Evaluating the Impact of Drug Regulation Stringency on Global Drug-Use Patterns: A Cross-Sectional Study

Abstract

Highlights • Global analysis of drug policy stringency versus drug-use prevalence was performed. celistitem0001 • Policy scores are not predictive; governance and socioeconomic factors are stronger. celistitem0002 • Alcohol use is consistently linked to drug use at population level. celistitem0003 simple celist0001 author-highlights abs0001 Introduction Global drug policies vary widely in their level of restrictiveness and alignment with human rights and health standards. However, the relationship between national drug policy frameworks and drug-use prevalence remains poorly understood. This study aimed to evaluate whether the stringency or rights-based orientation of national drug policies is associated with the prevalence of injection drug use and illicit drug use across countries. Methods A cross-sectional ecologic analysis was conducted using publicly available data from international databases. An overall drug policy score was developed to quantify policy stringency, and the Global Drug Policy Index was included to assess rights-based policy quality. Additional variables included Democracy Index, gross domestic product per capita, alcohol consumption, and Corruption Perceptions Index. Multivariate linear regression was used to identify predictors of injection drug-use and illicit drug-use prevalence. Results Whereas bivariate analysis revealed several significant correlations of policy, socioeconomic, and behavioral indicators with drug-use prevalence, multivariate analysis showed that neither overall drug policy score nor Global Drug Policy Index significantly predicted injection drug use or illicit drug use. For injection drug use, only alcohol consumption (=0.006) and Democracy Index (=0.016) remained significant in the model, which explained 61% of the variance (R²=0.61,=0.015). Only alcohol consumption (=0.032) emerged for illicit drug use in the full model despite a good overall fit (R²=0.61,=0.001). Conclusions Because this study uses a cross-sectional ecologic design, the findings identify associations at the country level but cannot establish causality. The association between regulation strictness and drug-use prevalence was not detected. The observed relationships—such as higher reported drug use in less corrupt or more rights-oriented countries—may reflect differences in data quality or reporting practices rather than true differences in prevalence. The findings might indicate the need to adopt more comprehensive approach in regard to drug-use prevalence rather than a legal framework, underlining the need for incorporating social, cultural, and behavioral factors in understanding drug-use patterns. abs0002 Graphical abstract Image, graphical abstract http://www.w3.org/1999/xlink celink0003 float portrait ga1.jpg fig0003 anchor portrait graphical abs0003