Study shows significant increase in drug overdoses among young women in Colombia

According to a study by Columbia University's Mailman School of Public Health, overdose rates in Colombia involving illicit opioids, hallucinogens, stimulants and sedative psychotropic drugs rose sharply between 2018 and 2021, mainly caused by overdoses among young women. The number of drug overdoses increased by 356 percent between 2010 and 2021, from 8.5 to 40.5 percent per 100,000 people. The results were published in the American Journal of Public Health.

The study is the first to describe national trends in overdose rates, including prescription and illicit substances and alcohol, across different populations in Colombia.

In particular, the pandemic has contributed to higher levels of stress and mental health problems such as depression and anxiety in Colombia, similar to other countries.”

Silvia Martins, MD, PhD, professor of epidemiology at the Columbia Mailman School and lead author of the study

Higher prescription rates and use of tranquilizers/sedatives/antidepressants in Colombia during the pandemic due to higher levels of anxiety, sadness and sleep disturbances may have led to overuse of medications. This effect was more pronounced in women.”

Nearly 14 percent of people who used substances in 2020 met the criteria for a substance use disorder.

Based on results from the 2019 National Survey on Substance Use (CNSSU) Estudio Nacional de Consumo de Sustancias Psicoactivas de Colombia, 2019), researchers found that substance use of most substances in the country has increased over the past three decades. There was only a slight decrease in the use of alcohol, cannabis and cocaine in 2019 compared to 2013.

To examine trends in overdose rates from 2010 to 2021 by substance type, gender, age group and intent, as well as sociodemographic characteristics, the researchers also used data from SIVIGILA – a national public health surveillance system from 2010 to 2021, a mandatory reporting system for detecting health events.

The SIVIGILA data include 127,087 substance-related overdoses among people aged 10 and over. 54 percent of those affected were male, 75 percent were people aged 10 to 34, 72 percent had at least a high school diploma or higher, and 51 percent and 38 percent, respectively, were people who either contributed to the health system or received subsidies.

The information was used to classify overdoses by substance type into the following categories: hallucinogens; stimulants (including prescription stimulants, cocaine, and methamphetamine); opioids (including prescription opioids, heroin, methadone, and buprenorphine); inhalants; tranquilizers, sedatives, and antidepressants; and cannabis. The researchers identified the most common combinations of multiple substances throughout the study period and the number of overdoses caused by these combinations.

The most commonly reported substances were tranquilizers/sedatives/antidepressants (43 percent), cannabis (16 percent), stimulants (16 percent), alcohol (16 percent), and opioids (6 percent). The majority (95 percent) of stimulant overdoses were due to cocaine, while opioid overdoses were mostly due to prescription opioids (74 percent).

Tranquilizers/sedatives/antidepressants and opioid overdose rates increased during the study period and increased even more rapidly after 2018. Cannabis and stimulant overdoses also increased until 2017 but declined thereafter. Among women, the largest increase in overdose rates was for tranquillizers/sedatives/antidepressants, which increased even more rapidly from 2018 to 2021 (from 12 to 33 per 100,000).

Further research is needed on risk factors, motivations for use, and sources of these drugs to improve harm reduction interventions and strategies,” notes Julian Santaella-Tenorio, DrPH, Professor at the Universidad Pontificia Javeriana in Cali, Colombia, a former DrPH student at Columbia University and lead author of the study. “We also believe that suicide risk screening and access to complementary mental health care that addresses suicidal thoughts or behavior can improve the health of individuals prescribed these medications and those who have recently overdosed.”

“Addressing the challenges associated with substance use, including the emergence of new drugs and polysubstance use, is a complex task that requires a good understanding of the magnitude of the problem and the burden it places on the population and the health care system,” said Martins and Santaella-Tenorio.

The decline in cannabis and stimulant use among younger people may be due to mobility restrictions during the COVID pandemic, but the reduction in overdose rates may also be due to changes in consumption patterns that are less likely to lead to overdoses, the researchers said.

According to Martins and Santaella, the survey data likely underestimate the prevalence of drug use because the CNSSU is a household survey that excludes populations at high risk of drug use – that is, the homeless and the incarcerated. In addition, overdoses that are not treated in health facilities are not included in the SIVIGILA data.

Over the past thirty years, Colombia has transitioned to a drug regulatory framework that is guided by human rights and public health and complies with the guidelines of the United Nations Office on Drugs and Crime.

The findings suggest that additional prevention efforts are needed, including harm reduction and community-based programs, as well as increased access to treatment services that can reduce the risk of overdose in the population.

“Health surveillance systems are an important tool to support overdose prevention efforts in countries with limited data resources. While this particular study focuses on Colombia, the methodology of their surveillance systems can provide information for public health prevention efforts in other resource-poor countries,” Martins noted.

Co-authors are Jhoan Sebastian Zapata Lopez, Pontificia Universidad Javeriana, ColombiaLuis E. Segura, Department of Epidemiology, Columbia University, Magdalena Cerda, Department of Population Health, NYU, Thiago Fidalgo and Vitor Tardelli, Federal University of Sao Paulo UNIFESP), Brazil.

The study was supported in part by a Global Innovation Fund from Columbia University.