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ix

EXECUTIVE SUMMARY

The World Report presents a comprehensive over- for drug dependence: only an estimated one in six problem view of the latest developments in drug markets. It covers drug users had received treatment in the preceding year. production, trafficking, consumption and related health consequences. Chapter 1 of this year’s report examines the Maritime trafficking poses challenge global situation and the latest trends in the different drug to authorities markets and the extent of illicit drug use, as well as the Given the large quantities of licit substances that make related health impact. their way across oceans and continents every day, in con- Chapter 2 addresses the phenomenon of new psychoactive tainers and even small boats, maritime trafficking poses a substances (NPS), which can have deadly consequences particularly knotty challenge for the authorities. for their users but are hard to control, with dynamic, fast- East and West Africa seem to be gaining in prominence mutating producers and “product lines” which have with regard to routes for maritime trafficking. A new mari- emerged over the past decade. time route going southwards from via ports in the Islamic Republic of Iran or is increasingly The global picture being used by traffickers to reach consumer markets Global drug use situation remains stable through East and West African ports. Since 2009, seizures of have risen sharply in Africa, especially in East On the whole, the global drug use situation has remained Africa, where they increased almost 10-fold. stable. While there has been some increase in the estimated total number of users of any illicit substance, estimates Experience has shown that a maritime seizure is consist- show that the number of drug users with dependence or ently more likely to be larger than a seizure involving trans- drug use disorders has remained stable. The increase in the port by road or rail. In fact, although maritime seizures annually estimated number of users is, to a large extent, a constitute no more than 11 per cent of all cases across all reflection of an increase in the world population. drug categories globally, each maritime seizure was on aver- age almost 30 times larger than seized consignments traf- However, polydrug use, especially the combination of pre- ficked by air. Targeted interdiction efforts by the authorities scription and illicit substances, continues to be a would enable them to seize larger quantities of drugs being concern. The misuse of and tranquillizers is of trafficked over water. particular concern, with more than 60 per cent of the countries covered in the report ranking such substances as New drug trafficking routes among the first three misused types of substances. Traffickers are increasingly looking for new routes to sup- The increasing number of NPS appearing on the market plement the old ones: new land routes for heroin smuggling has also become a major public health concern, not only seem to be emerging, e.g. in addition to the established because of increasing use but also because of the lack of Balkan and northern routes, heroin is trafficked southward scientific research and understanding of their adverse from Afghanistan via the Islamic Republic of Iran or Paki- effects. stan, leading through the Middle East via Iraq. While the Balkan trafficking route remains the most popular one, a Injecting drug use and HIV remain a decrease in the amount of heroin being trafficked on this public health concern route has been noted. New data reveal that the prevalence of people who inject Moreover, Afghan seem to be emerging as compe- drugs and those who inject drugs and are also living with tition to opiates produced and consumed in the East and HIV in 2011 was lower than previously estimated: 14.0 South-East Asia subregion, as seizures made in countries million people between the ages of 15 and 64 are estimated of that region show. to be injecting drugs, while 1.6 million people who inject drugs are living with HIV. This reflects a 12 per cent While it is clear that the African continent is becoming decline in the number of people who inject drugs and a increasingly important and vulnerable in terms of the pro- 46 per cent decline in the number of people who inject liferation of trafficking routes, the availability of data is drugs that are living with HIV since the 2008 estimates. very limited. In order to effectively monitor this worrying trend, there is an urgent need to improve the data collec- In 2011, the number of drug-related deaths was estimated tion and analysis capacity of countries in the region. at 211,000. Most of those deaths were among the younger population of users and were, to a large extent, preventable. seizures in indicate that the Atlantic remained the most commonly reported group of route may be gaining in prominence as compared with the substances involved in drug-related deaths. There contin- Pacific route in maritime trafficking; linguistic ties appear ues to be a major gap in the delivery of treatment services to play a role in cocaine trafficking from South America WORLD DRUG REPORT 2013 WORLD DRUG REPORT x WORLD DRUG REPORT 2013

