (10.6%) are the only countries in addition to Argentina where the

prevalence among 18‐34 year olds exceeds 10%. In Bolivia’s 2014 study the prevalence among 12‐17 year‐olds

was 2.9% and among 18‐34 year‐olds, it was 18.1%. Likewise, in Ecuador (2013), past month prevalence

among 12‐17 year olds was 2.4%, and among 18‐34 year‐olds it was 10.7%. As mentioned previously, the

actual age ranges represented in Canada, Argentina and Uruguay do not correspond exactly with the 12 to 17

year olds in the other countries and may impact the prevalence in the 12‐17 age group.

This type of information is useful for countries that want to prevent tobacco use by young people who may go

on to be long term users that fall victim to the health consequences associated with tobacco consumption. On

the other hand, relatively low prevalence in the younger age groups does not necessarily guarantee low

prevalence in the older age group. Take the cases of the United States and Bolivia where prevalence in the 12

to 17 age group is relatively low at 7.8% and 6% respectively, but consumption in the older age group is

relatively higher than most of the other countries, with rates of 37.7% and 29.9% respectively.

Trends in tobacco consumption in the general population

The trends in tobacco consumption in the general population mirror those that we have seen in the secondary

school population. In all countries shown in graphs 2‐19 to 2‐23, there is a steady and sustained decline in past

month prevalence over a number of years. In the case of the United States (Graph 2‐19), prevalence rates have

declined steadily from 26% in 2002 to 21.3 % in 2013, and this is almost identical to the trend shown in Graph

2‐20 where the prevalence rates in Chile have declined from 30.6% in 2002 to 21.9% in 2012. While the

prevalence rates in Argentina and Uruguay have also declined, the rate of the decline has been less. In

Argentina (Graph 2‐21), the prevalence rates have declined from 33.5% to 29.1% during the eight‐year period

from 2004 to 2011. Similarly, Uruguay (Graph 2‐23) experienced the most gentle decline in past month

prevalence of the countries shown here, with rates declining from 34.5% in 2001 to 31% in 2011. The country

with the steepest decline was Peru (Graph 2‐22), where prevalence rates fell from 44.5% in 1998 to 21.1% in

2010.


Graph 2‐19: Past month prevalence of tobacco use among the general population in the USA, 2002‐2013

Graph 2‐20: Past month prevalence of tobacco use in the general population in Chile, 1994‐2012

Graph 2‐21: Past month prevalence of tobacco use in the general population in Argentina, 2004‐2011

Graph 2‐22: Past month prevalence of tobacco use in the general population in Perú, 1998‐2010

Graph 2‐23: Past month prevalence of tobacco use in the

general population in Uruguay, 2001‐2011

25.4 24.9 24.3 23.322.1 21.3

0

5

10

15

20

25

30

35

40

45

2002 2004 2006 2008 2010 2012

Prevalence (%)

41.344 43.6

41.2

34

0

5

10

15

20

25

30

35

40

45

1994

1996

1998

2000

2002

2004

2006

2008

2010

2012

Prevalence (%)

33.5 33.932.1

30.2 29.1

0

5

10

15

20

25

30

35

40

45

2004 2006 2008 2010 2011

Prevalence (%)

26.522.5

18.4

13.3

0

5

10

15

20

25

30

35

40

45

1998 2002 2006 2010

Prevalence (%)

34.5 3431

0

5

10

15

20

25

30

35

40

45

2001 2006 2011

Prevalence (%)

60 | O A S ‐ C I C A D

Graph 2‐24 shows the comparison of past month prevalence of tobacco use in the general population in

Colombia in 2008 and 2013 by sex. For males, there was a decline during this period of 5.2 percentage points

from 24% to 18.8%. For females, there was a decline from 11.0% to 7.4%. These figures suggest that there is

likely a trend of decreasing prevalence of tobacco use in Colombia as in the case in most of the countries in the

Americas.

Graph 2‐24: Past month prevalence of tobacco use in the general population in Colombia in 2008 and 2013 by Sex.

The following tables present data from Colombia that compare prevalence rates for tobacco consumption

(Table 2‐2) and incidence rates for tobacco consumption (Table 2‐3) in 2008 and in 2013 in the general

population. Table 2‐2 shows that there was clearly a decline in prevalence in 2013 compared to 2008. For

example, the past year prevalence rate declined from 21.6% to 16.2% over the five‐year period.

Table 2‐2: Prevalence of Tobacco Use in the General Population in Colombia in 2008 and 2013

Prevalence 2008 2013

Lifetime 45.45 42.07

Past Year 21.62 16.21

Past Month 17.62 12.95

Table 2‐3 shows an estimate of what has happened with respect to new users by comparing figures for the

same time period. In 2008, the proportion of potential new users who initiated tobacco use was 4.77% or

538,815 individuals. In 2013, this rate was estimated to be 1.88% and the number of new cases was 258,272.

These figures indicate that the proportion of persons initiating tobacco use in 2013 had declined by more than

half of the proportion estimated for 2008. This is certainly one of the explanations for the decline in prevalence

figures that have been observed in Colombia and also in other countries in the Americas.

0

5

10

15

20

25

30

35

40

45

Males Females

Prevalence (%)

2008 2013


Table 2‐3: Annual incidence rate and estimated number new smokers in Colombia in 2008 and 2013.

2008 2013

Rate (%) No. of Cases Rate (%) No. of Cases

4.77 538,815 1.88 258,272

Tobacco use among university students

Students at universities and other higher level institutions are usually 18 years or older and include a broad

range of individuals of varying ages and backgrounds that are enrolled to study various subjects. There is a lack

of data on the drug‐using behaviors of this group, and currently there are only seven countries for which data

on tobacco consumption are available for this report. Graph 2‐25 shows the past month prevalence of tobacco

use among university students in these seven countries, arranged in order of prevalence. Prevalence values

range from a low of 9.4% in Venezuela to 24.3% in Ecuador. Bolivia, Peru and Brazil hover just over 20% and

Colombia and El Salvador have values around 19% and 12% respectively.

Graph 2‐25: Past month prevalence of tobacco use in the university population in seven Countries.

If these data are disaggregated by sex as in Graph 2‐26, it is clear that prevalence among males exceeds that

among females in all countries. The differences between genders are more pronounced in El Salvador, Bolivia

and Ecuador.

Graph 2‐26: Past month prevalence of tobacco use in the university population by Sex

0

5

10

15

20

25

30

Ecuador(2012)

Bolivia(2012)

Peru(2012)

Brazil(2010)

Colombia(2012)

El Salvador(2012)

Venezuela(2014)

Prevalence (%)

0

10

20

30

40

Bolivia(2012)

Peru(2012)

Brazil(2010)

Colombia(2012)

El Salvador(2012)

Venezuela(2014)

Prevalence (%)

Males Females

62 | O A S ‐ C I C A D

0

5

10

15

20

25

30

Prevalence (%)

CHAPTER 3: M A R I J U A N A

Introduction Marijuana is the controlled substance that is most often used worldwide. According to United Nations

estimates, in 2012, 177 million people aged 15 to 64 reported that they had used marijuana during the year

prior to the survey. Since 243 million used at least one illicit drug over the same period, it therefore possible to

estimate that the proportion of users of marijuana represents approximately 73% of all users of illicit drugs.

Secondary school students Indicators of marijuana use

The Appendix shows lifetime, past year and past month prevalence of marijuana use among secondary school

students, broken down by males, females (Table A3.2 Appendix) and total high school population. Table A3.3

in appendix gives the findings by grade—8th, 10th and 12th grades, which roughly corresponds to ages 13, 15

and 17.

The map below shows past year prevalence of marijuana use among secondary school students in almost all of

the countries of the hemisphere. In four countries, past year use of marijuana was over 20%, that is, at least

one in five secondary school students in Antigua and Barbuda, Canada, Chile and the United States reported

having used marijuana at least once in the year prior to the surveys.

Graph 3‐1: Past year prevalence of marijuana consumption among secondary school students in the Americas


Graph 3‐2: Past year prevalence of marijuana use among secondary school students, by country and subregion

The graph shows that there are wide variations in prevalence of marijuana use between countries and within

subregions, particularly in South and Central America.

Countries with prevalence of less than 5% are El Salvador, Honduras, Panama, Bolivia, Brazil, Guyana, Paraguay,

Peru, Ecuador, Venezuela, Suriname, Haiti and the Dominican Republic. On the other hand, Canada, the United

States, Belize, Chile, Uruguay, Antigua and Barbuda, Barbados, Dominica, Saint Kitts and Nevis, Saint Vincent

and the Grenadines and Saint Lucia have prevalence rates of over 15%.

In North America, the two countries that have information available at the national level have rates of over

20%. In Central America, there is a notable gap between the country with the highest use, Belize (15.8%) and

Honduras, with a little more than 1%, although it should be noted that the figure for Honduras dates back to a

2005 study.

In South America, there is a striking difference between the countries that have lower levels of marijuana use‐‐

Peru, Ecuador and Venezuela, each with rates of less than 3%‐‐and the country with the highest level of use,

Chile, which has a prevalence of around 28%, while in the Caribbean, six of the twelve countries reporting

marijuana use have prevalence of over 15%. As a subregion, the Caribbean is fairly homogeneous in terms of

marijuana use, with the exception of Haiti and the Dominican Republic, where use is substantially lower.

0

5

10

15

20

25

30

United

States (2014)

Canada (2010/11)

Belize (2013)

Costa Rica (2012)

El Salvador (2008)

Panam

a (2008)

Honduras (2005)

Chile (2013)

Uruguay (2014)

Argentina (2011)

Colombia (2011)

Surinam

e (2006)

Brazil (2010)

Guyana (2013)

Bolivia (2008)

Paraguay (2005)

Ecuador (2012)

Peru (2012)

Ven

ezuela (2009)


Dominica (2011)


S.Lucia (2013)

S.Kitts‐Nevis (2013)

Barbados (2013)

Granada (2013)

Jamaica (2013)

Trinidad

‐Tobago (2013)

Baham

as (2011)

Haiti (2014)

Dominican

Rep

(2008)

Prevalence (%)

64 | O A S ‐ C I C A D

The table below shows past year marijuana use among secondary school students by subregion and for the

hemisphere as a whole.

Table 3‐1: Lifetime, past year and past month prevalence of the use of marijuana among secondary school students, by subregion and total hemisphere*

Subregion Prevalence

Lifetime Past year Past month

North America 30.50 24.20 14.40

South America 9.96 7.21 5.09

The Caribbean 10.68 6.72 3.76

Hemisphere 21.26 16.52 11.12



The table above shows that the North American subregion, with data from Canada and United States, has

higher average rates of use of marijuana for all three indicators. South America and the Caribbean have

lower average values and close to each other, differing only in the prevalence of recent use (in the

past 30 days), where South American students show higher use of marijuana.

The hemispheric average of recent marijuana use is 16.5% but North America exceeds that average by

8 points. Consideration should be given to the fact that the hemispheric average is influenced by

population sizes of the countries, and in this context, the weight of the United States is relevant.

The graph below shows prevalence by sex, sorted within each subregion by the magnitude of the

indicator (Table A3.2 Appendix).

Graph 3‐3: Past year prevalence of marijuana use among secondary school students,

by sex, country and subregion

0

5

10

15

20

25

30

35

United

States (2014)

Canada (2010/11)

Belize (2013)

Costa Rica (2012)

El Salvador (2008)

Panam

a (2008)

Honduras (2005)

Chile (2013)

Uruguay (2014)

Argentina (2011)

Colombia (2011)

Surinam

e (2006)

Guyana (2013)

Bolivia (2008)

Paraguay (2005)

Ecuador (2012)

Peru (2012)

Ven

ezuela (2009)


Dominica (2011)


S.Lucia (2013)


Barbados (2013)

Granada (2013)

Jamaica (2013)

Trinidad

‐Tobago (2013)

Baham

as (2011)

Haiti (2014)

Dominican

Rep

(2008)

Prevalence (%)

Males Females


The chart shows first that in all of the countries, marijuana use by male students is higher than among female

students (a ratio of more than 1 in all cases), although the difference varies somewhat between countries.

Thus, for example, in those countries where there are higher levels of marijuana use by secondary school

students, such as Canada, the United States and Chile, the difference between marijuana use by males and

females is quite small. This is particularly true in Chile, where the ratio of male to female prevalence is 1.057,

that is, there are only 5.7% more male users of marijuana than female users (prevalence of 29.2% for males

and 27.6% for females). The largest difference is found in Suriname, where reported marijuana use by male

students was 3.6 times higher than for females (prevalence of 8% for males and 2.2% for females).

One area of interest for drug use prevention policies has to do with the age of first use of a substance, in this

case, marijuana. While this issue can be described using various indicators, such as the average or median age

of first use, the present report will examine the use of marijuana at an early age by looking at the percentage of

eighth grade students (mostly 13 years old) who said that they had used marijuana at least once in their lives.

Graph 3‐4: Lifetime prevalence of marijuana use among 8th grade secondary school students,

by country and subregion

The graph 3‐4 shows that the situation we have been examining thus far in relation to the past year use of marijuana changes when lifetime use by younger students is taken as the reference point. In some countries in the Caribbean such as Dominica and Antigua and Barbuda, the use of marijuana begins at a very early age in more than 20% of 8th grade students who have used marijuana in their lifetime, as is also the case in Belize and Chile. The indicators on the extent of drug use in the population (prevalence, for example) should therefore be read

together with indicators that describe patterns of use and identify populations at higher risk (frequency and

intensity of use).

0

5

10

15

20

25

United

States (2014)

Canada (2010/11)

Belize (2013)

Costa Rica (2012)

Panam

a (2008)

El Salvador (2008)

Honduras (2005)

Chile (2013)

Uruguay (2014)

Argentina (2011)

Colombia (2011)

Guyana (2013)

Bolivia (2008)

Peru (2012)

Ecuador (2012)

Surinam

e (2006)

Paraguay (2005)

Ven

ezuela (2009)

Dominica (2011)


S.Lucia (2013)



Granada (2013)

Jamaica (2013)

Trinidad

‐Tobago (2013)

Barbados (2013)

Baham

as (2011)

Haiti (2014)

Dominican

Rep

(2008)

Prevalence (%)

66 | O A S ‐ C I C A D

It is clear that the figures shown in the chart above should be analyzed in the context of school‐based

prevention policies and their impact on the lower grades in the countries’ school systems.

Trends among secondary school students

In the United States, the trend in past year marijuana use in the period 1991‐2014 shows a sharp increase

between 1991 and 1997, from 15% to 30%. After that, the rate dropped until 2008, when a prevalence of 21%

is reached, followed by a rise to almost 26% in 2013. The most recent study, which was conducted in 2014,

shows a decline in use of more than one percentage point, which may or may not be confirmed in future

studies.

Graph 3‐5: Past year prevalence of marijuana use among secondary school students in the United States, 1991‐2014

In addition to the US, data are available for four South American countries: Chile, Peru, Argentina and Uruguay

with four or more comparable studies that allow us to see trends. For Guyana, we have data from two studies,

one conducted in 2007 and the other in 2013: Prevalence fell two percentage points in those years, going from

6.4% to 4.2%.

Available data from Mexico City on past year prevalence by sex show that the increase for both sexes was

significant between 1989, the beginning of the data series, and the end, 2012. The increase in the rates of use

was sharper for women, going from 0.6% to 9.9%, while the rates for males quintupled, going from 2.6% in

1989 to 14.4% in 2012. The increase was sustained over time for both sexes.

The countries of the Caribbean have data from two studies: some have studies from 2006 or earlier, while

others have studies from 2011 and 2013, depending on the country. Past year use of marijuana increased in

nine of the eleven Caribbean countries, but by different amounts. In one country, the increase was 10

percentage points; in three, the increase was between 4 and 7 points; in two, it was an increase of 2 and 3

points, and in two more countries, the increase was of one percentage point. The drop in use in two countries

was of almost three percentage points.

In the countries of the Southern Cone, marijuana use increased during the various periods examined, with the

exception of Peru, where use in 2005 was 2.8%, falling to 2.2% in 2012.

14.3

22.5

29

28.2

27.2

26.1

23.8

22

21.5 24.5

24.7

24.2

0

5

10

15

20

25

30

35

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

Prevalence (%)


Graph 3‐6: Past year prevalence of marijuana use among secondary school students in

Chile, 2001‐2013


Uruguay, 2003‐2014


Peru, 2005‐2012


Argentina, 2001‐2011

Marijuana use increased in all coutnries with the exception of Peru where use starts at 2.8% in 2005 and decreases to 2.2% in 2012 (Graph 3‐8). Chile is the country with the highest use of marijuana in the region, and its trend increases from 2001 to 2013.

The largest increase took place between the two most recent studies (2011 and 2013), where it increased by

more than 10 percent points. Over the complete period since 2001, the increase was of 15.4 and 16 percentage

points for males and females respectively.

In Argentina, the increase was sustained since 2001, as shown in graph 3‐9, but was sharper for males, for

whom the rate increased by almost 10 points, with 5 points for females at the end of the period, which was

2011.

In Uruguay over the period 2003‐2014, marijuana use doubled, from 8.4% to 17%. There was a period

between 2007 and 2011 when use declined, but it rose again between 2011 and 2014. The trend was similar

for both sexes, but still with higher prevalence rates among males.

14.8 13 14.7 15.6

15.1

19.5

30.6

0

5

10

15

20

25

30

35

2001 2003 2005 2007 2009 2011 2013

Prevalence (%)

8.4 9.4

14.812.5 12

17

0

5

10

15

20

25

30

35

2003 2005 2007 2009 2011 2014

Prevalence (%)

2.81.9 2.4 2.2

0

5

10

15

20

25

30

35

2005 2007 2009 2012

Prevalence (%)

3.55.7

7.7 8.410.4

0

5

10

15

20

25

30

35

2001 2005 2007 2009 2011

Prevalence (%)

68 | O A S ‐ C I C A D

The information available for Costa Rica only presents 3 studies but it reflects an increase in consumption of

almost twofold between 2006 and 2012 as shown in the graph 3‐10.


Costa Rica, 2006‐2012

The Caribbean countries have information from two studies, the first one from 2009 or earlier and the latter

studies between 2011 and 2014, depending on the country. Regarding the prevalence of marijuana use in the

past year or recent use, in 10 of the 12 countries with information, consumption increased, but in different

magnitudes. In one country the increase was 10 percentage points, in three of them the increase was between

4 and 7 points, in four countries the increase was 2 and 3 points, and two countries increased one percentage

point. Only two countries showed a decline in consumption between two and three percentage points

respectively.

Graph 3‐11 Past year prevalence of marijuana use among

secondary school students in Caribbean countries, 2009‐2014

Guyana has data from two studies, one conducted in 2007 and the second one in 2013 (not shown). Prevalence

dropped two percentage points in those years, from 6.4% to 4.2%.

The data available for prevalence by sex in Mexico city indicate that in both sexes, the increase was significant

between the start of the series, 1989 to the end in 2012. But the increase in consumption rates was stronger

5.7 6.89.7

0

5

10

15

20

25

30

35

2006 2009 2012

Prevalence (%)

0

5

10

15

20

25

30

35

Antigua‐Barbuda

Baham

as

Barbados

Belize

Dominica

Grenada

Haiti

Jamaica

S. Kitts‐Nevis


S. Lucia

Trinidad

‐Tobago

Prevalence (%)

2009 or earlier 2011‐2014


among women, rising from 0.6% to 9.9%, while in men rates increased fivefold from 2.6% in 1989 to 14.4% in

2012. The increase was sustained over time for both sexes.

Perception of risk

Perceptions of the high risk of the occasional use of marijuana are shown to be highly variable between

countries, along a range of less than 10% to more than 70%. However, we can say that in only four countries do

more than half of high school students view occasional use of marijuana as highly risky; three of these

countries are in the Caribbean and one is in Central America. The perception of high risk is under 20% in four

countries, three of which are South American and one in North America (Table A3.9 Appendix).

It is not always the case that low levels of perceived high risk are associated with very high rates of use of a

particular drug. A myriad of other factors intervene in whether the rates of use of a psychoactive substance are

high or low, such as the availability of a substance on the market, the price of the drug, the degree of

acceptance or rejection in society, its capacity to produce addiction, among many other factors.

At each end of the scale, we see a correlation between low and high prevalence of use and high and low levels

of the perception of the risk of occasional use of marijuana.

The graph below shows the perception of the high risk of occasional use of marijuana by sex. Views about high

risk are distributed evenly among the sexes: in some countries, females perceive higher risk while in others, it is

males that see greater risk, but the differences are small. In two countries, the United States and Bolivia, there

are no differences according to gender.

Graph 3‐12: Perception of high risk of occasional use of marijuana among secondary school students,

by sex and country

0

10

20

30

40

50

60

70

Canada (2010/11)

United

States (2014)

El Salvador (2008)

Belize (2008)

Panam

a (2008)

Costa Rica (2012)

Surinam

e (2006)

Guyana (2013)

Paraguay (2005)

Ven

ezuela (2009)

Colombia (2011)

Bolivia (2008)

Ecuador (2012)

Peru (2012)

Argentina (2011)

Chile (2013)

Uruguay (2014)

Haiti (2014)

Dominican

Rep

(2008)

Baham

as (2011)

Trinidad

‐Tobago (2013)

S. Vincent‐Grenadines(2013)

Jamaica (2013)

Granada (2013)

S. Lucia (2013)

Barbados (2013)

Dominica (2011)



Males Females

70 | O A S ‐ C I C A D

The variation between countries is less when we look at perception of risk of frequent use. In more than

twenty countries, between 60% and 80% of the students view frequent use as risky, and in those countries

where perception of risk is lower (50% or less of students think that way), use is higher (Table A3.10 Appendix).

As stated earlier, there is an association between the perception of high risk of occasional use of marijuana and

the prevalence of use by secondary school students (graph 3‐13).

Graph 3‐13: Past year prevalence of marijuana use and perception of high risk of

occasional use among secondary school students

Perception of ease of access and offers of marijuana

Perception of ease of access is a subjective indicator that has to do with how easy or difficult it is for someone

to obtain a particular drug, whether to buy it or to obtain it from friends or acquaintances. A drug that is

perceived as easy to access is generally cheaper and more available on the market.

We see great variations between countries in the students’ perceptions of ease of access to marijuana in graph

3‐14, with some countries where this view is held by less than 5% and anothers country with a little more than

60%.

In four countries 50% or more of students think that marijuana is easy to obtain, these countries also have the

highest rates of use according to graph 3‐15. While in those countries where prevalence are less than 5%, 30%

of students or fewer consider that it is easy to obtain marijuana. Ten countries have between 40% and 50% of

students who agree that access is easy.

0

5

10

15

20

25

30

0 20 40 60 80

Prevalence (%)

Perception of risk (%)


Graph 3‐14: Perception of ease of access to marijuana among secondary school students, by country and subregion

The association between prevalence of use and perception is shown in the graph below, where we can observe

a direct association between both variables, meaning that coutries where access to marijuana is perceived as

easy, show higher levels of drug use.

Graph 3‐15: Past year prevalence and perception of ease of access to marijuana

among secondary school students, by country

An offer of drugs is an objective indicator that reflects offers of a particular substance made directly to interviewees. Like the indicator on ease of access, the indicator on direct offers helps estimate how available a psychoactive substance is to users. This indicator is often useful in determining possible associations between rates of use and availability of drugs. In most of the countries with information on offers of marijuana, more than 20% of students declare having received an offer in the past year, and 15% of students declare having received an offer in the past month.

0

10

20

30

40

50

60

70

United

States (2014)

Belize (2008)

Panam

a (2008)

El Salvador (2008)

Uruguay (2014)

Chile (2013)

Colombia (2011)

Argentina (2011)

Surinam

e (2006)

Paraguay (2005)

Guyana (2013)

Peru (2012)

Ecuador (2012)

Ven

ezuela (2009)


Dominica (2011)

S. Lucia (2013)


Jamaica (2013)


Barbados (2013)

Trinidad

‐Tobago (2013)

Granada (2013)

Baham

as (2011)

Dominican

Rep

(2008)

0

5

10

15

20

25

30

0 20 40 60 80

Prevalence (%)

Perception of ease of access (%)

72 | O A S ‐ C I C A D

Graph 3‐16: Offers of marijuana in the past year and past month among secondary school students,


Graph 3‐17 shows in countries where at least 20% students have been offered marijuana in the past year the past year prevalence of marijuana use is at least 10%. While most of these countries are Caribbean, the group also includes Chile, Uruguay and Belize. Countries in which a smaller percentage of students has been offered marijuana have lower prevalence of consumption.

Graph 3‐17: Prevalence of use and offers of marijuana in the past year among

secondary school students, by country

General population Indicators of use

Table A3.4 in appendix shows lifetime, past year and past month prevalence of the use of marijuana in the

general population.

0

5

10

15

20

25

30

35

40

Belize (2008)

Costa Rica (2012)

El Salvador (2008)

Uruguay (2014)

Chile (2013)

Argentina (2011)

Ecuador (2012)

Surinam

e (2006)

Guyana (2013)

Bolivia (2008)

Peru (2012)

Paraguay (2005)



Barbados (2013)


S. Lucia (2013)

Dominica (2011)

Granada (2013)

Trinidad

‐Tobago (2013)

Jamaica (2013)

Baham

as (2011)

Haiti (2014)

Dominican

Rep

(2008)

Past month Past year

0

5

10

15

20

25

30

0 10 20 30 40

Prevalence (%)

Offer (%)


In Canada and the United States, lifetime use of marijuana is over 40%, very much higher than in the countries

of South America. Among these, Chile and Uruguay are the countries with higher consumption, with lifetime

use of marijuana is around 20%, half of that of Canada and the United States.

At the other extreme are some countries where 6% or less of the population has used marijuana in their

lifetime. This is the case with Mexico, Bolivia, Ecuador, Paraguay (most recent study dating from 2003), Peru,

Venezuela and the Dominican Republic. There is a group of countries where around 10% of the population

reported that they had used marijuana at least once in their lives: Belize (most recent study available dates

from 2005), El Salvador, Argentina, Brazil, Colombia and Suriname (most recent study from 2007).

When the indicator is past year use, the trend of use is maintained in the same among countries of North

America (around 12%) and South America where there is higher use (Chile and Uruguay with between 7% and

8% respectively), as shown in the graph below.

Graph 3‐18: Past year prevalence of use of marijuana in the general population, by country and subregionx

Marijuana use is more prevalent among adolescents and young adults. In most countries the highest prevalence rates of consumption are in the segment of 18‐34 years. The difference with the segment of 12 to 17 years is higher, particularly in countries with higher consumption. However it is important to note that over 10% of the population 15‐17 in Canada and 12‐17 in the United States report having used marijuana in the past year.

x Canada: population aged 15‐64. Argentina: population aged 16‐64 Uruguay: population aged 15‐65

0

2

4

6

8

10

12

14

United

States (2013)

Canada (2012)

Mexico (2011)

Belize (2005)

Costa Rica (2010)

El Salvador (2014)

Uruguay (2011)

Chile (2012)

Surinam

e (2007)

Colombia (2013)

Argentina (2011)

Brazil (2005)

Ven

ezuela (2011)

Bolivia (2014)

Peru (2010)

Ecuador (2013)

Paraguay (2003)

Barbados (2006)

Dominican

Rep

. (2010)

Prevalence (%)

74 | O A S ‐ C I C A D

Graph 3‐19: Past year prevalence of marijuana use among populations

aged 12‐17 and 18‐34, by country and subregionxi


The use of marijuana in the population aged 12 and older in the United States has been monitored for more

than ten years, and the results show that use stabilized at a prevalence of around 11% until 2009, when there

was a slight increase, that concludes the period with a prevalence 1.5 percentage points higher than at the

beginning of the period.

Graph 3‐20: Past year prevalence of marijuana use among

the general population aged 12 and older, United States 2002‐2013.

The use of marijuana among the general population in the countries of South America for which we have

information has increased in the last decade. Peru had the lowest prevalence, and after an increase in

consumption between 1998‐2002, after which it dropped again to 1% in 2010 (graph 3‐21).

xi Canada: population aged 15‐64. Argentina: population aged 16‐64 Uruguay: population aged 15‐65

0

5

10

15

20

25

30

Canada (2012)

United

States (2013)

Mexico (2011)

Belize (2005)

Costa Rica (2010)

El Salvador (2014)

Uruguay (2011)

Chile (2012)

Colombia (2013)

Argentina (2011)

Surinam

e (2007)

Peru (2010)

Paraguay (2003)

Bolivia (2014)

Ecuador (2013)

Barbados (2006)

Dominican

Rep

(2010)

Prevalence (%)

12‐17 18‐34

10.6 10.4 10.111.4

11.512.6

0

5

10

15

2002 2004 2006 2008 2010 2012

Prevalence (%)


In Argentina, the prevalence of use of cocaine in the general population rose from 0.3% to 0.9% between 2004

and 2011, from 2% to slightly over 4%, with an uptick of 7% in 2006 (graph 3‐22).


the general population, Peru 1998‐2010.

Graph 3‐22: Past year prevalence of marijuana use among the general population, Argentina 2004‐2011, aged 16‐65.


the general population, Chile 1994‐2012

Graph 3‐24: Past year prevalence of marijuana use among the general population aged 15‐64 in Uruguay 2001‐2011


the general population, Mexico 1998‐2011

Trends that have been monitored in Chile for almost twenty years show an increase of three percentage points

over the entire period, from 4% in 1994 to slightly over 7% in 2012 (graph 3‐23).

0.71.8

0.7 1

0

5

10

15

1998 2002 2006 2010

Prevalence (%)

1.9

7

4 3.54.2

0

5

10

15

2004 2006 2008 2010 2011

Prevalence (%)

4 4.85

7.2

4.6

7.1

0

5

10

15

1994

1996

1998

2000

2002

2004

2006

2008

2010

2012

Prevalence (%)

1.4

5.5

8.3

0

5

10

15

2001 2006 2011

Prevalence (%)

1.2 1 0.6 1.2 1.4

0

5

10

15

1988 1998 2002 2008 2011

Prevalence (%)

76 | O A S ‐ C I C A D

Available data from Uruguay show that marijuana use among the general population rose almost sixfold, from

1.4% to 8.3% in a decade (graph 3‐24); the increase was the same for both sexes, but still with higher use

among males.

The changes in prevalence in Colombia between 2008 and 2013 were also upward, going from 2.1% to 3.3%.

Perception of high risk of marijuana use

Depending on the country, between 27% and 87% of the general population believe that occasional use of

marijuana is highly risky (Table A3.11 Appendix). Those countries that have a smaller proportion of people who

think that occasional use is highly risky are the countries that have higher past year prevalence. Inversely,

where there is a greater perception of harm, the use tends to be lower.

Graph 3‐26: Perception of high risk of occasional use of marijuana among the general population, by sex and countryxii

When the data are examined by sex, more women than men perceive that the risk is high; the exceptions are

Costa Rica and Ecuador.

There is less variation between countries as to the perceived high risk of frequent use of marijuana, a view held

by 80%‐90% of the general population. In the United States, Canada and Uruguay, fewer people see frequent

use as risky, and they are countries where use is higher(Table A3.11 Appendix).

xii Canada: population aged 15‐64. Argentina: population aged 16‐64 Uruguay: population aged 15‐65

0

10

20

30

40

50

60

70

80

90

100

Males Females


Ease of access and offers of marijuana

As with the secondary school students, there is a great variation between countries with respect to the

perception in the general population about ease of access to marijuana, ranging from 16% to 62%. In those

countries that have prevalence of less than 2%, fewer than 35% perceive access as easy.

Graph 3‐27: Perception of ease of access to marijuana among in the general population,

by country

The two South American countries where marijuana use is higher are also those that report higher numbers of

offers of marijuana among the general population (Chile and Uruguay).

Graph 3‐28: Offers of marijuana in the past year and past month among the

general population, by country

0

10

20

30

40

50

60

70

0

2

4

6

8

10

12

14

16

18Past month Past year

78 | O A S ‐ C I C A D

University students Indicators of use

Information is available from seven Latin American countries that conducted studies on drug use among

university students. There is great variation among countries, where lifetime use ranges from 6% to 31% (Table

A3.7 Appendix), and past year use ranges from 3.1% to 15%.

Graph 3‐29: Past year prevalence of marijuana use among university students, by country

More than ten percentage points separate the countries with higher prevalence among university students

from those with lower prevalence of marijuana use.

The graph below shows that use among males doubles that of females, regardless of the level of use in the

countries.

Graph 3‐30: Past year prevalence of marijuana use among university students, by sex and country

0

2

4

6

8

10

12

14

16

Colombia(2012)

Brazil(2010)

Ecuador(2012)

Peru(2012)

Bolivia(2012)

El Salvador(2012)

Venezuela(2014)

Prevalence (%)

0

5

10

15

20

25

Col

ombi

a(2

012)

Bra

zil

(201

0)

Ecu

ador

(201

2)

Pe

ru(2

012)

Bo

livia

(201

2)

El S

alva

dor

(201

2)

Ven

ezue

la(2

014)

Prevalence (%)

Males Females


Trends among university students

The use of marijuana among university students increased between 2009 and 2012 in all of the countries with

data for these measurements. However, they differ in the levels of use and the degree of the increase. For

example, Colombia, which has high relative prevalence in 2009, rose by almost four percentage points, while in

Ecuador, with a prevalence of 4% in 2009, increases marijuana use by almost 5 percent points, doubling

previous levels. In Peru and Bolivia, the increase was of 1 and 1.4 points respectively.

Graph 3‐31: Past year prevalence of marijuana

use among university students, by country, 2009 ‐ 2012

Perception of high risk

Fifty per cent or less of the university students in the five countries for which information is available consider

that the occasional use of marijuana is high risk. These percentages are higher for females than for males, but

they do not go beyond 56%. The country where perceived risk is lowest is the one that has the highest use

(Table A3.13 Appendix).

Graph 3‐32: Perception of high risk of occasional use of marijuana among university students,

by sex and country

0

2

4

6

8

10

12

14

16

Colombia Ecuador Peru Bolivia

Prevalence (%)

2009 2012

0

10

20

30

40

50

60

Peru (2012) Bolivia (2012) Ecuador (2012) El Salvador (2012) Colombia (2012)

Males Females

80 | O A S ‐ C I C A D

Larger proportions of university students consider that the frequent use of marijuana is highly risky. The

country where there is the lowest perceived risk (73% of students) is the country with the highest level of use

(Table A3.14 Appendix).

Perception of ease of access and offers of marijuana

University students’ perceptions about ease of access to marijuana range from 22% to 62%. We see a

correlation in this population group between perception of higher risk and higher use, and vice versa.

Graph 3‐33: Perception of ease of access to marijuana

among university students, by country

The differences between countries become smaller when we look at the number of times marijuana was

offered to university students. Between 27% and almost 50% of university students have been offered

marijuanain the past year.

Graph 3‐34: Marijuana offered in the past year and past month to university students, by country

0

10

20

30

40

50

60

70

Colombia(2012)

Ecuador(2012)

El Salvador(2012)

Peru(2012)

Bolivia(2012)

0

10

20

30

40

50

60

Colombia(2012)

Ecuador(2012)

Peru(2012)

El Salvador(2012)

Bolivia(2012)



CHAPTER 4: I N H A L A N T S

Introduction Inhalants are volatile substances that give off chemical gases that can be inhaled to cause psychoactive or

mind‐altering effects. The definition of an inhalant is problematical in drug research, since it covers a wide

gamut of chemical substances that have varying degrees of psychoactive and pharmacological effects. This

variety of products or substances poses challenges for research on the use of these substances, the reasons for

using them, related behaviors and the harm they may cause to individuals. 46

We may identify four classes of inhalants: solvents, aerosols, gases and nitrites, or various combinations that

may be found in the same country. Solvents are liquids intended for both industrial and household use that

vaporize at ambient temperature; they include paint solvents or removers, toluene, glue and liquid correction

fluid. Aerosols are a type of spray that contains propellants and solvents used in common products such as

deodorants and cooking spray. Gases are found in household or commercial products such as butane and

propane, and are also used as anesthetics for medical purposes. Nitrites are used principally to intensify sexual

pleasure, and are sold commercially as “poppers”.

Many of these substances are common household items and are easy to obtain. Although inhalants are not

illicit, they are similar to illicit drugs because of their high potential for addiction and are associated with the

use of other drugs. Even though inhalants are not controlled substances, and can easily be obtained as

household products, efforts are being made to minimize or control their availability.

