OEA - Analysis of Treatment from the CICAD 2023 Call for Data

March 2026 Technical Report Analysis of Treatment from the CICAD 2023 Call for Data Inter-American Drug Abuse Control Commission (CICAD) Organization of American States (OAS)OAS Cataloging-in-Publication Data Inter-American Drug Abuse Control Commission

Technical Report: Analysis of Treatment from the CICAD 2023 Call for Data p.; cm. (OAS. Official records; OEA/Ser.L)

COPYRIGHT© Organization of American States. All rights reserved under International and Pan-American Conventions. No portion of the content of this material may be reproduced or transmitted in any form, nor by any electronic or mechanical means, totally or partially, without the express consent of the Organization.

Suggested citation: Inter-American Drug Abuse Control Commission (CICAD), Organization of American States (OAS). Technical Report: Analysis of Treatment from the CICAD 2023 Call for Data,

Washington, D.C., March 2026. Comments on the document are welcome and can be sent to: OID_CICAD@oas.org. The contents of this document are presented exclusively for informational purposes. They do not necessarily represent the opinion or official position of the Organization of American States, its General Secretariat, or its member states. This document was prepared and published by the Inter-American Observatory on Drugs (OID, by its Spanish-language acronym) of the Inter-American Drug Abuse Control Commission (CICAD, by its Spanish -language acronym), which is located within the Secretariat for Multidim ensional Security (SMS) of the Organization of American States (OAS).General Coordination Marya Hynes Authors Juan Carlos Araneda Pernell Clarke Paula Demassi Marya Hynes

The Executive Secretariat of CICAD (ES -CICAD) wishes to thank the national drug commissions of the OAS member states, without whom the preparation of this document would not have been possible.

The Executive Secretariat of CICAD (ES -CICAD) wishes to thank the national drug commissions of the OAS member states, without whom the preparation of this document would not have been possible. ES-CICAD is also grateful for the invaluable contributions to this document made by the national drug observatories of the OAS member states of Latin America and the Caribbean. Special thanks go to the Governments of Italy and the United States for their support and funding of this publication.Summary The rapid evolution of synthetic drug markets in the Americas, characterized by increasing diversification, potency, and widespread polysubstance use, has significant implications for treatment systems and public health responses. While early warning systems h ave traditionally relied on forensic and seizure data, treatment data provides a critical and underutilized source of real -time intelligence on emerging drug trends, including shifts in demand, patterns of use, and the health impacts of new substances and mixtures. This technical paper analyzes treatment data submitted by CICAD Member States through the 2023 Call for Data, with a focus on identifying signals relevant to emerging synthetic drugs and complex drug combinations. The findings highlight a growing presence of synthetic substances, particularly methamphetamine and ecstasy-type drugs, in treatment demand, alongside persistent gaps in monitoring polydrug use, which remains a defining feature of contemporary drug markets. By strengthening the integration of treatment data into national and regional early warning systems, countries can improve their capacity to detect emerging threats, anticipate health system impacts, and design more effective, evidence -based responses to s ynthetic and evolving drug markets. Treatment systems are often the first to detect the health consequences of emerging synthetic drugs and drug mixtures, including substances that may not yet be identified through forensic channels. As such, treatment data represents a critical component of an integrated early warning approach, supporting both public health preparedness and operational responses to evolving drug threats. Key Implications for Emerging Synthetic Drug Markets The findings from this analysis of treatment data provide important insights into the evolving

