World Health Organization
منظمة الصحة العالمية
Organisation mondiale de la Santé

Strengthening public health response to substance use in the Eastern Mediterranean Region

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Editorial

Hanan Balkhy 1

1Regional Director, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt.

Keywords: substance use, drug use disorder, Regional Health Alliance, Eastern Mediterranean

Citation: Balkhy H. Strengthening public health response to substance use in the Eastern Mediterranean Region. East Mediterr Health J. 2025;31(6):357–358. https://doi.org/10.26719/2025.31.6.357.

Copyright © Authors 2025; Licensee: World Health Organization. EMHJ is an open access journal. All papers published in EMHJ are available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

Substance use is a major public health challenge that has implications for security, safety and development, and requires coordinated, multidimensional and multidisciplinary response. Substance use and its consequences, particularly crime, health problems and lost productivity, cost as much as 2% of the Gross Domestic Product (GDP) of some countries (1). The United Nations 2024 World Drug Report estimates that globally, 292 million (5.6%) individuals aged 15–64 years used drugs in 2022 and cannabis was the most used substance (2). Injecting drug use continues to be an important driver of HIV and viral hepatitis epidemics in some populations, and 64 million people suffer from substance use disorders (SUDs) globally (2).

In the WHO Eastern Mediterranean Region (EMR), 6.7% of the population use drugs and half of the drug users have opioid use disorder, which accounts for 80% of all Disability-Adjusted Life Years (DALYs) attributable to SUDs (3,4). The age-standardized rates for DALYs attributable to SUDs have increased by 20.1% globally since 1990 (5). Although there are significant challenges with the availability, reporting and reliability of data on substance use, evidence shows a huge treatment gap. Only 1 in 13 persons with SUDs in the EMR received treatment in 2022, compared to 1 in 11 globally (3,4).

To address this public health challenge, the WHO Regional Office for the Eastern Mediterranean launched the regional flagship initiative for accelerating the public health response to substance use (6), which was endorsed by the Regional Committee for the Eastern Mediterranean at their 71st Session in October 2024 (7,8). Together with the other 2 flagship initiatives on expanding equitable access to medical products (9) and investing in a resilient and sustainable health workforce (10), the initiative aims to accelerate implementation of the Strategic Operational Plan for the Eastern Mediterranean Region, 2025–2028 (11) and achievement of the health-related Sustainable Development Goals.

The initiative on substance use aims to reduce morbidity and mortality by preventing initiation among vulnerable populations; expanding availability and accessibility to services for the management of SUDs; and strengthening monitoring, surveillance and evidence generation on substance use. To achieve these, WHO is strengthening coordination and collaboration across WHO and with other United Nations entities, building on existing structures such as the Regional Health Alliance (a collaborative platform comprising 18 United Nations entities in the region). WHO is providing targeted guidance and support tailored to the context, needs and resources at country level across 3 domains: (1) preventing the initiation of substance use through evidence-based interventions such as parenting skills, family strengthening and life skills education; (2) health systems interventions that embed evidence-based SUDs interventions in Universal Health Coverage to ensure effective and affordable care for individuals at par with other chronic conditions across the health and social care systems; and (3) supporting policies and regulations that prioritize availability of evidence-based treatment and harm reduction delivered in a coordinated manner across health and social care systems rather than relying on punitive measures (12).

Implementing the initiative requires substantial financial investments. Therefore, WHO is reaching out to donor agencies and other United Nations entities to mobilize financial and technical resources, including strengthening and expanding the network of WHO collaborating centres across EMR, setting up a technical advisory group and fostering coalition among civil society organizations at the regional level.

To accelerate implementation of the initiative, a high-level policy dialogue was held in Abu Dhabi, United Arab Emirates, in February 2025, with the participation of over 100 stakeholders from the health and drug control sectors, United Nations entities, global and regional professional organizations, civil society, and academia (13). The meeting led to the development of a consensus statement (14) and establishment of the Strategic and Technical Advisory Group on Mental Health and Substance Use, to guide countries in developing evidence-based policies, regulations and services and promote regional research on substance use. A Regional Coalition for Mental Health and Substance Use Prevention (15) was launched to engage civil society organizations, ensure inclusiveness and facilitate engagement with people with SUDs.

One of the key enablers of this flagship initiative is the enhancement of capacities among EMR countries to develop fit-for-purpose workforce. WHO is working across all levels of the organization to facilitate implementation of the International Standards for the Treatment of Drug Use Disorders and development of a competency-based curriculum for initiation of addiction medicine certified programmes by Member States, in collaboration with global, regional and national certifying bodies while enhancing the substance use module for the  Regional Professional Diploma in Family Medicine.