to Europe via Brazil, Portugal and lusophone countries in ficking or use. Significant increases have been noted in Asia, Africa. The cocaine market seems to be expanding towards Oceania and Central and South America and the Carib- the emerging economies in Asia. bean. In Central America, intensified competition in traf- ficking of cocaine has led to growing levels of violence. Overall trends across drug categories Cocaine has long been perceived as a drug for the affluent. Opiates There is some evidence which, though inconclusive, suggests that this perception may not be entirely ground- Trends with regard to the production and consumption of less, all other factors being equal. Nonetheless, the extent opiates witnessed some major shifts. of its use is not always led by the wallet. There are examples The limited available data suggest that use (prescrip- of wealthy countries with low prevalence rates, and tion opioids, heroin and ) has gone up in parts of vice-versa. Asia (East and South-East Asia, as well as Central and West Arguably, parts of East and South-East Asia run a higher Asia) and Africa since 2009. risk of expansion of cocaine use (although from very low levels). Seizures in , , rose dramatically, Use of opiates (heroin and opium), on the other hand, to almost 600 kg in 2010, and had exceeded 800 kg by remains stable (around 16.5 million people, or 0.4 per cent 2011. This can be attributed to several factors, often linked of the population aged 15-64), although a high prevalence to the glamour associated with its use and the emergence for use has been reported from South-West and of more affluent sections of society. In the case of Latin Central Asia, Eastern and South-Eastern Europe and North America, in contrast, most of the increase appears to be America. linked to “spill-over” effects, as cocaine is widely available In Europe specifically, there are indications that heroin use and relatively cheap owing to the proximity to producing is declining, due to a number of factors, including an aging countries. user population in treatment and increased interdiction of In North America, seizures and prevalence have declined supply. Nevertheless, non-medical use of prescription opi- considerably since 2006 (with the exception of a rebound oids continues to be reported from some parts of Europe. in seizures in 2011). Between 2006 and 2011, cocaine use Production-wise, Afghanistan retained its position as the among the general population in the fell by lead producer and cultivator of opium globally (74 per 40 per cent, which is partly linked to less production in cent of global illicit opium production in 2012). While Colombia, law enforcement intervention and inter-cartel the global area under cultivation rose by 15 per cent violence. in 2012, driven largely by increases in Afghanistan and While, earlier, North America and Central/Western Europe , global opium production fell by almost 30 per dominated the cocaine market, today they account for cent, to less than 5,000 tons in 2012, mainly as a result of approximately one half of users globally, a reflection of the poor yields in Afghanistan. remained the largest fact that use seems to have stabilized in Europe and producer of opium in the Americas. declined in North America. It appears that opium production in the Lao People’s Dem- In Oceania, on the other hand, cocaine seizures reached ocratic Republic and Myanmar may not be able to meet new highs in 2010 and 2011 (1.9 and 1.8 tons, respec- the demand posed by the increasing number of heroin tively, up from 290 kg in 2009). The annual prevalence users in some parts of Asia. rate for cocaine use in for the population aged 14 years or older more than doubled from 1.0 per cent in While seizures of and heroin increased globally 2004 to 2.1 per cent of the adult population in 2010; that in 2011, declines were noted in specific regions and coun- figure is higher than the