be identified through forensic channels. As such, treatment data represents a critical component of an integrated early warning approach, supporting both public health preparedness and operational responses to evolving drug threats. Key Implications for Emerging Synthetic Drug Markets The findings from this analysis of treatment data provide important insights into the evolving synthetic drug landscape in the Americas and highlight the critical role of treatment systems within early warning frameworks: • Rising treatment demand for synthetic substances signals expanding market penetration. Increases in methamphetamine and ecstasy -type substances reported by multiple countries indicate that synthetic drugs are no longer confined to isolated markets but are becoming established across subregions. • Treatment systems are detecting the health impacts of synthetic drugs in real time. Treatment systems provide critical insight into the health impacts of synthetic drugs, complementing forensic data. They offer a more comprehensive picture of emerging patterns, including treatment demand, pressure on health systems, andthe severity of substance use disorders – dimensions not fully captured by forensic data alone. In addition, treatment settings can identify new symptoms and shifts in clinical presentations, generating early signals that can inform EWS alerts and support preparedness across emergency and health services. • Polysubstance use —closely associated with synthetic drug markets —is underreported. Despite evidence that synthetic drug markets are increasingly characterized by mixtures, only a small proportion of countries reported polydrug use data, limiting visibility into one of the most significant current risk factors. • Current treatment data systems are not yet fully adapted to synthetic drug complexity. Variability in reporting (e.g., age categories, substance classification, and institutional data) constrains the ability to detect and compare emerging synthetic trends across countries. • Regional differences in primary drugs mask emerging synthetic dynamics. While alcohol, cannabis, and cocaine remain dominant drivers of treatment demand, increases in synthetic drug treatment —particularly stimulants—suggest a shifting landscape that may accelerate rapidly without early detection. • Treatment data should be systematically integrated into Early Warning Systems (EWS). Strengthening the use of treatment indicators within national and regional EWS

synthetic drug treatment —particularly stimulants—suggest a shifting landscape that may accelerate rapidly without early detection. • Treatment data should be systematically integrated into Early Warning Systems (EWS). Strengthening the use of treatment indicators within national and regional EWS frameworks would enhance the capacity to identify emerging synthetic threats, triangulate data sources, and support timely public health and operational responses. • Gender disparities in treatment may obscure synthetic drug risks among women. The strong male predominance in treatment admissions suggests potential under -detection of women who use synthetic drugs, particularly in contexts of hidden or stigmatized use. • High rates of treatment re -entry may reflect the impact of potent and fast -evolving synthetic substances. Patterns of repeated treatment episodes are consistent with substances associated with high dependency potential, reinforcing the need for long -term and adaptive treatment responses.1. Introduction This analytical report presents a comprehensive review of drug treatment indicators submitted to CICAD under the 2023 Call for Data . Twenty-four Member States submitted at least partial treatment data, representing all subregions of the Americas: the Caribbean, Central America, North America, and South America. The data covers 10 standardized indicators, including: • Persons in treatment (sex, age, drug) • Treatment trends (2021–2022) • Drug rankings • Treatment modalities and institutions • Entry pathways • Polydrug use • Specialized programs

Focal points in participating countries were provided with a standard Microsoft Excel spreadsheet and instructions on formats, time periods, and how to enter the data. Follow up was done where data were missing or some clarifications were needed. This report provides an analysis of the data itself along with the quality of the data including data gaps and completeness. The goal is to provide a hemispheric overview of treatment demand and system capacity, highlight regional differences, and identify key implications for policy development.

2. Reporting Completeness Across Countries Countries varied significantly in the number of indicators reported.

Overall reporting levels (N = 24 countries): Indicator % of Countries Reporting

provide a hemispheric overview of treatment demand and system capacity, highlight regional differences, and identify key implications for policy development.

2. Reporting Completeness Across Countries Countries varied significantly in the number of indicators reported.

Overall reporting levels (N = 24 countries): Indicator % of Countries Reporting Persons in treatment (sex) 75% Persons by drug, sex, age 75%Drug ranking 66.7% Treatment trends (2021–2022) 54.2% Specialized programs 54.2% Institutions / modality / entry type 45.8% Polydrug combinations 33.3% Persons by polydrug use 20.8%

Countries consistently reported basic demographic and drug -specific treatment counts , but reporting on institution-level treatment data and especially polydrug use remains very limited.

3. Subregional Reporting Patterns Caribbean Countries such as Antigua & Barbuda, Dominican Republic, Grenada, and Trinidad & Tobago reported nearly all major indicators. Belize submitted a partial dataset, and data from Saint Lucia could not be used.

