Cultivation andproduction D. offences. drug-use offending by females,wasquitesimilarfortraffickingand class,intermsoffrequency(ranking) ofeachdrug of below 50percent.Moreover, therelative importance sonal use,buttypicallyonlymarginallyso,andstillfar for traffickingoffencesthanpossessionrelated toper- offemaleoffenderstendedtobehigher The proportion data forwomen. use andtraffickingoffences. use This conformswithdrug offemales, forbothproportions possession forpersonal tranquillizers standing out as the one with relatively high of sedatives and classes, with the category ous drug offemaleoffendersvaried significantlyforthevariportion of offenders wereone quarter female. However, that pro- 87 Lao People’s Democratic Republic in 2013 was estimated In South-East Asia, the total area under cultivation in the as pronounced asinAfghanistan. Myanmar, theincrease inthearea ofcultivation wasnot inHelmandincrease wasobserved andKandahar. ofthecountry,southern andwestern part whilethemajor of cultivation inAfghanistanwasnineprovinces inthe 154,000 ha in 2012to 209,000 ha in 2013. The main area of opiumpoppycultivation increased 36percent,from inAfghanistan,wheremain increase thearea wasobserved tivation wasseeninbothAfghanistanandMyanmar. The 1998 whenestimatesbecameavailable. Anincrease incul 2013 was296,720hectares (ha),thehighest level since The global area under illicit opium poppy cultivation in Source: 1997-2002: UNODC;since2003:NationalIllicitCrop MonitoringSystem supportedbyUNODC. Fig. 15.

2013. “Afghanistan opiumsur ofCounterNarcoticsUNODC andMinistry ofAfghanistan, OPIATES: OVERVIEW

Hectares Opium poppycultivationanderadicationinAfghanistan,1997-2013 100,000 125,000 150,000 175,000 200,000 225,000 250,000 25,000 50,000 75,000 0 vey 2013: summary findings”,vey 2013:summary November

1997 58,000 Eradication Cultivation

1998 64,000

1999 400 91,000

2000 121 82,000

2001 8,000

2002 74,000 87 In In 80,000 - 2003 21,430 - 2012 inSouth-West Asia,andfrom 6tonsin2011to4.85 cent, respectively (from 117tonsin2011to82 Europe, where seizures declinedby 29percentand19 were reported inSouth-West Asiaand Western andCentral 19 percentin2012. The maindeclinesinopiateseizures Globally, seizures of heroin and illicit morphine went down Seizures to 2008estimatesof600tons(seefigure 16). unknown purity)hasalsoincreased to560 tons, comparable (5,500 tons). The potential production of heroin (of accounts for80percentoftheglobalopiumproduction 2011 and2008. The opiumproduction inAfghanistan at 6,883tons,whichisareturn in tothelevels observed The potentialproduction ofopiumin2013isestimated different countriesandregions). details on opium poppy cultivation and production in the tivation thatbegan after2006. survey. tion satelliteimagesandtimeofconductingthehelicopter methodologyintheuseofhigh-resolu due tothevarying estimates are notcomparablewiththeestimatesof2012 as 3,900ha(range:1,900-5,800ha).However, the2013 89 88 2004 131,000 seizures declinedby 58percentinMexico butincreased 0.723 tonsreported in2011).In North America,heroin 2011) andinSouth Asia(1.3tonsin2012compared with Zealand (1.09tonsin2012compared with0.61tonsin zures alsoincreased substantiallyinAustralia andNew increased quantitiesreported seized in Turkey. Heroin sei compared with9.88tonsin2011),mainlyasaresult of Eastern andSouth-Eastern Europe (15.98tonsin2012 tial increase inheroin seizures, however, wasreported in tons in2012 Western andCentralEurope). Asubstan-

Ibid. UNODC, 2005 5,103 104,000 88

2006 15,300 165,000 Myanmar continuedthetrend ofincreasing cul Southeast Asia OpiumSoutheast Asia Survey 2013(B 2007 19,047 193,000

2008 5,480 157,000

2009 5,351 123,000

2010 2,316 123,000 89

2011 3,810 131,000 (See tablesinannexIfor

2012 9,672 154,000 angkok, 2013).

2013 7,348 209,000 D. Opiates:overview - - - 21 WORLD DRUG REPORT 2014 22 1. RECENT STATISTICS AND TREND ANALYSIS OF THE ILLICIT DRUG MARKET

Fig. 16. Global potential opium production, 1998-2013

9,000

8,000

7,000

6,000

5,000

4,000

Production (tons) Production 3,000

2,000

1,000

0 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Afghanistan Myanmar Lao People's Democratic Republic Rest of the World

Source: 1997-2002: UNODC; since 2003: National Illicit Crop Monitoring System supported by UNODC.

Fig. 17. Seizures of heroin and illicit morphine, in selected countries and by region, 2003-2012

180 Oceania 160 Africa South Asia 140 Central and South America and Caribbean Eastern Europe 120 North America 100 Central Asia and Transcaucasian countries East and South-East Asia 80 Western, Central and South-Eastern Europe Seizures (Tons) 60 Near and Middle East /South-West Asia Iran (Islamic Republic of) 40 Pakistan Afghanistan 20 Turkey 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Source: UNODC data from annual report questionnaire and other official sources.

