Emerging patterns of substance use are creating more complex and less predictable health risks across Europe and beyond, as synthetic drugs rapidly reshape global markets. Experts warn that health systems are struggling to keep pace, while access to treatment and prevention services remains limited.
Speaking at an international forum on countering transnational drug threats in Samarkand, World Health Organization Director-General Tedros Adhanom Ghebreyesus described substance use disorders as a major and expanding public health challenge. Globally, an estimated 300 million people used drugs at least once in the past year, according to the United Nations Office on Drugs and Crime, with between 40 and 64 million living with drug use disorders. Each year, around 600,000 deaths are linked to drug use, including from overdose and drug-related diseases such as HIV and viral hepatitis.
“These lives can be saved,” Tedros noted, pointing to evidence-based prevention, treatment and harm reduction. Yet access remains limited, with only a small proportion of people receiving the care they need. Barriers such as stigma, discrimination, and criminalisation continue to push vulnerable groups away from health services. Women, young people and those with co-existing conditions face particularly high risks.
Synthetic drugs reshape the landscape
Health systems in Central Asia are also struggling to keep pace with the rapid evolution of drug markets. According to Salome Flores, Head of the UNODC Information Centre for researching and analysing transnational drug threats, the region has undergone a significant shift in recent years. The decline in opium production in Afghanistan has altered supply patterns, while synthetic drugs are becoming more widespread. Unlike traditional substances, synthetics can be produced locally using precursor chemicals, making them harder to monitor and control.
At the same time, another trend is emerging: the misuse of pharmaceuticals. “We’re also talking about the use of pharmaceuticals for non-medical purposes,” Flores told Euronews. “People go to pharmacies and buy tranquilizers, antidepressants, sleeping pills, and in certain doses they can produce certain effects.” This combination of synthetic substances and pharmaceutical misuse is creating a more complex health challenge, requiring both stronger regulation and expanded medical responses.
Experts say current health system responses are no longer adequate. Many national approaches were originally developed to address heroin, cocaine and amphetamines. But the rise of synthetic drugs, combined substance use and new distribution channels, has changed the nature of the problem. Health systems now need to integrate services for mental health, substance use and infectious diseases, particularly at the primary care level. Community engagement is also seen as critical to reaching vulnerable populations and improving outcomes. Treatment, experts emphasise, should be voluntary, evidence-based and grounded in human rights. Punitive approaches alone are unlikely to reduce dependence or improve public health outcomes.
Uzbekistan shifts focus to treatment and rehabilitation
In Uzbekistan, officials are increasingly framing drug use as a health and social issue rather than solely a criminal one. According to Asilbek Khudayarov, Uzbekistan’s Minister of Health, the forum highlighted the need for new approaches. He said the discussions reinforced that drug addiction is a complex issue linked to human health and the future of younger generations, requiring coordinated and comprehensive responses. “In the context of the spread of synthetic drugs, it is necessary to further improve treatment and rehabilitation systems,” he said.
Khudayarov also stressed the importance of combining international medical experience and providing integrated care including medical, psychological and social support for people affected by drug dependence. Strengthening prevention, early detection and outpatient care services is also seen as critical, placing additional responsibility on healthcare systems. As part of this approach, Uzbekistan has proposed creating a Central Asian Association of Narcologists to support knowledge exchange and improve rehabilitation practices across the region.
Prevention is another key pillar, particularly in a region with a relatively young population. According to Zhandos Aktayev, Chairman of the Public Fund “Esbol Qory” in Kazakhstan, engaging young people directly is essential. “Central Asia is a region with a very young population, so all our countries must focus on youth and engage them as subjects and actors of prevention work,” he said. Evidence-based programmes and training are being used to raise awareness and help young people develop the skills needed to avoid risky situations. Experts say early prevention can reduce long-term health risks and limit the social impact of drug use.
The discussions in Samarkand reflect a broader shift in how drug-related challenges are being understood. Rather than focusing solely on law enforcement, there is growing recognition that effective responses must address the underlying health, social and economic dimensions of drug use. This includes improving access to treatment, strengthening health systems and reducing stigma, while also adapting to new risks posed by synthetic substances. As drug markets continue to evolve, experts say the effectiveness of responses will depend on how quickly health systems can adapt and how well countries can work together to protect the most vulnerable.
For European readers, these developments carry direct implications. The rise of synthetic drugs and pharmaceutical misuse is not confined to Central Asia; similar trends are emerging across the continent, from Berlin to Barcelona. European health systems, already under pressure from other demands, must now prepare for a more complex drug landscape. The UK's recent generational tobacco ban, for instance, sets a precedent for proactive health policy, but synthetic drugs require a different kind of response—one that integrates mental health, addiction services, and primary care. As the WHO and UNODC stress, the time to act is now.
