Amphetamine use disorder-related hospitalizations are rising in the Eastern region of Saudi Arabia with rates increasing nearly 18 times from 2005 to 2018. In consistency with previous studies, our study revealed that the 25–40 age group amphetamine-related admission rate has largely and consistently increased from 2005 to 2018 . The current study found that reported ATS seizure quantity was significantly and positively associated with the increase in amphetamine use disorder admission rates, which rejects our null hypothesis. This association is more apparent toward the end of the study period, particularly from 2013 to 2017 when the largest quantity of ATS was seized by the authorities.
In 2018, both ATS seizure quantity and admission rates significantly increased, nearly doubling from the previous year. However, there was a statistically insignificant fluctuation in a few years of the study period, particularly between the years 2005 to 2008. This might be attributed to geopolitical reasons, as the civil war in Syria started in 2011 leading to a spike in illicit ATS manufacturing . According to the UNODC report, in the last 10 years, large quantities of illicit amphetamine-type stimulants seized in Saudi Arabia were manufactured in the Syria Arab Republic, and Lebanon .
One theory that might explain the link between amphetamine-related admissions and ATS seizure quantity is that the law enforcement war against drug trafficking doesn’t necessarily mean a reduction in drug supply [12, 13]. On the contrary, it could reflect the unseized quantities entered the kingdom, which means more ATS supply, higher availability, and elevation of negative consequences such as rising crime rate, violence, and hospitalizations [13, 14]. Increased amphetamine-related admissions are likely due to rising in amphetamine use and availability. As an Australian study concluded that fluctuations in amphetamine availability explained half of the variation in amphetamine-related admissions . In general, increasing the severity of law enforcement toward drug trafficking associated with dealing drugs raises for all types of illicit drugs [14, 15]. In the U.S. during Nixon’s presidency, policymakers announced a war against drug trafficking to achieve their goal of a drug-free world. Years later, studies found that cocaine and heroin prices have fallen substantially during a period of the most increased movement in law enforcement against drug trafficking . Another significant aspect that might interpret the relationship of amphetamine seized quantities with the increase of amphetamine use disorder-related admission rates is illicit drug potency. Overall, the purity and potency of illicit drug material have consistently increased over time . In the recent World Drug Report in 2021, they revealed that organized crime groups succeeded in manufacturing highly potent amphetamine and making it available in the illicit drug market . Therefore, it is likely that the seized quantities of ATS in the last decade contain more potent ATS than ever before which in return might result in a larger number of users with a higher risk of addiction who might seek treatment.
Saudi Arabia is considered a major target for many illicit drug traffickers in the world such as traffickers in Eastern Europe, and Southeast Asia . In response to the rising trafficking activities, the authorities represented by the General Directorate of Narcotics Control (GDNC) in Saudi have initiated a strict prohibition against the possession, dealing, and consumption of illicit substances . The purpose of this initiation was based on the theory that the vigorous enforcement of laws prohibiting drug production, distribution, and use will eventually break the cycle of the supply and demand of drugs, and subsequently exterminate the illicit drug market. It has been demonstrated in many regions in the world like North America, Latin America, and Europe that law enforcement approaches concentrate on arrests and punishment toward producers, traffickers and users have been failing in reducing the scale of illicit drugs in the markets [14, 19,20,21]. Thus, the GDNC strategy might not have been successfully achieving its goal of weakening the drug market in the Kingdom. However, no previous studies have been conducted in Saudi to confirm or reject this hypothesis.
Rigorous, and multidisciplinary interventional studies to evaluate the factors associated with the increasing abuse of ATS should be a priority for policymakers and researchers in Saudi Arabia. Policymakers in Saudi are highly encouraged to start investing heavily in research and investigation into the effect of different policies and programs implemented in the Kingdom. Meanwhile, harm reduction efforts should be applied to enhance the awareness level of amphetamine abusers and minimize amphetamine related-fatal risks. This can be accomplished through widespread educational and interventional programs on the risk associated with amphetamine use targeted toward the community, especially high-risk age groups. Additionally, encouraging and providing adequate culturally sensitive treatment services for individuals suffering from amphetamine use disorder should be considered. These collective efforts will contribute to a movement of breaking the taboos, establish an open debate, and promote policies that effectively decrease the number of ATS users, and would eventually prevent potential ATS-related harms.
There are several limitations to this study. First, due to the nature of the observational study, only correlations but no causal relationships can be determined between sized ATS and amphetamine use disorder admission rates. Second, the study is subject to ecological fallacy, conclusions are inferred about individuals from the results of aggregate data assuming all individual members of the two datasets have the average characteristics of the group as a whole.