in the United States, to 5.5 tons in 2012, compared with million past-year users. Opiate use at levels much higher 4.8 tons in 2011. However, overall heroin seizures in North than the global average of 0.4 per cent remain in South- America have remained stable over the previous year. West Asia (1.21 per cent), Eastern and South-Eastern Europe (0.82 per cent) and in Central Asia and Transcau- Extent of use casia (0.81 per cent). Past-year use of opioids, including heroin and prescription Opiates: market analysis painkillers, is estimated at between 28.6 and 38 million people globally. Compared to the global average prevalence In comparison with other plant-based drugs, the global of 0.7 per cent, opioid use remains high in North America market for illicit opiates is perhaps the most complex. In and Oceania, with prevalence rates of 4.3 per cent and 3 contrast to cannabis, illicit cultivation and production per cent respectively. While opioid use has increased glob- feeding the illicit opiate market are limited to certain coun- ally over the past year, the main increase has been observed tries and regions. Consequently, illicit opiates are neces- in the United States. Although recent and reliable estimates sarily trafficked across large distances and through multiple are not available from Asia and Africa, many experts from countries in order to meet demand. In contrast to coca countries in those regions also perceive an increase in bush, illicit cultivation of opium poppy occurs on a sig- opioid use. The use of opiates (heroin and opium), how- nificant scale in at least three geographically distinct areas ever, remained stable globally, with 12.8 million to 20.2 — South-West Asia, South-East Asia and Latin America. in keysupplyindicators,along-termperspective (taking In spiteoftheapparent complexityandthefluctuations Long-term assessment various stagesof thesupplychain. that may involve diversion from licit to illicit markets at as licitpharmaceuticalproducts, resulting inaninterplay similar,cologically very are alsowidelyavailable andused more, opiatesandotheropioids,chemicallypharma- which isthenusedinthemanufacture ofheroin. Further usedtomanufactureconsumed asisandfurther morphine, and consumptionare For intertwined. instance,opiumis concentrated regions. in certain These layers of production illicit opiatesiswidespread andcannotbeassumedto routes diversifying accordingly. Moreover, demandfor rather thanfrom several —have blurred, withtrafficking assumed tooriginateinoneofthosesource regions — of illicitopiatesinagiven consumermarket couldbe Moreover thehistoricaldelineationswhereby thesupply 90 estimates ofglobalconsumptiondatetothelate1990s. With respect tothedemandside,earliestUNODC increased from 4-9percentin1991to18-30 the illicitmarket (bothexpressed inopiumequivalents) seizures of opiates to illicitly produced opiates present in ratio (sometimesreferred toasthe“interception rate”) of supply of opiates. UNODCestimates indicate that the steadily. This increase hasasignificantimpactonglobal mately 10kgofopiumper1heroin) increased quite (aggregated by assuming a conversion factor of approxi Over thesameperiod,seizures ofillicitopiatesworldwide Afghanistan in2013isexcluded. production ofopiumpoppy, even ifthesharpincrease in trend over the period 1991-2013 was one of increasing tuations attributabletoenvironmental factors),theoverall South-West Asia(disregarding year-on-year fluc transitory margin). However, owing tothetypicallyhigheryieldsin the highlevel of1991(even exceeding itby asmall 2013, returned forthe firsttimetoalevel comparableto mar. Global cultivation reached alow around 2005andin tion returned to an increasing trend, as of 2007, in Myan significantly (reaching arecord level in2013),andcultiva- decline inthatregion, cultivation in Afghanistan increased cultivated inSouth-East Asia;following asignificant As oftheearly1990s,opiumpoppywaspredominantly in theunderlyingfundamentalindicatorsat a global level. point)reveals1991 asastarting someelementsofstability in 2012.

These calculationsare approximate andare derived by assuming that amount ofopiates present inthemarket. moving average ofopiumproduction isconsidered asaproxy forthe into heroin and in locations far removed from the source, a two-year seizures ofderived opiates,someofwhichare madeafterprocessing order toaccountforthedelaybetween theproduction ofopiumand needed for 1 kg of heroin at the point of manufacture. In addition, in at the pointof manufacture, and that a range of 7-10kg of opium are are believed to bepredominant) isnolessthanonethird ofthepurity which seizures atupper levels ofthesupplychain, in termsofweight, the weighted average purityofheroin seizures worldwide(among 90 - - - -

becoming more discernable in the big picture, had the effect seizures by law enforcement authorities worldwide, while Numerically, itwouldappearthattheimpact ofopiate only marginally, ifatall,over theperiod1998-2012. (net ofseizures) peropiateuserappearstohave increased inherent intheseestimates,theavailable supplyofopiates standing the large degree of fluctuation and uncertainty Even withoutthatadditionaladjustment,andnotwith supply wouldmove even closertothetrend indemand. would suggestthattheappropriately adjustedtrend in times ofexcess production. If suchlossesdidoccur, it take into account any possible losses that may occur in are takenintoaccount.Further, theseestimationsdonot moves closertothegrowth trend indemandonceseizures the growth in supply. However, the growth trend in supply users. That growth in demand appears to be weaker than means thatthere hasbeenanincrease inthenumberof since the global population has also been increasing, this trend intermsofprevalence rateofannualuse.However, comparable. Nevertheless, theyindicateagenerallystable being continuallyupdated,andare therefore notstrictly of thelatestavailable data,usingamethodologythatwas Those estimateshave alwaysbeenproduced onthebasis uted tothedecline inseizures along thisroute, including declined inrecent years. Various factorsmayhave contrib and EuropeTurkey, viaIran (Islamic Republic of) has Balkan route, from Afghanistanto Western andCentral It appears that the flow of heroin along the long-established European markets andtheirrelationship toAfghanistan licit markets foropioids(includingopiates). destinations, andoftheinterplaybetween theillicitand sumer markets other than the long-established European heroin from Afghanistanbecomingmore available incon cant changesintheflows ofheroin outofAfghanistan, taken intoaccount. There isgrowing evidenceofsignifi- trendsfar from static,especiallywhenshorter-term are globally inthelongterm,illicitmarket foropiatesis Although globalsupplyanddemandmaybeevening out Recent trends fore subjecttoahighdegree ofuncertainty. useareestimates ondrug basedonlimiteddataandthere - been different. Moreover, to notethatthe itisimportant oftheinternationalcommunity happened hadtheefforts tain, forthepurposesofcomparison,whatwouldhave is anassessmentoftheendresult, butitisdifficulttoascer so astokeepsupplystable.Most importantly, thispicture be excluded: thatproduction adjustedtocorrect forseizures tained asaconsequenceofseizures, buttheoppositecannot words, onepossibilityisthattheavailable supplywascon- circumstances inorder tokeepmeetingdemand.In other it couldpossiblybetheoutcomeofsupplyadjustingto gone conclusionthatthere isinfactacausalrelationship; slowly thanopiumproduction. However, itisnotafore- in linewiththegrowth indemand,whichincreased more of bringing the apparently strong growth in supply more D. Opiates:overview - - - - 23 WORLD DRUG REPORT 2014 24 1. RECENT STATISTICS AND TREND ANALYSIS OF THE ILLICIT DRUG MARKET

Evolution of main opiate supply and supply reduction indicators, 1991 2013- Global prevalence of illicit opiate use Fig. 18. Evolution of main opiate supply and Fig. a20.nd suppGlobally of prevalence illicit opiates of illicit per user, opiate use supply reduction indicators, 1991-2013 and supply199 8-of201 illicit2 opiates per user, 1998-2012