European average and exceeds the tries, including and Western and Central Europe. corresponding prevalence rates in the United States. Cocaine -type The global area under cultivation amounted to There are signs that the market for amphetamine-type 155,600 ha in 2011, almost unchanged from a year earlier stimulants (ATS) is expanding: seizures and consumption but 14 per cent lower than in 2007 and 30 per cent less levels are increasing, manufacture seems to be spreading than in 2000. Estimates of the amounts of cocaine manu- and new markets are developing. factured, expressed in quantities of 100 per cent pure cocaine, ranged from 776 to 1,051 tons in 2011, largely The use of ATS, excluding “ecstasy”, remains widespread unchanged from a year earlier. The world’s largest cocaine globally, and appears to be increasing in most regions. In seizures (not adjusted for purity) continue to be reported 2011, an estimated 0.7 per cent of the global population from Colombia (200 tons) and the United States (94 tons). aged 15-64, or 33.8 million people, had used ATS in the However, there has been an indication in recent years that preceding year. The prevalence of “ecstasy” in 2011 (19.4 the cocaine market has been shifting to several regions million, or 0.4 per cent of the population) was lower than which have not been associated previously with either traf- in 2009. 15-64) ascompared withprevious estimatesin 2009. users (180.6millionor3.9per centofthepopulationaged There wasaminorincrease intheprevalence ofcannabis remains themostwidelyusedillicit substance. feeds localmarkets. cultivation islargelylocalized and,more oftenthannot, intheworld,its country is produced inpracticallyevery and production remains adifficulttask:althoughcannabis Providing aglobalpicture oflevels ofcannabiscultivation Cannabis average. a prevalence of“ecstasy” usethatisabove theglobal North AmericaandOceania remain thethree regions with to beincreasing inEurope. In ascending order, Europe, While “ecstasy” usehasbeen declining globally, itseems pared with2010. 2011, withthetotalnumberremaining fairlystablecom- number ofamphetaminelaboratories(58versus 57)in Europe andtheUnited States reported almostthesame sisting largelyofamphetamine. largely inpillform,marketed as“captagon” pillsandcon- ticularly intheMiddle East,where isavailable thedrug Figures foramphetamineseizures have alsogoneup, par- region. market withinthe organizations inthesyntheticdrugs an increase intheinfluenceofMexican trafficking drug increased manufacturingactivityinCentralAmericaand and theRussian Federation. There isalsoanindicationof well: locationswere new uncovered, interalia,inPoland manufacture seemstobespreading as years, indicatingthatthesubstanceisanimminentthreat. increased to8.8tons,thehighestlevel duringthepastfive Seizures methamphetamine,however, ofcrystalline cent declinecompared with2010(134.4millionpills). million pillswere seized in2011,althoughthiswasa9per dominant ATS inEastandSouth-East Asiawhere 122.8 seizures in2011.Methamphetamine pillsremain thepre- ATS business;itaccountedfor71percentofglobalATS Methamphetamine continuestobethemainstayof year, thussurpassingtheUnited States forthefirsttime. doubling, from 13tonsto31tons,withinthespaceofa the largestamountofmethamphetamineseized, more than tons) andadoublingsince2005(60tons).Mexico clocked tons in2011,a66percentrisecompared with2010(74 At thegloballevel, seizures havehigh:123 risentoanew the region ishigherthantheglobalaverage. facture. The estimatedannualprevalence ofATS usein sions ofprecursors, seizures andmethamphetaminemanu- Africa, anassessmentthatisborneoutby increasing diver- South-East Asia,andthere isalsoanemergingmarket in market inAsia’s developed economies,notablyinEastand America andOceania, there seemstobeanincrease inthe While useissteadyinthetraditionalmarkets ofNorth The areas ofcannabiseradicatedincreased intheUnited tries andclimaticzones. densityfluctuateswildly, tivation anderadication,asthisvaries widelyacross coun- found. It isdifficulttocompileanaccuratepicture ofcul- and theNetherlands, alargernumberofindoorplantsare with lessfavourable climaticconditions,suchasBelgium countries withfavourable climaticconditions.In countries In Europe, cannabisisgenerallycultivated outdoorsin in theregion. herb, withNigeria reporting thelargestquantitiesseized Many countriesinAfricareported seizures ofcannabis and Morocco. declined initsmainproducing countries,i.e.Afghanistan duction ofcannabisresin seemstohave stabilizedandeven replace resin, imported mainlyfrom Morocco. The pro- indicate