Inhalant use is common in many countries around the world, both in high risk populations and in the general

population.47,48,49,50,51,52 However, there is great variation among countries and within countries in the type of

inhalants used, the different groups of users, and the names used to identify the substances. It is important to

bear in mind this diversity in patterns of use and in identification of the substances when we compare the

findings among countries.

Secondary school students Indicators of use

Tables A4.1 and A4.2 in appendix show lifetime, past year and past month prevalence of inhalant use among secondary school students, by males, females and total population. Table A4.3 in appendix gives the results for 8th, 10th and 12th grade students.

The map below shows overall prevalence of past year use of inhalants in each country.

82 | O A S ‐ C I C A D

Graph 4‐1: Past year prevalence of inhalant use among secondary school students, by country and subregion

First, we see wide variations between subregions in rates of use of inhalants, variations also seen to a lesser

extent within each subregion. Graph 4‐2 gives past year prevalence rates in the countries by subregion.

Graph 4‐2: Past year prevalence of inhalant use among secondary school students, by country and subregion

Past year prevalence of inhalant use ranges from 0.5% to 11% (Graph 4‐2). The graph shows countries with

prevalence rates of under 1.5%, such as Honduras, Peru and the Dominican Republic, and countries with

0

2

4

6

8

10

12


S.Lucia (2013)

Barbados (2013)

Grenada (2013)


Trinidad

‐Tobago (2013)

Jamaica (2013)

Antigua‐Barbuda‐Barbuda (2013)

Dominica (2011)

Haiti (2014)

Baham

as (2011)

Dominican

Rep

(2008)

Prevalence (%)

0123456789101112

United

States (2014)

Canada (2010/11)

Belize (2013)

Panam

a (2008)

Costa Rica (2012)

El Salvador (2008)

Honduras (2005)

Brazil (2010)

Chile (2013)

Guyana (2013)

Surinam

e (2006)

Argentina (2011)

Bolivia (2008)

Uruguay (2014)

Colombia (2011)

Ecuador (2012)

Paraguay (2015)

Peru (2012)

S. Lucia (2013)


Barbados (2013)

Grenada (2013)


Trinidad

‐Tobago (2013)

Jamaica (2013)


Dominica (2011)

Haiti (2014)

Baham

as (2011)

Dominican

Rep

(2008)

Prevalence (%)


prevalence of over 8%: Grenada, Barbados, Saint Kitts and Nevis, Saint Vincent and the Grenadines and Saint

Lucia.

Inhalant use is particularly high in the Caribbean. Of the twelve Caribbean countries that have information on

inhalants, eight have prevalence rates of use of over 5.9%, which are higher than rates in all other countries of

the hemisphere. This places the Caribbean subregion, with the exception of the Dominican Republic where use

is substantially less, in the highest range of prevalence.

In Central America, there are considerable differences between the country with the highest rate of inhalant

use, Belize with 5.5%, and Honduras, with the lowest rate of use at 0.6% (although it should be noted that the

figure for Honduras comes from a study in 2005). In South America, there are also differences between the

countries with lower rates of use, Peru, Paraguay, Colombia and Ecuador, with rates of less than 2% and the

countries with higher rates of use, Brazil, Chile and Guyana, with prevalence of between 4% and 6%. North

America shows less variation in its prevalence rates, with 1.8% in Canada and 3.8% in the United States.

Table 4‐1 shows the indicators of lifetime, past year and past month inhalant use by subregion and total

hemisphere. It is important to note that only recent studies conducted between 2010 and 2014 have been

used, and that different countries have different weights and influence on the figures for each subregion.

Table 4‐1: Lifetime, past year and past month prevalence of inhalant use among secondary school students, by subregion and total hemisphere*



North America 8.3 3.43 1.4



Hemisphere 7.21 3.55 1.33



These data by region confirm our earlier analysis, showing that the Caribbean has the highest prevalence of

inhalant use among secondary school students.

While this general pattern is the same for lifetime and past month use, the extent of the differences by

subregion differs. For past month use, North, Central and South America hover around 1%, while the Caribbean

is around 3%. For lifetime prevalence, North America and the Caribbean have double the prevalence rates of

around 5% for Central and South America.

In addition to this overall analysis of inhalant use, we can look at the situation use according to sex (Table A4.2

Appendix). The graph below shows past year prevalence rates for females and males, by subregion.

84 | O A S ‐ C I C A D

Graph 4‐3: Past year prevalence of inhalant use among secondary school students,


What we see first in Graph 4‐3 is the wide variations in inhalant use among males and females. In some

countries, use among female students is higher than among males. Particularly in the Caribbean, where there

are higher reported levels of inhalant use among secondary school students, half of the countries have

prevalence that are higher among females, as we see in Saint Lucia, Barbados, Trinidad and Tobago, Saint

Vincent and the Grenadines, Jamaica and Antigua and Barbuda. In other regions, countries such as the United

States, Chile and Uruguay also report that female students have higher prevalence than males, although the

differences by sex are small. The greatest differences are found in the Dominican Republic and Panama, where

prevalence among males is between 7 and 10 times higher than among females. Of those countries where

females use inhalants more than males, the greatest difference is found in Antigua and Barbuda, where

reported inhalant use by female students is double that of males. In terms of differences among subregions,

while in South America, the countries that have higher use among females show gender differences of around

30%, in the Caribbean, these differences range from 60% to 100%.

One area of interest for drug prevention policies has to do with the first use of a substance, in this case,

inhalants. We will look in this chapter at the use of inhalants at an early age, by examining the percentage of

8th grade students (most of whom are aged 13) who reported that they had used inhalants at least once in

their lives. This indicator identifies a population that is at high risk and that should be taken into account in

substance abuse prevention policies. The graph below shows lifetime prevalence of inhalant use among 8th

and 12th grade students, comparing rates of inhalant use among different ages of secondary school students

and identifying those countries where prevalence are particularly high among younger students.

0

1

2

3

4

5

6

7

8

9

10

United

States (2014)

Belize (2013)

Panam

a (2008)

El Salvador (2008)

Costa Rica (2012)

Honduras (2005)

Guyana (2013)

Surinam

e (2006)

Bolivia (2008)

Chile (2013)

Argentina (2011)

Ecuador (2012)

Colombia (2011)

Paraguay (2005)

Uruguay (2014)

Peru (2012)

Grenada (2013)

S. Lucia (2013)


Barbados (2013)

Trinidad

‐Tobago (2013)

Dominica (2013)


Jamaica (2013)


Haiti (2014)

Dominican

Rep

(2008)

Ba ham

as (2011)

Prevalence (%)


Graph 4‐4: Lifetime prevalence of inhalant use among 8th and 12th grade students,


This graph shows prevalence that vary among different groups of students in different countries, with a

generally high lifetime prevalence among students aged 13 or younger, showing initiation of inhalant use

among young students at a very early age. In the Caribbean, Saint Vincent and the Grenadines, Saint Lucia and

Saint Kitts and Nevis report that more than 10% of their students aged 13 or less as having used inhalants at

least once in their lives. In the other regions, the United States, Belize and Chile have more than 5% of their 8th

grade students who have used inhalants; the other countries show lower prevalence.

Delving further into the question of early initiation of inhalant use, we see that in the majority of countries,

prevalence among 8th grade students is higher than among 12th graders, which suggests that inhalants are

used predominantly among younger students. There are exceptions to this pattern in the countries of Central

America, where inhalant use is similar in different grades, or slightly higher among 12th grade students, except

for Belize. In South America, use is higher among 12th grade students in Uruguay and Paraguay, but higher

among 8th grade students in the remainder of the countries. In the Caribbean also, inhalant use is higher

among the younger students, except for Grenada, Trinidad and Tobago, Jamaica and the Dominican Republic.

Saint Vincent and the Grenadines, Saint Kitts and Nevis and the Bahamas are among the countries in the

Caribbean where the differences between 8th and 12th grades are larger. In every region, the countries with

higher prevalence rates report use among 8th grade students that is at least double that of 12th graders.

0

2

4

6

8

10

12

14

16

United

States (2014)

Belize (2013)

Panam

a (2008)

Costa Rica (2012)

El Salvador (2008)

Honduras (2005)

Chile (2013)

Guyana (2013)

Surinam

e (2006)

Argentina (2011)

Bolivia (2008)

Colombia (2011)

Ecuador (2012)

Uruguay (2014)

Paraguay (2015)

Peru (2012)


S. Lucia (2013)


Barbados (2013)

Grenada (2013)


Jamaica (2013)

Dominica (2011)

Trinidad

‐Tobago (2013)

Haiti (2014)

Baham

as (2011)

Dominican

Rep

(2008)

Prevalence (%)

8th grade 12th grade

86 | O A S ‐ C I C A D


The graphs below show trends in the use of inhalants in different countries of the hemisphere. All the countries

shown have past year prevalence of inhalant use between 2005 and 2011, with at least four observation points

over the period.

Graph 4‐5: Past year prevalence of inhalant use among

secondary school students, Argentina 2001‐2011.


secondary school students, Chile 2001‐2013.


secondary school students, Uruguay 2003‐2014.


secondary school students, Peru 2005‐2012

Graph 4‐9: Past year prevalence of inhalant use among secondary school students, United States 1991‐2014.

0.5

2.4 2.2 1.72.6

0

2

4

6

8

10

12

14

16

2001 2005 2007 2009 2011

Prevalence (%)

1.93.2 2.8 3.1 3

45.2

0

2

4

6

8

10

12

14

16

2001 2003 2005 2007 2009 2011 2013

Prevalence (%)

1.4 1.6 2.3 1.4 1.42.1

0

2

4

6

8

10

12

14

16

2003 2005 2007 2009 2011 2014

Prevalence (%)

1.8 1.8 2 1.20

2

4

6

8

10

12

14

16

2005 2007 2009 2012

Prevalence (%)

7.89.6

9.9

8.57.7

6.1 6.76.9 6.4

6

4.53.6

0

2

4

6

8

10

12

14

16

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

Prevalence (%)


The graphs show a trend of a gradual increase in inhalant use in Chile, from 1.9% in 2001 to 5.2% in 2013, and

in Argentina, from 0.5% in 2001 to 2.6% in 2011. Uruguay remained stable between 2003 and 2014, with

figures ranging from 1.4% to 2.1%. Peru also remained fairly stable, with prevalence rates of between 1.2% and

2% in the period 2005‐2012. Mexico City experienced an increase in inhalant use between 2003 and 2009, with

prevalence stabilizing in 2012. On the other hand, the United States showed a clear downward trend in the use

of inhalants among secondary school students, from 9.9% in 1995 to 3.6% in 2013.

Graph 4‐10: Past year prevalence of inhalant use among secondary school students in countries of the Caribbean, 2009‐2014.

Although the countries of the Caribbean have data from only two studies and we cannot therefore speak of

trends, we can see changes between the studies conducted in 2009 or earlier, and those from 2011‐2014.

Prevalence rates in Trinidad and Tobago and Jamaica fell to almost half. Barbados remained stable. At the

other extreme, the largest increases are seen in Belize and Saint Vincent and the Grenadines, where prevalence

almost tripled between 2009 or earlier, and 2011‐2014. The remaining countries showed an increase from one

study to the next, but with less significant changes.

Perception of risk

An important factor in understanding the differences in prevalence rates of inhalant use is the perception of

the risk of using the substance. The graphs below show: (a) perception of the high risk of occasional use of

inhalants, by sex, country and subregion, and (b) perception of high risk of occasional use of inhalants as a

function of the past year prevalence of inhalant use.

0

2

4

6

8

10

12

14

16

S. Lucia


Barbados

Grenada

S. Kitts‐Nevis

Trinidad

‐Tobago

Jamaica

Antigua‐Barbuda

Belize

Dominica

Haiti

Baham

as

Prevalence (%)

2009 o r earlier 2011‐2014

88 | O A S ‐ C I C A D

Graph 4‐11: Perception of high risk of occasional use of inhalants

among secondary school students, by sex and country

Graph 4‐12: Past year prevalence of inhalant use among secondary

school students and perception of high risk of occasional use

The perceived high risk of occasional use of inhalants among secondary school students in the hemisphere

ranges from 26.4% to 55.4% (Table A4.6 Appendix). Graph 4‐11 again shows variations among countries, with

perceived high risk of between 27.9% and 56.1% for males and between 25% and 54.7% for females. Since not

all countries of the hemisphere have information available for this indicator, we cannot make comparisons

among subregions. Looking only at the countries shown here, we see important differences within each

subregion, but not between Central America and South America.

Graph 4‐12 shows no obvious association between the perception of high risk and past year prevalence: for

example, countries with perceived high risk of around 35% may have low prevalence rates (1.5%) or high

prevalence rates (4.5%).


The graph below gives prevalence of inhalant use in the general population, for the most part aged 12‐65.

0

10

20

30

40

50

60Males Females

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

20 30 40 50 60

Prevalence (%)



Graph 4‐13: Past year prevalence of inhalant use in the general population, by country and subregionxiii

Prevalence rates of inhalant use show great differences between secondary school students and the general

population: the past year prevalence of inhalant use in the general population ranges from 0% to 2.6%. In the

majority of the countries, past year prevalence rates are below 0.2%, with the exception of the United States

(0.6%), Belize (1%), Brazil (1.2%), Suriname (2.6%), Bolivia (0.3%) and Barbados (0.8%). Given that few recent

studies have been conducted of drug use among adults in many of the countries, particularly in the Caribbean,

it is difficult to make comparisons between subregions. However, within each subregion, we see differences

between countries, which are even more pronounced than the differences we saw among secondary school

students. Graph 4‐14 shows prevalence of use among females compared to males for past year use, by

subregion.

Graph 4‐14: Past year prevalence of inhalant use, by sex, country and subregionxiv

xiii Argentina: population aged 16‐64 Uruguay: population aged 15‐65

0

1

2

3

Prevalence (%)

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

United

states (2013)

Mexico (2011)

Belize (2005)

El Salvador (2014)

Costa Rica (2010)

Surinam

e (2007)

Bolivia (2007)

Colombia (2013)

Argentina (2011)

Uruguay (2011)

Chile (2012)

Paraguay (2003)

Ecuador (2013)

Peru (2010)

Barbados (2006)

Dominican

Rep

(2010)

Prevalence (%)

Males Females

90 | O A S ‐ C I C A D

Looking at the use of inhalants by sex, we find great variations in inhalant use among males and females. In

some countries, inhalant use among female students is higher than among males, as we see in Belize, Peru,

Suriname and Barbados. The size of this difference ranges from 1.3 times in Belize to 3.9 times in Suriname,

where past year prevalence rates of inhalant use among females was 3.9%, four times higher than reported use

among males (0.8%).

Among the countries where males use more than females, we find the greatest difference in El Salvador, where

reported use of inhalants among males is 36 times higher than among females, followed by Argentina,

Colombia and Chile. Paraguay and Costa Rica are the only two countries where there is the same prevalence

among males as among females.

As stated earlier, it is important to identify the sub‐populations having higher rates of use in each country.

Differentiating use of inhalants according to age group has an important role to play in giving direction to

public policies on drugs, particularly as they related to prevention of first use. Graph 4‐15 shows a higher rate

of inhalant use among adolescents between the ages of 12 and 17 than among young adults aged 18‐34 in

most South American countries as well as in the United States, Barbados and El Salvador. Other countries such

as Suriname, Bolivia and Peru report higher use among young adults than among adolescents. In a third group

of countries, Belize, Costa Rica, Paraguay and the Dominican Republic, inhalant use is concentrated almost

exclusively among young adults aged 18‐34, with very low prevalence rates among adolescents.

Graph 4‐15: Past year prevalence of inhalant use, ages 12‐17 and 18‐34,

by country and subregionxv


Trends in the general population show stabilization at very low prevalence of use, primarily due to the fact that

these are age groups within the population where the consumption of this substance seems to be very low.

xiv Argentina: population aged 16‐64 Uruguay: population aged 15‐65 xvArgentina: population aged 16‐64 Uruguay: population aged 15‐65

0

1

2

3

United

States (2013)

El Salvador (2014)

Belize (2005)

Costa Rica (2010)

Surinam

e (2007)

Ecuador (2013)

Uruguay (2011)

Chile (2012)

Colombia (2013)

Bolivia (2014)

Peru (2010)

Argentina (2011)

Paraguay (2003)

Barbados (2006)

Dominican

Rep

(2010)

Prevalence (%)

12 to 17 18 to 34



Complementing the data on prevalence rates, the graph below shows the perception of the high risk of

occasional use of inhalants, by sex and country.

Graph 4‐16: Perception of high risk of occasional use of inhalants among the general population,

by sex and country

The graph shows the variations among countries, with perceived risk at between 48% and 90.8% for males, and

between 49.2% and 92.5% for females. Looking only at the countries shown in the graph, the perceived risk is

lower in Bolivia and Paraguay than in the Dominican Republic, Costa Rica and El Salvador. No significant

differences between sexes are seen in any of the countries in terms of perceived risk.


National studies on drug use among university students have been conducted in six countries of the

hemisphere: the four Andean countries, Brazil and El Salvador.

Graph 4‐17: Past year prevalence of inhalant use among university students, by country

Past year prevalence of inhalant use among university students are variable, but on the whole low. Except for

Brazil, with a prevalence rate of 6.5%, all the countries are in the range of 0.25% to 1%, with El Salvador and

0102030405060708090100

DominicanRep (2010)

Costa Rica(2010)

El Salvador(2008)

Ecuador(2013)

Paraguay(2003)

Bolivia(2008)

Males Females

0

1

2

3

4

5

6

7

Brazil(2012)

Colombia(2012)

El Salvador(2014)

Bolivia(2012)

Ecuador(2012)

Peru(2012)

Prevalence (%)

92 | O A S ‐ C I C A D

Ecuador among the lowest (Graph 4‐17). Looking at gender (Graph 4‐18), we see higher use among females in

Peru, Bolivia and Ecuador, in contrast to Colombia, where there is higher use among males.

Graph 4‐18: Past year prevalence of inhalant use among university students, by sex and country


Although we do not have trends in prevalence of inhalant use among university students, the Andean countries

conducted two studies in 2009 and 2012 that are comparable and that used the same methodology (Graph 4‐

19). The study data show that inhalant use fell in all of the Andean countries between 2009 and 2012. The

most pronounced decline was in Bolivia, from 2% to 0.5%, while Colombia had the smallest change, from 1.4%

to 0.98%.

Graph 4‐19: Past year prevalence of inhalant use among university students, by country, 2009‐2012.


Fewer than 60% of university students in the Andean countries saw the occasional use of inhalants as being of

high risk (Graph 4‐20). In all of the countries, the perception of high risk is greater among females than among

males, with figures ranging from between 29% and 50% of male university students, and between 35% and

57% among females. The perceived high risk is notably lower in Colombia than in the rest of the countries

0

0.5

1

1.5

2

Colombia (2012) Peru (2012) Bolivia (2012) Ecuador (2012)

Prevalence (%)

Males Females

0

0.5

1

1.5

2

2.5

Colombia

Peru

Bolivia

El Salvador

Ecuador

Prevalence (%)

2009 2012


shown, both among males and among females, which may explain in part the higher prevalence of inhalant use

among university students in that country.

Graph 4‐20: Perception of high risk of occasional use of inhalants among university students, by sex and country

0

10

20

30

40

50

60

Peru Ecuador Bolivia Colombia

Males Females

94 | O A S ‐ C I C A D

CHAPTER 5: C O C A I N E AND SMO K A B L E C O C A I N E

This chapter on cocaines discusses the use of three substances that contain the alkaloid cocaine, extracted

from the leaves of the coca bush of the genus Erythroxylum, namely, cocaine hydrochloride, cocaine base paste

and crack. These are three drugs with a common origin but which are differentiated by the process of

preparation by which they are produced and by the form in which they are used. Specifically, cocaine is

snorted, inhaled or injected, and cocaine base paste and crack are smoked. The way in which they are used has

a great impact on the health of the users, as do the adulterants and thinners that may be present in each drug

by the time it is used.

What is clear is that these three drugs have different markets, forms of trafficking and dealing, and patterns of

use, and that they change according to how they are adulterated or cut.

Cocaine has been called the drug of the eighties and nineties because of its great popularity and widespread

use during that time. Coca leaves from which cocaine is produced have been ingested for thousands of years,

while the pure chemical substance, cocaine hydrochloride, has been used for more than one hundred years.

Cocaine is usually sold on the street in the form of a fine white crystalline powder, which is known as “coke”,

“C”, “snow”, “flake” and “blow”. Traffickers generally mix cocaine with other inert substances, such as

cornstarch, talc or sugar, or with certain active drugs such as procaine (a local anesthetic of similar chemical

composition) or other stimulants such as amphetamine. Some users combine cocaine with heroin in what is

called a “speedball”.

There are two chemical forms of cocaine that are in general use: hydrochloride salt (which is water‐soluble)

and cocaine crystals, or “freebase” (which are not soluble in water). Hydrochloride salt, the power form of

cocaine, is injected or snorted. Cocaine crystals have been processed with ammonia or sodium bicarbonate and

water, and then heated to eliminate the chlorohydrate and produce a substance that can be smoked. The term

“crack”, the street name for cocaine crystals or base, refers to the cracking or popping sound it makes when

heated.

According to Castaño’s definition,53 smokable cocaines are substances derived from coca leaf that, when

chemically processed have a low melting point and can be volatilized through sublimation or can be heated and

boiled. Both cocaine base paste (CBP), and crack and freebase are smokable cocaines. It is CBP that emerged

and became rooted in the countries of South America, mainly Argentina, Chile, Uruguay and Brazil (where it is

called “crack”) at the beginning of the twenty‐first century. In recent years, Paraguay has also reported the

spread of the use of PBC, where it is called crack or chespi.

This chapter will provide available information on each of these substances separately: cocaine, cocaine base

paste and crack.


COCAINE Introduction Worldwide estimates by the United Nations for 2012 indicate that some 17.2 million people between the ages

of 15 and 64 reported that they had used cocaine during the twelve months prior to the survey, representing a

worldwide prevalence of 0.37%. Cocaine would therefore be in fourth place in the use of controlled

substances globally, but it is relatively concentrated in the Americas, Europe and Oceania. Almost all of the

cocaine produced comes from three countries in South America.


The findings show great variations in cocaine use among secondary school students, whether lifetime, past

year or past month. The subregional averages encompass very dissimilar levels of use in the countries in those

subregions, mostly in South America.

Graph 5‐1: Past year prevalence of cocaine consumption among secondary school students in the Americas

0

0.5

1

1.5

2

2.5

Grenada (2013)




Haiti (2014)

Barbados (2013)

Trinidad

‐Tobago (2013)

Dominica (2011)

Jamaica (2013)

Baham

as (2011)

S.Lucia (2013)

Dominican

Rep

(2008)

Prevalence (%)

96 | O A S ‐ C I C A D

The graph below shows past year prevalence of cocaine use among secondary school students, by subregion:

Graph 5‐2: Past year prevalence of cocaine use among secondary school students, by country and subregion

The graph shows three South American countries, Chile, Argentina and Colombia, where prevalence for

secondary school students are higher than 2.5%; they are followed by Canada, Grenada, Uruguay and Brazil,

where use was over 2%. The lowest prevalence are 0.3% and 0.2% in Venezuela and Suriname respectively.

South America is the subregion that has the greatest variations in cocaine use.

The prevalence in the Caribbean range from 0.5% to slightly more than 2%. In six countries (Grenada, Saint

Kitts and Nevis, Antigua and Barbuda, Saint Lucia, Haiti and Trinidad and Tobago) we find prevalence of 1.5% or

more, while in three, prevalence are barely over 0.5%.

Three countries in Central America have prevalence of 1% or more (Belize, Panama and El Salvador). And in

North America, Canada is one of the countries in the hemisphere where there is higher use, while the United

States is in the middle range.

Past year cocaine use by sex is shown below (Table A5.5 Appendix) . The prevalence are ordered within each

subregion by the size of the indicator.

0

0.5

1

1.5

2

2.5

3

3.5

4

Canada (2010/11)

United

States (2014)

Belize (2013)

Panam

a (2008)

El Salvador (2008)

Honduras (2005)

Costa Rica (2012)

Chile (2013)

Argentina (2011)

Colombia (2011)

Uruguay (2014)

Brazil (2010)

Bolivia (2008)

Guyana (2013)

Ecuador (2012)

Peru (2012)

Paraguay (2005)

Ven

ezuela (2009)

Surinam

e (2006)

Grenada (2013)



S. Lucia (2013)

Haiti (2014)

Trinidad

‐Tobago (2013)

Dominica (2011)

Jamaica (2013)

Baham

as (2011)


Dominican

Rep. (2008)

Prevalence (%)


Graph 5‐3: Past year prevalence of cocaine use among secondary school students,


First, we see a higher level of cocaine use by male students in all of the countries, independently of the

prevalence. The exception is Saint Vincent and the Grenadines, where prevalence are low overall, and similar

by sex (0.58% for males and 0.69% for females).

In those countries that have higher prevalence of cocaine use, except for the Caribbean region, the ratio of

male to female use ranges from 1.5 to 2.1, as is the case with Argentina. By contrast, in the Caribbean the ratio

of male to female use is 32:1 in Grenada, the country with the highest level of use in the subregion, followed by

Saint Lucia with 7:1, and around 3:1 in Haiti and Jamaica.

In South America, use by male students is six times higher than for females in Venezuela, 5 times higher in

Guyana and 3.7 times higher in Ecuador. In Central America, Honduras and Costa Rica, the figures show that

use by male students is three and four times higher than females, respectively.

The table below shows that the hemisphere‐wide average of past year use of cocaine by secondary school

students was 1.8%. South America is above this average, with a rate of 2.2%, where rates of lifetime and past

month use are also the highest. North America, not including data from Mexico, is the subregion with the

second highest prevalence of cocaine use, followed by the Caribbean.

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Canada (2010/11)

United

States (2014)

Belize (2013)

Panam

a (2008)

El Salvador (2008)

Honduras (2005)

Costa Rica (2012)

Chile (2013)

Argentina (2011)

Colombia (2011)

Bolivia (2008)

Uruguay (2014)

Guyana (2013)

Ecuador (2012)

Peru (2012)

Paraguay (2005)

Ven

ezuela (2009)

Surinam

e (2006)

Grenada (2013)

S. Lucia (2013)



Trinidad

‐Tobago (2013)

Haiti (2014)

Dominica (2011)

Jamaica (2013)

Baham

as (2011)

Dominican

Rep

. (2008)

S.Vinc ent‐Grenadines (2013)

Prevalence (%)

Men Women

98 | O A S ‐ C I C A D

Table 5‐1: Lifetime, past year and past month prevalence of cocaine use by secondary school students, by subregion and total for the hemisphere




Central America 1.50 0.85 0.43



Hemisphere 3.24 1.83 0.86 *Only countries with information from 2010 and later are included. Weighted means are not available


Drug use among the adolescent population assumes that use began at an early age. However, we can identify

use at a much younger age by looking at the prevalence of cocaine use by 8th grade students, that is, the

youngest in the universe studied. Lifetime prevalence among 8th graders indicates the proportion of students

who had used cocaine at least once in their lives by the age of thirteen or younger. Cocaine use by the age of

thirteen is an early warning sign and should alert prevention programs of the need to address the issue.

Graph 5‐4: Lifetime prevalence of cocaine use among 8th grade students or equivalent, by country and subregion

This early use is found in the Caribbean in at least in three countries where prevalence are over 4% (Antigua

and Barbuda, Grenada and Saint Lucia) and in Saint Kitts and Nevis, where prevalence is as high 6%.

0

1

2

3

4

5

6

7

United

States (2014)

Belize (2013)

Panam

a (2008)

El Salvador (2008)

Costa Rica (2012)

Honduras (2005)

Chile (2013)

Argentina (2011)

Colombia (2011)

Bolivia (2008)

Peru (2012)

Guyana (2013)

Uruguay (2014)

Ecuador (2012)

Paraguay (2005)

Ven

ezuela (2009)

Surinam

e (2006)



Grenada (2013)

S.Lucia (2013)

Trinidad

‐Tobago (2013)

Haiti (2014)

Barbados (2013)

Dominica (2011)

Jamaica (2013)


Baham

as (2011)

Dominican

Rep

. (2008)

Prevalence(%

)


In South America, Chile had a high rate of adolescent use in the past year, and in addition, lifetime use by

students aged 13 and under was more than 4%. Argentina is in second place in this indicator, with over 3%.

In Central America, the two countries with the highest past year prevalence (Belize and Panama) show very

early use of over 3%.

For North America, we have data only from the United States, where there are no significant changes in these

indicators.


The countries of South America that have comparable data over time show different trends. There is a certain

stability in cocaine use, but with prevalence that are high or low, as in Chile and Peru. However, use increased

throughout the period in Argentina and Uruguay.

Available data from Chile show that recent use of cocaine between 2001 and 2013 remained at around 3.2%,

ending the period with a slight increase to 3.6%.

Graph 5‐5: Past year prevalence of cocaine use by

secondary school students, Chile 2001‐2013.

Graph 5‐6: Past year prevalence of cocaine use by secondary school students, Argentina 2001‐2011.

The information from Argentina indicates that following a sharp increase between 2001 and 2005, prevalence was around 2.5%, with a slight increase towards the end of the period. Cocaine use among secondary school students in Peru was around 1% between 2005 and 2012.

In Uruguay, cocaine use among secondary school students rose from 1.7% to 2.1% over a period of eleven

years, but with increases between 2005 and 2007, a decrease in 2007‐2011 and another increase in 2014.

3.2

2.8

3.43.6

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

2001 2003 2005 2007 2009 2011 2013

Prevalence (%)

1

2.2 2.5 2.32.7

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

2001 2005 2007 2009 2011

Prevalence (%)

100 | O A S ‐ C I C A D

Graph 5‐7: Past year prevalence of cocaine use by secondary school students, Uruguay 2003‐2014.

Graph 5‐8: Past year prevalence of cocaine use by

secondary school students, Peru 2005‐2012

Guyana conducted two studies (2007 and 2013), which showed that prevalence decreased from 2.8% to 1.1%. Brazil has two comparable studies from 2004 and 2010 of students aged 10‐19 and older living in 27 state capitals. Over this period, cocaine use rose slightly from 1.7% to 1.9%. For Central America, information is available from Costa Rica from three studies conducted in 2006‐2012. The trend towards the end of the period was of a slight decrease in past year use, from 1.2% to 0.8%.

Graph 5‐9: Past year prevalence of cocaine use

by secondary school students, Costa Rica 2006‐2012.

The information available for the United States for the period 1991‐2014, the most long‐standing monitoring in

the hemisphere, shows a spike in cocaine use of 4.5% in 1998. A decline began that year, and between 2002

and 2006, a plateau was reached with a prevalence of around 3.7%. And then, there was a sustained decrease

to an estimated prevalence of 1.6% in the most recent study of 2014.

1.71.5

3.7

2.51.4

2.1

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

2003 2005 2007 2009 2011 2014

Prevalence (%)

1.1 0.9 1 0.9

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

2005 2007 2009 2012

Prevalence (%)

1.2 1.30.8

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

2006 2009 2012

Prevalence (%)


Graph 5‐10: Past year prevalence of cocaine use by secondary

school students, United States, 1992– 2014

Recent use of cocaine by secondary school students in Mexico City monitored between 1989 and 2012 shows a

sharp increase for both sexes, but with a sharper increase among female students, going from 0.3% to 2.1%,

while use by male students went from 0.9% to 2.8%. The gap between male and female rates of use was not

significant, either at the beginning or the end of the period.

The graph below shows that in the Caribbean, cocaine use in ten of the eleven countries rose between 2009

and 2011‐2014. The countries where use doubled were Antigua and Barbuda, Belize, Saint Kitts and Nevis,

Saint Vincent and the Grenadines and Saint Lucia. In The Bahamas, Dominica, Haiti and Trinidad and Tobago,

cocaine use increased by more than 100% over the figures from the first studies.

Prevalence at the end of the period was 1.5% or more in seven countries; the highest prevalence in the

Caribbean was 2.2%. A decline in use was observed in Jamaica—bearing in mind that it had the highest past

year prevalence in the Caribbean in 2009 or before, so the decline was significant over the period studied.

Graph 5‐11: Past year prevalence of cocaine use among secondary school

students in the countries of the Caribbean, 2009‐2014.

2.1

2.8

44.5

3.9

3.73.5

3.5

2.9

2.21.9

1.6

0

1

2

3

4

5

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

Prevalence (%)

0

1

2

3

4

5

Antigua‐Barbuda

Baham

as

Belize

Dominica

Grenada

Haiti

Jamaica

S. Kitts‐Nevis


S. Lucia

Trinidad

‐Tobago

Prevalence (%)

2009 or earlier 2011‐2014

102 | O A S ‐ C I C A D

Perception of risk

The perception of high risk of occasional use of cocaine is held by half of the students or more (up to 80%) in

four countries in the hemisphere. Another four countries registered 40‐50%, and in eight countries, the opinion

of high risk is held by between 27% and 40% of secondary school students. Included in these latter countries

are those where past year prevalence of cocaine use was 2% or more (Table A5.9 Appendix).

No major differences by sex are seen in the views of secondary school students about the risk of occasional use

of cocaine. The small differences show a larger proportion of male students who view occasional use as risky,

with the exception of Colombia, where more female students perceive risk. There are no significant differences

according to gender either in countries where there is a high perception of risk—close to 80%‐‐or in those

where nearly 30% perceive a risk.

Graph 5‐12: Perception of high risk of occasional use of cocaine among

secondary school students, by sex and subregion

Frequent use of cocaine is seen as highly risky by a large proportion of students in all of the countries,

exceeding 50% and even up to 90%. Only in Chile, which is the country with the highest prevalence, is this view

held by less than 50% of secondary school students. In countries where cocaine use is above 2%, 70% to 80% of

the students perceive high risk, and indeed, 83% as in Uruguay (TableA5.10 Appendix).

By contrast to views about occasional use, the perception of the high risk of frequent use of cocaine is greater

among women, with the exception of Chile and Suriname where differences of perception among the sexes are

very small.

The graph below shows how the perceptions of high risk of the occasional use of cocaine are or are not related

to rates of use. We find countries in which this relationship is clear: high rates of perception of high risk and

low levels of use.

0

10

20

30

40

50

60

70

80

90Males Females


However, we also have countries where the perception of high risk is low and cocaine use is also low. Here we

should ask what percentage of the population have no opinion about, or do not know about, the occasional use

of cocaine.

Similar perceptions of high risk are found in countries with dissimilar prevalence of over 1.5% and under 1%.

Graph 5‐13: Prevalence of use and perception of high risk of the occasional

use of cocaine among secondary school students, by country

Perception of ease of access to cocaine and offers of cocaine

Fifteen per cent of secondary school students in Argentina, Trinidad and Tobago and Uruguay perceive cocaine

as easy to obtain, the highest perception in the hemisphere. This perception is shared by between 10% and

14% of the students in eleven countries, while the perception of ease of access in the other eleven is less

frequent.

Graph 5‐14: Perception of ease of access to cocaine among secondary school students, by country and subregion

The association between use and perception of ease of access is not very clear, except at the extremes where countries with higher perception of ease of access, also have higher use of cocaine, and vice versa. There are also countries with similar levels of perception of ease of access but dissimilar or opposite levels of cocaine use.

0

0.5

1

1.5

2

2.5

3

3.5

4

0.0 20.0 40.0 60.0 80.0 100.0

Prevalence (%)


0

5

10

15

20

25

Belize (2013)

Panam

a (2008)

El Salvador (2008)

Argentina (2011)

Uruguay (2014)

Surinam

e (2006)

Colombia (2011)

Chile (2013)

Peru (2012)

Paraguay (2005)

Ecuador (2012)

Ven

ezuela (2009)

Trinidad

‐Tobago (2013)

Dominica (2011)

Barbados (2013)

Grenada (2013)

Baham

as (2011)


S.Lucia (2013)

Dominican

Rep

(2008)



Guyana (2013)

Jamaica (2013)

Haiti (2014)

104 | O A S ‐ C I C A D

This may be explained by the fact that perceptions about ease of access come from a variety of sources, and are not necessarily subjective or in line with reality.

Graph 5‐15: Past year prevalence of cocaine use and perception of ease of access

to cocaine among secondary school students, by country

The graph below shows data on cocaine offered to students; the figures are notably lower than the perception

of ease of access. However, in countries where the perception of ease of access is higher, there is a correlation

with the numbers of offers of cocaine.

In four countries, 6% or more of secondary school students were offered cocaine over a one‐year period, with

the highest rate being more than 8%. In nine countries, 3% or less of secondary school students were directly

offered cocaine in the past year.