6 35 ) 1.8 1.2 5 30 1.6 1.0 1.4 1991) 25 Pe rcentage 4 19 98) 1.2 0.8 20

ne li ne 1.0 3 0.6 15 0.8 2 0.6 0.4 ( use ye ar

10 (base ex

Index (baseline Index 0.4 1 5 Ind 0.2 0.2

0 0 (percentage) rate Interception 0.0 0.0 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 199 8 199 9 200 0 200 1 200 2 200 3 200 4 200 5 200 6 200 7 200 8 200 9 201 0 201 1 201 2 lence of past- of eva lence Pr Interception ratea Available supply of opiates per past-year opiate Total opiate seizures in opium user, range (indexed) equivalents (indexed, left axis) Global population in the 15-64 age bracket Opium cultivation (indexed, left axis) (indexed, baseline 1998) Opium production (indexed, left axis) Global prevalenceª of past-year use of illicit opiates (percentage, right axis)* a The practical significance of the “interception rate” should be Global prevalenceª of past-year use of illicit approached with caution, as this concept is ultimately an abstract ratio which, depending on the context, may not always be intuitive (see foot- opiates (percentage, right axis)ᵇ note 90). Available supply of illicit opiates per past-year Source: UNODC estimates based on annual report questionnaire user, line of best fit (indexed, baseline 1998) and national illicit crop monitoring systems supported by UNODC, supplemented by other official data. Source: UNODC estimates based on annual report questionnaire, national illicit crop monitoring systems supported by UNODC and UNPD population data, supplemented by other official data. Fig. 19. Comparison of growth rates in supply Note: Comparable data is not available for 1999, 2000 and 2007-2009. of and demand for illicit opiates, 1998-2012 the success of law enforcement authorities in key transit 2.0 countries and a decline in demand in the destination 1.8 market. 1.6 Based on UNODC estimates, the number of past-year 1.4 users of opiates in Western and Central Europe may have declined by almost one third between 2003 and 2012 1.2 (from 1.6 million to 1.13 million). This is also observed 1.0 for example, in the data from Germany, where the number of people arrested for the first time for heroin use fell stead-

Index (baseline 1998) (baseline Index 0.8 ily between 2003 and 2012 — overall, by more than one 0.6 half. Even so, in 2011 and 2012, there may have been a

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 certain deficiency in the available supply of heroin (which may yet be corrected), as the purity-adjusted price of Available supply of opiates, range (indexed) heroin underwent a distinct transition between 2010 and Opium production, 2 year moving average 2011, and maintained the increased level in 2012. Indeed, (indexed relative to line of best fit) the decline in heroin flowing on the Balkan Route appears Number of opiate users (UNODC estimates) (indexed relative to line of best fit) to have been too sudden to be accompanied by a corre- sponding drop in demand. The ensuing shortfall may have Opium production (line of best fit, baseline 1998) helped trigger the development of routes serving as alter- Available opium supply (line of best fit, natives to the Balkan route — whose emergence is sug- baseline 1998) gested by other evidence — to supply Europe, possibly via Number of opiate users (line of best fit, the Near and Middle East and Africa, as well as directly baseline 1998) from Pakistan, suggesting that the so called Southern Route is expanding.91 Source: UNODC estimates based on annual report questionnaire and national illicit crop monitoring systems supported by UNODC, 91 UNODC, The illicit drug trade through South-Eastern Europe, supplemented by other official data. 2014. ber 2012 in which heroin was seized from air passengers In ananalysisof120casesintheperiodJune 2006-Octo- affected by thisflow toasignificantextent. were alsomentioned.Italy appearstobe inparticular ofprovenance,try althoughEthiopia, Kenya andUganda previous years, appearstobethemostprominent asacoun tered annuallevels ofseizures significantly higher thanin Tanzania, whichthroughout theperiod2010-2012regis- Among East-Africancountries,theUnited Republic of istan) andSouth-Eastern Europe (including Turkey). Near andMiddle East/South-West Asia(includingAfghan regions intermsofnumbermentions,following the area ofprovenance, wasamongthemore prominent such ously never beenidentifiedby aEuropean asan country Europe; incontrast,2012,EastAfricawhichhadprevi indicated asaregion ofprovenance forheroin reaching reporting years 2002-2011,Africawasonlysporadically In thereplies tothe annual report questionnaires forthe 92 tries ofprovenance inthoseitineraries. well astheNear andMiddle East,alsoappeared ascoun- countries from Africa,includingEastand West Africa,as to theyear 2012.In additiontoEuropean countries,other period, thecasesinvolving Kenya related almostexclusively appeared tobeonthedecline oversit country thattime and followed by Kenya. While therole of Turkey asatran ofprovenance,most citedcountry secondonlyto Turkey on itinerariesinvolving Europe, c b a Production: Nationalillicitcrop monitoringsystemsupportedbyUNODC. Seizure data:UNODCannualreport questionnaire supplementedbyotherofficial data. Possiblyrepresentativeofthesouthern route. Taken asrepresentative ofthenorthernroute. Taken asrepresentative oftheBalkanroute. Fig. 21.

pean airports, Germany Customs.pean airports, Data seizures from thedatabase onillicitdrug withrelation toEuro-

2003-2012 compared withheroin seizure trends inPakistanandopiumproduction inAfghanistan, IndexedIndexed heroin heroin seizures seizures (baseline (baseline 2003 2003) ) Heroin seizure trends inkeycountriesandregions routes, alongtheBalkanandnorthern 0.5 1.5 2.5 3.5 0.5 1.5 2.5 3.5 1 2 3 0 Heroin seizures in Pakistan Pakistan in seizures Heroin axis) left (indexed, Central EuropeandWestern and of), Turkey(Islamic Republic Iran in heroin seizures Total Russian Asia CentralFederation and the in heroin seizures Total Average opium production in Afghanistan in preceding two years (tons, right axis) 0 1 2 3 Heroin seizures in Pakistan Pakistan in seizures Heroin axis) left (indexed, Central EuropeandWestern and of), Turkey(Islamic Republic Iran in heroin seizures Total Russian Asia CentralFederation and the in heroin seizures Total Average opium production in Afghanistan in preceding two years (tons, right axis) Heroinseizuretrends in countries key and regionsalong Balkan the Heroinseizuretrends in countries key and regionsalong Balkan the 2003 0320 0520 0720 0921 012012 2011 2010 2009 2008 2007 2006 2005 2004 2003 and northern routes, compared with heroin seizure trends in and northern routes, compared with heroin seizure trends in Pakistanand opium production in Afghanistan, Pakistanand opium production in Afghanistan, 92 2004 Pakistan wasthesecond 2005 2006 ͨ ͨ (indexed, left axis) left (indexed, (indexed, left axis) left (indexed, 2007 - - - - 2008 supplemented byotherofficial data. Source: Seizure data:UNODCannualreport questionnaire Fig. 22. HeroinHeroin seizures seizures (tons) (tons) 10 20 30 40 50 60 10 20 30 40 50 60 2009 0 0

