Responding to global stimulant use: challenges and opportunities

Lancet. 2019 Nov 2;394(10209):1652-1667. doi: 10.1016/S0140-6736(19)32230-5. Epub 2019 Oct 23.


We did a global review to synthesise data on the prevalence, harms, and interventions for stimulant use, focusing specifically on the use of cocaine and amphetamines. Modelling estimated the effect of cocaine and amphetamine use on mortality, suicidality, and blood borne virus incidence. The estimated global prevalence of cocaine use was 0·4% and amphetamine use was 0·7%, with dependence affecting 16% of people who used cocaine and 11% of those who used amphetamine. Stimulant use was associated with elevated mortality, increased incidence of HIV and hepatitis C infection, poor mental health (suicidality, psychosis, depression, and violence), and increased risk of cardiovascular events. No effective pharmacotherapies are available that reduce stimulant use, and the available psychosocial interventions (except for contingency management) had a weak overall effect. Generic approaches can address mental health and blood borne virus infection risk if better tailored to mitigate the harms associated with stimulant use. Substantial and sustained investment is needed to develop more effective interventions to reduce stimulant use.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adult
  • Amphetamines / adverse effects*
  • Amphetamines / therapeutic use
  • Cardiovascular Diseases / chemically induced
  • Cardiovascular Diseases / mortality
  • Central Nervous System Stimulants / therapeutic use
  • Cocaine / adverse effects*
  • Cocaine-Related Disorders / epidemiology
  • Cocaine-Related Disorders / mortality*
  • Cocaine-Related Disorders / prevention & control
  • Dopamine Uptake Inhibitors / adverse effects
  • Female
  • HIV Infections / chemically induced
  • HIV Infections / mortality
  • Hepatitis C / chemically induced
  • Hepatitis C / mortality
  • Humans
  • Incidence
  • Male
  • Mental Disorders / chemically induced
  • Mental Disorders / mortality
  • Middle Aged
  • Prevalence
  • Virus Diseases / blood
  • Virus Diseases / chemically induced
  • Virus Diseases / mortality
  • Young Adult


  • Amphetamines
  • Central Nervous System Stimulants
  • Dopamine Uptake Inhibitors
  • Cocaine