Global health. The current scenario and future perspectives

203 is an increase of 43% compared to 2019. This increase occurred during the Covid-19 pandemic. Of the total deaths in the year 2021, slightly more than 80 thousand are linked to opioids (75%) and out of these, 71 thousand are attributed to synthetic opioids (mainly fentanyl), which represents about 88% of all opioid-related deaths. In other words, deaths from overdose due to synthetic opioid analgesics use (mainly fentanyl) in the year 2021 (71,000) surpass all deaths from overdose caused by any other drug (excluding alcohol) until the year 2017 and correspond to an average of 200 deaths daily. Subsequently, a slight decline is observed towards 2022. On the other hand, a report from the Public Health Agency of Canada (Special Advisory Committee on the Epidemic of Opioid Overdoses, 2022) reports a total of 2,829 deaths apparently related to opioid toxicit y 19 , in 2016, a figure that increased to 7,560 in 2021 (a 167% increase compared to 2016). In 2021, 98% of the deaths were accidental and 74% were men and 26% women. The number of deaths in 2021 implies that approximately 21 people in Canada died per day due to apparent opioid-related toxicity. Why is it important to mention this situation? As described earlier, what best identifies levels of drug use as well as types of substances used is the diversity, between regions globally and between countries within the region. This does not include other dimensions that influence the drug problem such as large-scale production and drug trafficking or micro- trafficking, which will be mentioned later. History shows us that this diversity is not static, but that it changes over time. Thus, if the use of a particular substance is not present today in a country, this does not mean that this situation will remain over time. That is precisely the lesson we must learn from current realities in some countries or groups of countries. The same can be thought regarding drug trafficking: its absence or low impact at a certain moment does not guarantee it will be a situation sustained over time. In summary, although opioid pain relievers (fentanyl and others) are currently not present in most countries in the Americas. Where they are present, the result has been a large number of people requiring treatment and an important number of unintentional intoxication deaths. It is also important to recognize how these substances are used. A recent report from OID/CICAD on synthetic opioids (CICAD n. d.) states that some individuals start using these substances under medical prescription and then they fall into illicit use (Cicero et al., 2017). The report also indicates that there are signs of increasing prescription opioid use in some countries in South America and concludes with a reflection that we fully share: “ If anything is to 19 Deaths from apparent opioid toxicity overdose correspond to a death caused by intoxication or toxicity due to substance use, where one or more of those substances is an opioid, regardless of how the substance was obtained (through a prescription or illegally). Other substances may also be present.