prominence of Turkey as a transit transit a as Turkey of prominence axis) Heroin seizures in Islamic Republic of Iran (left axis) (left and Central seizures in Western Europe Heroin axis) Heroinseizures South-Eastern in Europe (left axis) Europe Central (left of),South-Eastern Europe and Westernand Totalheroin seizuresIranin (Islamic Republic country of provenance for heroin (right axis) as Turkey identifying countries of Number prominence of Turkey as a transit transit a as Turkey of prominence Number of countries identifying Turkey as Turkey identifying countries of Number axis) Heroin seizures in Islamic Republic of Iran (left axis) (left and Central seizures in Western Europe Heroin axis) Heroinseizures South-Eastern in Europe (left axis) Europe Central (left of),South-Eastern Europe and Westernand Totalheroin seizuresIranin (Islamic Republic country of provenance for heroin (right axis) Heroin seizures in key locations locations key in seizures Heroin 2002 locations key in seizures Heroin 2002-2012 T the Balkanroute andprominence of Heroin seizures inkeylocationsalong 2002 country for heroin, country for heroin, 2010 urkey asatransitcountryforheroin, along the Balkanroute and along the Balkanroute and 20032003 20042004 ᵃ 2011 ᵃ 2003 2003 (indexed, left axis) left (indexed, (indexed, left axis) left (indexed, 20052005 - - 20062006 2012 2012 2012 20072007 20082008 2002 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 2002 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 20092009 -

2010 -

2010 2012 2012

OpiumOpium production production in inAfghanistan Afghanistan (tons) (tons) 20112011 D. Opiates:overview ᵇ ᵇ 20122012 0 5 10 15 20 25 30 0 5 10 15 20 25 30

NumberNumber of ofcountries countries 25 WORLD DRUG REPORT 2014 26 1. RECENT STATISTICS AND TREND ANALYSIS OF THE ILLICIT DRUG MARKET

Fig. 23. First-timeFirst-time arrestees arrestees for heroinfor heroin use usein Germany, in Germany, 2003-2012 2003-2012

6,000 1,600 1,400 5,000 1,200 4,000 1,000 3,000 800 (by age) 600 2,000 400 2012 time arresteestime for heroinuse

- 1,000 200 and time arresteestime for heroinuse, -

2012, breakdown by gender) 0 0 2003 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

- (2003 - <13 14-17 18-20 21-24 25-29 30-39 40+ - -

Year/ age in years Number of first

Male arrestees, by year (left axis) Female arrestees, by year (left axis) Number of first Arrestees in 2003, by age group (right axis) Arrestees in 2012, by age group (right axis) Source: Germany Bundeskriminalamt. Data on individual heroin seizure cases93 from Pakistan patterns are likely most significant to the extent that they up to the first quarter of 2012 also confirm a recently reflect a broader tendency to source heroin from a given increasing frequency of use of airports in Europe (notably region using maritime or land transportation. The number the United Kingdom), the Near and Middle East (notably, of heroin seizure cases involving sea transport reported by in 2012, Oman and Saudi Arabia) and Bangladesh Pakistan was much more limited; however, since 2009 the (although that increasing mention of Bangladesh was offset only such cases with a known destination were predomi- by decreasing mention of other countries in South Asia) nantly of shipments being sent to West and Central Africa, as a destination for heroin couriers leaving Pakistan by air. with all others destined for Western and Central Europe. However, consignments trafficked via passenger aircraft are necessarily small, and it is not clear to what extent such A distinct market for heroin, also supplied for several years trafficking can affect the flow of heroin; these emerging by heroin from Afghanistan, is that of Eastern Europe, Heroin retail prices in Western and Central Europe and the United Fig. 24. Heroin retail prices in Western andStates, Central 2003 Europe-2012 and the United States, 2003-2012 1,200 35

1,000 30 25 800 20 600 Price 15 400 10

200 5

0 0 Central Europe (percentage)

2003ᵃ 2004ᵃ 2005 2006 2007 2008 2009 2010 2011 2012 purity inEquivalent Western and Equivalent average purity (12 countries, right axis)

Purity-adjusted retail price, weighted average, 12 countries in Western and Central Europe (United States dollars per pure gram) Purity-adjusted retail price, weighted average, 12 countries in Western and Central Europe (EUR per pure gram) Nominal price (unadjusted for purity), weighted average, 12 countries in Western and Central Europe (euros per gram) Purity-adjusted retailᵇ price in the United States (United States dollars per pure gram)

Source: For European countries, UNODC annual report questionnaire, EMCDDA, European Police Office (Europol). For the United States, Office of National Drug Control Policy, United States. a For 2003 and 2004, comparable price data for the United States were unavailable. b Purchases recorded in the System to Retrieve Information from Drug Evidence (STRIDE) database of the United States Drug Enforcement Agency.