Graph 5‐16: Offers of cocaine in the past year and past month among

secondary school students, by country and subregion

0

0.5

1

1.5

2

2.5

3

3.5

4

0 5 10 15 20 25

Prevalence (%)

Perception of ease of access (%)

0

1

2

3

4

5

6

7

8

9

10

Belize (2013)

Costa Rica (2012)

El Salvador (2008)

Chile (2013)

Argentina (2011)

Uruguay (2014)

Ecuador (2012)

Peru (2012)

Bolivia (2008)

Paraguay (2005)

Surinam

e (2006)

Barbados (2013)


Grenada (2013)

Trinidad

‐Tobago (2013)

Dominica (2011)

Guyana (2013)

Baham

as (2011)

Jamaica (2013)


S.Lucia (2013)


Haiti (2014)

Dominican

Rep

(2008)



Analyzing the indicator on offers of cocaine received and its association with cocaine use, it is clear that in

those countries where students were offered cocaine more frequently, use is higher: this is the case in

Argentina, Chile, Uruguay and Belize, countries for which information is available.

Graph 5‐17: Prevalence of use and offers of cocaine in the past year among


General population Indicators on use

According to available information on cocaine use in the hemisphere, nine countries have rates of past year use

ranging from 0.1% to 0.5%; seven have prevalence that are between 0.5% and 1%, and the three countries

where cocaine use is highest have rates of 1.3%, 1.6% and 1.9%.

The graph below shows past year prevalence of cocaine use by country and subregion.

Graph 5‐18: Past year prevalence of cocaine use in the general population, by country and subregionxvi

xvi Canada: population aged 15‐64. Argentina: population aged 16‐64 Uruguay: population aged 15‐65

0

0.5

1

1.5

2

2.5

3

3.5

4

0 2 4 6 8 10

Prevalence (%)

Offer (%)

0

0.5

1

1.5

2

2.5

3

Prevalence (%)

106 | O A S ‐ C I C A D

Looking at cocaine use by sex (graph 5‐19), rates for males in all of the countries are higher than the overall

rates of use, which means that cocaine use is predominantly male. The exceptions are Belize, Paraguay and

Ecuador—countries with dissimilar prevalence—where there are no differences in use between the sexes.

In the two Caribbean countries that have information on this, the ratio is 10 males to every female cocaine

user. The ratio drops to 9 in Mexico and in El Salvador, Argentina and Venezuela, between seven and eight

times more men than women use cocaine. Peru and Suriname have between five and six male cocaine users

for every female, while the ratio in Uruguay is 3.4 and in the United States, 2.2.

Graph 5‐19: Past year prevalence of cocaine use in the general population,

by sex, country and subregion xvii

Looking more specifically at use profiles in the countries, we examined the rates of use among the two age

groups that worldwide tend to have the highest rates of use of illicit drugs.

The graph below shows rates of past year use for the populations aged 12‐17 and 18‐34 (recalling the age

ranges used in the United States, Argentina and Uruguay).

We see first of all that in all of the countries, the rates of use by young adults aged 18‐34 are higher than the

overall rates for each country and therefore, with some exceptions, cocaine use in the hemisphere is

concentrated in this age group.

The exceptions are found in South America, in Ecuador in particular, where 12‐17 year olds use cocaine more

than young adults (0.5% and 0.1% respectively). Thus, Ecuadorian adolescents are similar to those in the United

States in their level of cocaine use. In Argentina, rates of use among 16 and 17 year olds and young adults aged

18‐34 are almost the same. The two age groups are the same in Paraguay, but with low prevalence, around

0.3%. Lastly, household surveys in Suriname found no reports of cocaine use by 12‐17 year olds.

xvii Uruguay: population aged 15‐65. Argentina: population aged 16‐64

0

0.5

1

1.5

2

2.5

3

3.5

Prevalence(%

)

Males Females


Graph 5‐20: Past year prevalence of cocaine use among 12‐17 and 18‐34 year olds, by country and subregion xviii


In Argentina, the use of cocaine in the general population increased from 0.3% to 0.9% between 2004 and 2011, with a spike in 2006.

Graph 5‐21: Past year prevalence of cocaine use in the general population aged 16‐65, Argentina 2004‐2011.

Graph 5‐22: Past year prevalence of cocaine use in the

general population, Peru 1998‐2010.

In Peru, cocaine use was 0.4% at the beginning and end of the 1998‐2010 period, with an uptick in 2002.

xviii Uruguay: population aged 15‐65. Argentina: population aged 16‐64

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Prevalence (%)

12 to 17 18 to 34

0.3

2.6

1.10.9 0.9

0

0.5

1

1.5

2

2.5

3

3.5

4

2004 2006 2008 2010 2011

Prevalence (%)

0.4

0.7

0.3 0.4

0

0.5

1

1.5

2

2.5

3

3.5

4

1998 2002 2006 2010

Prevalence (%)

108 | O A S ‐ C I C A D


general population, Chile 1994‐2012.

Graph 5‐24: Past year prevalence of cocaine use in the general population, aged 15‐64, Uruguay 2001‐2011.

Trends have been monitored in Chile for almost twenty years and show a prevalence close to 1% at the

beginning and end of the period, but with some phases of higher use of around 1.5% between 1998 and 2006,

then a spike around 2008 and a decline starting in 2010.

In Uruguay, which has conducted three general population studies, cocaine use rose between 2001 and 2011,

going from 0.2% to 1.9%.

In Colombia, which has two comparable studies (2008‐2013), past year prevalence remained stable at 0.7%.

Data from the United States show a drop in cocaine use in the general population between 2002 and 2013,

from 2.5% to 1.6%. After stabilizing at the highest rates in 2002‐2006, the decline was constant until 2012,

when there was a slight increase.


general population. United States, 2002‐2013


general population. Mexico, 1988‐2011.

0.9

1.5

1.3 1.8

0.9

0

0.5

1

1.5

2

2.5

3

3.5

41994

1996

1998

2000

2002

2004

2006

2008

2010

2012

Prevalence (%)

0.2

1.6

1.9

0

0.5

1

1.5

2

2.5

3

3.5

4

2001 2006 2011

Prevalence (%)

2.5 2.4 2.52.1

1.81.5 1.6

0

1

2

3

4

2002 2004 2006 2008 2010 2012

Prevalence (%)

0.20.5 0.4 0.5 0.5

0

0.5

1

1.5

2

2.5

3

3.5

4

1988 1998 2002 2008 2011

Prevalence (%)


Perception of risk

The occasional use of cocaine is considered by more than 80% of the population aged 12‐65 in Costa Rica,

Dominican Republic, Colombia, Argentina and Peru to be highly risky. In the remaining countries for which

information is available, between 60% and 80% of the population hold this perception of risk (Table A5.11

Appendix).

The graph below shows that there are no major differences between sexes with respect to their views about

the high risk of occasional use of cocaine.

Graph 5‐27: Perception in the general population of high risk of occasional use of cocaine, by sex

Frequent use of cocaine is felt by 90% of the population of six countries to be highly risky. These data are

consonant with the highest prevalence rates seen, which are all less than 2% (Table A5.4 Appendix). There are

no significant differences between men and women in their opinion about the risk of frequent use of cocaine:

both sexes have similar views, by large percentages which are close to or over 90% in a number of countries.

Perception of ease of access and offers of cocaine

The perception of ease of access to cocaine among the general population varies according to country, ranging

from 12% to 49%. Generally speaking, in countries with higher use—rates over 1%‐‐there is higher perception

of ease of access; however, this relationship is not lineal in the sense of magnitude. In other words, Costa Rica

is not the country with the highest level of use but it does have the highest perception of ease of access to

cocaine.

0

10

20

30

40

50

60

70

80

90

100Males Females

110 | O A S ‐ C I C A D

Graph 5‐28: Perception of ease of access to cocaine, general population, by country

The highest percentages of people who said they had been offered cocaine directly in the past year and past

month are in the countries of the Southern Cone. In Central America, offers of cocaine received in the past year

are similar among countries with very different rates of use, such as El Salvador and Costa Rica, where 2% of

the population stated that they had been offered cocaine in the past month.

Graph 5‐29: Offers of cocaine in the past year and past month, general population, by country


Information is available from seven countries on cocaine use by university students. In Brazil and Colombia,

lifetime prevalence is over 7%, while in Venezuela it is less than 1%, showing once again the variations in

cocaine use in the Americas.

The graph below shows recent prevalence, with Brazil and Colombia having the highest rates. Except for

Ecuador, the other countries’ rates tend to be similar at under 0.5%.

0

10

20

30

40

50

60

0

1

2

3

4

5

6

7Past month Past year


Graph 5‐30: Past year prevalence of cocaine use among university students, by country

As with other population groups, cocaine is used mainly by males. In those countries with the highest

prevalence rates, such as Brazil and Colombia, for each female student who used cocaine in the past year,

three males used cocaine. This difference between sexes rises to 12 and 8 times in Ecuador and Peru

respectively. The country that is an exception here is El Salvador, where there is no difference among sexes in

terms of cocaine use.

Graph 5‐31: Past year prevalence of cocaine use among university students,

by sex and country


The Andean countries conducted two comparable studies of university students in 2009 and 2012, which show

changes in past year prevalence of cocaine in Colombia, a slight decrease from 2.4% to 2.1%, and in Ecuador

where cocaine use doubled (0.6% to 1.2%). Peru and Bolivia remained stable, at 0.5% and 0.2% respectively.

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

Prevalence (%)

0

1

2

3

4

5

6

Brazil(2010)

Colombia(2012)

Ecuador(2012)

Peru (2012) Venezuela(2014)

El Salvador(2012)

Bolivia(2012)

Prevalence (%)

Males Females

112 | O A S ‐ C I C A D

Graph 5‐32: Past year prevalence of cocaine use

among university students, by country, 2009‐2012.

Perception of risk

Data from the Andean countries and El Salvador show that between 57% and 66% of university students consider that the occasional use of cocaine involves high risk: these are countries where recent use ranges between 0.3% and 2% (Table A5.13 Appendix). Differences by sex in views about risk are not significant. In Ecuador and Colombia, the two countries where cocaine use is higher (leaving aside Brazil), the view of risk is slightly higher among women, while the opposite is true in Peru, El Salvador and Bolivia.

Graph 5‐33: Perception of high risk of occasional use of cocaine among university

students, by sex

Like other population groups examined, the proportion of those who see the frequent use of cocaine as highly

risky rose by 30 percentage points, with women slightly higher than men.

0

0.5

1

1.5

2

2.5

Colombia Ecuador Peru Bolivia

Prevalence (%)

2009 2012

0

10

20

30

40

50

60

70

80

90

100

Ecuador (2012) Peru (2012) El Salvador(2012)

Colombia (2012) Bolivia (2012)

Males Females


Ease of access to cocaine and offers of cocaine

One fourth of Colombian and Ecuadorian university students perceive cocaine as easy to obtain. Note that

these are the countries with the highest rates of past year use, leaving aside Brazil.

Graph 5‐34: Perception of ease of access to cocaine among university students, by country

Given the number of students who were report that they were offered cocain directly during the past year,

University students may be considered a group at risk. In the two countries where cocaine use is highest,

almost 14% of students were offered cocaine. Notwithstanding, even in countries where prevalence is less than

0.5% around 8% of students were offered cocaine.

Graph 5‐35: Offers of cocaine in the past year and past month among university students, by country

0

5

10

15

20

25

30

Colombia (2012) Ecuador (2012) Peru (2012) El Salvador(2012)

Bolivia (2012)

0

2

4

6

8

10

12

14

16

Colombia(2012)

Ecuador (2012) Peru (2012) Bolivia (2012) El Salvador(2012)


114 | O A S ‐ C I C A D

COCAINE BASE PASTE Introduction Cocaine base paste (CBP) is an intermediate product in the production of cocaine hydrochloride from coca

leaves. It is generally produced by dissolving dried coca leaves in water and treating the solution first with

kerosene or gasoline, and then with alkaline substances and potassium permanganate, and finally with

sulphuric acid. (Castaño, G.A., 54).

The product is a pasty, strong‐smelling yellowish‐white powder which is liposoluble and volatilizes at high

temperatures. It contains between 40% and 85% cocaine sulphate and is used to then produce cocaine

hydrochloride. It is smoked in a pipe or similar, or mixed with tobacco or marijuana cigarettes.

CBP is a chemically complex product, which should not be regarded as having the same biological and

toxicological properties as cocaine, even though cocaine is its major component.

CBP is adulterated or cut with, with various other products such as, lactose, talc, flour, brick dust or sugar,

which are added to increase its volume. To offset the potency lost to adulteration, stimulants like

amphetamine or caffeine are added, along with freezing agents (lidocaine, benzocaine, levamisole) to mimic

the anesthetic effect.

Because smokable cocaines are highly liposoluble, they pass rapidly through the blood‐brain barrier and reach

the central nervous system within five seconds, which is one of the reasons for their highly addictive nature.

CBP has different names in different countries or according to particular groups of users. In Argentina, it is

called “paco”, and also cocaine base paste in Chile and Uruguay. In Brazil, it is called “crack” (but it is not the

same substance as that produced from cocaine hydrochloride). In Paraguay, it may be called either crack, or

“chespi”. In Brazil, depending on the degree of adulteration of CBP, it may be called “merla” (containing a high

percentage of solvents and battery acid), or “oxi” (which is the waste material from cocaine base paste

containing gasoline, kerosene and lime).

As we have seen, there are a variety of names and products whose origin is cocaine base paste but which are

converted into different products as a result of various adulterations.

In the nineteen seventies, use of CBP was confined to the Andean countries (Colombia, Ecuador, Peru and

Bolivia), but in the nineties and the early years of the twenty‐first century, it exploded in South America,

particularly in the Southern Cone, where it had a major social impact in terms of different groups involved, new

forms of dealing, security and environmental problems, and became a political and institutional problem for

the governments.

In the Southern Cone countries, the emergence of the problem of CBP use involved emergency room episodes

of overdose, an increase in the demand for treatment, problems of insecurity and vulnerability associated with

CBP users, a source of new episodes of violence, and demands for help and treatment by family members. In


no case did the findings of general population or secondary school surveys provide an early warning of this new

pattern of use, since estimated prevalence were low and remained stable over time.

New methodologies were needed to understand and estimate the users of cocaine base paste in hidden

populations or groups that were difficult to access: the methods included sampling driven by the interviewees

(Respondent Driven Sampling), the Network Scale‐up Method (NSUM), or else specific samples in particular

geographical areas, such as slums, which were then supplemented with ethnographic and qualitative

approaches.


Tables A5.17‐A5.19 in appendix shows prevalence rates of the use of cocaine base paste (lifetime, past year

and past month) by sex and totals, as well as by student grade level.

In the countries of South America, lifetime prevalence varies between 0.8% (Colombia) and 4.3% (Chile), that is,

a difference of 3.5 percentage points. The gap is smaller for past year prevalence (2.3 percentage points) (Table

A5.17 Appendix).

Argentina, Bolivia and Chile are the countries with the highest prevalence of past year use of cocaine base

paste, with rates that range from 1% to 2.2%.

Graph 5‐36: Past year prevalence of the use of cocaine base paste among secondary school students, by country

The graph below gives prevalence by sex, and shows that CBP use is largely by male students, with the

exception of Uruguay where use among females is double that of males, in the context of an overall low

prevalence (0.6% and 0.3% respectively).

At the other extreme, use by male students is triple that of women, while in Chile, use by males is double that

of females, the same as in Bolivia, Colombia and Peru. Among Argentine students, the gap between the sexes is

smaller in terms of CBP use.

0

0.5

1

1.5

2

2.5

Chile(2013)

Bolivia(2008)

Argentina(2011)

Peru(2012)

Ecuador(2012)

Colombia(2011)

Uruguay(2014)

Prevalence (%)

116 | O A S ‐ C I C A D

Graph 5‐37: Past year prevalence of use of cocaine base paste among

secondary school students, by sex and country

Taking our examination of CBP use further, we look particularly at the rates of use by 8th grade students, the

youngest in the universe under analysis: these rates are an indicator of the use of cocaine base paste at an

extremely early age.

Graph 5‐38: Lifetime prevalence of use of cocaine base paste among 8th grade students, by country

Use of cocaine base paste at an early age is found in more than 1.5% of 8th grade students in Peru, Bolivia and

Argentina, rising to over 4% in Chile.


Information from Argentina, Chile, Peru and Uruguay will help us assess trends in the use of cocaine base

paste.

In Argentina, we see a sharp rise in use between 2001 and 2005 from 0.5% to 1.5%, followed by a drop to 1% in

2009 and remaining stable in the most recent estimates available, which are from 2011.

0

0.5

1

1.5

2

2.5

3

3.5

Chile(2013)

Bolivia(2008)

Argentina(2011)

Peru(2012)

Ecuador(2012)

Colombia(2011)

Uruguay(2014)

Prevalence (%)

Male Female

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Chile(2013)

Argentina(2011)

Bolivia(2008)

Peru(2012)

Colombia(2011)

Ecuador(2012)

Uruguay(2014)

Prevalence (%)


Graph 5‐39: Past year prevalence of the use of cocaine

base paste among secondary school students, Argentina 2001–2011.


base paste, Chile 2001 – 2013, secondary school students.

Data available from Chile show that up to 2009, use of cocaine base paste among secondary school students

was stable at around 2.5% and then fell slightly to 2.3%.

Prevalence among Peruvian secondary school students was stable at around 1% during the period 2005‐2012.


base paste, Peru 2005 – 2012, secondary school students

Graph 5‐42: Past year prevalence of the use of cocaine base paste, secondary school students, Uruguay 2003 –

2014.

Use of cocaine base paste by secondary school students in Uruguay fluctuated between 0.7%, 1.1% and 0.5%.

The highest prevalence was reported in 2007, followed by a slight drop in 2011‐14.

Perception of risk

Occasional use of cocaine base paste was perceived as risky in no more than 50% of the countries, and no less

than 25% (Table A5.22 Appendix). The countries where use is highest also have a greater perception of high

0.5

1.51.4

0.91

0

0.5

1

1.5

2

2.5

3

2001 2005 2007 2009 2011

Prevalence (%)

2.32.5 2.5

2.6

2.62.2

2.3

0

0.5

1

1.5

2

2.5

3

2001 2003 2005 2007 2009 2011 2013

Prevalence (%)

0.8 0.7

1 1

0

0.5

1

1.5

2

2.5

3

2005 2007 2009 2012

Prevalence (%)

0.7 0.6

1.1

0.60.4

0.5

0

0.5

1

1.5

2

2.5

3

2003 2005 2007 2009 2011 2014

Prevalence (%)

118 | O A S ‐ C I C A D

risk and vice versa, which may mean that there is a significant percentage of secondary school students who

are unaware of the risks.

Males in Uruguay and Argentina have a greater perception of high risk of occasional use of cocaine base paste,

while the perceptions by sex are reasonably similar in the other countries.

Graph 5‐43: Perception of high risk of occasional use of cocaine base paste

among secondary school students, by sex and country

As was to be expected, the percentages of students who feel that frequent use of cocaine base paste is highly

risky are higher than their perceptions about occasional use. They represent 85% in Uruguay, 76% in Argentina,

70% in Colombia, 63% in Peru and 43% in Ecuador (Table A5.23 Appendix).

In all of the countries, a higher proportion of female students view the frequent use of cocaine base paste as

high risk. The exceptions are Uruguay and Ecuador, where the difference by sex is small (one percentage

point). These are countries at the opposite ends of the scale: while in Uruguay more than 80% of male and

female students view the risk as high, in Ecuador, only 40% hold that view.

Perception of ease of access and offers of cocaine base paste

The highest percentages of the perception of ease of access to cocaine base paste are found in Argentina,

Colombia and Uruguay, as reported by 14%‐16% of secondary school students.

Graph 5‐44: Perception of ease of access to cocaine base paste among


0

10

20

30

40

50

60

Uruguay(2014)

Chile(2013)

Argentina(2011)

Colombia(2011)

Peru(2012)

Ecuador(2012)

Males Females

0

2

4

6

8

10

12

14

16

18

Argentina(2011)

Colombia(2011)

Uruguay(2014)

Chile(2013)

Peru(2012)

Ecuador(2012)


Offers of cocaine base paste reported by the students during the past year are around 3% in four South

American countries, but double that figure in Chile. Past month offers were half or less, depending on country.

Graph 5‐45: Offers of cocaine base paste in the past year and past month

among secondary school students, by country


We give below available data from Belize and the countries of South America. Variations between countries are

seen in lifetime prevalence rates of CBP use ranging from 0.1% (Paraguay and Belize) to 1.9% (Chile). Lifetime

prevalence over 1% are found in Peru (1.5%), Colombia (1.2%) and Uruguay (1.1%) (Table A5.20 Appendix).

Graph 5‐46: Past year prevalence of use of cocaine base paste in the general population, by countryxix

Use of cocaine base paste in the past twelve months in the general population ranges from 0.04% to 0.47%,

with Peru, Chile and Uruguay having the highest rates of use.

xix Argentina: population aged 16‐64 Uruguay: population aged 15‐65

0

1

2

3

4

5

6

7

Chile (2013) Ecuador (2012)Argentina (2011) Peru (2012) Uruguay (2014)


00.05

0.10.15

0.20.25

0.30.35

0.40.45

0.5

Prevalence(%)

120 | O A S ‐ C I C A D

Looking at the use of cocaine base paste by sex, rates for men are higher, meaning that CBP use is

predominantly male. In Paraguay, there are no reports of CBP use by women.

The male to female ratio is high: 17.5 in Uruguay, 13.3 in Colombia, 9.6 in Chile, 8.2 in Peru, 8 in Argentina and

Venezuela, 3.3 in Bolivia and 2.5 in Belize.

Graph 5‐47: Past year prevalence of use of cocaine base paste

in the general population, by sex and country xx

A more specific reading of the use of cocaine base paste is given in the graph below, which gives rates of past year use for the 12‐17 and 18‐34 age groups.

Graph 5‐48: Past year prevalence of use of cocaine base paste,

12‐17 and 18‐34 age groups, by countryxxi

In the three countries with highest past year use, use of CBP among 18‐34 year olds is even higher than among

the general population as a whole. However, we also find the use of cocaine base paste among adolescents

xx Argentina: population aged 16‐64 Uruguay: population aged 15‐65 xxiArgentina: population aged 16‐64 Uruguay: population aged 15‐65

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

Prevalence (%)

Males Females

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

Peru(2010)

Uruguay(2011)

Chile(2012)

Colombia(2013)

Paraguay(2003)

Argentina(2011)

Bolivia(2014)

Belize(2005)

Prevalence (%)

12 to 17 18 to 34


aged 12‐17, although at lower levels. Rates in Uruguay and Argentina refer to adolescents aged between 15

and 16 to 17, which may be impacting the prevalence.

While rates are low, use in Paraguay seems to be concentrated among adolescents, while in Bolivia and Belize,

countries that are mid‐range in South America in terms of use, adolescents reported little or no use, while 18‐

34 year olds did report some use.


General population studies in Argentina show that following an increase in CBP use between 2004 and 2006,

rates declined and ended the period at 0.1%, which was higher than at the beginning.

In Peru, the studies show that in 1998, use was at 0.6%; it fell to half in 2006, and rose slightly to 0.5% in 2010.

Graph 5‐49: Past year prevalence of use of cocaine base paste in the general population, aged 16‐65,

Argentina 2004‐2011

Graph 5‐50: Past year prevalence of use of cocaine

base paste in the general population, Peru 1998‐2010

Graph 5‐51: Past year prevalence of use of cocaine

base paste in the general population, Chile 1994‐2012

The Chilean data for the period 1994‐2012 show a drop in the use of cocaine base paste in the general

population from almost 1% to 0.4%.

0

0.5

0.2 0.02 0.1

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

2004 2006 2008 2010 2011

Prevalence (%)

0.60.7

0.3

0.5

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

1998 2002 2006 2010

Prevalence (%)

0.9

0.70.8

0.7

0.5 0.7

0.40.4

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

1994

1996

1998

2000

2002

2004

2006

2008

2010

2012

Prevalence (%)

122 | O A S ‐ C I C A D

In Uruguay, where changes in prevalence are reflected in the studies from 2006 and 2011, there is a certain

stability during the period with low prevalence, at 0.3% and 0.4% respectively. We see the same in Colombia,

where the prevalence of 0.2% in 2008 was unchanged in 2013 (not shown).

Perception of risk

More than 60% of the population in nearly all of the countries consider the occasional use of cocaine base

paste to be highly risky, a figure that approaches 90% in countries where there is higher and lower use, such as

Uruguay and Argentina. However, the problem of cocaine base paste in the countries of the Southern Cone

has had a great impact in the media, which has probably influenced opinions about risk (Table A5.24

Appendix).

The risk of occasional use of cocaine base paste is not seen differently by men or women, or else shows a slight

difference in Peru, Ecuador and Bolivia, where more women perceive risk.

Graph 5‐52: Perception of high risk of occasional use of cocaine base paste in the general population,

by sex and countryxxii

Frequent use of CBP is considered by almost all of the general population of Argentina, Chile, Uruguay and Peru

to be of high risk, whereas in Colombia, Paraguay and Ecuador, 70% to 85% think it highly risky. As with

perceptions about occasional use, the differences by sex are minimal.

Perception of ease of access to and offers of cocaine base paste

More than one third of people in countries such as Chile, Colombia and Uruguay, where rates of use are

dissimilar, view access to cocaine base paste as easy (recalling that the minimum age for the surveys in

Uruguay was different). In the remaining Andean countries, the perception of ease of access is below 16%.

xxii Argentina: population aged 16‐64 Uruguay: population aged 15‐65

0

10

20

30

40

50

60

70

80

90

100

Argentina(2010)

Uruguay(2011)

Chile(2012)

Peru(2010)

Colombia(2013)

Paraguay(2003)

Ecuador(2013)

Bolivia(2014)

Males Females


Graph 5‐53: Perception of ease of access to cocaine base paste in the general population, by countryxxiii

The proportion of secondary school students who were offered cocaine base paste is low: it is less than 3% of

the general population in any country. And we note a gap between offers and perception of ease of access. In

countries with higher rates of use, there was a greater proportion of people who said that they had been

offered CBP in the past year or past month (Peru, Chile and Uruguay).

Graph 5‐54: Offers of cocaine base paste in the past year and past month in the general population, by country


Recent use of cocaine base paste among university students has low prevalence, not exceeding 0.5%. Users

are primarily male. Prevalence range from 0.1% to 0.5% in the four countries for which we have information on

CBP.

xxiii Argentina: population aged 16‐64 Uruguay: population aged 15‐65

0

5

10

15

20

25

30

35

40

45

Uruguay(2011)

Colombia(2013)

Chile(2012)

Argentina(2010)

Peru(2010)

Ecuador(2013)

Bolivia(2014)

0

0.5

1

1.5

2

2.5

3

Chile(2012)

Uruguay(2011)

Argentina(2010)

Ecuador(2013)

Peru(2010)

Colombia(2013)

Bolivia(2014)


124 | O A S ‐ C I C A D

Graph 5‐55: Past year prevalence of use of cocaine base paste among

university students, by sex and country

Perception of risk

Disapproval of the occasional use of CBP due to the risk of use is reported by 70% of university students in

Colombia, Peru and Ecuador, countries that had different prevalence. Fifty‐seven per cent of Bolivian students

found it to be risky (Table A5.26 Appendix). This view is held by both males and females, although slightly

higher among male students. The difference is greater in Bolivia.

Graph 5‐56: Perception of high risk of occasional use of cocaine base paste among

university students, by sex and country

The perception of the high risk of frequent use of cocaine base paste increases by 20 and 15 percentage points,

depending on the country (Table A5.27 Appendix), and differences, although slight in some countries, are seen

between the sexes, with more females than males reporting perception of risk.

0

0.1

0.2

0.3

0.4

0.5

0.6

Ecuador (2012) Peru (2012) Bolivia (2012) Colombia (2012)

Prevalence (%)

0

10

20

30

40

50

60

70

80

Colombia (2012) Peru (2012) Ecuador (2012) Bolivia (2012)

Males Females


Perception of ease of access and offers of cocaine base paste

The perception of ease of access in countries where use is higher (Ecuador and Peru) is around 8%,

with a higher rate in Colombia, at 14%.

Graph 5‐57: Perception of ease of access to cocaine base paste

among university students, by country

Offers in the past year of CBP reported by university students were the highest (5%) in Ecuador, followed by

Peru and Colombia, with 1% or less in the past 30 days. With regard to offers of CBP, the latter two countries

were similar, but differed as to use.

Graph 5‐58: Offers of cocaine base paste in the past year and past month among

university students, by country

0

2

4

6

8

10

12

14

16

Colombia (2012) Ecuador (2012) Peru (2012) Bolivia (2012)

0

1

2

3

4

5

6

Ecuador (2012) Peru (2012) Colombia (2012) Bolivia (2012)


126 | O A S ‐ C I C A D

CRACK

Introduction As we said at the beginning of this chapter, chemical changes to cocaine hydrochloride made with ammonia or

bicarbonate of soda and water, and then heated to eliminate the hydrochloride produce a new substance:

crystal or cocaine base, which can be smoked. The word “crack”, the street name for the crystals or cocaine

base, refers to the crackling sound made when the substance is heated and smoked.

The surveys that have been conducted for more than ten years using the basic SIDUC55 framework include

crack, cocaine base paste and cocaine in the list of illicit drugs. The Spanish‐speaking countries of South

America have generally investigated only lifetime use, and have focused more on cocaine base paste, because

of the impact it has had, as described above.

The use of smoked crack or cocaine crystals is more extensive and better known in the countries of Central

America and the Caribbean. Nonetheless, more information is needed on the chemical composition of these

substances, the names that users give them and the way they are used.

The following data on crack or cocaine crystals that are drawn from the sources of information we have

available.

Secondary school students Table A5.29 in appendix gives lifetime prevalence rates of crack use. The graph below shows past year

prevalence, based on information from all of the countries of the Caribbean, four from South America, five

from Central America, and the United States, from North America.

The highest prevalence rates, ranging from 1.5% to 2.2%, are found in half of the Caribbean countries:

Grenada, Saint Kitts and Nevis, Haiti, Antigua and Barbuda, Saint Lucia and Barbados. Panama, Guyana,

Trinidad and Tobago and Jamaica have prevalence of 1% or more.

The lowest prevalence, under 0.5%, are found in South America (Brazil, Suriname and Ecuador), Costa Rica and

Honduras in Central America, and the Dominican Republic in the Caribbean.


Graph 5‐59: Past year prevalence of crack use among secondary school students,


In general terms, higher rates of use are by males, the highest ratio being almost six males to one female who

use crack. In Saint Lucia, all the students that reported crack use were male. In Antigua and Barbuda and

Barbados, the male‐female ratio was 4.4 and 3.3 respectively. Haiti is the exception among countries with a

high rate of use and high prevalence of male users, where for each 1.4 male user, there is one female. In Saint

Vincent and the Grenadines, it was females who reported higher use of crack.

Graph 5‐60: Past year prevalence of crack use among secondary school students, by sex, country and subregion

0

0.5

1

1.5

2

2.5

Uni

ted

Sta

tes

(201

4)

Pan

ama

(20

08)

Bel

ize

(201

3)

El S

alva

dor

(200

8)

Cos

ta R

ica

(201

2)

Hon

dura

s (2

005)

Guy

ana

(201

3)

Bra

zil (

2010

)

Sur

inam

e (2

006

)

Ecu

ador

(20

12)

Gre

nad

a (2

013)

S.K

itts-

Nev

is (

2013

)

Hai

ti (

2014

)

Ant

igua

-Bar

buda

(2

013)

S.L

ucia

(20

13)

Bar

bado

s (2

013)

Tri

nid

ad-

Tob

ago

(201

3)

Jam

aic

a (

201

3)

Dom

inic

a (2

011

)

S.V

ince

nt-G

rena

dine

s (2

013)

Bah

amas

(20

11)

Dom

inic

ana

Re

p (2

008

)

Prevalence (%)

0

0.5

1

1.5

2

2.5

3

3.5

4

Prevalence (%)

Males Females

128 | O A S ‐ C I C A D

When we look at crack use at a young age, we see the highest rates of lifetime use by students aged

13 or younger in the countries where there is higher use overall. In five countries, between 3% and 4%

of 8th grade students have used crack, and in one country, the rate exceeds 7%.

Graph 5‐61: Lifetime prevalence of crack use among 8th grade students, by country and subregion

General population Information about crack use in the general population is scarce. The highest prevalence of between 0.2% and

0.3% are found in Costa Rica, El Salvador, the United States and Venezuela.

Graph 5‐62: Past year prevalence of crack use in the general population, by country

0

1

2

3

4

5

6

7

8

Prevalence (%)

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

Prevalence (%)


Crack use is found more among men—between five and seven times more than among women in the countries

where there is the highest rate of use. In some countries such as Argentina and Mexico there were no reports

of crack use among females.

Graph 5‐63: Past year prevalence of crack use in the general population, by sex and countryxxiv

Crack use is higher among 18‐34 year olds in all of the countries for which there is information.

Graph 5‐64: Past year prevalence of crack use among the 12‐17 and 18‐34 age groups, by country xxv

xxiv Argentina: population aged 16‐64 xxv USA and Dominican Republic, age group 12‐17, prevalence rates are 0

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

Prevalence (%)

Males Females

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

Costa Rica(2010)

El Salvador(2014)

United States(2013)

Dominican Rep(2010)

Prevalence (%)

12 to 17 18 to 34

130 | O A S ‐ C I C A D

CHAPTER 6: AM P H E T AM I N E ‐ T Y P E S T I M U L A N T S

Introduction Amphetamine‐type stimulants (ATS) are a group of substances that include synthetic stimulants such as

amphetamine, methamphetamine, ecstasy‐type substancesxxvi (such as MDMA, MDA, MDE/MDEA and their

analogues), illicitly obtained or falsified prescription medications that contain these substances, and other

stimulants such as methcathinone and 2C‐B.56

According to the World Drug Report (UNODC, 2014), ATS are the psychoactive substances most used

worldwide after marijuana. It was estimated in 2012 that the number of ATS users was 34.4 million for the

amphetamine class alone, and 18.7 million users of ecstasy‐type substances, while there were 177.6 million

users of marijuana, 33 million users of opioids, 16 million users of opiates, and 17 million users of cocaine.

Amphetamines group

The amphetamines group inlcudes both amphetamine and methamphetamine. Although some amphetamine

are produced for medical purposes, most are distributed illegally and produced illicitly in clandestine

laboratories.

Methamphetamine are the ATS most widely produced and used. They are a central nervous system stimulant

commonly known as “speed”, “meth” and “chalk”. These terms generally refer to the crystalline form of the

drug, which can be smoked as “ice”, “crystal”, “crank” or “glass”. It is a white, bitter‐tasting, odorless powder

or crystal that is easily soluble in water and alcohol.

The substances in the amphetamines group were originally compounded at the end of the nineteenth century,

and sold without medical prescription as nasal decongestants beginning in 1932. When used in similar doses to

amphetamine, methamphetamine reach the brain in larger amounts than amphetamine, which makes them a

more powerful central nervous system stimulant, whose effect is of longer duration.

Both amphetamine and methamphetamine are under international control, and both are on Schedule II of the

Convention on Psychotropic Substances of 1971.

North America has had a large and growing market for ATS for a number of years. Manufacture of

methamphetamine in particular in Mexico and the United States appears to have grown significantly and,

according to the United States, large volumes of the drug are brought into the country as contraband from

Mexico. However, the use of methamphetamine has remained at relatively low and stable levels thus far

throughout the subregion.

xxvi Given the wide variety of drugs sold on the market as “ecstasy” but after chemical analysis are shown to contain little or no MDMA, this report will use the word “ecstasy” or “ecstasy‐type substances” interchangeably to refer to these drugs.


In Canada, the market for methamphetamine appears to be fairly limited. The findings of the annual

population survey of people aged 15 or older in 2012 show that methamphetamine are the second least

frequently used drug in terms of lifetime prevalence, at 0.8%, followed by heroin at 0.5%.57

Past year prevalence of methamphetamine use in the United States remained stable. The National Survey on

Drug Use and Health (NSDUH) conducted each year among people aged 12 and older showed that past year

prevalence of methamphetamine use declined from 0.5% in 2009 to 0.4% in 2010, a rate that has remained

stable in recent years. In 2013, past year prevalence of methamphetamine use was 0.5%, slightly higher than

LSD with 0.4% and higher only than heroin and crack, at 0.3% and 0.2% respectively.58

According to the annual survey conducted of 8th, 10th and 12th grade students in the United States, the past

year prevalence of methamphetamine use has been falling consistently between 1999, when the rate was

4.1%, and 2014, when it was 0.8% (Graph 6‐1).59

Graph 6‐1: Past year prevalence of methamphetamine use among students

in the United States, 8th, 10th and 12th grades combined, 1999‐2014

Despite the rapid increase in seizures of methamphetamine in Mexico, local use appears to be relatively low.