Central America • Costa Rica had the most comprehensive reporting. • El Salvador, and Honduras submitted partial datasets. North America • Mexico provided nearly full reporting, including trends, modalities, institutions, and drug breakdowns. South America • Suriname was the only country with full indicator coverage. • Argentina, Bolivia, Colombia, Peru, Uruguay, and Chile submitted partial data.

Implication: The diversity of reporting completeness reflects major disparities in national monitoring systems and suggests that regional comparison must be interpreted cautiously.4. Ranking of Primary Drugs for Which Treatment Is Requested CICAD collects data on the top 5 drugs for which treatment is sought in each country.

Regional Patterns • North America (Mexico is the only country from which data was received): Methamphetamine is the most common primary drug. • Central America: Alcohol dominates treatment admissions. • Caribbean: Cannabis is the leading drug. • South America: Highly diverse profile —tobacco, cannabis, alcohol, cocaine in multiple

• North America (Mexico is the only country from which data was received): Methamphetamine is the most common primary drug. • Central America: Alcohol dominates treatment admissions. • Caribbean: Cannabis is the leading drug. • South America: Highly diverse profile —tobacco, cannabis, alcohol, cocaine in multiple forms, and crack/base paste.

Country Examples • Antigua & Barbuda: 1) Marijuana herb, 2) Alcohol, 3) Powder cocaine • Dominican Republic: 1) Marijuana herb, 2) Cocaine, 3) Crack • Mexico: 1) Methamphetamine, 2) Alcohol, 3) Cannabis Subregional differences reflect distinct drug markets and availability, shaping treatment demand and required modalities.

5. Trends in Treatment Demand (2021–2022) Countries reported whether demand increased, decreased, or remained stable by drug category.

Alcohol

• Large increases: Belize, Mexico, Guyana
• Stable: Costa Rica, Chile, Suriname, Uruguay
• Small decreases: El Salvador, Colombia

Cannabis

• Major increases: Belize, Costa Rica, Mexico • Stable: Chile, Colombia, Guyana • Small decreases: Suriname, Antigua & BarbudaCocaine (all forms)
• Large increases: Mexico, Bolivia • Stable: Antigua & Barbuda, Chile, Colombia • Mixed trends: others

Synthetic Drugs

• Methamphetamine increases: Mexico, Guyana • Ecstasy increases: Costa Rica, Mexico, Guyana Synthetic drug treatment is a growing challenge across several subregions.

6. Persons in Treatment: Total and Sex Distribution Countries reported the number of individuals in treatment for 2022 (with year variations in Chile and Guyana).

Largest treatment populations: • Mexico: 167,905 persons • Peru: 62,529 persons • Argentina: 31,327 persons • Costa Rica: 27,210 persons • Chile: 23,280 persons Sex distribution Across the hemisphere, treatment populations are consistently 70–85% male, a pattern seen in

• Peru: 62,529 persons • Argentina: 31,327 persons • Costa Rica: 27,210 persons • Chile: 23,280 persons Sex distribution Across the hemisphere, treatment populations are consistently 70–85% male, a pattern seen in nearly every country.

Treatment systems must ensure gender-sensitive services for women, who are underrepresented but highly vulnerable.

7. Treatment Demand by Drug, Sex, and Age Countries supplied detailed demographic breakouts, though age group definitions vary widely , making comparability difficult.General Patterns • Alcohol use disorders affect almost all age groups in the range 18–64. • Cannabis admissions concentrate in ages 12–34. • Cocaine (powder, crack, base/paste) skew toward adult men in urban environments. • Opioid treatment is low region-wide except in Mexico.

Age Group Incompatibility Countries such as Belize, Honduras, Suriname, and Colombia use unique age brackets. Cross-country comparison requires harmonization, which remains a major challenge for regional monitoring.

8. Treatment by Institution Type Countries reported treatment at: • General hospitals • Psychiatric hospitals/clinics • Specialized centers / community mental health centers • Therapeutic communities • NGO or religious institutions Subregional Variations • Costa Rica: 87% treated in community mental health centers. • Mexico: 63% treated in "other" institutions (mostly NGOs). • Peru: Broad institutional mix across hospitals, specialized centers, and primary care. • Suriname: Split between psychiatric clinics (56%) and NGOs (44%).