93 UNODC IDS database. If thatisthecase,itwouldbeyet anotherinstanceofthe sources whentheinfluxofheroin subsequentlydeclined. ulated ademandforopioids,whichwasmetby alternative it isplausiblethattheincreased availability mayhave stim 1998 and2004.Since then,overall seizures declined,but betweensentative route) of that was northern observed the Russian Federation andCentralAsiatogether(repre- Central Asia.Amarked increase intotal heroin seizures in tities ofheroin flowing northwards from Afghanistanvia consumer market forillicitopiates,withsignificantquan the global average. The Russian Federation remains a major where thelevels ofopiateuseare significantlyhigherthan Source: UNODCestimates basedonannualreport questionnaire andUNPD populationdata,supplementedbyotherofficial sources. a airports IDEAS,GermanCustoms. Source: Databaseonillicitdrugseizures withrelation toEuropean N Fig. 26. Fig. 25. Data for2012wereincomplete. ear andear Middle East/South WestAsia Number of cases 10 12 14 16 0 2 4 6 8 Number of cases of heroin being seized seized being heroin of of cases Number Eastern/South-Eastern Europe 2007 countries of provenance, 2007 provenance, of countries

from air with selected air passengersfrom users, 2012 Ranking ofpast-yearuseillicitopiatesbysubregion, basedonprevalence andnumberof 2007-2012 selected countriesofprovenance, in selectedEur seized from airpassengersrecorded Number ofcasesheroin being Western/Central Europe Western/Central West andCentralAfrica ey aitnTurkey Pakistan Kenya East/South-East Asia East/South-East 2008 Central Central America Southern Africa South America North America Eastern Eastern Africa North Africa Central Central Asia South Asia 2009 Caribbean Opiateusers as percentageof population aged15-64 (global, midpoint) Opiateusers as percentageof population aged15-64, subregionby (midpoint) Number past-yearof users (midpoint) Oceania Ranking of past-year use of illicit opiates by subregion, based on on subregion, based by opiatesuse of illicit of Rankingpast-year Annual prevalence of use of illicit opiates (percentage, left to right) 5,000,000 opean airportswith 2010 0.0 Number past-yearof users illicit of opiates (right to left) 4,000,000 2011 - 2012a prevalence and number of users, users, number2012 andof prevalence 2012a 3,000,000 0.5 a

- - 2,000,000 Although opiate use, particularly theuseofopium,isnot Although opiateuse,particularly only 6percentoftheglobalpopulationaged15-64years. West Asia,inspite ofthefactthatregion accountsfor live inthesubregion oftheNear andMiddle East/South- Approximately onefifthofillicitopiateusersworldwide Other markets andnewflows through Pakistan ficked inlargequantities. desomorphine istypicallyhome-madeandnotusuallytraf 65 gof heroin in 2012 and 55 g in 2011) confirms that was low (8.2gin2012and3.52011,compared with fact that the average quantity per seizure of desomorphine four seizuresheroin seizures for every in that country.) The 2011, there hadbeenapproximately three desomorphine seizures intheRussian Federation. (For comparison,in mately one desomorphine seizure three for every heroin in termsofnumbercases,2012there wasapproxi small incomparisonwiththequantitiesofseized heroin, 2011 and95kgin2012.Althoughthesequantitiesare from pharmaceuticalproducts —amountingto100kgin 95 94 per centin2013. estimated tohave risenfrom 0.7percentin2006to1.0 In Pakistan, theannualprevalence ofregular opiate use is other opioids) close to this major source of illicit opium. increase intheuseofopiates(and,by association,possibly production inAfghanistanmayhave brought aboutan inthatregion,new itisplausiblethatthehigh levels of In 2011and2012, interaction between the licit and illicit markets for opioids. a substituteforheroin thatcanbederived relatively easily Russian Federation reported seizures of desomorphine —

Pakistan, report”. 2013:technicalsummary UNODC andPakistan, ofNarcotics Ministry Control, “D sian Federation for2012. UNODC, annualreport questionnaire, replies 1.0 1,000,000 95 With reference totheperiod21March 94 inadditiontoseizures ofheroin, the West and Central Africa Western/ Central Europe North America Eastern/South-Eastern Europe South Asia Near and Middle East/South WestAsia East/South-East Asia Central America Oceania Caribbean South America East Africa Southern Africa Central Asia - 1.5

North Africa submitted by the Rus - D. Opiates:overview rug usein rug - - 27 WORLD DRUG REPORT 2014 28 1. RECENT STATISTICS AND TREND ANALYSIS OF THE ILLICIT DRUG MARKET