According to the general population survey of people aged 12‐64 conducted in 2011, past year prevalence of

methamphetamine use was 0.12%, lower than past year prevalence of marijuana (1.20%), cocaine (0.50%) and

opioids (0.38%).60

According to data on patients treated for drug problems in facilities recognized by the State of Mexico, around

3.2% were treated for methamphetamine use in 2012, slightly higher than the 2.3% of patients treated for

methamphetamine in 2011, but considerably lower than the 26.9% of admissions for treatment of cocaine use,

and the 32.2% admitted for marijuana use in 2012.xxvii

Ecstasy‐type substances

Ecstasy‐type substances are synthetic substances that are chemically related to stimulants of the amphetamine

class, although they differ to some extent in their effects. The most common substance in this group is 3,4‐

methylenedioxy‐methamphetamine (MDMA), although other analogues such as 3,4‐methylenedioxy‐

xxvii Questionnaire for OID/CICAD reports. Report by Mexico. The figures on the total number of patients in treatment—62,294 in 2011 and 72,364 in 2012—do not include patients admitted for treatment for alcohol.

4.1

3.53.2

2.6

2.0

1.41.3

1.00.8

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

199

920

00

200

120

02

200

320

04

200

520

06

200

720

08

200

920

10

201

120

12

201

320

14

Prevalence (%)

132 | O A S ‐ C I C A D

amphetamine (MDA) and 3,4‐methylenedioxy‐N‐ethylamphetamine (MDEA) are also frequently found in

“ecstasy” pills.

The use of “ecstasy” arose in Europe in the mid nineteen eighties, and it became popular at rave parties in the

United States before spreading to the rest of the world. It was first manufactured in Europe, but has recently

spread to younger and more lucrative markets throughout the world. The purity of “ecstasy” fell in Europe

between 2008 and 2009, along with the emergence of New Psychoactive Substances (NPS), such as 1‐

benzylpiperazine (BZP), methylendioxypirovalerone (MDPV) and in particular, ephedrine. However, since 2012,

the “ecstasy” market has shown signs of recovery in Europe, probably due to the resurgence of a high MDMA

content in “ecstasy” pills.

Worldwide, a number of pills that are sold as ecstasy‐type substances in fact contain a variety of substances in

addition to MDMA, which may be potentially toxic. According to a study conducted in Colombia, adulterants

found in MDMA tablets sold on the street include methamphetamine, caffeine, dextromethorphan (a cough

medicine sold without medical prescription), ephedrine (a primary precursor used to produce

methamphetamine) and cocaine. Like other addictive drugs, MDMA is rarely used alone and is frequently used

together with substances such as alcohol and marijuana.

Although there are some indications that the use of “ecstasy” is higher than the use of other ATS in most of the

countries of the Americas, its market share still appears to be relatively low compared to other drugs under

international control. For example, a national survey in treatment centers in Argentina conducted in 2010

looked at the drug that motivated patients to enter treatment, and the findings showed that 74 patients

sought help because of “ecstasy” use, 43 for amphetamine and 26 for unspecified stimulants. However, the

total number of persons treated for ATS use represented less than 1.0% of patients treated for drug use that

year.61

Colombia reported that most of the people treated for ATS use in 2012 were treated for the use of “ecstasy”

(53%, or 48 people), followed by methamphetamine (42% or 38 people) and amphetamine (around 5%, or 5

people). However, the number of people treated for use of ATS alone were 10.3% of the total number treated

for drug use in Colombia that year, while the proportion of those in treatment for marijuana use was 33.0%

(292 people) and for cocaine use, 32.1% (181 people).62

These figures shows that although the problem of the use of “ecstasy” and other ATS does exist in the

Americas, other drugs under international control such as marijuana and cocaine continue to represent a much

larger share of the market. Nonetheless, the rates of use of “ecstasy” by young people in the region are of

concern, as shown in drug use surveys of secondary school students.

“Ecstasy” use among secondary school students

“Ecstasy” is the ATS that is most used in the countries of Latin America and in the Americas as a whole.

Although the rates of use tend not to be particularly high among the general population, “ecstasy” is one of the

substances that is most often used by young people in the region. According to national surveys, there are


major differences among students in the various subregions in the lifetime use of ecstasy‐type substances

(Table A6.1 Appendix). Students in North America have the highest rates of use: 7.6% in Canada and 3.5% in

the United States. In the other subregions, Antigua and Barbuda (3.7%) and Chile (3.5%) are higher than the

rest of the countries of the Caribbean and South America respectively. Hemisphere‐wide, the rates of

“ecstasy” use are, in descending order, highest in North America, then South America, the Caribbean and

Central America. In Central America, the highest rate of use is found in Belize, with 2.4%xxviii (Graph 6‐2).

Graph 6‐2: Lifetime prevalence of “ecstasy” use among secondary school students

Generally speaking, analyses of drug use by age or grade level (Table A6.3 Appendix), as in this case, show that

the higher the age or grade level, the higher the use of a particular psychoactive substance. For the use of

ecstasy‐type substances by secondary school students in the Americas, this is true for 19 of a total of 28

countries that reported information on “ecstasy”: Canada, United States, Costa Rica, El Salvador, Argentina,

Colombia, Ecuador, Guyana, Paraguay, Suriname, Uruguay, Antigua and Barbuda, Bahamas, Barbados,

Dominica, Haiti, Jamaica, Dominican Republic and Trinidad and Tobago. In all these countries, lifetime

prevalence of “ecstasy” use is higher among 12th graders than among 8th grade students. Interestingly, in the

case of students in Canada and the United States, the differences between rates of use by 8th graders (2.9%

and 1.4% respectively) and 12th graders (11.9% and 5.6% respectively) are very marked (Graph 6‐3).

xxviii However, for three of the five countries of Central American for which information is available, the data are from 2008.

0

1

2

3

4

5

6

7

8C

anad

a (2

010/

11)

Uni

ted

Sta

tes

(201

4)B

eliz

e (2

013)

Pan

ama

(20

08)

El S

alva

dor

(200

8)C

osta

Ric

a (2

012)

Hon

dura

s (2

008)

Chi

le (

2013

)A

rgen

tina

(201

1)G

uyan

a (2

013)

Bol

ivia

(20

08)

Col

ombi

a (2

011)

Bra

zil (

2010

)S

urin

ame

(20

06)

Per

u (2

012

)E

cuad

or (

2012

)U

rugu

ay (

2014

)V

enez

uela

(20

09)

Par

agua

y (2

005)

Ant

igua

-Bar

buda

(2

013)

Dom

inic

a (2

011

)B

arba

dos

(201

3)G

ren

ada

(201

3)S

.Luc

ia (

2013

)Ja

mai

ca (

201

3)T

rin

ida

d-T

obag

o (2

013

)S

.Kitt

s-N

evis

(20

13)

Bah

amas

(20

11)

Hai

ti (2

014)

Dom

inic

an R

ep (

200

8)S

. Vin

cent

-Gre

nadi

nes

(20

13)

Prevalence (%)

134 | O A S ‐ C I C A D

Graph 6‐3: Lifetime prevalence of “ecstasy” use among secondary school students.

Comparison between 8th and 12th grades

In Grenada, there are no differences in “ecstasy” use between 8th and 12th grade students, while in Belize,

Panama, Saint Kitts and Nevis, Saint Lucia, Chile and Peru, 8th grade students have higher rates of “ecstasy”

use than 12th graders.xxix This is an unusual situation, and may be reflecting a market that is trying to

encourage use of “ecstasy” at an early age in order to consolidate it over the years to come.

As to “ecstasy” use at a young age, 8th grade students in Chile have the highest lifetime prevalence in the

region, with 3.6%, followed by 8th grade students in Canada with a lifetime prevalence of 2.9%, Panama with

2.8%, and then Antigua and Barbuda, and Saint Lucia with 2.7% and 2.5% respectively. Overall, lifetime use of

“ecstasy” at a very early age is not characteristic of any region in particular, but rather is accounted for by

higher rates of use overall among students in particular countries.

Unfortunately, very few countries in the hemisphere have information on past year prevalence of the use of

ecstasy‐type substances among secondary school students. According to available information, past year

prevalence of “ecstasy” use was 5.0% in Canada, followed by 2.2% in the United States. In the other

subregions, Chile had past year use of 1.9%, while Argentina, Colombia, Panama, Peru and Uruguay reported

rates of around 1.0%. Costa Rica and Ecuador reported rates of 0.4% and 0.5% respectively (Graph 6‐4).

xxix Students in Saint Vincent and the Grenadines report no use in the 12th grade, but higher use was reported by 10th graders than by those in the 8th grade.

0

2

4

6

8

10

12

14

Can

ada

(201

0/1

1)U

nite

d S

tate

s (2

014)

Bel

ize

(201

3)P

anam

a (2

008

)E

l Sal

vado

r (2

008)

Cos

ta R

ica

(201

2)C

hile

(20

13)

Arg

entin

a (2

011)

Guy

ana

(201

3)C

olom

bia

(201

1)S

urin

ame

(20

06)

Per

u (2

012

)E

cuad

or (

2012

)V

enez

uela

(20

09)

Uru

guay

(20

14)

Par

agua

y (2

005)

Ant

igua

-Bar

buda

(2

013)

Dom

inic

a (2

011

)B

arba

dos

(201

3)G

ren

ada

(201

3)S

.Luc

ia (

2013

)Ja

mai

ca (

201

3)T

rin

ida

d-T

obag

o (2

013

)B

aham

as (

2011

)S

.Kitt

s-N

evis

(20

13)

Hai

ti (2

014)

Dom

inic

an R

ep. (

200

8)S

. Vin

cent

-Gre

nadi

nes

(20

13)

Prevalence (%)

Grade 8th Grade 12th


Graph 6‐4: Past year prevalence of “ecstasy” use among secondary school students

(*Paraguay: past year prevalence of 0.0%)

A common characteristic of the use of this type of substance among secondary school students is that, with the

exception of Panama and Uruguay where past year rates for males and females are similar, the use of “ecstasy”

is higher among males than females (Graph 6‐5).

Graph 6‐5: Past year prevalence of “ecstasy” use among secondary school students, by sex

(*Paraguay: past year prevalence of 0.0%)

Summarizing the information by subregion and the hemisphere as a whole, we see rates of lifetime use of 3.5%

among North American students, 1.7% in South America, 1.2% in the Caribbean, and 0.6% in Central America.

Bearing in mind that no data are available from a large number of countries, and that in some others the

information is out of date, hemisphere‐wide rates of the use of ecstasy‐type substances among secondary

0

1

2

3

4

5

6

Prevalence (%)

0

1

2

3

4

5

6

Prevalence (%)

Males Females

136 | O A S ‐ C I C A D

school students are: 2.7% lifetime prevalence; 1.8% past year prevalence, and 0.7% past month prevalencexxx

(Table 6‐1).

Table 6‐1: Lifetime, past year and past month prevalence of “ecstasy” use among secondary school students,

by subregion and total hemisphere

Prevalence

Subregion Lifetime Past year Past month


Central America 0.6 0.4 0.1


Caribbean 1.2

Hemisphere 2.7 1.8 0.7

Trends in “ecstasy” use among secondary school students

United States is the only country in the region that has a long series of studies on drug use by 8th, 10th and

12th grade students. According to the data from the 2014 Monitoring the Future survey, past year prevalence

of the use of “ecstasy” among secondary school students showed a downward trend between 2012 (2.5%) and

2014 (2.2%). This is all the more striking when we consider that in 2010, prevalence was 3.8%. The students’

rates of use were the highest of all the series between 2000 and 2002, fluctuating between almost 5% up to

6%. Major decreases in rates of “ecstasy” use were seen starting in 2002, with a spike in 2010, and then the

subsequent decreases noted below (Graph 6‐6). The experience of the United States shows that there have

been significant variations in the use of “ecstasy” over almost two decades of monitoring, which has probably

been associated with fluctuations in the market, the influence of prevention programs and specific campaigns

to address this problem among young students, among many other variables.

Graph 6‐6: Trends in past year prevalence of “ecstasy” use among secondary school students in the United States, 8th, 10th and 12th grades combined, 1996‐2014.

xxx For the purposes of these calculations, we considered only those countries that have data on lifetime, past year and past month prevalence.

3.4

3.7

6.0

4.9

3.1

2.62.7 2.9

3.8

2.52.2

0

1

2

3

4

5

6

7

1996

1998

2000

2002

2004

2006

2008

2010

2012

2014

Prevalence (%)


As has been said often in this chapter, very few countries in Latin America have detailed information on the use

of “ecstasy”, much less with the kind of regularity that would enable us to determine trends in use. In those

few countries where information was available, the only information at hand was lifetime prevalence.xxxi In

Argentina, Chile, Costa Rica, Peru and Uruguay, the data show a significant decline in use in 2011‐2012 in

comparison with previous years. In the case of Chile and Uruguay, which have data from studies done in 2013

and 2014 respectively, the information shows a significant increase in “ecstasy” use compared to the previous

study. In the case of Chile, use of “ecstasy” rose from 2.2% in 2011 to 3.5% in 2013, while in Uruguay, use

doubled between 2012 and 2014, with rates of 0.5% and 1.0% respectively. Costa Rica saw a drop in use, with

rates of 2.1% in 2009 and 0.5% in 2012 (Graphs 6‐7 to 6‐11).

Graph 6‐7: Trends in lifetime prevalence of “ecstasy” use among secondary school students, Argentina 2005‐2011

Graph 6‐8: Trends in lifetime prevalence of “ecstasy” use

among secondary school students, Chile 2005‐2013

Graph 6‐9: Trends in lifetime prevalence of “ecstasy” use among secondary school students, Costa Rica 2006‐2012

Graph 6‐10: Trends in lifetime prevalence of “ecstasy” use

among secondary school students, Peru 2005‐2012

xxxi Given that not all of the countries have data sets on past year prevalence, it was possible only to estimate trends in lifetime use of ecstasy.

1.2 1.2

2.62.1

0

1

2

3

4

5

6

7

2005 2007 2009 2011

Prevalence (%)

3.9 3.8 3.7

2.2

3.5

0

1

2

3

4

5

6

7

2005 2007 2009 2011 2013

Prevalence (%)

1.1

2.1

0.50

1

2

3

4

5

6

7

2006 2009 2012

Prevalence (%)

1.0 1.2

1.91.4

0

1

2

3

4

5

6

7

2005 2007 2009 2012

Prevalence (%)

138 | O A S ‐ C I C A D

Graph 6‐11: Trends in lifetime prevalence of “ecstasy” use among secondary school students, Uruguay 2005‐2014

Perception of high risk among secondary school students

By contrast to what is commonly seen with other controlled drugs, where perceptions of the risk of use tend to

be very high, the perception of the high risk of “ecstasy” use among secondary school students is fairly low. In

general terms, the percentage of secondary school students that perceive lifetime or occasional use of

“ecstasy” as high risk does not exceed 50% in most of the countries. In other words, one in two students do not

perceive that occasional use of “ecstasy” is high risk.xxxii In most of the countries, the perceived risk is

somewhat higher among females than males—which explains to some extent the lower rates of use by female

students—but that is not always the case. In Panama, the Dominican Republic, Saint Kitts and Nevis, Argentina,

Paraguay, Peru, Suriname, El Salvador, Uruguay and Venezuela, the perception of high risk of occasional use of

“ecstasy” is slightly higher among male students, while in Bolivia and Ecuador, there are no differences by sex

in the perceived risk (Graph 6‐12).

Graph 6‐12: Perception of high risk of occasional use of “ecstasy” among secondary school students

xxxii This group may include a large proportion of students who “don’t know” the risk they are running.

0.71.7

1.20.5

1.00

1

2

3

4

5

6

7

2005 2007 2009 2011 2014

Prevalence (%)

0102030405060708090

100

Can

ada

(201

0/1

1)

Uni

ted

Sta

tes

(201

4)

Bel

ize

(201

3)

Cos

ta R

ica

(201

2)

Pan

ama

(20

08)

El S

alva

dor

(200

8)

Chi

le (

2013

)

Sur

inam

e (2

006

)

Par

agua

y (2

005)

Col

ombi

a (2

011)

Ven

ezue

la (

2009

)

Uru

guay

(20

14)

Arg

entin

a (2

011)

Per

u (2

012

)

Bol

ivia

(20

08)

Ecu

ador

(20

12)

Bah

amas

(20

11)

Dom

inic

an R

ep (

200

8)

Tri

nid

ad-

Tob

ago

(201

3)

Bar

bado

s (2

013)

Dom

inic

a (2

011

)

Jam

aica

(20

13)

Guy

ana

(201

3)

S.L

ucia

(20

13)

Ant

igua

-Bar

buda

(2

013)

Gre

nad

a (2

013)

S.K

itts-

Nev

is (

2013

)

S. V

ince

nt-G

rena

dine

s (2

013

)

Males Females


It is not always the case that low perceived risk is associated with very high rates of use of a particular drug. A

myriad of other factors come into play with regard to high or low rates of use, such as the availability of the

substance on the market, the price of the drug, the level of public acceptance or rejection, and the drug’s

addictive capacity, among many other factors.

For any drug, the perceived risk of frequent use is always higher than the perceived risk of occasional or

sporadic use. In the case of the perceived high risk of frequent use of “ecstasy”, we see the same trend as with

other drugs, and thus, the percentage of perceived risk ranges from over 70% in Canada, El Salvador, Panama,

Argentina, Paraguay and Uruguay, countries where the risk is perceived as higher, to less than 50% in Saint

Kitts and Nevis, Saint Vincent and the Grenadines, and Ecuador. Probably, the lower percentages of perceived

risk of frequent use are associated with the lack of information or the absence of prevention programs for

students that specifically address the risks of “ecstasy” use. It is also probable that the higher rates of “ecstasy”

use by students in Canada, Argentina and Uruguay are associated with a greater perception of the risk of

frequent use of “ecstasy” in those countries (in the sense that users are already well aware of the drug). By

contrast to the students’ perceived risk of occasional use of “ecstasy”, in all of the other countries except for

Suriname, the perception of the risk of frequent use of “ecstasy” is always higher among females than among

males (Graph 6‐13).

Graph 6‐13: Perception of high risk of frequent use of “ecstasy” among secondary school students

Perception of ease of access to “ecstasy” among secondary school students

The perception of ease of access is a subjective indicator that has to do with how easy or difficult it is for

someone to obtain a particular drug, whether by purchasing it or obtaining it from friends or acquaintances. A

drug perceived as easy to obtain is generally cheaper and more available on the market.

0

10

20

30

40

50

60

70

80

90

100

Canada (2010/11)

Panam

a (2008)

El Salvador (2008)

Costa Rica (2012)

Belize (2013)

Argentina (2011)

Paraguay (2005)

Uruguay (2014)

Colombia (2011)

Surinam

e (2006)

Peru (2012)

Ven

ezuela (2009)

Bolivia (2008)

Ecuador (2012)

Barbados (2013)

Trinidad

‐Tobago (2013)

Baham

as (2011)


Dominica (2011)

Jamaica (2013)

S.Lucia (2013)

Guyana (2013)

Grenada (2013)



Males Females

140 | O A S ‐ C I C A D

Compared to other substances, “ecstasy” does not tend to be a drug that is easily accessible to secondary

school students, particularly in Latin America. The information available indicates that 21.4% of students in the

United States perceive that “ecstasy” is easy to obtain, a figure not very different from that of students in

Argentina, with 19.8%.xxxiii However, the differences with the rest of the countries of Latin America and the

Caribbean are greater. Thus, 10.5% of students in Colombia and 11.7% of students in Suriname perceive that it

is easy to obtain “ecstasy”, while 10% of students in Belize, 11.5% in Antigua and Barbuda, and 11.4% in

Barbados find that it is easy to obtain (Graph 6‐14). Generally speaking, the students perceive easier access to

“ecstasy” precisely in those countries where rates of use are higher: United States, Argentina, Colombia and

Suriname. Chile is the exception: the perception of ease of access is low but the rate of use is higher than in all

of the other countries of Latin America.

Graph 6‐14: Perception of ease of access to “ecstasy” among secondary school students

Offers of “ecstasy” to secondary school students

Offers of drugs are, according to surveys in the countries of Latin America and the Caribbean, an objective

indicator that attempts to account for direct offers of a particular substance to the interviewees. Like the

indicator on ease of access, the indicator on direct offers helps estimate how available a psychoactive

substance is to users, and it tends to be more precise in establishing possible associations between rates of use

and availability of drugs. We thus find that secondary school students who have received more offers of

“ecstasy” have higher rates of use. For example, Belize, which has high rates of lifetime use of “ecstasy” among

secondary school students, has the highest percentages of offers of drugs, with 6.1%. Similarly, Antigua and

Barbuda has the highest rate in the Caribbean of “ecstasy” use by students (3.7%) and the highest percentage

of offers of “ecstasy” (7.0%). In the case of South America, the highest rate of lifetime use of “ecstasy” among

xxxiii Argentina is an exception here compared to the other countries of the subregion.

0

5

10

15

20

25


secondary students was in Chile with 3.5%, where there was also the highest percentage of offers of “ecstasy”

in the past year, with 6.0% (Graph 6‐15).

Graph 6‐15: Offers of “ecstasy” in the past year to secondary school students

Use of “ecstasy” in the general population

Prevalence of drug use in the general population shows major contrasts between the rates of use of ecstasy‐

type substances in Canada and the United States and the remaining countries of the hemisphere (Table A6.4

Appendix). In terms of lifetime prevalence, the high rates in the United States (6.8%) and Canada (5.3%) are far

higher than lifetime use in Uruguay (1.5%), Colombia and Barbados (0.7%), Venezuela (0.6%), Belize (0.5%) and

Chile (0.4%). These rates in Canada and the United States compared to the rest of the hemisphere also hold

true for past year and past month prevalence, although Belize, with past year prevalence of 0.5%, would seem

to be a little higher than the rest of the countries of the region (Graph 6‐16).

Graph 6‐16: Lifetime prevalence of “ecstasy” among the general population

0

1

2

3

4

5

6

7

8

0

1

2

3

4

5

6

7

8

Prevalence (%)

142 | O A S ‐ C I C A D

The data indicate that in all of the countries that have information available, the past year prevalence of

“ecstasy” use is always higher among men than women. In Belize, however, the difference is almost

nonexistent, with rates of 0.33% for men and 0.31% for women. The exception to the rule is found in Paraguay,

where there is no use by males and women report a rate of use of 0.10% (Graph 6‐17).

Graph 6‐17: Past year prevalence of “ecstasy” use among the general population, by sex

Perception of high risk among the general population

Unlike the situation with secondary school students, where the perception of high risk of the occasional use of

“ecstasy” was low, the percentages of perceived risk of occasional use are high in the general population—

between 70% and 80% in most of the countries, with the exception of El Salvador, Bolivia and Paraguay. Also to

be noted in the general population is that differences by sex of perceived risk are less or nonexistent.

Perceived high risk of frequent “ecstasy” use in the general population is even greater when compared to the

perceived risk of occasional use. In most of the countries, the perceived risk is over 90% (Graph 6‐18).

Graph 6‐18: Perception of high risk of occasional and frequent use of “ecstasy” (%) among the general population (Chile, no data available data por frecuent use)

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

Prevalence (%)

Males Females

0102030405060708090

100Occasional Frequent


Perception of ease of access among the general population

Just as we saw in the findings of the surveys of secondary school students, the perceptions of ease of access to

“ecstasy” among the general population are higher in Argentina with 19.2%, Colombia with 22.7% and Uruguay

with 18.5%, which are the countries with the highest rates of use. Costa Rica is interesting, in that while it does

not have the highest rates of “ecstasy” use in the region, it does have a high level of perceived ease of access to

the drug (24%), which may be a reflection of a recent market for “ecstasy” use in the country (Graph 6‐19).

Graph 6‐19: Perception of ease of access to “ecstasy” among the general population

Offers of “ecstasy” among the general population

Unlike the case with secondary school students, the association between direct offers of “ecstasy” and level of

use in the general population is not very clear.xxxiv In general terms, the levels of offers of ecstasy‐type

substances do not vary much in those countries for which information is available, with percentages of offers in

the past year of around 1%, with the exception of Peru (0.5%) and Colombia (1.4%) (Graph 6‐20).

Graph 6‐20: Offers of “ecstasy” in the past year in the general population

xxxiv The weaker association between reports of offers received and rates of ecstasy use in the general population studies may be related to the fact that the age ranges in the different general population studies are broader.

0

5

10

15

20

25

30

0.0

0.20.40.6

0.81.01.2

1.41.6

144 | O A S ‐ C I C A D

“Ecstasy” use among university students

Very few countries have conducted surveys on drug use among university students. However, for those

countries where information is available, we see significant differences between rates of use. Looking at

lifetime prevalence of “ecstasy” use, we see a rate of 7.5% in Brazil,xxxv followed by Colombia with 3.2%.

Ecuador and Peru have rates of lifetime use of 1.4% and 1.1% respectively. Rates are lower in Bolivia (0.6%) and

Venezuela (0.5%), with El Salvador having the lowest rate of 0.2%. As with surveys of the general population

and secondary school students, rates of use among university students tend to be higher among males than

females. For example, in Brazil, lifetime use by male university students was 11%, double the rate for females,

which was 4.9%. Something similar occurred in Colombia, where the rate of use among males was 4.5% and

2.0% for females. In Ecuador, lifetime use of “ecstasy” among males is 2.6%, which is six times the rate of use

by females with 0.4%. The same pattern is repeated in the other countries (Table 6‐2).

Past year and past month prevalence of “ecstasy” use among university students are similar to lifetime

prevalence, that is, the rates of use are higher in Brazil and Colombia than in the other countries, and rates of

use are always higher among males than females in all of the countries that have information available.

Table 6‐2: Prevalence of “ecstasy” use among university students, by sex and total

Country Lifetime Past year Past month

Male Female Total Male Female Total Male Female Total

Bolivia (2012) 0.8 0.4 0.6 0.0 0.0 0.0 0.0 0.0 0.0

Brazil (2010) 11.0 4.9 7.5 4.7 1.9 3.1 2.8 1.3 1.9

Colombia (2012) 4.5 2.0 3.2 1.1 0.5 0.8 0.3 0.2 0.2

Ecuador (2012) 2.6 0.4 1.4 0.6 0.0 0.3 0.1 0.0 0.1

El Salvador (2012) 0.3 0.0 0.2 0.1 0.0 0.0 0.0 0.0 0.0

Peru (2012) 1.8 0.4 1.1 0.5 0.1 0.3 0.1 0.0 0.1

Venezuela (2014) 0.8 0.2 0.5 0.4 0.1 0.2 0.2 0.0 0.1

University students, comparative data

Surveys on drugs of university students in the Andean countries have detailed information on “ecstasy” use, as

well as on other synthetic drugs. The data show that past year prevalence of “ecstasy” use among Andean

university students increased from 0.4% in 2009 to 0.5% in 2012.63 The country with the highest rate of use was

Colombia, where past year prevalence remained at around 0.9% between 2009 and 2012. University students

in Peru reported a large increase in use, with rates of 0.2% in 2009 and 0.6% in 2012. In the cases of Ecuador

and Bolivia, rates of “ecstasy” use are lower, and the differences between 2009 and 2012 are less (Graph 6‐21).

xxxv The methodology used in the study of university students in Brazil is not the same as that used in the other countries.


Graph 6‐21: Past year prevalence of “ecstasy” use among university students in the Andean region, 2009‐2012

Perception of high risk among university students

The university students’ perceptions of the high risk of occasional or frequent use of “ecstasy” tend to be

somewhere in between the perceptions of secondary school students and of the general population. Thus, the

perception of the high risk of occasional use of “ecstasy” is over 50% in all of the countries for which

information is available, but in no case does it exceed 70% (Graph 6‐22). However, the perception of the risk of

frequent use of “ecstasy” tends to be closer to perceptions in the general population, where the percentages in

most countries are close to 90%, with the exception of Bolivia, around 80%. Again, the perceived risk of the use

of “ecstasy” is higher among females than among males (Graph 6‐23).

Graph 6‐22: Perception of high risk of occasional “ecstasy” use among

university students, by sex (2012)

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

Colombia Peru Ecuador Bolivia

Prevalence (%)

2009 2012

0

10

20

30

40

50

60

70

80

90

100

El Salvador Ecuador Colombia Peru Bolivia

Males Females

146 | O A S ‐ C I C A D

Graph 6‐23: Perception of high risk of frequent use of “ecstasy” among

university students, by sex (2012)

Perception of ease of access among university students

The perception of ease of access to “ecstasy” among university students confirms that where there is a

perception of easier access to the drug, the rates of use are higher. This is the case with Colombia, where the

perceived ease of access to “ecstasy” is 20.4%, the highest of all of the countries with available information,

and where the university students reported the highest rates of use (Graph 6‐24).

Graph 6‐24: Perception of ease of access to “ecstasy” among university students

0

10

20

30

40

50

60

70

80

90

100

El Salvador Peru Colombia Ecuador Bolivia

Males Females

0

5

10

15

20

25

El Salvador Colombia Ecuador Peru Bolivia


Offers of “ecstasy” to university students

The data on direct offers of “ecstasy” to university students are similar to those seen among secondary school

students: in other words, the higher levels of reported offers occur in those countries reporting the highest

rates of “ecstasy” use. Thus, the highest rates of offers of “ecstasy” received in the past year were among

university students in Colombia and Ecuador, with 7.9% (Graph 6‐25).

Graph 6‐25: Offers of “ecstasy” to university students in the past month and past year

0

1

2

3

4

5

6

7

8

9

El Salvador Bolivia Colombia Ecuador Peru


148 | O A S ‐ C I C A D

CHAPTER 7: N E W P S Y C H O A C T I V E S U B S T A N C E S A N D O T H E R E M E R G I N G D R U G S I N T H E R E G I O N

NEW PSYCHOACTIVE SUBSTANCES In recent years, the illicit drug market has seen the appearance of a number of new substances that often have

chemical and/or pharmacological properties similar to internationally controlled substances. Their variety has

never been greater than it is now.

These new psychoactive substances (NPS) have been termed “designer drugs”, “legal highs”, “herbal highs”,

“bath salts”, “research chemicals” and “laboratory reagents”. In an effort to clarify the language, UNODC uses

only the term new psychoactive substances, which are defined as: "substances of abuse, either in a pure form

or a preparation, that are not controlled by the 1961 Single Convention on Narcotic Drugs or the Convention on

Psychotropic Substances of 1971, but which may pose a threat to public health". The word “new” does not

necessarily refer to new inventions, a number of NPS were first synthesized forty years ago, but rather means

that they are substances that have appeared recently on the market and that have not been scheduled in the

UN Convention.

NPS mimic the effects of controlled substances64

Many new psychoactive substances on the market contain chemical products that have structural and/or

pharmacological properties similar to the substances under international control and are designed to mimic

them.

For example, synthetic cannabinoids, which include the JWH series (such as JWH‐018), are compounds that

mimic THC (delta‐9‐tetrahydrocannabinol), which is the principal psychoactive compound in marijuana.

Synthetic cathinones, which include substances like mephedrone, methylone and MDPV, may produce

stimulant and empathogenic effects similar to amphetamine, including MDMA.

Phenethylamines include substances such as the 2C series (such as 2C‐I) and NBOMe compounds (such as 25I‐

NBOMe), which produce effects that range from stimulant to hallucinogenic. Some substances in this group

are already under international control through the Convention on Psychotropic Substances of 1971, but many

of them are still not scheduled.

Tryptamines and their derivatives that have been reported as NPS are indolealkylamine molecules. While some

tryptamines of natural origin are neurotransmitters (for example, serotonin, melatonin and bufotenin), most

are found as psychoactive hallucinogens in plants, mushrooms and animals (for example, N,N‐

dimethyltriptamin (DMT) psilocybin, and 5‐methoxy‐N,N‐dimethyltriptamine (5‐MeO‐DMT) [1‐3].


Ketamine is also closely related to the internationally controlled phencyclidine (PCP), which appears in

Schedule II of the 1971 Convention on Psychotropic Substances.

In general, a similar chemical structure does not mean that the pharmacological effects are similar. Therefore,

new psychoactive substances—designed to mimic a controlled substance—may have greater or lesser

pharmacological action, different stimulant effects and a toxicological composition different from the drug that

it is intended to mimic.

North America: a large market for new psychoactive substances

North America, predominantly the United States and Canada, represents one of the largest and most

diversified markets for NPS in the world. There have been a growing number of NPS reports from the United

States and Canada, which have almost quadrupled between 2010 and 2013. Since 2008, synthetic cannabinoids

have made up an increasing share of NPS, making up 31% of the total by 2013, followed by synthetic

cathinones at 24% and phenethylamines at about 22%. Other reports of NPS, such as aminoindans, ketamine

and phencyclidine type substances, piperazines, plant‐based substances and tryptamines, have been increasing

steadily over the years, and together have made up less than 25% of the annual total since 2009. So far, Mexico

has only reported one phenethylamine in 2012.65

In the United States, synthetic cannabinoids first emerged on the drug market in 2008 and were marketed as a

“legal alternatives to marijuana”, since the use of synthetic cannabinoids produce effects similar to those of

cannabis. The number of calls to poison control centers regarding “synthetic marijuana” (i.e., synthetic

cannabinoids) increased in the United States by almost 80% between 2010 and 2012. A synthetic cannabinoid

laboratory was also discovered in Canada in 2012. Prevalence data indicate high levels of NPS use among youth

in the United States. The Monitoring the Future drug use survey among twelfth‐grade students showed that in

2014, past year prevalence of the use of synthetic cannabinoids was the fifth highest most used drug at 5.8%

after marijuana at 35.1%, amphetamine at 8.1%, Adderall at 6.8%, and narcotics other than heroin at 6.1%.

Past year prevalence for other NPS were also reported in 2014, such as salvia divinorum at 1.8%, ketamine at

1.5% and “bath salts” at 0.9%. According to these results, NPS use has become significantly higher than that of

many internationally controlled substances66 (Figure 7‐1).

Figure 7‐1: Past year prevalence of NPS use in United States

12th grade students, 2011‐2014

11.4 11.3

7.9

5.85.9

4.43.4 1.8

1.30.9 0.9

1.7 1.51.4 1.5

0

2

4

6

8

10

12

2011 2012 2013 2014

Prevalence (%)

Synthetic cannabinoids Salvia divinorum

Bath Salts (synthetic stimulants) Ketamine

150 | O A S ‐ C I C A D

A survey of 7th and 12th grade students in Canada in school year 2012‐2013 also showed significant rates of use of new psychoactive substances. The NPS most used among students in the past month was Salvia divinorum (2%), followed by synthetic cannabinoids (1.4%), bath salts (0.6%) and benzylpiperazine (0.5%). The rates of use were always higher for students in the higher grades than in the lower grades (Graph 7‐2). NPS use is always higher among males than among females (Graph 7‐3).

Graph 7‐2: Past month prevalence of New Psychoactive Substances by grouped grades, grades 7‐12, Canada,

2012‐2013xxxvi

Graph 7‐3: Last month prevalence of New Psychoactive Substances by sex, grades 7‐12, Canada, 2012‐2013xxxvii

The most recent survey of drug use among secondary school students in Mexico City, which is from 2012,

reported lifetime prevalence of the use of hallucinogenic plants/herbs of 3.8%, exceeded only by the rates of

use of controlled substances such as marijuana at 15.9% and cocaine at 5% (Graph 7‐4). Treatment records

provided by the Mexican Government show that in 2012, at least 1,213 people sought treatment for problems

derived from the use of plants. According to the most recent general population study in Mexico, lifetime

prevalence of the use of hallucinogenic plants/herbs was 0.7%, higher than the rates of use of controlled

substances like amphetamine and heroin, and slightly lower than the rate of methamphetamine use (0.8%).

xxxvi Source: Health Canada, Youth Smoking Survey 2012‐2013. xxxvii Source: Health Canada, Youth Smoking Survey 2012‐2013.