thatdomesticallyproduced cannabiscontinuesto zures ofcannabisresin (“”) went down. This may In Europe, seizures ofcannabisherbincreased, whilesei- herb seizures rose by 46percentin2011. Americas asawhole.In South America, reported . Cultivation alsoseemstohave goneupinthe States, possiblyindicatinganincrease inthearea under and deathsrelated tothesubstance, althoughthe“substi- which hasapositive impactonhealth-related consequences thereafter,trolled orscheduled, itsusedeclinesshortly It that,whenaNPS iscon- hasgenerally beenobserved under control. attempting toputsinglesubstances ortheiranalogues variety of methods withintheirlegislative frameworks,by Member States have responded tothischallengeusinga trolled drugs. stances orproducts intendedtomimictheeffectsofcon- an umbrella term forunregulated psychoactive (new) sub- become available inspecificmarkets. In general,NPSis inventionsto new butsubstancesthathave newly In thiscontext,theterm“new” doesnotnecessarilyrefer conventions, butwhichmayposeapublichealththreat. preparation, that are notcontrolled by internationaldrug NPS are substancesofabuse,eitherinapure formora number ofsubstancesunderinternationalcontrol (234). first time,thenumberofNPSactuallyexceeded thetotal mid-2012, anincrease ofmore than 50percent.For the UNODC rose from 166attheendof2009to251by The numberofNPSreported by Member States to psychoactive substances(NPS). the speedandcreativity ofthephenomenonknown asnew control systemisfloundering,forthefirsttime,under drug unfailing regularity scene,theinternational onthedrug harmfulsubstanceshaveWhile new beenemergingwith New psychoactivesubstances and environmental factors. depending onthecultivation method(indoororoutdoor) Executive summary xi WORLD DRUG REPORT 2013 xii WORLD DRUG REPORT 2013

tution effect” has inhibited any in-depth research on the What makes NPS especially dangerous and problematic is long-term impact of NPS scheduling. There are of course, the general perception surrounding them. They have often instances when scheduling or controlling a NPS has had been marketed as “legal highs”, implying that they are safe little or no impact. Generally, the following kinds of to consume and use, while the truth may be quite differ- impacts have been observed after the scheduling of a NPS: ent. In order to mislead the authorities, suppliers have also marketed and advertised their products aggressively and (a) The substance remains on the market, but its use de- sold them under the names of relatively harmless everyday clines immediately. Examples include in products such as room fresheners, , herbal the United and Northern incenses and even plant fertilizers. Ireland, BZP in New Zealand, “legal highs” in Poland, mephedrone in Australia and MDPV in the United Countries in nearly all regions have reported the emergence States of America; of NPS. The 2008-2012 period in particular saw the emer- (b) Use of the substance declines after a longer interval, gence of synthetic and synthetic , maybe a year or more (e.g. in the United while the number of countries reporting new phenethyl- States); amines, ketamine and piperazines declined (as compared (c) Scheduling has little or no immediate impact on the with the period prior to 2008). use of the substance, e.g. 3,4-methylenedioxy-N- Origin and manufacture methylamphetamine (MDMA), commonly known as “ecstasy”, in the United States and other countries. While most widespread in Europe and North America, NPS seem to originate nowadays primarily in Asia (East Further, there are cases of NPS disappearing from the and South Asia), notably in countries known for their market. This has also been the case with the majority of advanced chemical and pharmaceutical industries. Domes- the substances controlled under the 1961 Convention and tic manufacture has also been reported by countries in the 1971 Convention. Of the 234 substances currently Europe, the Americas and Asia. Nonetheless, the overall under international control, only a few dozen are still being pattern is one of transregional trafficking which deviates misused, and the bulk of the misuse is concentrated in a from the clandestine manufacture of controlled psycho- dozen such substances. tropic substances such as ATS, which typically occurs It is obvious that legislations to control NPS are not a “one within the same region as where the consumers are located. size fits all” solution, and there are always exceptions to Role of technology the rule. However, a holistic approach which involves a number of factors — prevention and treatment, legal The Internet seems