2011-19 March 2012,96 experts in the Islamic Republic total for China for that year. It is likely that these quanti- of Iran, a country with relatively high rates of opium use, ties originate in Myanmar, in line with the increasing trend perceived an increase in both opium and heroin use. in opium poppy cultivation in this country in recent years. With respect to Afghanistan, a recent study97 conducted More broadly, South-West Asia (or countries therein) has by the United States Government found high (in compari- recently been mentioned as a source of heroin with increas- son with other countries) levels of use or exposure in the ing frequency by countries in South-East Asia, including urban population of Afghanistan (overall and among both Indonesia and Malaysia, both of which have registered men and women), with 2.6 per cent of the urban test increasing heroin seizures since 2006. Malaysia in particu- population (of all ages) testing positive for opioids (includ- lar has a significant market for heroin, with a relatively ing pharmaceutical opioids). Users of opioids in the form high level of heroin use (although declining according to of opium and heroin were predominantly men, while expert perception101), and an increasing inflow of heroin, women predominantly used codeine. Even a relatively high trafficked via sea and air cargo, facilitated by groups with proportion of children tested positive for opioid use ties to Pakistan (possibly in collusion with West African (including heroin): the study indicates that some 1.3 per groups active mainly in Malaysia in the trafficking of meth- cent of urban children were exposed to an opioid present amphetamine and cocaine) and intended for both the local in their physical environment or had been given the drug market and for onward trafficking.102 by an adult. Nevertheless, the main source for heroin in Malaysia likely Although the annual prevalence of use of illicit opiates in continues to be Myanmar.103 In addition to heroin, it East and South-East Asia is estimated to be significantly appears that the use of morphine is, or at least was in 2010, below the global average, this subregion accounts for widespread in Malaysia; moreover, in recent years, authori- approximately one fifth of all users globally, mainly by ties have dismantled a number of clandestine laboratories virtue of the large population of China. In the past, the processing heroin (seven in 2011), apparently producing heroin market in China was supplied mainly from South- a low purity end product.104,105 The fact that heroin sei- East Asia; although Myanmar in particular continues to zures in Pakistan have increased markedly since 2009, inde- be a major source country for heroin reaching China, it pendently of the trend in opium production in Afghanistan appears that around 2006, a surplus of heroin from and in contrast to seizures in key countries along the Afghanistan started to find its way to China, via Pakistan Balkan and northern routes, suggests a major transforma- and other countries in South-East Asia.98 By 2007, the tion in the flows out of Afghanistan, with Pakistan playing number of registered heroin users in China, which had an important role. declined in 2005, was on the increase, and heroin seizures in China followed a similar pattern, with a slight delay, Given the extensive coastline of Pakistan on the Indian which could be attributable to a time lag as law enforce- Ocean and that maritime channels generally provide the ment authorities adjusted their efforts to the changing flow. possibility of trafficking large quantities over long dis- tances, it is likely that significant quantities of heroin are This evidence does not immediately translate into a con- trafficked by sea out of Iran (Islamic Republic of) and clusion that heroin use in China is on the rise, especially Pakistan. Seizures by the Pakistan Anti-Narcotics Force since some of these indicators could reflect drug supply (one of several law enforcement agencies in Pakistan) at and demand reduction efforts rather than supply itself; seaports reached almost 1.2 tons in 2013, more than indeed, the latest UNODC estimates suggest that annual double the annual amounts throughout the period 2010- prevalence of opiate use in China (in 2012) is lower than 2012.106 Reports of individual seizure cases also corrobo- previously thought (0.19 per cent of the general popula- tion aged 15-64, compared with 0.25 per cent in 2005). However, it seems clear that the share of heroin in the 101 UNODC, Patterns and Trends of Amphetamine-Type Stimulants and Chinese market originating in South-West Asia continues Other Drugs: Challenges for Asia and the Pacific (November 2013). to increase, as has also been indicated by Chinese 102 Ibid. authorities,99 who detected 98 instances of heroin traffick- 103 Malaysia assessed the proportion of seized heroin originating in Myanmar at 80 per cent in 2010. For the reporting year 2011, ing from South-West Asia in 2012 and 148 cases in Malaysia mentioned the Lao People’s Democratic Republic, Myanmar 2013.100 Heroin seizures in the Chinese province of and Pakistan as the main countries of provenance. Over the period Yunnan (bordering Myanmar), continued to increase, 2010-2012, Myanmar nationals accounted for the largest number of foreign nationals arrested for drug-related offences in Malaysia. See reaching 5.4 tons in 2012, constituting 74 per cent of the also UNODC, Patterns and Trends of Amphetamine-Type Stimulants, p. 92. 96 Solar Hijri calendar year 1390. 104 UNODC, Patterns and Trends of Amphetamine-Type Stimulants (November 2013). 97 United States, Department of State, Afghanistan National Urban Drug Use Survey (ANUDUS) (December 2012). 105 Country report submitted by Malaysia to the Thirty-seventh Meeting of Heads of National Drug Law Enforcement Agencies, Asia and the 98 World Drug Report 2011, pp. 73 and 74 and fig. 42. Pacific. 99 China, National Narcotics Control Commission, 2013 Annual Report 106 Pakistan Anti-Narcotics Force “Heroin and precursors trafficking on Drug Control in China (Beijing, 2013). through southern route”, presentation made at the UNODC work- 100 Ibid., 2014 Annual Report on Drug Control in China (Beijing, 2014). shop on Afghan opiate trafficking through the southern route, held origin fortheheroin traffickedinthosecases. of waters have confirmedthatAfghanistanisthecountry by theCombined Maritime Forces seizures inexcess of100kgeach)in2012and2013made analysisofseveral largeheroin seizurestory (atleastfive andPakistan. Labora- coast ofIran (Islamic Republic of) being transferred for maritime conveyance on the southern regions inAfrica,reinforces theevidencethatheroin is zures intheIndian Ocean, andcoastal aswell asinseaports significantsei international forces onspecific,particularly mation from nationallawenforcement agencies climbed torecord levels in2010and2011.Further infor- the increase wasmore also gradual,buttheproportion than inanyprioryear. In termsofthenumberseizures, record level in2009andsincethen,hasremained higher seizures madeby authoritiesofPakistan) rose sharplytoa ofprovenancestan wasmentionedasacountry (including of total weightproportion seized in cases for which Paki- consignments known tohave beentraffickedby sea,the on alimitednumberofofficiallyreported seizures ofheroin rate those maritime patternsofheroin trafficking. Based 109 108 107 database, Office oftheNationalNarcotics Control CommissionofChina(annualreports). Source: UNODCannualreport questionnaire, National illicitcrop monitoringsysteminAfghanistansupportedby UNODC,UNODCIDS Fig. 27.

operations in theIndian Ocean, made at the UNODC workshop on Presentation by theCombinedMaritime Forces oncounter-narcotics bodies ofwater. shippinglanesin the Indianmost important Ocean and adjoining operates ininternationalwaters,encompassing someoftheworld’ Combined Maritime Forces that is amultinationalnaval partnership Afghan opiatetrafficking,March 2014. trafficking: Nigeria’s experience”, madeattheUNODCworkshop on the National Drug LawEnforcement AgencyofNigeria on“heroin Republic of Tanzania andby on heroin trafficking inthecountry Presentations b on 24and25March 2014.

supply inSouth-West Asia,2002-2012 Indicators ofheroin useandsupplyinChina,compared withselectedindicatorsofopiate y the Drug Control Commission of the United Proportion of consignmentsᵃ with planned destination in East and South East Asia (percentage) China China (including Hong Kong) planned as destination (bynumber, left axis) planned destination in rest the of East and South-East Asia (by number, left axis) Heroinseizures inPakistan, indexed(baseline 2002, rightaxis) Heroinseizures inChina, indexed (baseline 2007, rightaxis) Registeredheroin usersinChina indexed(baseline 2007, rightaxis) Percentage of reported heroin consignments trafficked air by seized by Pakistan Percentage of reported heroin consignments trafficked air by seized by Pakistan Production opiumof inAfghanistan, indexed (baseline2002, right axis) 10 20 30 40 50 0 0220 0420 0620 0820 0021 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 108 ininternational 109 107 and - s

of “brown sugar” (alsoreferred toas“low-quality heroin”) diversion ofopiumfrom licitcultivation andmanufacture of opium poppy in some pockets within India, suspected Moreover, Indian authoritiesalsoindicateillicitcultivation annual report questionnaire). itself (according toinformation submitted by India in the most of the remainder (54 per cent) originated in India seizures inIndia in2011wasassessedat45percent,while South-West oftotalheroin Asianoriginasaproportion of $72,bothinthesameyear). The share ofheroin of Western andCentralEurope andweighted by population, States and an average price, taken from 17 countries in per gramofheroin from South-West AsiaintheUnited gram, as of 2011, compared with a range of $100-$400 in India (reported to be the equivalent of $8.6-$13 per markets thanIndia, given therelatively low priceofheroin Asia. These destinationsare presumably more lucrative tions suchasEurope, theUnited States andSouth-East stan border andtendstobetraffickedonward todestina- from South-West Asia reaches India across the India-Paki the 2011UNODCannualreport questionnaire) heroin Pacific, andthereply submittedby India inresponse to National Drug LawEnforcement Agencies,Asiaandthe mitted by India to MeetingThirty-seventh ofHeads of According toIndian authorities nating inbothSouth-East AsiaandSouth-West Asia. in the15-64agebracket,isexposedtoillicitopiatesorigi India, withalmost18percentoftheworld’s population Afghan opiatetrafficking, March 2014. ( i.e. country report sub i.e. country 0.0 0.5 1.0 1.5 2.0 2.5 ᵃ ᵃ with with with Index D. Opiates:overview - - - 29 WORLD DRUG REPORT 2014 30 1. RECENT STATISTICS AND TREND ANALYSIS OF THE ILLICIT DRUG MARKET