0

0.5

1

1.5

2

2.5

3

3.5

Prevalence (%)

Grades 7-9 Grades 10-12 Total

0

0.5

1

1.5

2

2.5

3

Prevalence (%)

Male Female


Graph 7‐4: Lifetime prevalence of drug use among secondary students, Mexico City, 2012

The appearance of new psychoactive substances in Central and South America

A total of 73 individual NPS were reported to UNODC between 2008 and 2014 by Argentina, Brazil, Chile,

Colombia, Costa Rica, Ecuador, Panama and Uruguay, most of which were phenethylamines followed by

synthetic cannabinoids, synthetic cathinones, piperazines and plant‐based substances67 (Graph 7‐5).

Graph 7‐5: Number of NPS reported to UNODC’s EWA from

Central and South America over the six‐year period, 2008‐2014 xxxviii

Although there have been relatively few reports of ketamine in the region, it was found in some seizures of

controlled substances. In 2013, Colombia reported the seizure of 7,000 pills sold as 2C‐B361, an internationally

controlled medication, but which according to the Colombian Observatory on Drugs contained ketamine and

small quantities of other unidentified substances.68 In 2012, Brazil also reported to UNODC that it had

discovered ketamine in substances sold as "ecstasy".

xxxviii Source: UNODC Early Warning Advisory on NPS, 2014

0

2

4

6

8

10

12

14

16

18

Prevalence (%)

0

2

4

6

8

10

12

14

16

18

NPS Reported (Nº)

152 | O A S ‐ C I C A D

In some countries, the use of ketamine has been reported at prevalence rates higher than other controlled

substances. In Argentina, a survey conducted in 2010 on drug use in the general population aged 12‐65 showed

lifetime prevalence of the use of ketamine at 0.30%, higher than the rate for opiates (0.07%) and prescription

stimulants (0.05%). A general population survey conducted in Uruguay in 2011 on drug use among people aged

15‐65 showed lifetime use of ketamine at 0.60%, higher than lifetime use of methamphetamine (0.20%),

opioids (0.18%) and prescription stimulants (0.03%). Other countries of the region, such as Costa Rica, Chile

and Colombia are similar in terms of ketamine use (Graph 7‐6).

Graph 7‐6: Lifetime use of ketamine in the general population

The results of a 2011 survey in Argentina showed lifetime prevalence of ketamine among secondary school

students of 0.7%, similar to rates of lifetime use of heroin, crack and opium. Another survey on drug use

conducted in 2010, this time among Brazilian students aged 10‐19, reported lifetime prevalence of ketamine

use of 0.2%. Something similar was observed in Costa Rica, where lifetime prevalence of the use of ketamine

among students aged 15‐16 was reported at 0.4% in a study from 2012 (Graph 7‐7).

Graph 7‐7: Lifetime prevalence of the use of ketamine among

secondary school students

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

Uruguay(2011)

Argentina(2010)

Costa Rica(2010)

Chile(2012)

Colombia(2013)

Prevalence (%)

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

Argentina(2011)

Costa Rica(2012)

Brazil(2010)

Uruguay(2012)

Peru(2012)

Prevalence (%)


NPS and LSD market

A survey on drug use among university students in the Andean countries (Bolivia, Colombia, Ecuador and Peru)

conducted in 2012 ranked LSD as the second most used drug in Colombia in terms of past year prevalence

(3.2%), after marijuana at 15.2%. The same study showed that lifetime prevalence of the use of LSD among

Colombian university students had also risen considerably, to 4.9%, but still lower than marijuana (32.1%),

cocaine (7.4 %) and solvents and inhalants (8.1%). In Ecuador, lifetime prevalence of the use of LSD among

university students was a reported 0.7%, higher than the rates of use of drugs such as crack, heroin and

ketamine. The findings of the surveys of university students in the four Andean countries show a statistically

significant increase in lifetime and past year prevalence of the use of LSD in two consecutive studies. Lifetime

prevalence rose from 0.5% in 2009 to 1.6% in 2012, while recent (past year) use showed an increase from 0.2%

in 2009 to 1.0% in 201269 (Graph 7‐8). The rates of LSD use among university students may be related to the

emergence in the region of certain phenethylamines, whose effects on users are similar to those of LSD.

Graph 7‐8: Lifetime and past year prevalence of LSD use among university students in the Andean region, 2009‐2012

Compounds of the NBOMe series are reported in the region

In 2013 and 2014, Brazil, Chile and Colombia reported the appearance of a series of NBOMe compounds.

Recently, police agencies in some countries of South America have reported that the substance is sold as "LSD"

on the illicit drug market. In June 2013, through its early warning advisory system (SAT), the Colombian

Observatory on Drugs reported that substances sold as LSD in fact contained two NBOMe compounds, 25B‐

NBOMe and 25C‐NBOMe.70 A number of studies on drug use conducted in Colombia have reported particularly

high rates of LSD use. The most recent general population survey in Colombia of people aged 12‐64, from

2013, showed a lifetime prevalence of LSD use at 0.73%, making it the fourth illicit drug of highest lifetime use

after marijuana, cocaine and bazuco, and higher than “ecstasy”, for which lifetime prevalence was 0.71%.71

Given the reports of NPS sold as "LSD", more investigation is needed of the potential connection between NPS

and high levels of "LSD" use among certain groups of users.

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

2009 2012

Prevalence (%)

Lifetime use of LSD

Past year use of LSD

154 | O A S ‐ C I C A D

Recently, there have also been reports of shipments of “ecstasy” and "LSD" containing NPS to South America

from Western Europe. In May 2013, the National Police of Chile seized 800 stamps that allegedly contained the

hallucinogen LSD, coming from a shipment from Spain, but that, after preliminary chemical analysis and

subsequent confirmations, in reality consisted of 25I‐NBOMe.72

An emerging market for plant‐based substances

Although the new psychoactive substances are for the most part synthetic drugs that are not controlled under

the international conventions, they also include a category of plant‐based drugs that, like the former, are not

necessarily new substances but have emerged in recent years not in the traditional context, and have become

a potential threat to public health. A large proportion of this type of new drug are plants or plant‐based

substances that have psychoactive properties. Those most frequently reported are: Kratom (mitragyna

speciosa Korth), a plant native to South East Asia that has different effects depending on the dosage used: it is

a stimulant at low doses and has sedative effects as higher doses. Salvia divinorum is a plant native to the

forests around Oaxaca, Mexico, which contains the active principle salvinorin A, a hallucinogenic substance.

Khat (catha edulis) is a plant native to the Horn of Africa and the Arabian Peninsula. The leaves of the plant are

chewed, releasing the stimulants cathinone and cathine.73

However, other varieties of plants having psychoactive properties have started to appear with increasing

regularity in the drug markets in Latin America. It used to be thought that many of them were destined solely

and exclusively for the religious rites of the original peoples of the Americas. However, data from the most

recent surveys show young people from wealthy, socially privileged backgrounds who are using these drugs

solely for recreational purposes.

The 2013 general population survey in Colombia reported the use of substance of vegetable origin such as

mushrooms (hallucinogens), Yagé (also known as ayahuasca) and cacao sabanero (the name used in Colombia

for Brugmansia or floripondio, the psychoactive component of which is the alkaloid scopolamine). The rate of

lifetime use was 0.8%, used considerably more among males (1.4%) than among females (0.3%). The use of

these plant‐based substances in Colombia was higher than the use of drugs such as LSD, “ecstasy”, ketamine

and amphetamine74 (Graph 7‐9).


Graph 7‐9: Lifetime prevalence of the use of psychoactive plant‐based substancesxxxix

and synthetic drugs in the general population in Colombia, by sex (2013)

Some countries of the region have reported in their general population surveys on the use of plants that have

psychoactive properties. With the exception of Brazil, the use of psychoactive plants in all countries that have

information available is much higher among males than among females. The rates of lifetime use in Argentina,

Colombia and Chile are similar, with 0.9%, 0.8% and 0.7% respectively (Graph 7‐10).

Graph 7‐10: Lifetime prevalence of use of plant‐based substances in the general population

Finally, the most recent survey on drug use among secondary school students in Costa Rica showed lifetime

prevalence of the use of hallucinogenic plants and herbs of 2.7%, exceeded only by rates of use of marijuana,

inhalants and medications. Treatment records provided by Costa Rica indicate that between 2009 and 2012, at

least 300 people sought treatment for problems derived from the use of plants.

xxxix These plant‐based substances exclude plants traditionally known as cannabis or marijuana.

00.20.40.60.8

11.21.41.6

Prevalence (%)

Male Female

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

Argentina(2010)

Colombia(2013)

Chile(2012)

Brazil(2005)

Costa Rica(2010)

Prevalence (%)

Male Female Total

156 | O A S ‐ C I C A D

HEROIN Heroin has been present in Mexico, the United States and Canada for some time, and appeared to be confined

to those countries. However, it seems that the situation has changed recently, and a few countries in Latin

America and the Caribbean have reported heroin use. Even though the prevalence of heroin use in some

countries cannot be determined with any precision, the National Observatories on Drugs of Colombia, the

Dominican Republic and Venezuela have confirmed the presence of heroin in treatment centers and among

some marginal populations.

According to the Government of Colombia, heroin use has increased rapidly in recent years in that country. In

2007 in the region of Antioquia, approximately 26 people sought treatment for heroin use, while in 2014 that

number rose to 142. Another study in Santander de Quilchao showed a strong relationship between the

cultivation of poppy and the use of heroin in areas where poppy is grown.75

Graph 7‐11: Countries that reported

any heroin presence in 2004

Graph 7‐12: Countries that reported

any heroin presence in 2014

In April 2013, OID/CICAD and the National Drug Council of the Dominican Republic published a study that

examined the status of the heroin problem in the Dominican Republic. The study confirmed the existence of a

number of heroin users, some of whom were receiving treatment but most of whom were not being given

adequate health care. Although not all heroin users in the country could be located, the study projected,

optimistically, between 250 and 500 users, but a more realistic estimate would put the number at around

2,000 users.

Fifty‐three patients in Dominican treatment centers were interviewed for the study, along with 130 heroin

users who were not receiving treatment, and 26 prisoners. A significant proportion of those interviewed said

that their first contact with heroin had been in another country (mostly in the United States), while 38% said

that they started to use heroin in the Dominican Republic. More than half of the users reported intravenous

heroin use, and almost one third shared needles. Other high‐risk behaviors such as sexually‐transmitted

diseases were also identified, representing a potential health problem for the rest of the population. Of the

130 heroin users in outpatient treatment centers, 78% reported that they injected heroin, and 39% said that

they had shared needles.


Graph 7‐13: Route of administration

Graph 7‐14: Use of needles among injecting heroin users

Around two thirds of patients in treatment centers said that they had had at least one previous treatment for

heroin; of the users who were not in treatment, almost 90% stated that if they had the opportunity, they

would return to treatment or start treatment for the first time. The reason most often given for not having

completed treatment was the craving to use heroin.

Treating heroin users in the Dominican Republic poses a number of challenges. Article 7 of the country’s Law

50‐88 on drugs provides that when LSD or any other hallucinogenic substance or opium and its derivatives are

involved, no matter what the quantity, the person(s) charged will be classified as a drug trafficker or dealer. In

other words, for substances like heroin, the law does not distinguish between a user who may have a dose for

personal use, and a dealer. Both users and dealers/traffickers are severely penalized. This prevents treatment

centers from using even small amounts of opium‐based substances to treat the patient by tapering off his or

her use.

Venezuela reported low levels of heroin use, with lifetime prevalence of less than 1% in the general population

and also among secondary school students. However, approximately 1,500 cases of heroin use have been

reported in treatment centers in the past five years.

The origins of the use of heroin appear to be different in different countries. In the case of Colombia and

Venezuela, countries where poppy is grown, it would seem that the problem arose domestically. That is unlike

the Dominican Republic, where there is evidence that heroin use began among individuals who had been

deported from the United States or other countries.76 Although there are only a few countries that are

reporting the use of heroin, the shift of heroin use to countries where it had not previously been found raises

concerns that heroin might become a problem for member states in the future.

22%

78%

Sniffed injected

11%

55%

18%

10%

Shares needles Does not share needles

Rarely shares needles Sometimes shares needles

158 | O A S ‐ C I C A D

USE OF PHARMACEUTICALS WITHOUT A MEDICAL PRESCRIPTION Some medications produce psychoactive effects and are sometimes abused, in other words, taken for non‐

medical reasons and without medical supervision. In many countries in the Western Hemisphere,

pharmaceuticals without medical prescription are the controlled substances most commonly used by

secondary school students after marijuana and alcohol. Indeed, pharmaceuticals without a medical

prescription are widely used among the general population across the Hemisphere.

This section provides some basic data on the use of pharmaceuticals without medical prescription in the

Hemisphere, and specifically substances referred to as stimulants and tranquilizers. We refer here only to

those substances that are available on the market as prescription drugs but are consumed without a medical

prescription. However, it is important to keep in mind that the local and brand names of substances within the

categories of stimulants and tranquilizers vary greatly country by country. The section goes on to discuss some

challenges in the collection and analysis of these data from member states.

Tranquilizers may refer to multiple drugs, such as barbiturates, benzodiazepines and sleep medications, which

are known by a broad range of commercial and street names. Tranquilizers produce a calming effect that slows

brain activity, and are frequently used for treating anxiety and sleep disorders. However, they can produce

health effects such as drowsiness, slurred speech, concentration problems, confusion, memory and movement

problems, lowered blood pressure and slowed breathing. In Graph 7‐15 we have aggregated the substances

reported to CICAD as tranquilizers, excluding opiates and analgesics.

Graph 7‐15: Past year prevalence of tranquilizer pharmaceutical use without a medical

prescription, secondary school students

We can see that there are measurable levels of use of pharmaceuticals without a medical prescription in each

of the countries shown. Among secondary school students, Paraguay and Chile have past year prevalence

0

1

2

3

4

5

6

7

8

9

10

United

States (2014)

Canada (2010/11)

Honduras (2005)

Costa Rica (2012)

Belize (2013)

El Salvador (2008)

Panam

a (2008)

Chile (2013)

Paraguay (2005)

Bolivia (2008)

Surinam

e (2006)

Uruguay (2014)

Ecuador (2012)

Peru (2012)

Argentina (2011)

Colombia (2011)

Guyana (2013)

Haiti (2014)

Dominican

Rep

. (2008)

S. Lucia (2013)

Grenada (2013)

Dominica (2011)

S. Kitts (2013)

Baham

as (2011)

Antigua (2013)

Barbados (2013)

Jamaica (2013)

Trinidad

‐Tobago (2013)

S. Vincent ‐Grenadines (2013)

Prevalence (%)


exceeding 7%, while Haiti, Suriname and Bolivia have prevalence rates of over 6%. Indeed, tranquilizers have

some of the highest prevalence of any controlled substance use in the hemisphere after marijuana.

When we look at the use of tranquilizers without medical prescription by sex, we can see that in more than half

the countries, secondary school girls use tranquilizers at a higher rate than males (Graph 7‐16).

Graph 7‐16: Past year prevalence of tranquilizer use among secondary school students, by sex

However, there are also many countries where male students use at higher rates than females. It would

therefore be important for countries to look at their own national data on pharmaceutical use, as there is no

single pattern by sex across countries.

Stimulants are medications that increase alertness, attention and energy and may increase blood pressure,

heart rate and breathing rate. High doses of stimulants can raise body temperature to dangerous levels and

cause irregular heartbeat, heart failure and seizures. Many of these are commercial amphetamines and

methylphenidates. Known by both commercial and street names, stimulant medications are found across the

hemisphere.

Graph 7‐17 describes stimulant pharmaceutical use without medical prescription among secondary school

students.

0

2

4

6

8

10

12U

nite

d S

tate

s (2

014)

Can

ada

(201

0/1

1)

Hon

dura

s (2

005)

Cos

ta R

ica

(201

2)

Bel

ize

(201

3)

El S

alva

dor

(200

8)

Pan

ama

(20

08)

Chi

le (

2013

)

Par

agua

y (2

005)

Bol

ivia

(20

08)

Sur

inam

e (2

006

)

Per

u (2

012

)

Arg

entin

a (2

011)

Col

ombi

a (2

011)

Guy

ana

(201

3)

Dom

inic

an R

ep. (

200

8)

Hai

ti (2

014)

Dom

inic

a (2

011

)

Uru

guay

(20

14)

Bah

amas

(20

11)

Ant

igua

-Bar

buda

(2

013)

Sai

nt L

ucia

(20

13)

Jam

aica

(20

13)

Bar

bado

s (2

013)

Tri

nid

ad-

Tob

ago

(201

3)

S. K

itts-

Nev

is (

2013

)

Gre

nad

a (2

013)

S. V

ince

nt-G

rena

dine

s (2

013

)

Prevalence (%)

Males Females

160 | O A S ‐ C I C A D

Graph 7‐17: Past year prevalence of stimulant pharmaceutical use without a medical

prescription among secondary school students

Rates of stimulant use are lower than tranquilizers but still show measurable levels among secondary school

students. Dominica shows past year prevalence exceeding 6%, followed by Bolivia with around 4%. In

Honduras, Paraguay, St. Lucia and Haiti, past year prevalence is between 3% and 4%.

0

1

2

3

4

5

6

7

Can

ada

(201

0/1

1)H

ondu

ras

(200

5)C

osta

Ric

a (2

012)

Bel

ize

(201

3)P

anam

a (2

008

)E

l Sal

vado

r (2

008)

Bol

ivia

(20

08)

Sur

inam

e (2

006

)P

arag

uay

(200

5)E

cuad

or (

2012

)C

hile

(20

13)

Per

u (2

012

)A

rgen

tina

(201

1)G

uyan

a (2

013)

Col

ombi

a (2

011)

Uru

guay

(20

14)

Dom

inic

a (2

011

)D

omin

ican

Rep

. (20

08)

San

ta L

ucia

(20

13)

Hai

ti (2

014)

Gre

nad

a (2

013)

S. K

itts-

Nev

is (

2013

)S

. Vin

cent

-Gre

nadi

nes

(20

13)

Bar

bado

s (2

013)

Bah

amas

(20

11)

Jam

aica

(20

13)

Ant

igua

-Bar

buda

(2

013)

Tri

nid

ad-

Tob

ago

(201

3)

Prevalence (%)


Graph 7‐18: Past year prevalence of stimulant use among secondary school students by sex

Similar to what we observed in tranquilizer use, there is no clear pattern of stimulant use across countries by

sex. In some countries males use stimulants at higher rates, in other countries, females do and in several

countries, rates are fairly similar between boys and girls. Again, it is important for member states to examine

their national data on pharmaceutical misuse in order to determine the most important populations for

interventions.

Graph 7‐19: Past year prevalence of tranquilizer use without a medical prescription among university students

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

Can

ada

(201

0/1

1)H

ondu

ras

(200

5)C

osta

Ric

a (2

012)

Bel

ize

(201

3)E

l Sal

vado

r (2

008)

Pan

ama

(20

08)

Bol

ivia

(20

08)

Sur

inam

e (2

006

)P

arag

uay

(200

5)C

hile

(20

13)

Per

u (2

012

)A

rgen

tina

(201

1)G

uyan

a (2

013)

Uru

guay

(20

14)

Col

ombi

a (2

011)

Dom

inic

a (2

011

)D

omin

ican

Rep

. (20

08)

Hai

ti (2

014)

S. L

ucia

(2

013)

S. V

ince

nt-G

rena

dine

s (2

013

)B

aham

as (

2011

)Ja

mai

ca (

201

3)B

arba

dos

(201

3)G

ren

ada

(201

3)S

. Kitt

s-N

evis

(20

13)

Tri

nid

ad-

Tob

ago

(201

3)

Ant

igua

-Bar

buda

(2

013)

Prevalence (%)

Males Females

0

0.5

1

1.5

2

2.5

3

Colombia (2012) Bolivia (2012) Ecuador (2012) El Salvador (2012) Peru (2012)

Prevalence (%)

Males Females Total

162 | O A S ‐ C I C A D

In Peru, male and female university students appear to use tranquilizers at similar rates. However, females

have a notably higher past year prevalence of tranquilizer use in Colombia, Bolivia, Ecuador and El Salvador.

Pharmaceutical use without medical supervision is clearly firmly entrenched in both secondary school students

and university student populations. There seems to be some evidence that there may be a need for targeted

interventions for tranquilizer use, particularly among females. At the same time, the use of stimulants without

medical prescription is of concern for both males and females in secondary schools. There are many challenges

associated with data gathering on the use of pharmaceuticals without medical prescription, and these

challenges vary country to country, which highlights the importance not only of gathering data but also the

need for countries to examine their own situation and take action according the individual problems that they

face.

OPIATES AND OPIOIDS Global context

According to the World Drug Report (UNODC, 2014)77 it is estimated that in 2012, some 243 million people (range: 162 million‐324 million) corresponding to about 5.2% (range 3.5% ‐7.0%) of the world's population aged 15‐64 had used an illicit drug at least once in the past year, mainly a substance belonging to the cannabis, opioid, cocaine or amphetamine‐type stimulant (ATS) group.

Although illicit drug use among men and women varies from country to country in terms of the extent and in terms of the substances used, generally males are two to three times more likely than females to have used an illicit substance. While there are varying regional trends in the extent of illicit drug use, overall global prevalence of drug use is considered to be stable. Similarly, the extent of problem drug use by regular drug users and those with drug use disorders or dependence also remains stable, at about 27 million people (range: 16 million‐39 million).


Opiates and opioids

About 33 million people used opioids sometime in the past year, and about 16.4 million used opiates in the

same period. The past year prevalence of opioid consumption was 0.7% and 0.35% for opiates. According to

the latest UNODC global drug report,78 after cannabis, opioids and ATS have similar rates of recent use around

0.7%. Substances such as opiates, cocaine and “ecstasy” have rates between 0.3% and 0.4% (Graph 7‐20).

Graph 7‐20: Past year prevalence of drug use worldwide. xl

Opioids

Opioids refer to a class of drugs that are typically prescribed for use as painkillers, and also have the potential

for being diverted and misused.79 These include drugs such as hydrocodone, oxycodone, morphine, and

codeine. Heroin, which is illegal, is also within the same class of drugs. The use of these substances is difficult

to quantify in a comparative way because there does not appear to be a universally accepted way of capturing

information on consumption.80 Nevertheless, there are some sources of consumption data that have enough

of a time series that would allow an examination of recent trends.

At the level of the general population aged 12 and older in the United States, a significant increase in non‐

medical use of psychotherapeutic drugs was registered, mainly opioids without a prescription, from 5.7% in

2011 to 6.4% in 2012.

The trends in past month use of psychotherapeutic drugs are presented in Graph 7‐21. There appears to be a

flat trend in past month prevalence among persons aged 12 and older with figures varying between 2.4% and

2.9% between 2002 and 2013.

xl Source: UNODC, World Drug Report

0

0.5

1

1.5

2

2.5

3

3.5

4

Cannabis Opioids Opiates Cocaine ATS Ecstasy

Prevalence (%)

164 | O A S ‐ C I C A D

Graph 7‐21: Past month non‐medical use of

psychotherapeutic drugs among persons aged 12 or older: 2002 – 2013. xli

When opioid substances are separated from the group of psychotherapeutic drugs as in Graph 7‐22, it is clear

that opioids are the most prevalent substances in this group. The trend in opioid use is similarly flat with past

month prevalence figures ranging from 1.7% and 2.1% between 2002 and 2013.

Graph 7‐22: Past month non‐medical use of types of psychotherapeutic drugs

among persons aged 12 or older: 2002 – 2013.xlii

The following graph (Graph 7‐23) shows the admissions to treatment centers of persons aged 12 and older in

the United States by primary substance of abuse for the years 2002 – 2012. This graph tells a different story

than the graph above, which shows past month prevalence. The trend for ‘other opiates or synthetics’ is clearly

on an upward trend, starting with 37,683 admissions in 2001 and ending with 169,868 admissions in 2011. The

xli Source: Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H‐48, HHS Publication No. (SMA) 14‐4863, 2014 xlii Source: Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H‐48, HHS Publication No. (SMA) 14‐4863, 2014

2.7 2.5 2.8 2.8 2.42.5

0

0.5

1

1.5

2

2.5

3

3.5

Prevalence (%)

1.92

1.81.9

2.12.1

1.9

2.1

2

1.7

1.9

1.7

0.8 0.80.7 0.7 0.7 0.7 0.7

0.80.9

0.7 0.80.6

0.6 0.60.5 0.5

0.6

0.4 0.40.5

0.4 0.40.5 0.5

0.20.1 0.1

0.1 0.20.1 0.1 0.1 0.1 0.1 0.1 0.1

0

0.5

1

1.5

2

2.5

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Prevalence (%)

Pain relievers Tranquilizers Stimulants Sedatives


number of admissions for opiates intersects that of stimulants (methamphetamines and amphetamines) in

2008 as well as the trend line for cocaine in 2010. The number of admissions in 2012 for opiates exceeded the

number for cocaine and the number for stimulants, which demonstrates the increasing problem being posed

by these substances.

Graph 7‐23: Admissions to treatment centers of persons aged 12 and older

in the USA by primary substance of abuse: 2002–2012. xliii

Opioid use among students

Among students in the 8th, 10th and 12th grades in the United States, past year prevalence of opioids recorded

significant declines from 2009 to 2014, particularly in the case of OxyContin and Vicodin, while heroin use has

remained fairly stable over the last decade, with rates below 1% and slight decreases in the last five years,

recording a 0.5% rate in 2014 (Graph 7‐24).

Vicodin, whose highest past year prevalence was recorded in 2009 with 6.5%, has since shown significant

declines to register a rate of 3% in 2014. In the case of OxyContin the situation is similar, from its highest

record of 3.9% in 2009 it has been declining, although to a lesser extent, to record a rate of 2.4% in 2014.

xliii Source: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2002‐2012. National Admissions to Substance Abuse Treatment Services. BHSIS Series S‐71, HHS Publication No. (SMA) 14‐4850. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Number of Admissions

Marijuana

Heroin

Cocaine

Meth/Amph

Other Opiates/Syn

166 | O A S ‐ C I C A D

Graph 7‐24: Past year prevalence of heroin, OxyContin and Vicodin among students of 8th, 10th and 12th grades

(combined) in the United States, 2004‐2014 81

Fentanyl

According to NIDA, fentanyl is a powerful synthetic opiate analgesic similar to but more potent than morphine.

It is typically used to treat patients with severe pain, or to manage pain after surgery. It is also sometimes used

to treat people with chronic pain who are physically tolerant to opiates. It is a Schedule II prescription drug.

When prescribed by a physician, fentanyl is often administered via injection, transdermal patch, or in lozenge

form. However, the type of fentanyl associated with recent overdoses was produced in clandestine

laboratories and mixed with (or substituted for) heroin in a powder form. Mixing fentanyl with street‐sold

heroin or cocaine markedly amplifies their potency and potential dangers. Effects include: euphoria,

drowsiness/respiratory depression and arrest, nausea, confusion, constipation, sedation, unconsciousness,

coma, tolerance, and addiction.82 The U.S. Drug Enforcement Administration reported that illicit use of

pharmaceutical fentanyls first appeared in the mid‐1970s in the medical community and continues to be a

problem in the United States. To date, over twelve different analogues of fentanyl have been produced

clandestinely and identified in the U.S. drug traffic. The biological effects of the fentanyls are indistinguishable

from those of heroin, except that the fentanyls may be hundreds of times more potent. Fentanyls are most

commonly used by intravenous administration, but like heroin, they may also be smoked or snorted.83

In Canada, the Canadian Alcohol and Drug Use Monitoring Survey84 collects information from respondents aged

15 years and older on three categories of pharmaceutical drugs: opioid pain relievers, stimulants, and

tranquilizers and sedatives. The results for 2012 indicate that, similar to the US, opioid pain relievers were the

most commonly used substances of this group with a past year prevalence rate of 16.9% overall. Among these

users, 5.2% (0.9% of the total population) reported that they had abused these substances.xliv

xliv That is, used it for the experience, the feeling it caused, to get high or for “other” reasons. (Health Canada)

0.90.8 0.8 0.8 0.8 0.8 0.8

0.7 0.6 0.6 0.5

3.3 3.4 3.53.5

3.4 3.9 3.8

3.4

2.9 2.9

2.4

5.8 5.7

6.3 6.2 6.16.5

5.9

5.1

4.3

3.7

3

0

1

2

3

4

5

6

7

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Prevalence (%)

Heroin OxyContin Vicodin


In summary, new and emerging substances are presenting the hemisphere with serious challenges. The lack of

data on these substances is hampering the countries’ ability to provide an adequate response to this situation.

NPS are characterized mainly by the fact that they are substances not regulated under the international

conventions and because they involve a serious threat to public health. Some of these new psychoactive

substances mimic the effects of controlled substances, and indeed, many of them are sold in the illicit drug

market. New psychoactive substances have burst onto the scene in the Americas over the last six years.

Sales of NPS over the Internet or through other lawful commerce are very common, principally in the United

States where strenuous efforts are being made to regulate them and impose legal restrictions. Most of the

information on the use of NPS comes from the countries of North America, chiefly the United States and

Canada, where synthetic cannabinoids, synthetic cathinones, bath salts, ketamine, piperazines and

phenethylamines have appeared regularly in the most recent surveys on drug use. But the use of some NPS

such as plant‐based substances, synthetic cannabinoids, phenethylamines, piperazines and ketamine has also

been found in Mexico and in countries of Latin America. Many of these substances are being seen among the

younger population such as secondary school students and university students. This emerging phenomenon,

which has been growing steadily over the last ten years, demands urgent attention internationally, since it

involves a new challenge for health, police and judicial authorities and the media.

In the case of the use of pharmaceuticals without a medical prescription, the inter‐American system (SIDUC)

does not have a standardized methodology for identifying all the different substances found in the countries. It

is thus up to each individual country to identify the different medications that are being misused. Even though

many countries have taken steps to improve this information, much still remains to be done in this area.

With respect to the limited data from treatment centers, it is notable that cocaine and smokable cocaine

represent the bulk of those receiving drug treatment in Argentina, Chile, Colombia and Uruguay despite the

fact that alcohol and marijuana have much higher prevalence rates. This implies that cocaine and smokable

cocaine have much higher impact on health and well‐being, and also indicates that cocaine and smokable

cocaine users have a larger impact on treatment services despite their smaller numbers than users of alcohol

and marijuana.

168 | O A S ‐ C I C A D

References 1 The Drug Problem in the Americas. Organization of American States, General Secretariat, 2013. 2 Statistical Yearbook of Latin America and the Caribbean, 2013. ECLAC‐United Nations. Data from the United States (own calculations based on data from the Bureau of the Census, 2013). 3 Statistical Yearbook of Latin America and the Caribbean, 2013. ECLAC and the World Bank. www.datos.bancomundial.org world development indicators. 4 Antigua and Barbuda, Argentina, Bahamas, Barbados, Bolivia, Chile, Colombia, Costa Rica, Dominica, Dominican Republic, Ecuador, Guatemala, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Saint Lucia, Saint Kitts and Nevis, Saint Vincent and the Grenadines, Suriname and Venezuela. ECLAC, Statistical Yearbook of Latin America and the Caribbean, 2013. 5 Observatorio Argentino de Drogas. SEDRONAR. Situación epidemiológica Argentina 2012. 6 Observatorio Chileno de Drogas. SENDA. Décimo Estudio de Drogas en Población Escolar de Chile 2013. Observatorio Chileno de Drogas. SENDA. 7 Observatorio Peruano de Drogas. DEVIDA.Situation and Trend Drugs, 2013 Report. 8 Instituto sobre Alcoholismo y Farmacodependencias (IAFA). Encuesta Nacional sobre Consumo de drogas en población de educación secundaria 2012 9 Observatorio Uruguayo de Drogas. Sexta encuesta nacional sobre consumo de drogas en estudiantes de enseñanza media. Uruguay 2104. 10 Johnston, L. D., O’Malley, P. M., Miech, R. A., Bachman, J. G., & Schulenberg, J. E. (2015). Monitoring the Future national survey results on drug use: 1975‐2014: Overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, The University of Michigan. 11 Observatorio Mexicano de Tabaco, Alcohol y otras drogas. Tendencias de Consumo de Drogas en Población Escolar Ciudad de México, 2012 12 Observatorio Argentino de Drogas. SEDRONAR. Situación epidemiológica Argentina 2012. 13 Observatorio Chileno de Drogas. SENDA. Décimo Estudio Nacional de Drogas en Población General de Chile 2012. 14 Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz; Instituto Nacional de Salud Pública; Secretaría de Salud. Encuesta Nacional de Adicciones 2011: Reporte de Drogas . Villatoro‐Velázquez JA, Medina‐Mora ME, Fleiz‐Bautista C, Téllez‐Rojo MM, Mendoza‐Alvarado LR, Romero‐Martínez M, Gutiérrez‐Reyes JP, Castro‐Tinoco M, Hernández‐Ávila M, Tena‐Tamayo C, Alvear Sevilla C y Guisa‐Cruz V. México DF, México: INPRFM; 2012 15 Observatorio Peruano de Drogas. DEVIDA. Situation and Trend Drugs, 2013 Report. Observatorio Peruano de Drogas. DEVIDA. 16 SAMHSA, Center for Behavioral Health Statistics and Quality National Survey on Drug Use and Health, 2002‐2013. Types of Illicit Drug Use in the Past Year among Persons Aged 12 or Older: Percentages, 2002‐2013 17 Observatorio Uruguayo de Drogas. Quinta encuesta nacional de Hogares sobre consumo de drogas 2011. 18 Pan American Health Organization (PAHO), Prevention of alcohol‐related injuries in the Americas: from evidence to policy action, 2011. 19 World Health Organization, Global Status Report on Alcohol and Health, 2011. 20 Interpersonal violence and illicit drugs. Liverpool, United Kingdom: WHO Collaborating Centre for Violence Prevention, 2009. 21 Taylor B, Rehm J, Caldera‐Aburto JT, Bejarano J, Cayetano C, et.al. Alcohol, Gender, Culture and Harm in the Americas. Washington, D.C.: PAHO 2007. 22 Ellsberg M, Peña R, Herrera A, Liljestrand J, Winkvist A. Candies in hell: women’s experience of violence in Nicaragua. Soc Sci Med2000;51(11):1595‐610. 23 Rodgers K. Wife assault: the findings of a national survey. Juristat Service Bulletin1994;14(1‐22). 24 Mujeres violentadas por su pareja en México. Mexico City, Mexico: INEGI2003. 25 Violencia interpersonal y alcohol. Geneva, Switzerland: WHO 2006. 26 Maltrato infantil y alcohol. Geneva, Switzerland: WHO 2006. 27 Walsh C, MacMillan HL, Jamieson E. The relationship between parental substance abuse and child maltreatment: findings from the Ontario Health Supplement. Child Abuse Negl2003;27(12):1409‐25. 28 Darke S. The toxicology of homicide offenders and victims: A review. Drug Alcohol Rev2010;29(2):202‐15. 29 Windle, M, Alcohol use among adolescents and Young Adults. National Institute on Alcohol Abuse and Alcoholism; http://pubs.niaaa.nih.gov/publications/arh27‐1/79‐86.htm. 30 Salas‐Wright CP, Vaughn MG, Ugalde J, Todic J. Substance use and teen pregnancy in the United States: Evidence from the NSDUH 2002‐2012, Addictive Behavior 2015, Feb 13:218‐225. 31 Kroutil, L, Colliver J* Gfoerer, J (2010). OAS Data Review: Age and cohort patterns of substance use among adolescents. Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies.