A robust mechanism has been set up to develop a unified data collection  tool and core indicators for monitoring progress on the flagship initiative. WHO is setting up a leadership course to establish a cohort of experts among policymakers and senior professionals who can lead the crucial transition from policy to implementation for strengthening public health response to substance use.

The regional flagship initiative for accelerating the public health response to substance use is more than a regional effort; it is a call for decisive, collective action to address one of the most urgent but neglected public health challenges. With the right investments in sustainable, evidence-based solutions, we hope to significantly improve public health outcomes and foster social stability for future generations through the initiative. Given the current challenging environment, it is critical to enhance collaboration, strategic alignment and efficiency by leveraging the Regional Health Alliance as a key mechanism for coordinated country level interagency policy dialogues and expedited implementation.

References

  1. World Health Organization. Substance use disorders: policy dialogue. News, 20 February 2025. https://www.emro.who.int/media/news/substance-use-disorders-policy-dialogue.html.
  2. UNODC. World Drug Report 2024. Vienna: UNODC, 2024. https://www.unodc.org/unodc/en/data-and-analysis/world-drug-report-2024.html.
  3. World Health Organization. Atlas of substance use in the Eastern Mediterranean Region 2021. Cairo: WHO Regional Office for the Eastern Mediterranean, 2023. https://applications.emro.who.int/docs/9789292740764-eng.pdf?ua=1.
  4. Rostam-Abadi Y, Gholami J, Jobehdar MM, Ardeshir M, Aghaei AM, Olamazadeh S, et al. Drug use, drug use disorders, and treatment services in the Eastern Mediterranean region: a systematic review. Lancet Psychiatry 2023;10(4):282-295. doi: 10.1016/S2215-0366(22)00435-7.
  5. Amirkafi A, Mohammadi F, Tehrani-Banihashemi A, Moradi-Lakeh M, Murray CJ, Naghavi M, Mokdad AH. Drug-use disorders in the Eastern Mediterranean Region: a glance at GBD 2019 findings. Soc Psychiatry Psychiatr Epidemiol. 2024;59(7):1113-1127. doi: 10.1007/s00127-023-02587-w.
  6. World Health Organization. Flagship initiatives. Cairo: WHO Regional Office for the Eastern Mediterranean, n.d. https://www.emro.who.int/about-who/regional-director/flagship-initiatives.html.
  7. World Health Organization. Regional flagship initiative 3: Accelerating public health action on substance use. Cairo: WHO Regional Office for the Eastern Mediterranean, 2024. https://applications.emro.who.int/docs/Flagship-initiative-substance-use-eng.pdf.
  8. World Health Organization. Regional strategic operational plan including the flagship initiatives. Cairo: WHO Regional Office for the Eastern Mediterranean, 2024. https://applications.emro.who.int/docs/RC71-R1-D-RSOP-flagships-eng.pdf.
  9. World Health Organization. Regional flagship initiative 1: Expanding equitable access to medical products. Cairo: WHO Regional Office for the Eastern Mediterranean, 2024. https://applications.emro.who.int/docs/Flagship-Initiative-Expanding-Access-Medical-Products-eng.pdf.
  10. World Health Organization. Regional flagship initiative 2: Investing in a resilient health workforce. Cairo: WHO Regional Office for the Eastern Mediterranean, 2024. https://applications.emro.who.int/docs/Flagship-Initiative-health-Workforce-eng.pdf.
  11. World Health Organization. Strategic operational plan for the Eastern Mediterranean Region, 2025–2028. Cairo: WHO Regional Office for the Eastern Mediterranean, 2024. https://applications.emro.who.int/docs/Strategic-operational-plan-eng.pdf?ua=1.
  12. United Nations. Human rights challenges in addressing and countering all aspects of the world drug problem. Report of the Office of the United Nations High Commissioner for Human Rights. 2023. https://docs.un.org/en/A/HRC/54/53.
  13. World Health Organization. Summary report on the policy dialogue on scaling up implementation of WHO’s regional flagship initiative to accelerate the public health response to substance use in the Eastern Mediterranean Region. Cairo: WHO Regional Office for the Eastern Mediterranean, 2025. WHOEMMNH240E-eng.pdf.
  14. World Health Organization. Consensus statement from a policy dialogue on scaling up implementation of WHO’s regional flagship initiative to accelerate the public health response to substance use. Cairo: WHO Regional Office for the Eastern Mediterranean, 2025. https://applications.emro.who.int/docs/WHOEMMNH239E-eng.pdf.
  15. Global Mental Health Action Network. Regional Coalition for Mental Health and Substance Use Prevention. London: Global Mental Health Action Network, n.d. https://gmhan.org/who-emr-regional-coalition.