Access to pain medication As stated in the International Narcotics Control Board (INCB) annual report for 2009, “One of the fundamental objec- tives of the international drug control treaties is to ensure the availability of narcotic drugs and psychotropic substances for medical and scientific purposes and to promote the rational use of narcotics drugs and psychotropic substances”. While opioids are essential in the management of pain experienced by millions of people who might be suffering from late-stage cancers, AIDS, surgical procedures and other debilitating diseases and conditions,1 they are also susceptible to abuse.2 This means that countries face the challenging task of balancing two public health needs: ensuring the availabil- ity of these controlled substances for medical purposes and preventing their misuse and diversion. Many countries have expressed concern about misuse, and available data show a high prevalence of misuse of prescription opioids in some countries. This includes the high-income countries,3 such as Australia, Canada and the United States that have high per capita consumption of opioids for medical purposes, and even lower-middle-income countries such as Nigeria and Pakistan, which have the lowest per capita consumption of opioids for medical purposes.4 That suggests that the dynamics of misuse of prescription opioids does not necessarily follow making opioids accessible or available for medical purposes.5 As a response to potential or real misuse of these medicines, many countries, contrary to the provisions of the drug control conventions, have laws and regulations that are unduly restrictive or burdensome,6 resulting in a situation where a large part of the population does not have access to most of the opioid medications commonly used for the treatment of pain and dependence syndrome.7 Globally, in 2011, the opioid consumption for medical purposes in morphine equivalence (ME) per person was 61.66 milligrams (mg) per person.8,9 This comprises six main opioids: fentanyl, hydromorphone, methadone, morphine, oxy- codone and pethidine. However, there is a great disparity among levels of consumption and accessibility of pain medica- tions. The high-income countries, which comprise 17 per cent of the global population, account for 92 per cent of the medical morphine consumed, whereas more than half of the countries that reported to INCB in 2011 had consumption levels of less than 1 mg of morphine per person. Comparison of per capita opioid consumption in morphine equivalence among lowest and highest consumption countries, 2011 Lowest consumption countries Highest consumption countries (mg per capita of morphine equivalence) (mg per capita of morphine equivalence) Nigeria 0.0141 Canada 812.1855 Myanmar 0.0152 United States 749.7859 Pakistan 0.0184 Denmark 483.1678 Australia 427.1240 Source: Pain and Policy Studies Group, University of Wisconsin-Madison. A survey conducted by INCB in 2011 found that the laws and regulations in place for control of pain medications in many countries were unduly restrictive or burdensome and were perceived to be a significant limitation on availability. Other impediments to accessibility to pain medication included insufficient training of health-care professionals in the recognition and management of pain, and economic and procurement impediments such as deficiencies in drug supply management due to low financial resources or low priority given to health care, among other areas.

1 WHO, Ensuring Balance in National Policies on Controlled Substances: Guidance for Availability and Accessibility of Controlled Medicines (Geneva, 2011). 2 UNODC, discussion paper based on a scientific workshop, entitled “ Ensuring availability of controlled medications for the relief of pain and preventing diversion and abuse: striking the right balance to achieve the optimal public health” (Vienna, 2011). 3 Based on the World Bank classification of income levels and development. 4 The annual prevalence of misuse of prescription opioids is as follows: Australia, 3.1 per cent; Canada, 1 per cent; Nigeria, 3.6 per cent; Pakistan, 1.5 per cent; and United States, 5.2 per cent. 5 B. Fischer and others, “Non-medical use of prescription opioids and prescription opioid related harms: why so markedly higher in North America compared to the rest of the world?” Addiction, vol. 109, No. 2 (February 2014), pp. 177-181, and the related debate. 6 Report of the International Narcotics Control Board on the availability of internationally controlled drugs: ensuring adequate access for medical and scientific purposes (United Nations publication, Sales No. E.11.XI.7), para. 131. 7 UNODC, discussion paper entitled “Ensuring availability of controlled medications for the relief of pain”. 8 INCB data on global per capita opioid consumption, 2011. 9 Pain and Policy Studies Group, “Global opioid global consumption, 2011” (University of Wisconsin-Madison), available at www.painpolicy.wisc. edu/2011-global-regional-and-national-opioid-consumption-statistics-now-available. 113 in West andCentralAfricaisabove theglobalaverage, authorities. The estimatedannualprevalence ofheroin use tries, whichalsoextendstodatafrom lawenforcement is aconsequenceofthepaucitydatafrom Africancoun between 0.92millionand2.29million. That broad range the number of past-year users of opiates is estimated at In Africa, aside from its increasing role as a transit area, territory. Asia asbeingamongthesources forheroin reaching their and boththosecountrieshave longindicatedSouth-West although theflow toSri Lankahasreportedly declined, countries in South Asia, such as Bangladesh and Sri Lanka, Moreover, heroin originatinginIndia alsoreaches other market. of licitly produced into the illicit opium portion diverted domestic origin,quiteplausiblyderived from aminorpro consumer market inIndia ismainlysuppliedby heroin of by indigenousgroups. 116 115 114 112 111 110 to highlevels ofheroin production inMexico andMexican of heroin continuedtoincrease inthat country, likelydue According totheUnited States, in2012,theavailability Federal Police were ofSouth-West Asianorigin. of heroin samplesfrom seizures analysedby theAustralian and inthefirstsixmonthsof2012,approximately onehalf average. According toAustralian authorities, ania isestimatedtobemore thanfourtimestheglobal low. However, theannualprevalence ofopioiduseinOce In Oceania, theannualprevalence ofopiate useisrelatively via EastAfricaandtheNear andMiddle East. market, derivingitsheroin supplyfrom South-West Asia naire, South Africaisalsobelieved tobeamajorconsumer the latest available responses to the annual report question trafficking by air, notablythrough Nigeria. those subregions beinglongassociatedwithsmall-scale