32 SAMHSA; TEDS Report, July 17, 2014; http://www.samhsa.gov/data/sites/default/files/WebFiles_TEDS_SR142_AgeatInit_07‐10‐14/TEDS‐SR142‐AgeatInit‐2014.pdf. 33 Estudio Nacional de Consumo de Sustancias Psicoactivas en Colombia, 2013 (National Study on Psychoactive Substance Use in Colombia, 2013). (Spanish only). 34 Babor T, Higgins‐Biddle J, Saunders J, Monteiro M; The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care, 2nd ed., World Health Organization, Department of Mental Health and Substance Dependence, 2001, WHO/MSD/MSB/01.6A. 35 Nizama‐Valladolid M, et al, Indirect diagnose of alcohol abuse/dependency in an adult population: a validation of a survey; Acta Médica Peruana, 27(2) 2010. 36 Binge drinking is defined in the NSDUH as having five or more drinks on the same occasion on at least 1 day in the 30 days prior to the survey. 37 Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on drug Use and health: Summary of National Findings, NSDUH Series H‐48, HHS Publication No. (SMA) 14‐4863. Rockville, MD: Substance Abuse and Mental Health Services Administration. 38 Colombian Observatory on Drugs, National Study on Psychoactive Substance Use in Colombia, 2013. 39 World Health Organization, The Alcohol Use Disorders Identification Test, Guidelines for Use in Primary Care, 2nd ed., 2001. 40 Health Topics. Tobacco, 2015. Retrieved from http://www.who.int/topics/tobacco/en/ 41 Electronic Cigarettes (e‐Cigarettes), 2014. Retrieved from http://www.fda.gov/NewsEvents/%20PublicHealthFocus/ucm172906.htm 42 Pan American Health Organization (PAHO), Tobacco Control Report for the Region of the Americas. 2013 43 Ansara, Donna L., Fred Arnold, Sunita Kishor, Jason Hsia, and Rachel Kaufmann, Tobacco Use by Men and Women in 49 Countries with Demographic and Health Surveys. 2013. DHS Comparative Reports No. 31. 44 Johnston, L. D., O’Malley, P. M., Miech, R. A.,Bachman, J. G., & Schulenberg, J. E. (2015). Monitoring the Future national survey results

on drug use: 1975‐2014: Overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, The University of Michigan. 45 Source: Monitoring the Future, 2014 46Balster,R.L., Cruz, S.L., Howard, M.O., Dell, C.A.&Cottler, L. B (2009). Classification of abused inhalants. Addiction 104 (6) 878‐882. 47Hynes‐Dowell M, MateuGelabert P, Taunhauser Barros HM, Delva J. Volatile Substance Misuse among High School Students in South America. Substance Use & Misuse, 46:27‐34, 2011. 48Neumark, Y, Bar‐Hamburger R. Volatile Substance Misuse among Youth in Israel: Results of a National School Survey, Substance Use & Misuse, 46:21‐26, 2011. 49Villatoro J, Cruz S, Ortiz A, Medina‐Mora M. Volatile Substance Misuse in Mexico: Correlates and Trends. Substance Use & Misuse, 46:40‐45, 2011. 50Sharma S, Lal R, Volatile Substance Misuse among Street Children in India: A Preliminary Report. Substance Use & Misuse, 46:46‐49, 2011. 51Vazan P, Khan M, Poduska O, Stastna L, Miovsky M. Chronic Toluene Misuse among Roma Youth in Eastern Slovakia. Substance Use & Misuse, 46:57‐61, 2011. 52Abbs P, MacLean S. Petrol Sniffing Interventions Among Australian Indigenous Communities Through Product Substitution: from Skunk Juice to Opal. Substance Use & Misuse, 46:99‐106, 2011. 53 Castaño, G.A. “Cocaínas fumables en Latinoamérica”, Adicciones, 2000. 54 G.A. Castaño: “Cocaínas fumables en Latinoamérica”, Adicciones. 2000.

55 Inter‐American Drug Use Data System. 56 UNODC, Global SMART Program, Amphetamine‐Type Stimulants in Latin America, 2014. 57 2012 Canadian Alcohol and Drug Use Monitoring Survey (CADUMS), Controlled Substances and Tobacco Directorate, Health Canada.

58 2013 National Survey on Drug Use and Health (NSDUH), Substance Abuse and Mental Health Services Administration (SAMHSA). 59 Monitoring the Future, National Survey Results on Drug Use, 2014. 60 Questionnaire for OID/ CICAD reports. Report by Mexico. 61 National Study on Patients in Treatment Centers. Argentine Observatory on Drugs, July 2011. 62 UNODC, Global Synthetic Drugs Assessment, 2014. 63 SG.CAN, II Estudio Epidemiológico Andino sobre Consumo de Drogas en la Población Universitaria. Informe Regional (Second Andean Epidemiological Study of Drug Use among University Students. Regional Report), 2012. (Spanish only). 64 UNODC’s Early Warning Advisories on NPS on have detailed information on each of the categories of this type of substance: https://www.unodc.org/LSS/Home/NPS 65 Global Synthetic Drugs Assessment, Amphetamine‐type stimulants and new psychoactive substances, 2014. 66 Monitoring the Future, 2014. 67 UNODC, Early Warning Advisory on NPS (EWA on NPS). 68 Early Warning Advisory System on NPS of Colombia. Information reported in June 2013.

170 | O A S ‐ C I C A D

69 II Epidemiological Study of Drug Use among University Students in the Andean Region, Regional Report, 2012. (Estudio Epidemiológico Andino sobre Consumo de Drogas en la Población Universitaria, Informe Regional, 2012). General Secretariat of the Andean Community, PRADICAN Project, January 2013 (Spanish only). 70 Early Warning Advisory System on NPS of Colombia, 2013.

71 National Study on the Use of Psychoactive Substances in Colombia, Final Report, 2013. 72 UNODC. Amphetamine‐Type Stimulants in Latin America, 2014. 73 UNODC Early Warning Advisory on NPS has detailed information on all of these substance: https://www.unodc.org/LSS/Home/NPS 74 National Study on the Use of Psychoactive Substances in Colombia, 2013: Information drawn up on the basis of the study database, with the authorization of the Colombian Government. 75 Ministry of Health, National University of Colombia (2009). Rapid Assessment of Heroin Use in the City of Santander de Quilchao, Cauca (Evaluación Rápida de la Situación de Consumo de Heroína en el Municipio de Santander de Quilchao, Cauca) (Spanish only). 76 CICAD/OAS and the National Drug Council of the Dominican Republic, Project on the Heroin Problem in the Dominican Republic: Report on Findings, April 2013. 77 United Nations Office on Drugs and Crime, World Drug Report 2014 (United Nations publication, Sales No. E.14.XI.7). 78 Ibid. 79 http://www.samhsa.gov/atod/opioids. 80 Voon and Kerr: “Nonmedical” prescription opioid use in North America: a call for priority action. Substance Abuse Treatment, Prevention, and Policy 2013 8:39. 81 NIDA, Monitoring the Future, 2014 82 National Institute on Drug Abuse, at http://www.drugabuse.gov/drugs‐abuse/fentanyl. 83 United States, Drug Enforcement Administration at: http://www.dea.gov/druginfo/concern_fentanyl.shtml. 84 Health Canada: Canadian Alcohol and Drug Use Monitoring Survey. Summary of Results for 2011 accessed at http://www.hc‐sc.gc.ca/hc‐ps/drugs‐drogues/stat/_2011/summary‐sommaire‐eng.php#a2, April 1, 2015.

A P P E N D I X : : R e p o r t o n D r u g U s e i n t h e A m e r i c a s : : 2 0 1 5 | 171

APPENDIX

172 | O A S ‐ C I C A D


Table A1.1: Lifetime, past year and past month prevalence of alcohol use among secondary school students.

Country (year of most recent

study)

Prevalence

Lifetime Past Year Past Month


72.79 57.88 37.45

Argentina (2011) 73.20 62.80 49.30

Bahamas (2011) 67.44 46.04 27.51

Barbados (2013) 68.53 53.52 30.88

Belize (2013) 65.95 48.40 33.06

Bolivia (2008) 46.50 35.40 27.70

Canada (2010/11) 70.60 49.90 n/a

Chile (2013) 78.37 60.60 33.89

Colombia (2011) 76.55 69.67 50.18

Costa Rica (2012) 60.40 42.00 23.80

Dominica (2011) 81.27 61.55 36.33

Dominican Republic (2008)

63.82 48.56 31.37

Ecuador (2012) 44.80 18.50 7.30

El Salvador (2008) 32.50 20.00 11.50

Grenada (2013) 72.58 55.58 35.60

Guyana (2013) 53.98 32.83 16.54

Haiti (2014) 56.56 35.38 22.97

Honduras (2005) 43.38 22.12 12.70

Jamaica (2013) 64.95 44.93 24.07

Panama (2008) 52.50 35.30 20.50

Paraguay (2005) 62.90 51.60 42.60

Peru (2012) 43.20 24.44 11.97

Saint Kitts‐Nevis (2013) 65.56 44.60 25.85

Saint Lucia (2013) 75.88 58.53 41.07

Saint Vincent‐Grenadines (2013)

72.32 58.79 47.06

Suriname (2006) 66.01 50.92 37.22

Trinidad‐Tobago (2013)

67.51 49.98 27.93

United States (2014) 46.40 40.70 22.6

Uruguay (2014) 75.10 60.20 38.70

Venezuela (2009) 47.20 30.10 17.90

Table A1.2: Past year and past month prevalence of alcohol use among secondary school students by sex.


study)

Past Year Past Month

Male Female Male Female


58.08 57.97 37.50 38.01

Argentina (2011) 64.00 62.00 51.30 47.60

Bahamas (2011) 44.29 47.97 26.86 28.30

Barbados (2013) 52.61 57.15 32.00 31.80

Belize (2013) 50.82 46.14 35.43 30.85

Bolivia (2008) 41.50 30.00 33.50 22.50

Canada (2010/11) 51.00 48.70 n/a n/a

Chile (2013) 58.00 63.26 34.10 33.77

Colombia (2011) 69.82 69.54 51.18 49.27

Costa Rica (2012) 42.40 41.70 24.70 23.10

Dominica (2011) 61.21 62.31 35.10 37.99


45.76 50.87 28.87 33.40

Ecuador (2012) 19.39 17.48 8.14 6.33

El Salvador (2008) 21.90 18.40 12.70 10.60

Grenada (2013) 53.86 57.23 36.97 34.47

Guyana (2013) 36.98 30.17 20.13 14.19

Haiti (2014) 44.66 27.52 30.11 16.84

Honduras (2005) 24.47 20.24 14.66 11.15

Jamaica (2013) 45.12 45.04 25.81 22.88

Panama (2008) 40.00 31.80 25.70 16.40

Paraguay (2005) 50.60 52.40 42.70 42.60

Peru (2012) 25.66 23.23 13.05 10.90


42.81 46.14 26.96 24.52

Saint Lucia (2013) 56.93 59.99 40.54 41.85


59.95 57.90 47.54 46.69

Suriname (2006) 58.82 44.44 44.53 31.25


46.83 53.01 26.91 28.97

United States (2014) 39.20 42.10 22.10 22.80

Uruguay (2014) 60.10 60.40 38.80 38.60

Venezuela (2009) 31.70 28.70 19.90 16.20

174 | O A S ‐ C I C A D

Table A1.3: Past year and past month prevalence of alcohol use among secondary school students by grade.


study)


8º 10º 12º 8º 10º 12º


39.62 63.05 76.09 25.23 40.36 50.38

Argentina (2011) 42.50 73.40 83.30 30.40 57.50 70.40

Bahamas (2011) 27.22 51.24 62.67 13.66 30.58 40.61

Barbados (2013) 26.73 28.49 73.46 11.60 28.49 45.89

Belize (2013) 39.63 58.81 52.12 24.56 42.82 37.71

Bolivia (2008) 20.30 34.10 52.40 16.90 26.40 40.30

Canada (2010/11) 25.30 53.90 69.50 n/a n/a n/a

Chile (2013) 40.93 68.56 76.54 16.64 38.24 51.37

Colombia (2011) 57.32 77.02 80.70 39.22 56.47 60.32

Costa Rica (2012) 25.30 45.70 54.30 13.40 24.50 33.10

Dominica (2011) 48.00 70.83 75.45 23.84 43.95 53.57


28.73 54.20 70.09 15.47 33.94 51.25

Ecuador (2012) 9.40 21.01 27.61 3.13 7.88 12.22

El Salvador (2008) 11.10 21.30 30.30 6.10 12.80 17.30

Grenada (2013) 35.94 60.98 72.62 20.86 40.15 47.86

Guyana (2013) 20.49 39.34 40.50 11.38 20.47 18.29

Haiti (2014) 25.97 37.96 41.26 16.00 23.64 28.04

Honduras (2005) 14.58 25.09 30.88 14.66 11.15 12.70

Jamaica (2013) 25.87 49.61 54.64 12.94 27.49 29.16

Panama (2008) 16.20 41.60 52.90 8.90 21.80 34.50

Paraguay (2005) 33.10 59.10 72.50 26.50 50.00 59.80

Peru (2012) 11.80 28.04 35.79 4.91 13.49 18.86


32.48 49.36 55.48 15.81 32.62 30.82

Saint Lucia (2013) 43.31 60.99 73.32 27.89 43.74 53.37


43.56 67.04 69.90 34.12 56.35 53.63

Suriname (2006) 38.80 47.65 60.08 26.01 32.17 47.25


29.20 53.07 62.61 15.01 27.78 37.20

United States (2014) 20.80 44.00 60.20 9.00 23.50 37.40

Uruguay (2014) 41.50 71.80 79.90 21.30 48.70 58.20

Venezuela (2009) 22.60 41.40 50.20 11.90 24.90 34.40

Table A1.4: Lifetime, past year and past month prevalence of alcohol use among the general population.


study)

Prevalence


Argentina (2011)* 77.75 66.18 50.57

Barbados (2006) 78.90 53.40 36.20

Belize (2005) 47.30 38.80 27.10

Bolivia (2014) 69.38 48.53 23.02

Brazil (2005) 74.60 49.80 38.30

Canada (2012)** 90.60 79.80 64.30

Chile (2012) 69.06 55.78 40.77

Colombia (2013) 87.07 58.78 35.77

Costa Rica (2010) 38.00 24.10 20.50


79.39 56.31 36.25

Ecuador (2013) 56.62 28.82 13.01

El Salvador (2014) 50.94 18.32 9.49

Mexico (2011) 71.30 51.40 31.60

Paraguay (2003) 81.20 65.30 45.20

Peru (2010) 75.31 52.58 30.63

Suriname (2007) 66.40 48.50 31.60

United States (2013) 81.50 66.30 52.20

Uruguay (2011)*** 92.40 74.00 55.30

Venezuela (2011) 68.00 52.70 33.50

*Argentina: Population of 16 ‐ 64 years. **Canada: Population of 15 ‐ 64 years. ***Uruguay: Population of 15 ‐ 65 years


Table A1.5: Past year and past month prevalence of alcohol use among the general population by sex.


study)



Argentina (2011)* 75.19 57.35 62.67 38.72

Barbados (2006) 68.90 43.30 54.30 24.00

Belize (2005) 41.96 35.70 30.96 23.29

Bolivia (2014) 57.28 41.55 31.53 16.23

Canada (2012)** 83.30 76.30 69.90 58.80

Chile (2012) 61.75 49.96 49.21 32.55

Colombia (2013) 69.03 49.12 46.24 25.89

Costa Rica (2010) 28.40 19.70 24.70 16.20


65.07 50.58 46.95 29.26

Ecuador (2013) 35.10 23.44 16.72 9.84

El Salvador (2014) 25.36 13.08 14.71 5.61

Mexico (2011) 62.70 40.80 44.30 19.70

Paraguay (2003) 77.40 55.80 60.90 33.00

Peru (2010) 59.38 46.85 38.88 23.66

Suriname (2007) 63.43 37.96 47.91 19.72

United States (2013) 69.40 63.40 57.10 47.50

Uruguay (2011)*** 83.10 65.80 68.10 43.70

Venezuela (2011) 59.50 45.80 42.30 24.70

*Argentina: Population of 16 ‐ 64 years. **Canada: Population of 15 ‐ 64 years. ***Uruguay: Population of 15 ‐ 65 year

Table A1.6: Past year and past month prevalence of alcohol use among the general population by age group.


study)


12 to 17

18 to 34

35 to 64

12 to 17

18 to 34

35 to 64

Argentina (2011)* 57.20 71.12 63.02 40.61 54.02 48.74

Barbados (2006) 33.60 61.10 51.70 14.90 40.30 37.20

Belize (2005) 17.91 49.73 38.66 11.35 36.08 26.12

Bolivia (2014) 12.81 59.89 54.94 7.99 46.61 25.69

Canada (2012)** 46.50 82.90 81.40 24.60 64.20 68.00

Chile (2012) 26.27 66.19 56.96 12.96 50.45 41.97

Colombia (2013) 40.39 71.81 53.68 19.32 47.10 31.46

Costa Rica (2010) 9.80 29.80 24.50 6.90 26.00 20.70

Dominican Rep. (2010) 37.38 68.37 50.73 15.26 46.23 33.18

Ecuador (2013) 12.85 41.04 24.03 5.58 18.27 11.11

El Salvador (2014) 6.16 20.92 19.24 2.49 10.45 10.48

Mexico (2011) 30.00 n/a n/a 14.50 n/a n/a

Paraguay (2003) 42.54 74.18 63.13 20.42 51.59 46.82

Peru (2010) 25.76 58.69 55.44 11.91 35.40 32.19

Suriname (2007) 30.07 52.78 50.33 11.58 35.64 33.95

United States (2013) 24.64 78.71 67.20 11.56 62.98 53.60

Uruguay (2011)*** 75.30 81.20 68.60 48.70 61.00 51.90


176 | O A S ‐ C I C A D

Table A1.7: Lifetime, past year and past month prevalence of alcohol use among university students.

Country (year of most recent study)

Prevalence


Bolivia (2012) 77.76 57.59 35.13

Brazil (2010) 86.20 72.00 60.50

Colombia (2012) 95.57 84.76 61.05

Ecuador (2012) 89.40 70.40 50.00

El Salvador (2012) 61.10 36.40 18.60

Peru (2012) 87.07 71.70 46.59

Venezuela (2014) 78.80 62.70 33.60

Table A1.8: Past year and past month prevalence of alcohol use among university students by sex.


study)



Bolivia (2012) 67.7 50.12 46.14 27.00

Brazil (2010) 77.30 68.00 66.60 55.80

Colombia (2012) 87.55 82.27 66.65 56.07

Ecuador (2012) 77.80 64.00 60.10 41.20

El Salvador (2012) 42.00 31.50 23.00 14.90

Peru (2012) 77.92 65.81 54.73 38.89

Venezuela (2014) 69.00 58.10 41.20 28.10

Table A1.9: Binge drinking among secondary school students by sex and grades.


Sex Grade

Total

Male Female 8º 10º 12º


53.60 56.10 56.20 50.10 59.50 55.10

Argentina (2011) 68.00 59.10 57.50 65.40 63.60 63.50

Bahamas (2011) 55.50 50.10 61.70 55.50 47.30 53.00

Barbados (2013) 51.20 54.40 55.10 60.30 50.30 53.30

Belize (2013) 69.50 64.90 64.80 66.30 76.40 67.20

Canada (2010/11)**

38.60 35.20 13.70 39.50 56.90 36.90

Chile (2013) 65.20 57.10 46.60 60.70 65.60 61.00

Costa Rica (2012)

51.90 49.70 44.80 52.60 50.70 50.80

Dominica (2011) 55.50 50.10 56.20 50.80 55.80 53.00

Ecuador (2012) 34.86 21.26 10.27 22.01 23.84 56.12

Grenada (2013) 59.40 51.60 54.30 56.80 55.10 55.50

Guyana (2013) 67.10 56.00 64.20 63.00 56.80 61.30

Haiti (2014) 49.00 43.10 39.20 48.00 50.00 47.10

Honduras (2005) 14.66 11.15 6.59 12.76 19.11 12.71

Jamaica (2013) 54.80 44.50 59.70 51.60 43.80 49.00

Peru (2012) 63.80 59.10 54.70 61.70 66.80 61.70


51.30 47.10 63.90 47.20 41.50 49.50

Saint Lucia (2013)

57.90 55.40 55.10 54.90 57.80 56.20


58.50 51.70 56.60 53.80 54.20 54.70

Suriname (2006) 68.50 64.00 73.10 65.70 64.70 66.40


60.20 48.40 61.30 54.20 51.30 53.70

United States (2014)***

12.50 10.90 2.70 11.20 23.50 11.90

Uruguay (2014) 71.20 64.60 49.50 67.90 73.40 67.50

*Based on the proportion of students who consumed alcohol during the past month **Based on the proportion of users who consumed alcohol during the past year ***Based on the entire high school population


Table A1.10: Percent of university students with signs of high risk or hazardous alcohol use as a proportion of past year consumers by sex. years 2009 and 2012.

Country 2009 2012 Male Female

2009 2012 2009 2012

Bolivia 30.39 38.80 42.78 47.91 17.59 29.72

Colombia 30.55 30.94 39.14 35.21 21.95 26.90

Ecuador 34.14 36.75 45.03 44.67 20.49 28.33

Peru 20.87 25.47 25.74 32.17 15.89 17.95

Table A1.11: Percent of university students with signs of alcohol dependence as a proportion of past year users by sex, years 2009 and 2012.

Country 2009 2012

Male Female

2009 2012 2009 2012

Bolivia 10.55 17.23 13.48 23.41 6.46 11.08

Colombia 12.10 14.05 16.03 17.64 7.17 10.65

Ecuador 15.86 15.50 21.28 21.45 8.85 9.16

Peru 8.26 10.76 10.31 14.46 5.44 6.62

178 | O A S ‐ C I C A D

Table A2.1: Lifetime past year and past month prevalence of tobacco use in the secondary school population.


Prevalence


Antigua‐Barbuda (2013) 13.04 4.56 1.83

Argentina (2011) 41.00 26.40 18.70

Bahamas (2011) 11.79 4.43 2.05

Barbados (2013) 17.57 6.55 2.91

Belize (2013) 32.67 14.35 8.18

Bolivia (2008) 40.50 22.30 13.30

Canada (2010/11) 33.40 n/a 12.90

Chile (2013) 55.04 38.39 24.49

Colombia (2011) 31.67 20.71 12.53

Costa Rica (2012) 26.00 11.10 6.70

Dominica (2011) 32.91 14.36 7.38

Dominican Republic (2008) 10.92 3.78 1.89

Ecuador (2012) 27.80 9.00 3.10

El Salvador (2008) 27.90 15.10 9.30

Grenada (2013) 26.83 8.85 5.39

Guyana (2013) 17.88 5.18 2.53

Haiti (2014) 13.28 6.86 5.13

Honduras (2005) 40.37 16.87 9.01

Jamaica (2013) 28.05 9.79 4.50

Panama (2008) 20.80 8.60 4.80

Paraguay (2005) 33.00 23.30 14.70

Peru (2012) 26.84 15.74 9.10


Saint Lucia (2013) 21.64 6.29 3.87


24.30 9.42 5.66

Suriname (2006) 38.42 16.63 8.76

Trinidad‐Tobago (2013) 29.03 13.99 7.08

United States (2014) 22.90 n/a 8.00

Uruguay (2014) 26.40 15.50 9.20

Venezuela (2009) 16.80 7.10 4.60

Table A2.2: Past year and past month prevalence of tobacco use among secondary school students by sex.




Antigua‐Barbuda (2013) 4.15 5.10 1.13 2.59

Argentina (2011) 27.40 25.50 19.70 17.90

Bahamas (2011) 5.48 3.27 3.04 1.16

Barbados (2013) 8.56 5.56 3.73 2.51

Belize (2013) 19.74 9.25 12.31 4.23

Bolivia (2008) 29.80 15.80 18.90 8.40

Canada (2010/11) n/a n/a 14.00 11.70

Chile (2013) 34.34 42.40 22.26 26.68

Colombia (2011) 25.15 16.70 15.54 9.80

Costa Rica (2012) 14.10 8.60 8.80 4.80

Dominica (2011) 17.30 11.07 9.07 5.38

Dominican Republic (2008) 4.25 3.42 2.40 1.50

Ecuador (2012) 11.90 5.65 4.51 1.47

El Salvador (2008) 19.90 10.90 13.20 5.90

Grenada (2013) 12.02 5.86 8.11 2.79

Guyana (2013) 7.35 3.73 4.46 1.24

Haiti (2014) 8.58 4.96 6.26 3.88

Honduras (2005) 22.67 12.24 12.89 5.91

Jamaica (2013) 10.69 9.15 5.08 4.07

Panama (2008) 10.70 7.00 6.00 3.80

Paraguay (2005) 26.00 21.10 17.70 12.30

Peru (2012) 19.17 12.35 11.68 6.54

Saint Kitts‐Nevis (2013) 7.12 3.20 3.69 1.64

Saint Lucia (2013) 8.77 3.48 5.73 1.95


11.04 8.18 5.78 5.57

Suriname (2006) 23.60 11.04 14.29 4.30

Trinidad‐Tobago (2013) 18.34 10.12 10.01 4.48

United States (2014) n/a n/a 8.40 7.30

Uruguay (2014) 14.50 16.40 8.50 9.80

Venezuela (2009) 9.60 4.80 6.60 2.80


Table A2.3: Past year and past month prevalence of tobacco use among secondary school students by grade.


study)


8º 10º 12º 8º 10º 12º


3.78 4.24 6.05 1.77 1.53 2.32

Argentina (2011) 18.00 30.50 35.20 12.50 21.30 26.00

Bahamas (2011) 3.55 4.13 5.80 1.56 2.07 2.52

Barbados (2013) 2.85 2.22 10.03 1.86 2.22 4.11

Belize (2013) 12.49 16.67 14.83 6.91 9.35 9.75

Bolivia (2008) 11.50 20.40 35.60 6.60 11.60 22.20

Canada (2010/11) n/a n/a n/a 6.00 12.30 20.50

Chile (2013) 26.22 44.53 46.65 13.59 28.56 33.78

Colombia (2011) 16.20 23.64 24.42 9.18 14.63 15.38

Costa Rica (2012) 7.10 12.90 13.40 4.20 7.90 7.80

Dominica (2011) 9.70 18.59 14.29 4.54 9.34 10.27


2.55 3.50 5.95 1.40 1.56 3.04

Ecuador (2012) 3.67 9.80 15.21 1.15 3.39 5.36

El Salvador (2008) 10.20 17.30 19.10 6.30 11.10 11.30

Grenada (2013) 7.26 12.20 7.14 5.03 7.50 3.57

Guyana (2013) 1.74 6.47 7.92 1.06 2.44 4.45

Haiti (2014) 4.49 7.09 8.59 3.65 5.52 6.07

Honduras (2005) 10.99 20.35 21.41 5.26 10.89 12.56

Jamaica (2013) 4.37 11.90 11.91 2.09 5.32 5.54

Panama (2008) 3.60 10.40 13.00 1.70 5.40 8.00

Paraguay (2005) 13.70 27.50 33.60 7.60 17.20 23.20

Peru (2012) 7.79 18.36 22.52 4.57 10.22 13.34


5.56 5.15 4.11 3.42 2.15 2.05

Saint Lucia (2013) 6.80 4.72 7.25 4.08 3.08 4.40


8.58 10.69 9.00 4.94 6.01 6.23

Suriname (2006) 9.92 16.00 20.89 5.42 6.56 12.24


8.51 14.13 17.78 3.93 6.67 9.61

United States (2014) n/a n/a n/a 4.00 7.20 13.60

Uruguay (2014) 8.00 18.90 25.20 4.80 11.20 14.80

Venezuela (2009) 3.30 7.30 10.50 1.90 4.30 5.90

Table A2.4: Lifetime, past year and past month prevalence of tobacco use in general population.


study)

Prevalence


Argentina (2011)* 52.89 32.48 28.91

Barbados (2006) 33.50 12.30 9.10

Belize (2005) 25.10 15.50 12.70

Bolivia (2014) 45.30 25.10 14.80

Brazil (2005) 44.00 19.20 18.40

Canada (2012)** 41.30 19.50 17.80

Chile (2012) 57.94 38.16 33.97

Colombia (2013) 42.07 16.21 12.95

Costa Rica (2010) 24.80 15.40 13.40


19.91 8.89 7.57

Ecuador (2013) 32.28 11.37 8.12

El Salvador (2014) 31.94 7.72 5.00

Mexico (2011) 21.70 23.60 12.30

Paraguay (2003) 39.30 18.30 14.90

Peru (2010) 49.82 21.31 13.37

Suriname (2007) 39.50 24.60 21.80

United States (2013) 61.80 25.30 21.30

Uruguay (2011)*** 57.30 33.90 31.00

Venezuela (2011) 38.30 22.90 19.20


180 | O A S ‐ C I C A D

Table A2.5: Past year and past month prevalence of tobacco use in general population by sex.


study)



Argentina (2011)* 37.75 27.32 33.91 24.01

Barbados (2006) 21.90 5.90 17.10 3.80

Belize (2005) 19.18 11.83 16.19 9.11

Bolivia (2014) 35.20 17.00 21.90 9.10

Canada (2012)** 22.60 16.40 20.60 15.00

Chile (2012) 40.78 35.61 36.98 31.03

Colombia (2013) 22.90 9.89 18.84 7.40

Costa Rica (2010) 20.50 10.10 18.00 8.60


11.57 7.14 10.12 5.90

Ecuador (2013) 16.83 6.70 11.36 5.36

El Salvador (2014) 14.96 2.32 9.39 1.73

Mexico (2011) 31.40 12.60 16.40 8.10

Paraguay (2003) 28.20 10.50 23.70 8.00

Peru (2010) 30.41 13.64 19.90 7.85

Suriname (2007) 41.86 12.09 38.39 9.88

United States (2013) 28.20 22.50 23.60 19.00

Uruguay (2011)*** 37.30 30.90 34.30 28.00

Venezuela (2011) 30.00 15.70 25.20 13.20


Table A2.6: Past year and past month prevalence of tobacco use in general population by age group.


study)


12 to 17

18 to 34

35 to 64

12 to 17

18 to 34

35 to 64

Argentina (2011)* 23.35 34.88 31.63 18.96 30.35 28.93

Barbados (2006) 4.30 16.50 10.80 0.80 12.10 8.50

Belize (2005) 6.77 17.70 17.91 3.67 13.74 16.37

Bolivia (2014) 7.30 30.87 28.08 2.85 18.05 17.50

Canada (2012)** 8.30 23.00 18.60 7.60 21.30 16.80

Chile (2012) 17.07 45.54 39.04 10.59 40.95 35.77

Colombia (2013) 8.16 20.65 15.01 4.77 15.94 12.98

Costa Rica (2010) 6.10 17.80 16.80 3.00 15.40 15.50


1.35 6.94 12.87 0.63 5.23 11.74

Ecuador (2013) 5.41 14.53 10.63 2.42 10.73 7.73

El Salvador (2014) 5.35 8.96 7.26 2.30 6.86 4.10

Mexico (2011) 12.30 n/a n/a n/a n/a n/a

Paraguay (2003) 8.03 20.55 19.23 4.23 15.93 17.26

Peru (2010) 8.75 26.84 20.43 4.35 16.87 13.13

Suriname (2007) 9.62 23.48 29.72 6.30 20.81 26.98

United States (2013) 13.90 47.08 21.30 7.84 37.71 19.00

Uruguay (2011)*** 18.70 41.30 30.50 14.40 38.20 27.90



Table A2.7: Lifetime, past year and past month prevalence of tobacco use among university students.


study)

Prevalence


Bolivia (2012) 58.70 34.70 22.30

Brazil (2010) 46.70 27.80 21.60

Colombia (2012) 58.61 29.37 18.98

Ecuador (2012) 61.20 34.40 24.30

El Salvador (2012) 38.40 18.70 12.10

Peru (2012) 59.86 36.18 22.10

Venezuela (2014) 35.20 17.00 9.40

Table A2.8: Past year and past month prevalence of tobacco use among university students by sex.


study)



Bolivia (2012) 50.20 23.20 35.40 12.80

Brazil (2010) 31.80 24.80 23.50 20.20

Colombia (2012) 37.31 22.30 25.24 13.42

Ecuador (2012) 47.80 22.70 35.70 14.30

El Salvador (2012) 27.90 10.80 19.30 6.00

Peru (2012) 44.26 28.53 28.72 15.84

Venezuela (2014) 22.50 13.10 12.70 7.00

Table A2.9: Perception of high risk of smoking cigarettes frequently in secondary school population by sex.


Sex

Male Female Total

Antigua‐Barbuda (2013) 75.40 72.70 74.10

Argentina (2011) 61.10 69.90 65.80

Bahamas (2011) 68.00 71.90 70.00

Barbados (2013) 77.90 76.50 77.00

Belize (2013) 70.80 73.10 72.00

Bolivia (2008) 55.60 63.30 60.20

Canada (2010‐11) 61.90 71.30 66.70

Chile (2013) 49.82 48.81 49.36

Colombia (2011) 62.60 70.00 66.50

Costa Rica (2012) 60.90 72.90 67.20

Dominica (2011) 67.80 73.10 70.10


Ecuador (2012) 51.62 57.98 54.57

El Salvador (2008) 48.10 49.70 48.90

Grenada (2013) 66.00 79.60 73.30

Guyana (2013) 66.30 72.70 70.10

Haiti (2014) 69.36 65.61 67.05

Jamaica (2013) 71.20 81.30 77.00

Panama (2008) 75.30 79.30 77.30

Paraguay (2005) 68.80 75.80 72.70

Peru (2012) 58.33 65.92 62.14


Saint Lucia (2013) 72.20 72.80 72.60

Saint Vincent‐Grenadines (2013) 67.30 69.80 68.70

Suriname (2006) 77.10 81.60 79.60

Trinidad‐Tobago (2013) 75.30 80.70 78.20

United States (2013)# 67.70 73.60 70.30

Uruguay (2014) 67.40 73.40 70.60

Venezuela (2009) 63.00 70.60 67.00

# Question is about use “regularly” intead of “frequently”

182 | O A S ‐ C I C A D

Table A3.1: Lifetime, past year and past month prevalence of marihuana use in the secondary school population.


Prevalence


Antigua‐Barbuda (2013) 32.58 23.89 17.96

Argentina (2011) 13.90 10.30 6.20

Bahamas (2011) 12.78 8.10 4.29

Barbados (2013) 20.93 15.96 10.44

Belize (2013) 24.27 15.84 10.64

Bolivia (2008) 6.20 3.60 1.90

Brazil (2010) 5.70 3.70 2.00

Canada (2010/11) 29.30 24.50 n/a

Chile (2013) 34.89 28.35 17.13

Colombia (2011) 9.86 7.08 3.77

Costa Rica (2012) 16.40 10.80 5.70

Dominica (2011) 32.87 19.77 12.47


Ecuador (2012) 6.70 2.90 1.30

El Salvador (2008) 5.50 3.50 1.80

Grenada (2013) 19.74 12.92 6.99

Guyana (2013) 7.15 4.19 2.38

Haiti (2014) 3.20 2.36 1.21

Honduras (2005) 2.86 1.06 0.41

Jamaica (2013) 21.11 11.93 6.29

Panama (2008) 6.20 2.90 1.80

Paraguay (2005) 4.20 3.00 1.60

Peru (2012) 5.02 2.53 1.55


Saint Lucia (2013) 28.77 17.22 10.71


26.70 19.39 14.11

Suriname (2006) 7.71 4.80 2.73

Trinidad‐Tobago (2013) 16.60 10.70 6.23

United States (2014) 30.50 24.20 14.4

Uruguay (2014) 20.10 17.00 9.50

Venezuela (2009) 1.70 0.90 0.60

Table A3.2: Lifetime and past year prevalence of marihuana use among secondary school students by sex.