The treatment infrastructure across the Americas is highly heterogeneous and often dominated by non-governmental providers.9. Treatment Modalities The dataset includes: • Residential services • Intensive outpatient • Individual counseling • Group therapy • Other modalities Examples • Mexico: Mostly residential treatment. • Costa Rica: Primarily intensive outpatient. • Suriname: 67% residential. • Bolivia: Wide variation including treatment groups and mixed modalities.

• Intensive outpatient • Individual counseling • Group therapy • Other modalities Examples • Mexico: Mostly residential treatment. • Costa Rica: Primarily intensive outpatient. • Suriname: 67% residential. • Bolivia: Wide variation including treatment groups and mixed modalities.

Countries are at very different stages of developing community -based services and evidence-based outpatient models.

10. Entry Pathways into Treatment Three principal categories: • First-time entrants • Re-entrants • Continuous care • Unknown/not classified Country Results • Dominican Republic: 84% first-time treatment entrants. • Costa Rica: Nearly equal proportions first-time vs. continuous care. • Mexico: Nearly 100% listed as first-time due to reporting structure. • Chile: 48.8% first-time, 49.5% re-entrants.High re-entry rates in certain countries indicate chronic, relapsing substance use disorders and underscore the need for long-term recovery support.

11. Polydrug Use This is the least reported indicator, with only 8–20% participation.

Most common combinations • Crack + Marijuana + Alcohol • Alcohol + Marijuana + Cocaine • Alcohol + Cannabis • Alcohol + Hallucinogens (Peru) • Crack + Cannabis (Suriname) Given that polydrug use is a major clinical risk factor, the lack of reporting is a significant limitation for treatment planning.

12. Availability of Specialized Programs Countries reported whether they offer dedicated programs for: • People with disabilities • Rural populations • Indigenous peoples • Migrants • Sex workers • Homeless people • Persons with severe mental illness • Other specialized groups

Coverage Patterns

• Strong coverage: Mexico, Trinidad & Tobago, Chile • Partial coverage: Peru, Uruguay • Minimal: Dominica (only for severe mental illness)Specialized programs remain uneven and insufficient in most of the hemisphere, particularly for migrants and rural populations—two groups facing rising vulnerability.

13. Overall Key Findings

• Partial coverage: Peru, Uruguay • Minimal: Dominica (only for severe mental illness)Specialized programs remain uneven and insufficient in most of the hemisphere, particularly for migrants and rural populations—two groups facing rising vulnerability.

13. Overall Key Findings

1. Widening subregional differences in primary drugs of concern.

2. Rapid rise in synthetic drug treatment admissions , especially methamphetamine and ecstasy-type substances.

3. Alcohol and cannabis remain the dominant treatment drivers across the hemisphere.

4. High gender imbalance (male-dominated admissions).

5. Large disparities in monitoring systems , especially for polydrug use and age harmonization.

6. Treatment largely provided by NGOs in multiple countries, especially Mexico and

Suriname.

7. Significant re-entry patterns in some countries, suggesting chronic relapse cycles.

14. Policy Recommendations Improve Data Quality & Comparability • Standardize age brackets across all countries. • Expand monitoring for polydrug use. • Require reporting on treatment outcomes, not just entry counts.

Strengthen Treatment Infrastructure • Expand community-based outpatient programs. • Establish minimum standards for NGO treatment centers. • Improve integration of mental health and substance use services. Address Emerging Threats • Scale up synthetic drug treatment capacity, especially for methamphetamine. • Strengthen early intervention for youth cannabis use.Increase Access for Vulnerable Populations • Expand specialized programs for: o Rural communities o Indigenous groups o Migrants o Women o Persons with co-occurring mental illness Support Long-Term Recovery • Develop aftercare and relapse prevention programs. • Incorporate vocational, housing, and social reintegration supports.