to play an important role in the busi- status, improving precursor controls and cracking down ness of NPS: 88 per cent of countries responding to a on trafficking rings — has to be applied to tackle the UNODC survey said that the Internet served as a key situation. source for the supply in their markets. At the same time, a Eurobarometer survey found that just 7 per cent of young There is a lack of long-term data which would provide a consumers of NPS in Europe (age 15-24) used the Internet much-needed perspective: no sooner is one substance to actually purchase such substances, indicating that, while scheduled, than another one replaces it, thus making it the import and wholesale business in such substances may difficult to study the long-term impact of a substance on be increasingly conducted via the Internet, the end con- usage and its health effects. still retains a preference for more traditional retail The problem of NPS is a hydra-headed one in that manu- and distribution channels. facturers produce new variants to escape the new legal frameworks that are constantly being developed to control Spread of new psychoactive known substances. These substances include synthetic substances at the regional level and plant-based psychoactive substances, and have rapidly spread in widely dispersed markets. Until mid-2012, the With its early warning system, comprising 27 European majority of the identified NPS were synthetic cannabinoids Union countries and Croatia, Norway and Turkey, Europe (23 per cent), phenethylamines (23 per cent) and synthetic has the most advanced regional system in place to deal with cathinones (18 per cent), followed by tryptamines (10 per emerging NPS. Through the early warning system, formal cent), plant-based substances (8 per cent) and piperazines notification was provided for a total of 236 new substances (5 per cent). The single most widespread substances were during the 2005-2012 period, equivalent to more than 90 JWH-018 and JWH-073 among the synthetic cannabi- per cent of all substances found globally and reported to noids; mephedrone, MDPV and among the UNODC (251). The number of identified NPS in the synthetic cathinones; and m-chlorophenylpiperazine European Union rose from 14 in 2005 to 236 by the end (mCPP), N-benzylpiperazine (BZP) and 1-(3-trifluoro- of 2012. methylphenyl)piperazine (TFMPP) among the pipera- NPS seem to constitute a significant market segment zines. Plant-based substances included mostly kratom, already. Close to 5 per cent of people aged 15-24 have and . already experimented with NPS in the European Union, region, of allsuchsubstances equivalent toonequarter of2012intheOceania fied duringthefirsttwoquarters Europe and North America.Overall, 44NPSwere identi- NPS are alsofoundinAustralia, similartothesituationin market forpiperazines,notablyBZP. A large numberof For manyyears, New Zealand hasplayed akeyrole inthe and TFMPP, twopiperazines. CostaRicareported theemergenceofBZP tryptamine; reported theemergenceof and ofDMMA(aphenethylamine)initsmarket; Chile noids. Brazil alsoreported theemergenceofmephedrone phenethylamines and,toalesserextent,syntheticcannabi- rum mine andplant-basedsubstances,notably America orEurope. Reported substancesincludedketa- of suchsubstancesintheregion are lower thaninNorth America, even though,generallyspeaking,levels ofmisuse NPS are alsomakinginroads inthecountriesofLatin (1.6 percent). (lifetime prevalence of5.8percent),jimsonweed or reported amongtenth-gradestudentsfor (11). In anational schoolsurvey, widespread usewas (18), syntheticcannabinoids(16)andphenethylamines States. Most ofthesubstanceswere syntheticcathinones of2012, i.e. almostasmanyintheUnitedquarters In Canada,authorities identified59NPSover thefirsttwo European Union. appears tobemore thantwiceaswidespread asinthe mixtures. Use ofNPSamongyouth intheUnited States thetic cannabinoidsascontainedinSpice orsimilarherbal owingthan theuseofanyotherdrug, primarilytosyn- cannabis, useofNPSamongstudentsismore widespread Both have aseriousnegative impactonhealth.Excluding and syntheticcathinones(31in2012,upfrom 4in2009). synthetic cannabinoids(51in2012,upfrom 2in2009) (73). The mostfrequently reported substanceswere identified, i.e.twiceasmanyintheEuropean Union worldwide: for2012asawhole,totalof158NPSwere The United States identifiedthelargestnumberofNPS total duringthe2005-2010period). the mostNPSinEuropean Union (30percentofthe The United thatidentified Kingdomisalsothecountry per cent),Germany (12percent)andSpain (8percent). Union total),followed by Poland (17percent),France (14 of NPS:United Kingdom(23percentoftheEuropean five countriesaccountforalmostthree-quarters ofallusers Within Europe, Eurobarometer datafor2011suggestthat has goneup. than cannabishasremained largelystable,theuseofNPS in Europe over other the pastdecade,andtheuseofdrugs has clearlydeclinedamongadolescentsandyoung people otherthancannabis. have useddrugs While cannabis use tried cannabisandclosetoaround halfofthenumberwho which isequivalent toone-fifthofthenumberswhohave , followed by piperazines,syntheticcathinones, (2.6percent),ahallucinogenicplant,andketamine Salvia divinorum Salvia divinorum Salvia divino- and