Lifetime Past Year


Antigua‐Barbuda (2013) 39.01 26.27 30.02 17.64

Argentina (2011) 19.30 9.40 14.4 6.90

Bahamas (2011) 17.28 8.27 10.88 5.37

Barbados (2013) 25.99 18.63 19.18 14.65

Belize (2013) 32.04 17.08 22.8 9.35

Bolivia (2008) 9.80 3.10 5.4 2.00

Canada (2010/11) 31.80 26.60 27.00 21.90

Chile (2013) 36.87 33.06 29.22 27.63

Colombia (2011) 12.11 7.82 8.97 5.36

Costa Rica (2012) 21.70 11.90 14.70 7.50

Dominica (2011) 40.47 24.03 24.60 14.26


Ecuador (2012) 9.59 3.36 4.11 1.51

El Salvador (2008) 8.30 3.10 5.40 1.80

Grenada (2013) 24.68 15.06 16.14 9.91

Guyana (2013) 11.11 4.53 6.85 2.42

Haiti (2014) 3.63 2.78 2.39 2.30

Honduras (2005) 4.45 1.60 1.65 0.58

Jamaica (2013) 25.42 17.98 14.45 10.06

Panama (2008) 9.20 4.00 4.80 1.40

Paraguay (2005) 6.00 2.70 4.60 1.80

Peru (2012) 6.27 3.79 3.29 1.77


Saint Lucia (2013) 35.62 22.69 23.26 12.14


35.46 20.01 24.75 15.31

Suriname (2006) 12.73 3.67 7.99 2.23

Trinidad‐Tobago (2013) 21.24 12.36 13.76 7.97

United States (2014) 31.70 29.00 25.20 22.80

Uruguay (2014) 22.40 18.10 18.60 15.70

Venezuela (2009) 2.60 1.00 1.40 0.50


Table A3.3: Lifetime and past year prevalence of marihuana use among secondary school students by grade.


study)

Lifetime Past Year

8º 10º 12º 8º 10º 12º


21.05 35.01 45.19 12.90 27.36 34.38

Argentina (2011) 7.70 15.70 22.20 5.40 11.80 16.80

Bahamas (2011) 5.42 15.29 18.54 2.82 10.23 11.85

Barbados (2013) 7.03 21.17 30.39 4.48 11.26 23.37

Belize (2013) 20.54 29.95 22.03 13.83 19.11 13.98

Bolivia (2008) 3.30 5.90 9.70 2.30 3.80 4.70

Canada (2010/11) 11.20 30.10 46.70 8.90 25.80 38.90

Chile (2013) 19.55 39.54 49.39 15.69 33.22 38.94

Colombia (2011) 6.65 11.81 12.69 5.22 8.28 8.61

Costa Rica (2012) 10.00 19.10 20.20 5.50 14.00 13.00

Dominica (2011) 25.00 40.42 30.80 14.03 25.17 18.75


1.10 2.02 2.17 0.59 1.34 1.12

Ecuador (2012) 2.98 6.74 11.71 1.25 3.05 4.95

El Salvador (2008) 3.70 6.40 6.90 2.60 4.00 4.20

Grenada (2013) 11.17 24.58 24.52 7.08 18.01 14.29

Guyana (2013) 4.93 8.10 8.79 3.03 4.35 5.44

Haiti (2014) 2.55 3.77 3.39 2.19 2.63 2.35

Honduras (2005) 1.83 3.31 3.99 0.73 1.26 1.29

Jamaica (2013) 10.18 24.52 26.07 4.84 14.97 14.45

Panama (2008) 4.90 6.80 7.20 3.60 3.10 1.60

Paraguay (2005) 2.00 4.40 7.50 1.50 3.50 5.00

Peru (2012) 3.25 5.19 6.99 1.34 2.79 3.67


16.24 28.76 29.45 8.97 20.17 20.55

Saint Lucia (2013) 19.50 31.83 36.27 12.02 18.07 22.28


16.52 31.85 34.60 13.09 24.28 22.15

Suriname (2006) 2.42 4.68 12.90 1.21 2.72 8.29


8.20 17.91 21.67 5.86 12.62 12.82

United States (2014) 15.60 33.70 44.40 11.70 27.30 35.10

Uruguay (2014) 9.90 24.40 33.50 8.10 21.00 29.00

Venezuela (2009) 1.40 1.90 1.90 n/a n/a n/a

Table A3.4: Lifetime, past year and past month prevalence of marihuana use in general population.


Prevalence


Argentina (2011)* 10.66 3.19 1.66

Barbados (2006) 16.20 7.90 6.20

Belize (2005) 11.70 8.50 6.90

Bolivia (2014) 3.61 1.27 0.67

Brazil (2005) 8.80 2.60 1.90

Canada (2012)** 46.70 12.20 7.60

Chile (2012) 22.99 7.08 4.42

Colombia (2013) 11.48 3.27 2.18

Costa Rica (2010) 7.10 2.50 1.90


Ecuador (2013) 5.26 0.67 0.22

El Salvador (2014) 9.26 2.03 1.29

Mexico (2011) 6.00 1.20 n/a

Paraguay (2003) 2.50 0.50 0.30

Peru (2010) 3.79 1.04 0.55

Suriname (2007) 9.40 3.80 3.20

United States (2013) 43.70 12.60 7.50

Uruguay (2011)*** 20.00 8.30 4.90

Venezuela (2011) 5.06 1.56 1.08


184 | O A S ‐ C I C A D

Table A3.5: Lifetime and past year prevalence of marihuana use among the general population by sex.


Lifetime Past Year


Argentina (2011)* 14.54 6.86 4.68 1.73

Barbados (2006) 27.70 8.40 13.90 3.90

Belize (2005) 14.77 8.56 10.62 6.32

Bolivia (2014) 5.75 1.92 1.86 0.81

Brazil (2005) 14.30 5.10 n/a n/a

Canada (2012)** 52.70 40.70 15.90 8.50

Chile (2012) 30.02 16.15 9.84 4.39

Colombia (2013) 17.69 5.62 5.36 1.30

Costa Rica (2010) 10.10 3.90 3.90 1.10


Ecuador (2013) 6.35 4.32 0.82 0.53

El Salvador (2014) 17.27 3.31 3.93 0.62

Mexico (2011) 10.60 1.60 2.20 0.30

Paraguay (2003) 4.60 0.90 0.80 0.30

Peru (2010) 6.63 1.40 2.02 0.22

Suriname (2007) 18.75 2.55 7.27 1.23

United States (2013) 48.60 39.20 15.50 9.80

Uruguay (2011)*** 25.20 15.20 11.50 5.40

Venezuela (2011) 7.89 2.22 2.55 0.56


Table A3.6: Lifetime and past year prevalence of marihuana use among the general population by age group.


Lifetime Past Year

12 to 17

18 to 34

35 to 64

12 to 17

18 to 34

35 to 64

Argentina (2011)* 8.47 16.05 6.43 4.24 5.74 0.97

Barbados (2006) 5.01 24.10 12.60 4.10 13.65 4.50

Belize (2005) 7.78 16.69 8.38 5.28 13.28 5.04

Bolivia (2014) 1.11 6.17 2.37 0.71 2.57 0.29

Brazil (2005) 4.10 15.25 5.60 n/a n/a n/a

Canada (2012)** 21.60 49.70 47.50 14.80 20.80 7.50

Chile (2012) 7.48 34.15 19.73 5.18 14.12 2.79

Colombia (2013) 6.92 16.14 9.04 4.35 5.75 0.91

Costa Rica (2010) 4.60 11.20 4.60 2.20 4.00 1.10


0.72 3.12 1.72 0.58 1.20 0.24

Ecuador (2013) 4.74 5.44 5.27 0.06 0.49 0.10

El Salvador (2014) 4.85 10.26 9.55 1.93 2.39 1.76

Mexico (2011) 2.40 8.70 4.80 1.30 1.90 0.60

Paraguay (2003) 1.69 3.74 1.53 0.85 0.78 0.10

Peru (2010) 2.23 4.92 3.32 1.94 1.46 0.43

Suriname (2007) 3.18 12.56 8.63 2.03 6.19 2.43

United States (2013)

16.44 54.50 43.12 13.44 26.11 6.51

Uruguay (2011)*** 14.90 34.40 10.20 11.00 16.10 2.30



Table A3.7: Lifetime, past year and past month prevalence of marihuana use among university students.


study)

Prevalence


Bolivia (2012) 11.97 3.44 1.45

Brazil (2010) 26.10 13.80 9.10

Colombia (2012) 31.16 15.01 7.14

Ecuador (2012) 21.90 9.00 3.70

El Salvador (2012) 11.80 3.30 0.70

Peru (2012) 11.58 4.29 1.62

Venezuela (2014) 6.10 3.10 1.10

Table A3.8: Lifetime and past year prevalence of marihuana use among university students by sex.


Lifetime Past Year


Bolivia (2012) 19.7 6.4 5.1 2.3

Brazil (2010) 34.5 19.9 19.8 9.2

Colombia (2012) 39.0 24.4 19.9 10.8

Ecuador (2012) 32.4 13.1 12.6 5.9

El Salvador (2012) 19.4 5.4 4.7 2.1

Peru (2012) 16.9 6.6 6.0 2.7

Venezuela (2014) 8.3 4.4 4.0 2.4

Table A3.9: Perception of high risk of using marihuana sometimes in secondary school population by sex.


Sex

Male Female Total

Antigua‐Barbuda (2013) 20.6 31.6 26.1

Argentina (2011) 17.0 16.2 16.6

Bahamas (2011) 42.8 48.7 45.8

Barbados (2013) 31.8 33.1 32.6

Belize (2013) 31.8 37.8 34.9

Bolivia (2008) 24.6 24.5 24.6

Canada (2010‐11) 32.1 32.3 32.2

Chile (2013) 14.3 11.2 12.8

Colombia (2011) 27.9 30.1 29.0

Costa Rica (2012) 25.0 28.1 26.7

Dominica (2011) 31.2 38.3 34.5


Ecuador (2012) 23.3 25.4 24.3

El Salvador (2008) 39.8 34.8 37.1

Grenada (2013) 34.0 38.3 36.3

Guyana (2013) 53.1 54.7 54.1

Haiti (2014) 56.2 47.8 51.5

Honduras (2005) n/a n/a 76.0

Jamaica (2013) 34.1 44.9 40.4

Panama (2008) 29.9 31.3 30.4

Paraguay (2005) 44.4 41.5 42.8

Peru (2012) 22.3 19.3 20.8


Saint Lucia (2013) 33.2 37.4 35.5


Suriname (2006) 56.6 66.3 62.0

Trinidad‐Tobago (2013) 38.7 43.9 41.5

United States (2014)# 17.6 16.7 17.1

Uruguay (2014) 10.1 7.8 8.8

Venezuela (2009) 43.7 42.4 43.0

# Question is about “try once or twice” instead of “use sometimes”

186 | O A S ‐ C I C A D

Table A3.10: Perception of high risk of using marihuana frequently in secondary school population by sex.


Sex

Male Female Total

Antigua‐Barbuda (2013) 40.5 59.5 49.9

Argentina (2011) 61.2 74.4 68.2

Bahamas (2011) 60.6 71.2 66.1

Barbados (2013) 58.2 64.7 62.1

Belize (2013) 59.8 70.3 65.2

Bolivia (2008) 66.3 72.6 69.5

Canada (2010‐11) 60.9 70.8 66

Chile (2013) 22.5 22.4 22.5

Colombia (2011) 60.2 70.5 65.6

Costa Rica (2012) 56.2 68.2 62.5

Dominica (2011) 52.6 65.9 58.7


Ecuador (2012) 51.8 61.0 56.1

El Salvador (2008) 73.9 75.7 74.9

Grenada (2013) 60.8 70.0 65.7

Guyana (2013) 69.4 75.9 73.3

Haiti (2014) 67.4 59.2 62.8


Jamaica (2013) 58.0 74.7 67.8

Panama (2008) 73.6 82.3 78.1

Paraguay (2005) 76.3 84.3 80.7

Peru (2012) 64.5 70.6 67.6


Saint Lucia (2013) 54.0 62.3 58.5


Suriname (2006) 81.9 87.6 85.1

Trinidad‐Tobago (2013) 58.9 70.0 64.8

United States (2014)# 43.5 51.7 47.3

Uruguay (2014) 50.2 59.0 55.0

Venezuela (2009) 68.9 77.4 73.4

# Question is about use “regularly” instead of “frequently”

Table A3.11: Perception of high risk of using marihuana sometimes in general population by sex.


Sex

Male Female Total

Argentina (2011)* 59.5 67.2 63.4

Bolivia (2014) 48.7 52.5 50.8

Canada (2012)** 23.9 30.2 27.1

Chile (2012) 44.5 49.0 46.8

Colombia (2013) 66.8 76.6 71.9

Costa Rica (2010) 85.6 85.8 87.5


Ecuador (2013) 65.5 63.2 64.3

El Salvador (2014) 46.3 50.9 48.9

Mexico (2011) n/a n/a n/a

Paraguay (2003) 66.8 71.6 69.5

Peru (2010) 75.8 78.4 77.2

United States (2013)# n/a n/a 28.2

Uruguay (2011)*** 34.0 44.2 39.4

*Argentina: Population of 16 ‐ 64 years. **Canada: Population of 15 ‐ 64 years. ***Uruguay: Population of 15 ‐ 65 years # Question is about smoke “once a month” instead of “sometimes”


Table A3.12: Perception of high risk of using marihuana frequently in general population by sex.


Sex

Male Female Total

Argentina (2011)* 83.3 89.0 86.2

Bolivia (2014) 81.3 83.2 82.3

Canada (2012)** 59.0 68.8 64.0

Chile (2012) 76.0 81.8 79.0

Colombia (2013) 87.2 92.8 90.9

Costa Rica (2010) 87.3 88.1 87.7


Ecuador (2013) 79.5 78.1 78.8

El Salvador (2014) 88.7 87.8 88.2

Mexico (2011) 56.6 68.1 62.6

Paraguay (2003) 85.2 87.0 86.2

Peru (2010) 92.3 93.8 93.1


Uruguay (2011)*** 63.8 72.4 68.3

*Argentina: Population of 16 ‐ 64 years. **Canada: Population of 15 ‐ 64 years. ***Uruguay: Population of 15 ‐ 65 years # Question is about smoke “once or twice a week” instead of “frequently”.

Table A3.13: Perception of high risk of using marihuana sometimes among university students by sex.


Sex

Male Female Total

Bolivia (2012) 48.0 52.0 50.0

Colombia (2012) 28.7 35.5 32.3

Ecuador (2012) 46.0 56.0 51.0

El Salvador (2012) 44.8 47.4 46.2

Peru (2012) 49.8 54.2 52.1

Table A3.14: Perception of high risk of using marihuana frequently among university students by sex.


Sex

Male Female Total

Bolivia (2012) 79.0 85.0 83.0

Colombia (2012) 66.9 78.5 73.0

Ecuador (2012) 79.0 85.0 82.0

El Salvador (2012) 81.9 89.3 85.9

Peru (2012) 83.1 88.9 86.1

188 | O A S ‐ C I C A D

Table A3.15: Perception of ease of access and percentage of direct offers (past year and past month) of marihuana in secondary school population.


Easy Access

Direct Offers

Past Month

Past Year

Antigua‐Barbuda (2013) 53.1 26.3 36.5

Argentina (2011) 38.0 11.6 19.0

Bahamas (2011) 30.0 8.2 15.0

Barbados (2013) 44.2 17.2 28.8

Belize (2013) 44.7 20.1 34.6

Bolivia n/a 4.3 n/a

Chile (2013) 44.2 25.7 37.4

Costa Rica n/a 11.3 18.9

Colombia (2011) 41.8 n/a n/a

Dominica (2011) 51.5 15.8 26.2


Ecuador (2012) 14.7 6.9 11.3

El Salvador (2008) 21.3 25.9 26.9

Grenada (2013) 40.6 12.9 22.5

Guyana (2013) 18.3 4.8 8.6

Haiti (2014) 7.29 2.3 4.0

Jamaica (2013) 44.3 10.6 20.9

Panama (2008) 23.8 n/a n/a

Paraguay (2005) 20.4 4.0 5.1

Peru (2012) 15.5 4.3 9.1


Saint Lucia (2013) 49.6 16.6 30.9


Suriname (2006) 27.6 4.9 7.5

Trinidad‐Tobago (2013) 43.0 12.9 23.2

United States (2013) 60.7 n/a n/a

Uruguay (2014) 53.3 20.0 31.2

Venezuela (2009) 4.8 n/a n/a

Table A3.16: Perception of ease of access and percentage of direct offers (past year and past month) of marihuana among university students.


Easy Access

Direct Offers

Past Month

Past Year

Bolivia (2012) 22.5 9.5 27.3

Colombia (2012) 62.7 21.8 47.8

Ecuador (2012) 36.0 14.6 34.8

El Salvador (2012) 35.2 10.9 35.3

Peru (2012) 28.6 11.3 30.5


Table A4.1: Lifetime, past year and past month prevalence of inhalants use in the secondary school population.


study)

Prevalence


Antigua‐Barbuda (2013) 14.02 5.93 3.84

Argentina (2011) 4.50 2.60 1.30

Bahamas (2011) 10.51 3.81 0.29

Barbados (2013) 20.20 9.77 7.05

Belize (2013) 10.13 5.50 3.19

Bolivia (2008) 4.20 2.50 1.40

Brazil (2010) 8.70 5.20 2.20

Canada (2010/11) 3.30 1.80 n/a

Chile (2013) 9.35 4.81 2.07

Colombia (2011) 3.32 1.92 0.87

Costa Rica (2012) 4.20 1.70 0.90

Dominica (2011) 10.76 5.31 3.38


1.13 0.50 0.24

Ecuador (2012) 3.50 1.70 0.80

El Salvador (2008) 2.80 1.50 0.80

Grenada (2013) 16.04 9.68 6.19

Guyana (2013) 10.79 4.22 2.80

Haiti (2014) 6.27 4.40 1.95

Honduras (2005) 1.86 0.63 0.21

Jamaica (2013) 13.39 6.60 4.18

Panama (2008) 4.40 2.70 1.10

Paraguay (2005) 2.80 1.50 0.70

Peru (2012) 2.71 1.12 0.49


Saint Lucia (2013) 20.48 11.00 6.68


17.45 10.44 4.05

Suriname (2006) 7.48 3.45 2.27

Trinidad‐Tobago (2013) 15.51 6.83 4.23

United States (2014) 8.80 3.60 1.40

Uruguay (2014) 4.20 2.10 0.80

Table A4.2: Lifetime and past year prevalence of inhalants use among secondary school students by sex.


Lifetime Past Year


Antigua‐Barbuda (2013) 11.63 16.86 4.01 8.05

Argentina (2011) 5.90 3.30 3.40 2.00

Bahamas (2011) 9.74 11.32 3.42 4.14

Barbados (2013) 18.55 22.54 7.86 11.79

Belize (2013) 10.50 9.75 6.26 4.83

Bolivia (2008) 6.00 2.50 3.50 1.60

Canada (2010/11) 4.00 2.50 2.20 1.30

Chile (2013) 8.28 10.44 4.29 5.35

Colombia (2011) 3.74 2.95 2.29 1.58

Costa Rica (2012) 4.50 4.00 1.90 1.40

Dominica (2011) 9.82 11.57 4.95 5.58


Ecuador (2012) 3.98 2.95 2.01 1.35

El Salvador (2008) 4.10 1.70 2.40 0.80

Grenada (2013) 17.84 14.24 11.12 8.29

Guyana (2013) 14.79 8.15 6.23 2.89

Haiti (2014) 7.19 5.61 5.21 3.78

Honduras (2005) 2.72 1.18 0.96 0.37

Jamaica (2013) 11.79 14.60 5.27 7.58

Panama (2008) 6.60 2.60 4.40 1.30

Paraguay (2005) 2.70 2.80 1.60 1.50

Peru (2012) 2.85 2.57 1.32 0.93


Saint Lucia (2013) 20.79 20.05 10.52 11.22


17.64 17.31 9.88 10.86

Suriname (2006) 9.55 5.82 4.50 2.62

Trinidad‐Tobago (2013) 14.90 16.04 6.29 7.31

United States (2014) 7.50 9.90 3.00 4.00

Uruguay (2014) 4.00 4.30 2.10 2.30

190 | O A S ‐ C I C A D

Table A4.3: Lifetime and past year prevalence of inhalants use among secondary school students by grade.


study)

Lifetime Past Year

8º 10º 12º 8º 10º 12º


16.33 15.59 8.73 7.85 4.73 4.88

Argentina (2011) 4.40 4.90 4.10 2.70 2.90 2.20

Bahamas (2011) 10.95 12.71 7.31 3.86 5.48 1.64

Barbados (2013) 17.65 22.22 20.58 9.02 8.25 8.99

Belize (2013) 11.04 10.03 6.78 6.40 5.15 2.97

Bolivia (2008) 3.90 4.00 4.70 2.70 2.40 2.50

Canada (2010/11) 3.90 2.90 3.10 2.30 1.40 1.50

Chile (2013) 9.09 10.45 8.26 5.87 4.99 3.14

Colombia (2011) 3.54 3.42 2.82 2.22 1.95 1.37

Costa Rica (2012) 4.50 4.20 4.00 1.70 1.60 1.80

Dominica (2011) 11.39 10.20 10.71 5.70 5.24 4.02


1.14 1.27 0.94 0.41 0.58 0.52

Ecuador (2012) 3.30 3.79 3.39 1.66 1.80 1.63

El Salvador (2008) 2.30 2.80 3.40 1.50 1.60 1.50

Grenada (2013) 12.66 18.01 17.86 8.19 11.44 9.52

Guyana (2013) 10.24 11.48 10.66 4.71 4.50 3.27

Haiti (2014) 6.40 6.03 6.31 5.00 3.68 4.34

Honduras (2005) 1.49 2.15 2.01 0.56 0.74 0.56

Jamaica (2013) 11.77 14.43 13.66 6.59 6.50 6.70

Panama (2008) 3.80 4.30 5.30 1.80 3.50 2.70

Paraguay (2005) 2.30 2.60 3.90 1.40 1.60 1.70

Peru (2012) 1.96 3.70 2.53 1.01 1.44 0.91


18.38 10.30 11.64 11.11 4.29 6.85

Saint Lucia (2013) 21.54 20.33 19.43 12.47 8.62 11.66


19.74 16.93 14.88 13.73 9.80 6.57

Suriname (2006) 7.00 8.46 6.79 3.24 4.07 3.11


12.51 16.28 17.12 5.69 7.74 7.03

United States (2014) 10.80 8.70 6.50 5.30 3.30 1.90

Uruguay (2014) 4.50 4.10 3.50 1.80 2.30 2.60

Table A4.4: Lifetime, past year and past month prevalence of inhalants use in general population.


Prevalence


Argentina (2011)* 0.58 0.12 0.03

Barbados (2006) 1.40 0.80 0.60

Belize (2005) 1.40 1.00 0.60

Bolivia (2014) 1.00 0.32 0.19

Brazil (2005) 6.10 1.20 0.40

Canada (2012)** 0.90 n/a n/a

Chile (2012) 0.71 0.11 0.08

Colombia (2013) 0.74 0.17 0.06

Costa Rica (2010) 0.60 0.00 0.00


Ecuador (2013) 0.12 0.07 0.05

El Salvador (2014) 1.39 0.16 0.10

Mexico (2011) 0.90 0.10 n/a

Paraguay (2003) 0.40 0.10 0.10

Peru (2010) 0.16 0.09 0.08

Suriname (2007) 4.30 2.60 1.60

United States (2013) 8.00 0.60 0.20

Uruguay (2011)*** 1.50 0.10 0.10




Table A4.5: Lifetime, past year and past month prevalence of inhalants use among university students.


study)

Prevalence


Bolivia (2012) 3.00 0.47 0.45

Brazil (2010) 20.40 6.50 2.90

Colombia (2012) 7.98 0.98 0.28

Ecuador (2012) 2.95 0.25 0.09

El Salvador (2012) 3.20 0.40 0.20

Peru (2012) 2.55 0.69 0.44

Table A4.6: Perception of high risk of using inhalants sometimes in secondary school population by sex.


Sex

Male Female Total

Argentina (2011) 35.90 35.60 35.70

Bolivia (2008) 27.90 29.10 28.50

Colombia (2011) 46.40 49.60 48.00

Costa Rica (2012) 43.30 47.60 45.60


Ecuador (2012) 37.75 40.87 39.20

El Salvador (2008) 28.00 25.00 26.40

Haiti (2014) 39.84 32.23 35.72

Panama (2008) 34.10 36.40 35.20

Paraguay (2005) 35.20 32.60 33.70

Peru (2012) 48.13 50.81 49.48

Uruguay (2014) 56.10 54.70 55.40

Venezuela (2009) 30.70 26.40 28.40

Table A4.7: Perception of high risk of using inhalants frequently in secondary school population by sex.


Sex

Male Female Total

Argentina (2011) 67.20 73.70 70.60

Bolivia (2008) 53.90 56.20 55.00

Colombia (2011) 65.10 73.50 69.50

Costa Rica (2012) 62.50 70.80 66.90


Ecuador (2012) 46.95 52.96 49.74

El Salvador (2008) 60.10 63.00 61.60

Haiti (2014) 52.61 44.55 48.11

Panama (2008) 66.80 73.40 70.20

Paraguay (2005) 68.10 74.40 71.60

Peru (2012) 62.02 69.23 65.65

Uruguay (2014) 77.40 81.80 79.80

Venezuela (2009) 59.90 62.60 61.30

Table A4.8: Perception of high risk of using inhalants sometimes and frequently in general population by sex.

Country(year of most recent study)

Sometimes Frequently

Bolivia (2014) 48.7 81.2

Costa Rica (2010) 88.4 88.3

Dominican Republic (2010) 91.8 93.5

Ecuador (2013) 73.2 78.5

El Salvador (2014) 83.9 n/a

Mexico (2011) n/a 80.4

Paraguay (2003) 62.7 80.9

Table A4.9: Perception of high risk of using inhalants sometimes and frequently among university students.

Country(year of most recent study)

Sometimes Frequently

Bolivia (2012) 50.5 82.4

Colombia (2012) 32.5 72.9

Ecuador (2012) 50.8 82

Peru (2012) 52.6 86.3

192 | O A S ‐ C I C A D

Table A5.1: Lifetime, past year and past month prevalence of cocaine use in the secondary school population.


Prevalence


Antigua‐Barbuda (2013) 3.26 1.85 1.52

Argentina (2011) 4.60 2.70 1.50

Bahamas (2011) 1.50 0.70 0.29

Barbados (2013) 2.80 1.65 1.32

Belize (2013) 2.98 1.64 0.82

Bolivia (2008) 3.10 2.00 1.20

Brazil (2010) 3.90 2.10 n/a

Canada (2010/11) 3.90 2.40 n/a

Chile (2013) 6.03 3.59 1.73

Colombia (2011) 4.05 2.66 1.45

Costa Rica (2012) 1.40 0.80 0.40

Dominica (2011) 2.84 1.31 0.90


Ecuador (2012) 2.20 1.00 0.40

El Salvador (2008) 1.90 1.10 0.50

Grenada (2013) 3.25 2.20 1.61

Guyana (2013) 1.52 1.05 0.66

Haiti (2014) 2.16 1.65 0.94

Honduras (2005) 2.14 0.88 0.40

Jamaica (2013) 2.08 1.08 0.51

Panama (2008) 2.20 1.50 1.20

Paraguay (2005) 1.00 0.70 0.50

Peru (2012) 1.82 0.89 0.64


Saint Lucia (2013) 2.95 1.77 1.12


1.21 0.64 0.64

Suriname (2006) 0.70 0.17 0.07

Trinidad‐Tobago (2013) 2.81 1.49 0.86

United States (2014) 2.90 1.60 0.70

Uruguay (2014) 2.70 2.10 0.90

Venezuela (2009) 0.60 0.30 0.30

Table A5.2: Lifetime and past year prevalence of cocaine use among secondary school students by sex.


Lifetime Past Year


Antigua‐Barbuda (2013) 3.81 2.79 2.63 1.12

Argentina (2011) 6.60 3.00 3.80 1.80

Bahamas (2011) 2.05 0.87 0.91 0.36

Barbados (2013) 4.39 1.80 2.88 0.88

Belize (2013) 3.82 2.21 2.12 1.20

Bolivia (2008) 4.40 1.90 2.60 1.40

Canada (2010/11) 4.90 2.90 2.90 1.90

Chile (2013) 7.75 4.36 4.58 2.66

Colombia (2011) 5.30 2.91 3.52 1.88

Costa Rica (2012) 2.00 1.00 1.20 0.40

Dominica (2011) 4.20 1.00 1.76 0.70


Ecuador (2012) 3.07 1.19 1.50 0.42

El Salvador (2008) 2.90 1.10 1.60 0.60

Grenada (2013) 5.58 0.74 4.17 0.13

Guyana (2013) 2.86 0.63 2.01 0.40

Haiti (2014) 2.37 2.03 1.82 1.54

Honduras (2005) 3.17 1.33 1.52 0.37

Jamaica (2013) 3.03 1.35 1.71 0.57

Panama (2008) 2.80 1.70 1.90 1.30

Paraguay (2005) 1.40 0.60 0.90 0.50

Peru (2012) 2.31 1.34 1.19 0.59


Saint Lucia (2013) 4.17 1.70 3.01 0.44


0.77 1.55 0.58 0.69

Suriname (2006) 1.50 0.06 0.39 n/a

Trinidad‐Tobago (2013) 3.54 2.14 2.22 0.84

United States (2014) 3.20 2.30 2.00 1.20

Uruguay (2014) 3.70 2.00 2.40 1.80

Venezuela (2009) 1.00 0.40 0.60 0.10


Table A5.3: Lifetime and past year prevalence of cocaine use among secondary school students by grade.


study)

Lifetime Past Year

8º 10º 12º 8º 10º 12º

Antigua‐Barbuda (2013) 4.13 2.30 3.34 2.36 1.95 1.02

Argentina (2011) 3.40 5.20 6.00 2.00 2.90 3.60

Bahamas (2011) 1.56 1.96 0.76 0.94 0.83 0.13

Barbados (2013) 2.32 3.25 2.81 2.09 0.95 1.61

Belize (2013) 3.41 2.98 1.27 1.86 1.76 0.42

Bolivia (2008) 2.30 3.20 3.60 1.60 2.20 2.10

Canada (2010/11) 1.50 3.10 7.30 1.00 1.90 4.40

Chile (2013) 4.39 5.85 8.48 2.63 3.41 5.15

Colombia (2011) 2.58 4.69 5.67 1.96 2.97 3.44

Costa Rica (2012) 1.50 1.30 1.60 0.70 0.60 1.10

Dominica (2011) 2.11 3.05 4.91 1.05 1.43 1.79


0.72 0.82 0.74 0.36 0.73 0.56

Ecuador (2012) 1.09 2.12 3.81 0.50 1.01 1.66

El Salvador (2008) 1.70 2.40 1.80 1.00 1.30 1.00

Grenada (2013) 4.10 3.38 2.14 3.17 1.88 1.43

Guyana (2013) 1.36 1.52 1.72 1.21 0.92 0.99

Haiti (2014) 2.48 2.01 1.99 2.05 1.38 1.50

Honduras (2005) 1.45 2.21 3.36 0.56 0.94 0.37

Jamaica (2013) 1.99 2.80 1.54 1.26 1.26 0.79

Panama (2008) 3.20 2.30 0.50 3.00 1.00 0.30

Paraguay (2005) 0.60 1.20 1.20 0.40 0.90 0.80

Peru (2012) 1.52 2.15 1.84 0.90 1.01 0.74

Saint Kitts‐Nevis (2013) 5.98 0.43 2.05 4.27 0.00 1.37

Saint Lucia (2013) 4.08 2.26 2.33 3.17 0.62 1.30


1.72 1.34 0.35 0.43 1.11 0.35

Suriname (2006) 0.46 0.28 1.19 0.16 0.00 0.32

Trinidad‐Tobago (2013) 2.66 3.14 2.69 1.50 1.71 1.33

United States (2014) 1.8 2.6 4.6 1.00 1.50 2.60

Uruguay (2014) 1.30 3.10 5.00 1.00 2.40 3.80


Table A5.4: Lifetime, past year and past month prevalence of cocaine use in general population.


Prevalence


Argentina (2011)* 3.08 0.68 0.32

Barbados (2006) 0.79 0.14 0.04

Belize (2005) 1.42 0.71 0.61

Bolivia (2014) 0.83 0.33 0.05

Brazil (2005) 2.90 0.70 0.40

Canada (2012)** 8.70 1.30 0.80

Chile (2012) 4.68 0.86 0.40

Colombia (2013) 3.23 0.70 0.40

Costa Rica (2010) 2.90 0.90 0.60


Ecuador (2013) 0.12 0.08 0.05

El Salvador (2014) 2.74 0.27 0.11

Mexico (2011) 3.30 0.50 n/a

Paraguay (2003) 0.70 0.20 0.20

Peru (2010) 1.76 0.42 0.29

Suriname (2007) 0.90 0.30 0.20

United States (2013) 14.30 1.60 0.60

Uruguay (2011)*** 6.20 1.90 0.90

Venezuela (2011) 1.61 0.53 0.34


194 | O A S ‐ C I C A D

Table A5.5: Lifetime and past year prevalence of cocaine use among the general population by sex.


Lifetime Past Year


Argentina (2011)* 5.15 1.06 1.23 0.15

Barbados (2006) 1.00 0.70 0.30 0.00

Belize (2005) 1.68 1.18 0.69 0.73

Bolivia (2014) 1.32 0.44 0.43 0.25

Brazil (2005) 5.40 1.20 n/a n/a

Canada (2012)** 11.60 5.80 1.70 n/a

Chile (2012) 7.29 2.13 1.28 0.45

Colombia (2013) 5.47 1.12 1.23 0.20

Costa Rica (2010) 4.70 1.10 1.40 0.30


Ecuador (2013) 0.13 0.11 0.10 0.07

El Salvador (2014) 5.75 0.50 0.54 0.07

Mexico (2011) 5.90 0.70 0.90 0.10

Paraguay (2003) 1.10 0.30 0.20 0.20

Peru (2010) 3.31 0.45 0.76 0.13

Suriname (2007) 1.60 0.41 0.57 0.10

United States (2013) 17.80 11.10 2.20 1.00

Uruguay (2011)*** 9.30 3.50 3.10 0.90

Venezuela (2011) 2.63 0.58 0.94 0.12


Table A5.6: Lifetime and past year prevalence of cocaine use among the general population by age group.


Lifetime Past Year

12 to 17

18 to 34

35 to 64

12 to 17

18 to 34

35 to 64

Argentina (2011)* 2.32 4.46 2.02 1.22 1.18 0.22

Barbados (2006) 0.00 0.57 1.13 0.00 0.31 0.04

Belize (2005) 0.73 1.90 1.29 0.10 0.91 0.84

Bolivia (2014) 0.44 1.55 0.32 0.11 0.75 0.02

Brazil (2005) 0.50 4.70 4.30 n/a n/a n/a

Canada (2012)** n/a 9.90 8.80 n/a 3.10 n/a

Chile (2012) 0.31 6.86 4.41 0.13 1.77 0.45

Colombia (2013) 0.80 4.60 2.85 0.33 1.48 0.17

Costa Rica (2010) 0.90 4.90 2.10 0.30 1.60 0.30


0.17 1.46 0.89 0.17 0.37 0.23

Ecuador (2013) 0.13 0.13 0.10 n/a n/a n/a

El Salvador (2014) 0.68 2.37 3.60 0.25 0.39 0.16

Mexico (2011) 0.70 5.20 2.50 0.40 0.80 0.30

Paraguay (2003) 0.28 0.87 0.57 0.28 0.26 0.10

Peru (2010) 0.27 2.59 1.51 0.17 0.68 0.28

Suriname (2007) 0.72 1.09 0.78 0.00 0.30 0.36

United States (2013)

0.86 15.38 15.92 0.53 3.91 0.75

Uruguay (2011)*** 2.80 11.20 3.00 0.80 4.00 0.60



Table A5.7: Lifetime, past year and past month prevalence of cocaine use among university students.


study)

Prevalence


Bolivia (2012) 1.55 0.24 0.03

Brazil (2010) 7.70 3.00 1.80

Colombia (2012) 7.00 2.12 0.87

Ecuador (2012) 4.20 1.20 0.30

El Salvador (2012) 2.30 0.43 0.20

Peru (2012) 2.78 0.49 0.14

Venezuela (2014) 0.65 0.29 0.06

Table A5.8: Lifetime and past year prevalence of cocaine use among university students by sex.


Lifetime Past Year


Bolivia (2012) 2.87 0.59 0.44 0.10

Brazil (2010) 11.30 5.00 4.80 1.60

Colombia (2012) 10.55 3.93 3.33 1.07

Ecuador (2012) 7.00 1.90 2.40 0.20

El Salvador (2012) 4.00 0.80 0.44 0.42

Peru (2012) 4.46 1.19 0.89 0.11

Venezuela (2014) 1.06 0.36 0.46 0.17

Table A5.9: Perception of high risk of using cocaine sometimes in secondary school population by sex.


Sex

Male Female Total

Argentina (2011) 30.30 26.00 27.90

Bahamas (2011) 65.50 64.10 64.80

Bolivia (2008) 29.80 29.10 29.40

Chile (2013) 37.45 36.25 36.86

Colombia (2011) 38.30 39.80 39.10

Costa Rica (2012) 41.80 40.80 41.20


Ecuador (2012) 27.10 26.87 26.99

El Salvador (2008) 40.40 35.80 37.90

Haiti (2014) 60.85 52.91 56.49

Panama (2008) 42.80 39.10 40.40

Peru (2012) 28.60 25.96 27.27

Suriname (2006) 79.50 79.00 79.20

United States (2014)# 50.90 47.80 49.30

Uruguay (2014) 37.90 30.10 33.60

Venezuela (2009) 46.20 44.30 45.20

# Question is about “try cocaine powder once or twice” instead of use “sometimes”

196 | O A S ‐ C I C A D

Table A5.10: Perception of high risk of using cocaine frequently in secondary school population by sex.