The twomainNPSinAsiatermsofconsumptionare nabinoids andplant-basedsubstances. synthetic cathinones,piperazines,ketamine,can- 018). Japan reported theemergenceofphenethylamines, witnessed theemergenceofsyntheticcannabinoids(JWH- (3-fluromethcathinone and4-methylecathinone).Oman (including JWH-018)andsyntheticcathinones saw theemergenceofanumbersyntheticcannabinoids sia informedUNODCoftheemergenceBZP. Singapore cathinones (4-methylethcathinoneandbutylone).Indone- of syntheticcannabinoids(suchasJWH-018)and Hong Kong, China,reported theemergenceofanumber United ArabEmirates). East (Bahrain, Israel, Jordan, Oman, Saudi Arabiaand Singapore; ; Viet Nam), aswell asintheMiddle China; Hong Kong, China;Indonesia; Japan; ; mostly inEastandSouth-East Asia(Brunei Darussalam; stances wasreported from anumberofcountriesandareas, gence ofNPSwasinAsia. The emergenceofsuchsub- the second-largestnumberofcountriesreporting theemer- According in2012, undertaken totheUNODCsurvey (13) andphenethylamines(8). of2012,ledby syntheticcathinones the firsttwoquarters identified worldwide.Australia identified33NPSduring warning systems” for NPS, “emergency scheduling”, “ana- Alternative systems, suchastheestablishmentof“early States beyond their capacities. authorities, amongothers, may stretch some Member authoritiesandthehealth laboratories, import/export number ofsubstances,affecting police,customs,forensic the onusofproof. Additionally, controlling anever-larger costly —process, especiallyasitistheauthoritieswhobear Scheduling orcontrolling asubstanceislengthy—and The road ahead consequences. may causeserioushealthproblems andothersocial ofNPSandthat,intermstheirspread, the category used substances(suchaskhatoribogaine)thatfallunder in Africa. There are, however, anumber oftraditionally and consumptionofNPSappeartobelesspronounced Nonetheless, theoverall problems related totheproduction nylmethylpiperidine (2-DPMP)and4-benzylpiperidine). mine, piperazines(BZP)andothersubstances(2-diphe- but alsotheemergenceofsyntheticcannabinoids,keta- the emergenceofplant-basedsubstances( emergence ofNPStoUNODC.Egypt reported notonly Ghana, South Africa, Togo andZimbabwe) reported the In total,7Africancountries (Angola,Cape Verde, Egypt, Yemen. sumption ofkhatispresent in Western Asia,notablyin even as“ecstasy”). In addition,large-scaletraditionalcon- for several years asa substitute for“ecstasy” (andsometimes East andSouth-East Asia.Ketamine pillshave beensold ketamine andkratom,mostlyaffectingthecountriesof Salvia divinorum Executive summary

) xiii WORLD DRUG REPORT 2013 xiv WORLD DRUG REPORT 2013

logue scheduling”, “generic scheduling”, application of the “medicines law” and other creative approaches, all have their pros and cons. Most have improved the situation and have taught valuable lessons in planning for future control regimes. However, what is missing is coordination at the global level so that drug dealers cannot simply exploit loop- holes, both within regions and even within countries. The establishment of a global early warning system is needed to inform Member States of emerging substances and to support them in their response to this complex and changing phenomenon.1 While the international drug con- trol conventions offer the possibility of scheduling new substances, the sheer rapidity of emerging NPS makes this a very challenging undertaking. What is needed is an understanding and sharing of methods and lessons learned in regional responses to the situation involving NPS before exploring the setting up of a global response to the problem.

1 In its resolution 56/4 of 15 March 2013, the Commission on Drugs encouraged the United Nations Office on Drugs and Crime “to share and exchange ideas, efforts, good practices and experiences in adopting effective responses to address the unique challenges posed by new psychoactive substances, which may include, among other national responses, new laws, regulations and restrictions”.