Sex

Male Female Total

Argentina (2011) 75.10 81.20 78.30

Bahamas (2011) 74.50 78.00 76.30

Bolivia (2008) 65.30 69.50 67.40

Chile (2013) 47.13 47.79 47.42

Colombia (2011) 67.10 73.70 70.50

Costa Rica (2012) 65.50 74.90 n/a


Ecuador (2012) 52.11 59.87 55.71

El Salvador (2008) 75.80 78.00 77.00

Haiti (2014) 68.64 60.88 64.26

Panama (2008) 73.50 80.50 77.10

Peru (2012) 65.47 70.70 68.10

Suriname (2006) 89.80 89.30 89.50

Uruguay (2014) 82.70 84.00 83.40

Venezuela (2009) 69.20 76.80 73.20

Table A5.11: Perception of high risk of using cocaine sometimes in general population by sex.


Sex

Male Female Total

Argentina (2011)* 84.2 86.6 85.4

Bolivia (2014) 61.6 62.0 61.8

Chile (2012) 73.3 75.1 74.2

Colombia (2013) 84.7 87.8 86.3

Costa Rica (2010) 88.4 87.9 88.2


Ecuador (2013) 66.2 67.5 66.9

El Salvador (2014) 68.8 67.4 68.0

Peru (2010) 79.9 81.3 80.6


Uruguay (2011)** 63.2 70.2 66.9

*Argentina: Population of 16 ‐ 64 years. **Uruguay: Population of 15 ‐ 65 years. # Question is about use “once a month” instead of “sometimes”

Table A5.12: Perception of high risk of using cocaine frequently in general population by sex.


Sex

Male Female Total

Argentina (2011)* 96.5 96.8 96.6

Bolivia (2014) 83.8 83.2 83.5

Chile (2012) 94.6 95.1 94.8

Colombia (2013) 94.6 95.6 95.1

Costa Rica (2010) 88.6 88.8 88.7


Ecuador (2013) 83.0 81.3 82.1

El Salvador (2014) 94.7 94.0 94.3

Mexico (2011) 79.9 84.3 82.2

Peru (2010) 93.9 94.5 94.2


Uruguay (2011)** 89.6 91.8 90.8

*Argentina: Population of 16 ‐ 64 years. **Uruguay: Population of 15 ‐ 65 years. # Question is about use “once o twice a week” instead of “frequently” Table A5.13: Perception of high risk of using cocaine sometimes among university students by sex.


Sex

Male Female Total

Bolivia (2012) 58.0 56.0 57.0

Colombia (2012) 61.5 64.2 62.9

Ecuador (2012) 65.0 67.0 66.0

El Salvador (2012) 63.0 59.6 61.2

Peru (2012) 65.0 63.5 64.2

Table A5.14: Perception of high risk of using cocaine frequently among university students by sex.


Sex

Male Female Total

Bolivia (2012) 84.0 88.0 86.0

Colombia (2012) 89.4 92.9 91.3

Ecuador (2012) 87.0 94.0 91.0

El Salvador (2012) 90.1 93.5 91.9

Peru (2012) 90.2 92.9 91.6


Table A5.15: Perception of ease of access and percentage of direct offers (past year and past month) of cocaine in secondary school population.


Easy Access

Direct Offers

Past Month

Past Year

Antigua‐Barbuda (2013) 10.7 2.5 5.4

Argentina (2011) 20.9 3.4 7.0

Bahamas (2011) 10.9 1.0 2.4

Barbados (2013) 12.1 2.6 4.5

Belize (2013) 13.2 3.6 6.7

Bolivia (2008) n/a 1.7 n/a

Chile (2013) 10.8 4.5 8.6


Costa Rica (2012) n/a 1.5 2.9

Dominica (2011) 13.9 1.7 3.4


Ecuador (2012) 6.9 2.4 5.2

El Salvador (2008) 11.1 6.5 15.1

Grenada (2013) 11.8 2.1 4.7

Guyana (2013) 6.8 1.7 3.4

Haiti (2014) 3.73 0.6 2.0

Jamaica (2013) 5.5 1.0 2.3

Panama (2008) 12.6 n/a n/a

Paraguay (2005) 7.7 1.6 2.8

Peru (2012) 9.5 2.0 4.9


Saint Lucia (2013) 8.9 0.9 3.2


Suriname (2006) 13.0 1.3 1.9

Trinidad‐Tobago (2013) 15.8 2.0 4.0

Uruguay (2014) 15.6 2.9 6.1


Table A5.16: Perception of ease of access and percentage of direct offers (past year and past month) of cocaine among university students.


Easy Access

Direct Offers

Past Month

Past Year

Bolivia (2012) 11.0 2.5 8.4

Colombia (2012) 25.8 4.8 13.6

Ecuador (2012) 25.8 4.8 13.6

El Salvador (2012) 12.3 1.9 7.1

Peru (2012) 14.4 2.3 9.2

Table A5.17: Lifetime, past year and past month prevalence of cocaine base paste use in the secondary school population.


Prevalence


Argentina (2011) 2.10 1.00 0.60

Bolivia (2008) 1.90 1.30 0.80

Chile (2013) 4.25 2.17 1.04

Colombia (2011) 0.79 0.53 0.22

Ecuador (2012) 1.20 0.60 0.20

Peru (2012) 1.88 0.86 0.66

Uruguay (2014) 0.90 0.50 0.10

Table A5.18: Lifetime and past year prevalence of cocaine base paste use among secondary school students by sex.


Lifetime Past Year


Argentina (2011) 2.70 1.60 1.30 0.80

Bolivia (2008) 2.90 1.10 1.80 0.90

Chile (2013) 5.13 3.42 2.89 1.48

Colombia (2011) 1.04 0.56 0.72 0.36

Ecuador (2012) 1.80 0.50 0.88 0.27

Peru (2012) 2.54 1.23 1.16 0.55

Uruguay (2014) 1.00 0.80 0.30 0.60

198 | O A S ‐ C I C A D

Table A5.19: Lifetime and past year prevalence of cocaine base paste use among secondary school students by grade.


study)

Lifetime Past Year

8º 10º 12º 8º 10º 12º

Argentina (2011) 2.30 2.20 1.60 1.20 1.10 0.60

Bolivia (2008) 1.90 2.20 1.70 1.40 1.50 1.00

Chile (2013) 4.22 4.26 4.28 2.23 2.04 2.27

Colombia (2011) 0.89 0.78 0.64 0.59 0.58 0.37

Ecuador (2012) 0.83 1.17 1.74 0.44 0.61 0.80

Peru (2012) 1.64 1.90 2.16 1.03 0.77 0.74

Uruguay (2014) 0.80 0.90 0.90 0.50 0.50 0.40

Table A5.20: Lifetime, past year and past month prevalence of cocaine base paste use in general population.


Prevalence


Argentina (2011) * 0.29 0.04 0.01

Belize (2005) 0.10 0.10 0.10

Bolivia (2014) 0.20 0.06 0.04

Chile (2012) 1.88 0.42 0.21

Colombia (2013) 1.18 0.21 0.17

Ecuador (2013) 0.02 0.00 0.00

Paraguay (2003) 0.10 0.10 0.00

Peru (2010) 1.49 0.47 0.31

Uruguay (2011)** 1.10 0.40 0.20

Venezuela (2011) 0.40 0.05 0.02

*Argentina: Population of 16 ‐ 64 years. **Uruguay: Population of 15 ‐ 65 years.

Table A5.21: Lifetime, past year and past month prevalence of cocaine base paste use among university students.


study)

Prevalence


Bolivia (2012) 0.30 0.10 0.00

Colombia (2012) 0.64 0.08 0.03

Ecuador (2012) 2.30 0.50 0.20

Peru (2012) 0.88 0.15 0.01


Table A5.22: Perception of high risk of smoking cocaine base past sometimes in secondary school population by sex.


Sex

Male Female Total

Argentina (2011) 42.50 34.50 38.10

Chile (2013) 47.66 46.80 47.26

Colombia (2011) 41.00 41.90 41.40

Ecuador (2012) 26.33 24.84 25.64

Paraguay (2005) 50.30 46.60 48.30

Peru (2012) 30.09 28.00 29.04

Uruguay (2014) 49.30 37.10 42.60

Table A5.23: Perception of high risk of smoking cocaine base paste frequently in secondary school population by sex.


Sex

Male Female Total

Argentina (2011) 74.20 77.70 76.00

Chile (2013) n/a n/a n/a

Colombia (2011) 66.90 73.80 70.50

Ecuador (2012) 42.24 43.75 42.94

Paraguay (2005) 77.30 84.00 81.00

Peru (2012) 61.62 65.19 63.42

Uruguay (2014) 84.40 85.90 85.20


Table A5.24: Perception of high risk of using cocaine base paste sometimes in general population by sex.


Sex

Male Female Total

Argentina (2011) * 89.9 90.1 90.0

Bolivia (2014) 57.3 58.1 57.7

Chile (2012) 82.1 81.2 81.6

Colombia (2013) 81.2 80.2 80.7

Ecuador (2013) 68.8 71.4 70.2

El Salvador (2014) 65.8 65.8 65.8

Paraguay (2003) 71.6 72.2 71.9

Peru (2010) 81.2 82.5 81.9

Uruguay (2011) ** 86.1 87.8 87.0

*Argentina: Population of 16 ‐ 64 years. **Uruguay: Population of 15 ‐ 65 years Table A5.25: Perception of high risk of using cocaine base paste frequently in general population by sex.


Sex

Male Female Total

Argentina (2011) * 95.8 96.4 96.1

Bolivia (2014) n/a n/a n/a

Chile (2012) 95.2 95.5 95.4

Colombia (2013) 86.4 84.6 85.5

Ecuador (2013) 77.6 76.0 76.7

El Salvador (2014) 94.6 92.1 93.2

Paraguay (2003) 86.0 86.0 86.0

Peru (2010) 93.5 93.7 93.6

Uruguay (2011) ** 94.1 95.9 95.0

*Argentina: Population of 16 ‐ 64 years. **Uruguay: Population of 15 ‐ 65 years

Table A5.26: Perception of high risk of using cocaine base paste sometimes among university students by sex.


Sex

Male Female Total

Bolivia (2012) 59.0 55.0 57.0

Colombia (2012) 71.1 69.4 70.2

Ecuador (2012) 69.0 68.0 68.0

Peru (2012) 70.6 68.9 69.7

Table A5.27: Perception of high risk of using cocaine base paste frequently among university students by sex.


Sex

Male Female Total

Bolivia (2012) 73.0 73.0 73.0

Colombia (2012) 84.8 86.3 85.6

Ecuador (2012) 81.0 87.0 84.0

Peru (2012) 88.3 90.0 89.2

Table A5.28: Perception of ease of access and percentage of direct offers (past year and past month) of cocaine base paste in secondary school population.


Easy Access

Direct Offers

Past Month

Past Year

Argentina (2011) 16.1 1.5 3.3

Chile (2013) 8.9 3.5 6.1


Ecuador (2012) 3.9 1.6 2.9

Paraguay (2005) 6.0 1.4 2.1

Peru (2012) 6.4 1.1 3.0

Uruguay (2014) 14.7 1.1 2.8

200 | O A S ‐ C I C A D

Table A5.29: Lifetime, past year and past month prevalence of crack use in the secondary school population.


Prevalence


Antigua‐Barbuda (2013) 2.76 1.70 1.26

Argentina (2011) 0.60 n/a n/a

Bahamas (2011) 1.06 0.51 0.29

Barbados (2013) 2.30 1.50 1.32

Belize (2013) 1.75 0.72 0.56

Brazil (2010) 0.60 0.40 n/a

Costa Rica (2012) 0.60 0.30 0.20

Dominica (2011) 2.30 0.86 0.63


Ecuador (2012) 0.70 0.30 0.10

El Salvador (2008) 1.20 0.60 0.40

Grenada (2013) 3.29 2.20 1.47

Guyana (2013) 2.07 1.10 0.45

Haiti (2014) 2.34 1.71 0.96

Honduras (2005) 0.43 0.21 0.10

Jamaica (2013) 2.03 1.11 0.62

Panama (2008) 1.20 1.00 1.00

Paraguay (2005) 0.30 0.00 0.00

Peru (2012) 0.33 n/a n/a


Saint Lucia (2013) 2.34 1.62 1.24


0.72 0.65 0.57

Suriname (2006) 0.66 0.32 n/a

Trinidad‐Tobago (2013) 2.17 1.14 0.70

United States (2014) 1.3 0.7 0.40

Uruguay (2014) 0.20 n/a n/a

Venezuela (2009) 0.50 0.20 0.20

Table A5.30: Lifetime and past year prevalence of crack use among secondary school students by sex.


Lifetime Past Year


Antigua‐Barbuda (2013) 3.76 1.84 2.79 0.64

Argentina (2011) 1.00 0.30 n/a n/a

Bahamas (2011) 1.52 0.51 0.76 0.15

Barbados (2013) 3.35 1.71 2.61 0.80

Belize (2013) 2.33 1.20 0.95 0.50

Costa Rica (2012) 1.00 0.30 0.50 0.20

Dominica (2011) 3.36 0.90 1.09 0.50


Ecuador (2012) 0.90 0.50 0.30 0.30

El Salvador (2008) 1.80 0.70 0.90 0.30

Grenada (2013) 4.88 1.58 3.72 0.67

Guyana (2013) 3.32 1.24 2.13 0.41

Haiti (2014) 2.63 1.91 1.93 1.40

Jamaica (2013) 2.75 1.48 1.64 0.68

Panama (2008) 1.40 1.00 1.10 1.00

Paraguay (2005) 0.50 0.20 0.00 0.00

Peru (2012) 0.48 0.19 n/a n/a


Saint Lucia (2013) 4.21 0.81 3.56 0.00


0.58 0.83 0.41 0.83

Suriname (2006) 1.10 0.30 0.42 0.23

Trinidad‐Tobago (2013) 3.00 1.33 1.89 0.48

United States (2014) 1.40 1.20 0.80 0.60

Uruguay (2014) 0.20 0.20 n/a n/a

Venezuela (2009) 0.80 0.30 0.40 0.10


Table A5.31: Lifetime, past year and past month prevalence of crack use in general population.


Prevalence


Argentina (2011)* 0.08 0.01 0.01

Barbados (2006) 0.20 n/a n/a

Belize (2005) 0.50 n/a n/a

Bolivia (2014) 0.40 n/a n/a

Brazil (2005) 0.70 0.10 0.10

Chile (2012) 0.07 0.00 0.00

Costa Rica (2010) 1.20 0.30 0.20


El Salvador (2014) 1.13 0.20 0.08

Mexico (2011) 1.00 0.10 n/a

Paraguay (2003) 0.04 0.02 0.02

Suriname (2007) 0.30 n/a n/a

United States (2013) 3.40 0.20 0.10

Uruguay (2011)** 0.40 n/a n/a

Venezuela (2011) 0.55 0.20 0.16

*Argentina: Population of 16 ‐ 64 years. **Uruguay: Population of 15 ‐ 65 years.

202 | O A S ‐ C I C A D

Table A6.1: Lifetime, past year and past month prevalence of ecstasy is use in the secondary school population.


Prevalence


Antigua‐Barbuda (2013) 3.73 n/a n/a

Argentina (2011) 2.10 1.20 0.70

Bahamas (2011) 1.06 n/a n/a

Barbados (2013) 2.40 n/a n/a

Belize (2013) 2.42 n/a n/a

Bolivia (2008) 1.60 n/a n/a

Brazil (2010) 1.50 n/a n/a

Canada (2010/11) 7.60 5.00 n/a

Chile (2013) 3.51 1.90 0.87

Colombia (2011) 1.59 1.00 0.45

Costa Rica (2012) 0.50 0.40 0.10

Dominica (2011) 2.57 n/a n/a

Dominican Republic (2008) 0.50 n/a n/a

Ecuador (2012) 1.10 0.50 0.20

El Salvador (2008) 0.80 n/a n/a

Grenada (2013) 1.88 n/a n/a

Guyana (2013) 1.69 n/a n/a

Haiti (2014) 0.88 n/a n/a

Honduras (2005) 0.24 0.08 0.05

Jamaica (2013) 1.62 n/a n/a

Panama (2008) 1.40 1.00 0.90

Paraguay (2005) 0.30 0.00 0.00

Peru (2012) 1.44 0.87 0.57

Saint Kitts‐Nevis (2013) 1.45 n/a n/a

Saint Lucia (2013) 1.78 n/a n/a


0.39 n/a n/a


Trinidad‐Tobago (2013) 1.55 n/a n/a

United States (2014) 3.50 2.20 0.80

Uruguay (2014) 1.00 0.80 0.20

Venezuela (2009) 0.50 0.30 0.20

Table A6.2: Lifetime and past year prevalence of ecstasy use among secondary school students by sex.


Lifetime Past Year


Antigua‐Barbuda (2013) 5.51 2.03 n/a n/a

Argentina (2011) 2.80 1.50 1.70 0.80

Bahamas (2011) 1.22 0.87 n/a n/a

Barbados (2013) 3.48 1.80 n/a n/a

Belize (2013) 3.82 1.10 n/a n/a

Bolivia (2008) 3.00 0.75 n/a n/a

Canada (2010/11) 7.90 7.40 5.50 4.40

Chile (2013) 4.13 2.89 2.16 1.65

Colombia (2011) 1.93 1.28 1.19 0.82

Costa Rica (2012) 0.70 0.30 0.60 0.20

Dominica (2011) 3.86 1.00 n/a n/a

Dominican Republic (2008) 0.62 0.41 n/a n/a

Ecuador (2012) 1.60 0.50 0.70 0.20

El Salvador (2008) 1.00 0.70 n/a n/a

Grenada (2013) 2.93 0.80 n/a n/a

Guyana (2013) 2.36 1.25 n/a n/a

Haiti (2014) 1.10 0.56 n/a n/a

Honduras (2005) n/a n/a n/a n/a

Jamaica (2013) 2.14 1.25 n/a n/a

Panama (2008) 1.40 1.40 1.00 1.10

Paraguay (2005) 0.50 0.20 0.00 0.00

Peru (2012) 1.61 1.28 1.11 0.63

Saint Kitts‐Nevis (2013) 2.03 0.95 n/a n/a

Saint Lucia (2013) 2.43 0.97 n/a n/a


0.56 0.27 n/a n/a

Suriname (2006) 2.62 0.50 n/a n/a

Trinidad‐Tobago (2013) 2.00 1.12 n/a n/a

United States (2014) 3.90 3.30 2.60 1.90

Uruguay (2014) 1.10 0.90 0.80 0.80

Venezuela (2009) 0.80 0.30 0.40 0.10


Table A6.3: Lifetime and past year prevalence of ecstasy use among secondary school students by grade.


study)

Lifetime Past Year

8º 10º 12º 8º 10º 12º


2.66 4.24 4.52 n/a n/a n/a

Argentina (2011) 1.70 2.50 2.40 1.10 1.50 1.10

Bahamas (2011) 0.83 0.62 1.89 n/a n/a n/a

Barbados (2013) 0.93 2.70 3.22 n/a n/a n/a

Belize (2013) 2.27 2.85 1.69 n/a n/a n/a

Canada (2010/11) 2.90 8.20 11.90 2.20 5.80 7.00

Chile (2013) 3.64 3.57 3.26 2.12 2.02 1.45

Colombia (2011) 1.23 2.05 1.55 0.87 1.31 0.79

Costa Rica (2012) 0.50 0.20 0.70 0.30 0.40 0.50

Dominica (2011) 1.69 3.15 3.57 n/a n/a n/a


0.21 0.56 0.84 n/a n/a n/a

El Salvador (2008) 0.80 0.60 1.20 n/a n/a n/a

Grenada (2013) 1.86 1.88 1.90 n/a n/a n/a

Guyana (2013) 1.36 2.03 1.69 n/a n/a n/a

Haiti (2014) 0.76 0.93 0.95 n/a n/a n/a

Jamaica (2013) 0.97 2.17 1.62 n/a n/a n/a

Panama (2008) 2.80 0.10 0.40 2.60 0.30 0.00

Paraguay (2005) 0.40 0.60 0.50 0.30 0.50 0.30

Peru (2012) 1.82 1.30 1.16 1.15 0.78 0.62


2.14 1.29 0.68 n/a n/a n/a

Saint Lucia (2013) 2.49 1.44 1.30 n/a n/a n/a


0.43 0.67 0.00 n/a n/a n/a

Suriname (2006) 0.76 0.98 2.15 n/a n/a n/a


1.17 1.91 1.58 n/a n/a n/a

United States (2014) 1.40 3.70 5.60 0.9 2.3 3.6

Uruguay (2014) 0.40 1.30 1.60 0.40 1.10 1.10


204 | O A S ‐ C I C A D

Table A6.4: Lifetime, past year and past month prevalence of ecstasy use in general population.


Prevalence


Argentina (2011)* 0.87 0.08 0.02

Barbados (2006) 0.70 0.30 0.10

Belize (2005) 0.50 0.50 0.10

Bolivia (2014) 0.04 0.01 0.00

Canada (2012)** 5.30 0.80 n/a

Chile (2012) 0.43 0.05 0.02

Colombia (2013) 0.71 0.19 0.02

Costa Rica (2010) 0.30 0.20 0.10


Ecuador (2013) 0.01 0.01 0.00

El Salvador (2014) 0.15 0.00 0.00

Paraguay (2003) 0.10 0.10 0.00

Peru (2010) 0.19 0.04 0.00


United States (2013) 6.80 1.00 0.30

Uruguay (2011)*** 1.50 0.20 0.10

Venezuela (2011) 0.56 0.13 0.05


Table A6.5: Lifetime, past year and past month prevalence of ecstasy use among university students.


study)

Prevalence


Bolivia (2012) 0.57 0.01 0.01

Brazil (2010) 7.50 3.10 1.90

Colombia (2012) 3.15 0.75 0.21

Ecuador (2012) 1.42 0.27 0.06

El Salvador (2012) 0.16 0.05 0.00

Peru (2012) 1.09 0.28 0.08

Venezuela (2014) 0.45 0.24 0.08

Table A6.6: Lifetime and past year prevalence of ecstasy use among university students by sex.


Lifetime Past Year


Bolivia (2012) 0.76 0.42 0.01 0.00

Brazil (2010) 11.00 4.90 4.70 1.90

Colombia (2012) 4.45 2.03 1.05 0.49

Ecuador (2012) 2.60 0.40 0.60 0.00

El Salvador (2012) 0.31 0.03 0.10 0.00

Peru (2012) 1.78 0.44 0.51 0.07

Venezuela (2014) 0.82 0.19 0.38 0.14


Table A6.7: Perception of high risk of using ecstasy sometimes in secondary school population by sex.


Sex

Male Female Total

Antigua‐Barbuda (2013) 36.10 44.00 40.00

Argentina (2011) 33.10 29.90 31.40

Bahamas (2011) 49.60 54.70 52.20

Barbados (2013) 43.40 48.60 46.50

Belize (2013) 45.10 47.60 46.40

Bolivia (2008) 27.70 27.70 27.60

Canada (2010‐11) 43.10 48.10 46.10

Chile (2013) 46.44 48.16 47.35

Colombia (2011) 40.10 42.10 41.10

Costa Rica (2012) 39.90 43.20 41.60

Dominica (2011) 42.20 51.00 46.20


Ecuador (2012) 27.30 27.30 27.30

El Salvador (2008) 37.00 35.30 36.10

Grenada (2013) 34.10 38.30 36.40

Guyana (2013) 38.60 42.40 40.90


Jamaica (2013) 34.40 49.20 43.00

Panama (2008) 42.80 41.20 41.70

Paraguay (2005) 42.90 42.50 42.70

Peru (2012) 29.91 28.20 29.05


Saint Lucia (2013) 34.60 46.00 40.80


Suriname (2006) 48.60 44.60 46.40

Trinidad‐Tobago (2013) 48.10 51.00 49.70

United States (2014) 34.80 36.60 35.70

Uruguay (2014) 36.10 32.60 34.10

Venezuela (2009) 38.30 36.00 37.10

# Question is about “used ecstasy at least once in lifetime” instead of “sometimes”.

Table A6.8: Perception of high risk of using ecstasy frequently in secondary school population by sex.


Sex

Male Female Total

Antigua‐Barbuda (2013) 55.30 64.30 59.80

Argentina (2011) 70.90 76.40 73.80

Bahamas (2011) 61.30 65.90 63.60

Barbados (2013) 62.50 71.50 67.70

Belize (2013) 60.40 68.00 64.30

Bolivia (2008) 53.70 57.10 55.40

Canada (2010‐11) 69.80 80.40 75.40

Colombia (2011) 65.10 73.30 69.40

Costa Rica (2012) 60.70 69.90 65.50

Dominica (2011) 52.60 64.40 57.90

Ecuador (2012) 45.30 50.10 47.60

El Salvador (2008) 70.40 77.10 74.00

Grenada (2013) 43.90 56.50 50.60

Guyana (2013) 50.70 57.10 54.50


Jamaica (2013) 48.20 64.60 57.70

Panama (2008) 70.10 77.90 74.20

Paraguay (2005) 69.20 77.10 73.60

Peru (2012) 61.78 66.75 64.28


Saint Lucia (2013) 51.60 60.50 56.40


Suriname (2006) 67.50 65.10 66.20

Trinidad‐Tobago (2013) 61.10 68.30 64.90

Uruguay (2014) 68.20 72.00 73.30

Venezuela (2009) 59.60 64.20 62.00

206 | O A S ‐ C I C A D

Table A6.9: Perception of high risk of using ecstasy sometimes in general population by sex.


Sex

Male Female Total

Argentina (2011)* 81.8 84.6 83.2

Bolivia (2014) 55.9 55.7 55.8

Canada (2012)** 72.4 80.2 76.5

Chile (2012) 79.7 80.8 80.3

Colombia (2013) 83.5 85.0 84.3

Costa Rica (2010) 85.3 85.7 85.5


Ecuador (2013) 67.9 68.8 68.4

El Salvador (2014) 67.8 68.0 67.9

Paraguay (2003) 49.9 52.3 51.3

Peru (2010) 81.3 81.7 81.5

Uruguay (2011)** 70.2 75.3 72.9

*Argentina: Population of 16 ‐ 64 years. **Canada and Uruguay: Population of 15 ‐ 65 years. Table A6.10: Perception of high risk of using ecstasy frequently in general population by sex.


Sex

Male Female Total

Argentina (2011)* 90.5 92.7 91.6

Bolivia (2014) 74.5 74.8 74.7

Canada (2012)** 95.7 96.0 95.9

Colombia (2013) 91.4 91.2 91.3

Costa Rica (2010) 85.5 85.6 85.6


Ecuador (2013) 79.1 76.9 77.9

El Salvador (2014) 91.5 89.6 90.4

Mexico (2011) n/a n/a n/a

Paraguay (2003) 59.6 61.0 60.4

Peru (2010) 92.3 92.0 92.1

Uruguay (2011)** 82.6 84.7 83.7


Table A6.11: Perception of high risk of using ecstasy sometimes among university students by sex.


Sex

Male Female Total

Bolivia (2012) 53.0 56.0 55.0

Colombia (2012) 56.6 63.2 60.1

Ecuador (2012) 62.0 68.0 65.0

El Salvador (2012) 63.0 62.3 62.6

Peru (2012) 65.7 66.8 66.3

Table A6.12: Perception of high risk of using ecstasy a frequently among university students by sex.


Sex

Male Female Total

Bolivia (2012) 75.0 80.0 77.0

Colombia (2012) 83.8 89.4 86.7

Ecuador (2012) 82.0 89.0 86.0

El Salvador (2012) 88.6 90.6 89.7

Peru (2012) 87.6 90.5 89.1


Table A6.13: Perception of ease of access and percentage of direct offers (past year and past month) of ecstasy in secondary school population.


Easy Access

Direct Offers

Past Month

Past Year

Antigua‐Barbuda (2013) 11.5 3.6 7.0

Argentina (2011) 19.8 1.5 3.1

Bahamas (2011) 9.3 1.1 2.5

Barbados (2013) 11.4 2.2 4.2

Belize (2013) 10.0 3.4 6.1

Bolivia (2008) n/a 1.3 n/a

Chile (2013) n/a 3.4 6.0


Costa Rica (2012) n/a 0.8 1.7

Dominica (2011) 8.4 1.2 2.2


Ecuador (2012) 4.4 1.7 3.2

El Salvador (2008) 5.5 5.1 6.2

Grenada (2013) 5.9 2.2 3.6

Guyana (2013) 6.8 1.2 2.7

Haiti (2014) 3.5 0.8 1.4

Jamaica (2013) 4.5 1.3 2.4

Panama (2008) 4.7 n/a n/a

Paraguay (2005) 4.8 1.3 1.8

Peru (2012) 5.7 1.3 3.1


Saint Lucia (2013) 6.6 1.1 2.8


Suriname (2006) 11.7 1.2 2.1

Trinidad‐Tobago (2013) 9.4 1.5 3.1

United States (2013) 21.4 n/a n/a

Uruguay (2014) 6.9 1.3 3.3


Table A6.14: Perception of ease of access and percentage of direct offers (past year and past month) of ecstasy among general population.


Easy Access

Direct Offers

Past Month

Past Year

Argentina (2011) 19.2 n/a n/a

Bolivia (2008) 5.7 1.0 0.4

Chile (2013) 17.3 1.2 0.5

Colombia (2011) 22.7 1.4 0.5

Costa Rica (2012) 24.0 1.2 1


Ecuador (2012) 14.9 0.9 0.5

El Salvador (2008) 11.8 1.2 0.4

Peru (2012) 10.9 0.5 0.1

Uruguay (2014) 18.5 1.1 0.4

Table A6.15: Perception of ease of access and percentage of direct offers (past year and past month) of ecstasy among university students.


Easy Access

Direct Offers

Past Month

Past Year

Bolivia (2012) 4.1 0.7 3.8

Colombia (2012) 20.4 1.8 7.9

Ecuador (2012) 7.6 7.9 1.8

El Salvador (2012) 5.6 0.3 3.4

Peru (2012) 7.0 0.5 3.6

208 | O A S ‐ C I C A D

Tabla A7.1: Lifetime, past year and past month prevalence of stimulantpharmaceuticalusewithoutamedicalprescriptionin the secondary school population.


Prevalence

Lifetime Past Year Past

Month

Antigua‐Barbuda (2013) 2.74 1.64 1.33

Argentina (2011) 2.40 1.20 0.80

Bahamas (2011) 3.33 1.83 1.14

Barbados (2013) 3.66 1.95 1.59

Belize (2013) 3.25 1.60 1.03

Bolivia (2008) 9.10 4.00 2.40

Canada (2010/11) 3.90 2.50 n/a

Chile (2013) 3.69 1.68 0.77

Colombia (2011) 0.87 0.51 0.22

Costa Rica (2012) 3.90 1.70 1.20

Dominica (2011) 15.58 6.39 2.93

Dominican Rep. (2008) 9.12 4.21 2.83

Ecuador (2012) 3.80 2.20 1.00

El Salvador (2008) 1.70 1.10 0.90

Grenada (2013) 4.35 2.88 1.80

Guyana (2013) 2.87 1.15 0.86

Haiti (2014) 7.65 3.36 1.55

Honduras (2005) 7.43 3.05 1.98

Jamaica (2013) 3.46 1.79 1.15

Panamá (2008) 4.70 1.20 0.50

Paraguay (2005) 3.80 2.30 1.10

Peru (2012) 2.56 1.50 0.98

S. Kitts‐Nevis (2013) 4.05 2.29 1.14


3.00 2.03 1.53

S. Lucia (2013) 5.01 3.40 2.54

Suriname (2006) 5.06 3.00 1.76

Trinidad‐Tobago (2013) 3.91 1.38 1.00

United States (2014) 3.50 2.20 0.80

Uruguay (2014) 1.00 0.50 n/a

Tabla A7.2: Past year prevalence of stimulantpharmaceuticalusewithoutamedicalprescriptionin the secondary school population by sex.


Sex

Male Female

Antigua‐Barbuda (2013) 2.27 1.04

Argentina (2011) 1.40 1.00

Bahamas (2011) 1.52 2.03

Barbados (2013) 2.67 1.57

Belize (2013) 1.28 1.81

Bolivia (2008) 3.70 4.30

Canada (2010/11) 2.60 2.30

Chile (2013) 1.73 1.64

Colombia (2011) 0.57 0.45

Costa Rica (2012) 1.00 2.20

Dominica (2011) 6.80 5.58

Dominican Rep. (2008) 3.84 4.46

El Salvador (2008) 1.10 1.20

Grenada (2013) 4.43 1.33

Guyana (2013) 1.54 0.90

Haiti (2014) 3.34 3.46

Honduras (2005) 2.49 3.49

Jamaica (2013) 1.61 1.89

Panamá (2008) 1.20 1.20

Paraguay (2005) 2.30 2.40

Peru (2012) 1.37 1.62

S. Kitts‐Nevis (2013) 3.41 1.29


1.55 2.39

S. Lucia (2013) 4.21 2.53

Suriname (2006) 3.67 2.47

Trinidad‐Tobago (2013) 1.52 1.25

Uruguay (2014) 0.50 0.70


Tabla A7.3: Lifetime, past year and past month prevalence of tranquilizerspharmaceuticalusewithoutamedicalprescriptionin the secondary school population.


Prevalence

Lifetime Past Year Past

Month

Antigua‐Barbuda (2013) 3.98 1.96 1.42

Argentina (2011) 4.70 2.40 1.40

Bahamas (2011) 3.99 1.98 1.10

Barbados (2013) 3.02 1.92 0.88

Belize (2013) 4.68 2.72 1.49

Bolivia (2008) 14.30 6.90 3.90

Canada (2010/11) 2.40 1.60 n/a

Chile (2013) 15.83 9.33 3.83

Colombia (2011) 2.42 1.60 0.73

Costa Rica (2012) 5.40 2.80 1.50

Dominica (2011) 11.44 2.84 1.98

Dominican Rep. (2008) 12.81 6.19 3.22

Ecuador (2012) 5.40 2.90 1.40

El Salvador (2008) 2.80 1.80 1.30

Grenada (2013) 4.00 3.01 1.85

Guyana (2013) 3.31 1.43 0.95

Haiti (2014) 11.21 6.46 4.36

Honduras (2005) 12.39 4.91 2.82

Jamaica (2013) 3.24 1.74 0.96

Panamá (2008) 7.40 1.60 1.00

Paraguay (2005) 12.30 7.40 4.70

Peru (2012) 4.51 2.46 1.44

S. Kitts‐Nevis (2013) 3.85 2.57 1.30


1.95 1.09 0.83

S. Lucia (2013) 4.78 3.09 2.02

Suriname (2006) 10.91 6.35 3.78

Trinidad‐Tobago (2013) 2.87 1.52 0.91

United States (2014) 5.30 3.40 1.50

Uruguay (2014) 5.80 3.10 n/a

Tabla A7.4: Past year prevalence of tranquilizerspharmaceuticalusewithoutamedicalprescriptionin the secondary school population by sex.


Sex

Male Female

Antigua‐Barbuda (2013) 2.06 1.91

Argentina (2011) 2.50 2.30

Bahamas (2011) 1.60 2.25

Barbados (2013) 2.44 1.68

Belize (2013) 2.23 3.22

Bolivia (2008) 5.80 7.90

Canada (2010/11) 1.90 1.20

Chile (2013) 7.84 10.80

Colombia (2011) 1.66 1.55

Costa Rica (2012) 2.30 3.30

Dominica (2011) 2.10 3.69

Dominican Rep. (2008) 4.91 7.21

El Salvador (2008) 1.30 2.20

Grenada (2013) 4.86 1.18

Guyana (2013) 2.25 0.89

Haiti (2014) 5.88 6.94

Honduras (2005) 3.33 6.15

Jamaica (2013) 1.58 1.87

Panamá (2008) 1.10 1.90

Paraguay (2005) 5.00 9.40

Peru (2012) 2.00 2.92

S. Kitts‐Nevis (2013) 3.71 1.26


0.99 1.16

S. Lucia (2013) 4.43 1.90

Suriname (2006) 5.63 6.94

Trinidad‐Tobago (2013) 1.77 1.31

United States (2014) 3.00 3.70

Uruguay (2014) 2.30 3.60

2015

Organization of American StatesSecretariat for Multidimensional SecurityInter-American Drug Abuse Control Commission

1889 F. Street, NW, Washington, DC 20006 | Tel: +1.202.370.5000 • Fax: [email protected] | CICAD.OAS.org

Organization ofAmerican States

Inter-American Drug Abuse Control Commission

ISBN 978-0-8270-6373-0

Documents

UsoDrogasAmericas ENG-22Table A2.6: Past year and past month prevalence of tobacco use in general population by age group. Table A2.7: Lifetime, past year and past month prevalence