Bangkok 21-24October 2013. of National Drug LawEnforcement Agencies,AsiaandthePacific, Australian Crime Commission,Illicit Data R Drug betw Each year oftheperiod2002-2012,Nigeria consistentlyranked See UNODC,World Repor Drug UNODC, annualreport questionnaire, replies submittedby Bangla Repor Country Report by IndiaCountry tothe Thir of National Drug LawEnforcement Agencies,AsiaandtheP Report by IndiaCountry to the Thirty-seventh Meeting of Heads for inboundseizures and70percentforoutbound seizures. 90 percent;in2012,thecorresponding was25percent proportion thathadbeentraffickedby airin2004tobe heroin onitsterritory declined to3percentby 2011.Nigeria assessedthepercentage of other than Pakistan, this number peaked at 51 per cent in 2004 and as apercentage of allsuchseizure caseswithaknown destination consignments traffickedby airwithNigeria asadestination;expressed heroin. Over theperiod2000-2011,Pakistan reported 681heroin annual report questionnaire ascountriesofprovenance oftrafficked ment Agencies,AsiaandthePacific. the MeetingThirty-seventh ofHeads ofNational Drug LawEnforce- desh, India report submittedby andSri India Lanka;andcountry to Bangkok 30October –2November 2012. National Drug LawEnforcement Agencies,AsiaandthePacific, Bangkok 21-24October 2013. een eighth and twelfth among all countries mentioned in the 113 t by India to the Thirty-seventh Meeting of Heads 110, 111 t 2013,pp. 33-35. Thus, itappearsthatthe ty-sixth Meeting ofHeads of eport 2011-12. eport 115 116 Based on in2011 acific, 114 112 - - - - -

in some countries and the manufacture of heroin in In LatinAmerica,despite illicit cultivation of opium poppy above). sumer market, is ofSouth-West Asianorigin(asdiscussed small inrelation tothesize oftheNorth Americancon reaching North Americafrom India, whileprobably still to theUnited States; itisplausiblethattheflow ofheroin both indicatedthatthere wasaflow ofheroin from India flow ofheroin from Canada.India andtheUnited States However, theUnited States hasnotreported asignificant to other countries, such as the Unitedexport States. in theuseofheroin across Canada,aswell aspossible 2013, andreported thatthiscouldbeduetoaresurgence of2012andinearly commercial airlines inthelatterpart increase inthenumberofheroin seizures from courierson enance forheroin reaching itsmarket, mentionedan and India asbeingamongtheprominent countriesofprov quantities. Canada,whichcontinuestoidentifyPakistan may bereaching theNorth Americanmarket inlarger inating inLatinAmerica,heroin from South-West Asia increase inheroin overdose deaths.Apart from heroin orig metropolitan areas intheUnited States experienced an traffickers expandinginto“white heroin” markets. 119 118 117 in theexpression ofthegenesbraincells. and persistent because it is related to significant changes by theopioid.Once established,that mechanismisstable being driven by normalliferewards orsalientstimulibut the opioid substance, with motivational reactions no longer “normal” mood. The entire reward systemishijackedby longer obtainareward butare aimingtore-establish a ance untilapointatwhichpeopleusingtheopioidno The rewarding effectisprogressively modulatedby toler- any negative consequence. dependence, seekingtoobtainthesubstanceinspiteof sive behaviourthatisthemaincharacteristicofopioid vulnerable individualsdevelop anuncontrollable compul pleasure and sedation. followeddescribe aninitialrush by feelingsofwarmth, able responses related tothebraindopaminerelease. Users  effect thatoccurs when the active compound binds tothe of opioid addiction Atis the powerful the heart rewarding pharmaceutical opioiduse The interplaybetweenillicitand heroin in2012. accounted forlessthan3percentofglobalseizures of America, CentralAmericaandtheCaribbeancollectively States, theprevalence ofopiateuseisrelatively low. South Colombia andMexico, destinedmainlyfortheUnited -opioid receptor, triggeringacascadeofintensepleasur-

europa.eu. EMCDDA, Drug profiles, heroin. Available fr for 2012. UNODC, annualreport questionnaire, replies submittedby Canada United States for2012. UNODC, annual report questionnaire, replies submitted by the 119 Once regular use is established, om www.emcdda. D. Opiates:overview

117 Some 118 - - - -

31 WORLD DRUG REPORT 2014 32 1. RECENT STATISTICS AND TREND ANALYSIS OF THE ILLICIT DRUG MARKET

Fig. 28. Price of heroin and past-month prevalence of use of OxyContin and heroin in the United States, January 2006-December 2012

1,400 0.30

1,200 0.25 1,000 0.20 800 0.15 600 0.10 400

Purity-adjusted price Purity-adjusted 0.05

200 (percentage) eva lence Pr 0 0.00 ars per gram) per do ll ars States (United p0 6 p0 7 p0 8 p0 9 p1 0 p1 1 p1 2 Jul-Se Jul-Se Jul-Se Jul-Se Jul-Se Jul-Se Jul-Se Jan-Mar06 Jan-Mar07 Jan-Mar08 Jan-Mar09 Jan-Mar10 Jan-Mar11 Jan-Mar12 Annual estimate of past-month prevalence of OxyContin use among population aged 12 or older (percentage, right axis) Annual estimate of past-month prevalence of heroin use among population aged 12 or older (percentage, right axis) Annual estimate of past-month prevalence of heroin and OxyContin use among population aged 12 or older (percentage, right axis) Average quarterly STRIDE heroin price, United States dollars per pure gram (left axis) Average annual STRIDE heroin price, United States dollars per pure gram (left axis) Source: Office of National Drug Control Policy, US Government and data from National Surveys on Drug Use and Health (NSDUH) of the Substance Abuse and Mental Health Services Administration and extracted from SAMHDA (Substance Abuse and Mental Health Data Archive) hosted by the Inter-university Consortium for Political and Social Research at the University of Michigan.

The use of multiple opioids is common among dependent and prescription opioids are strongly interconnected.123 users, who may choose one or the other depending on fac- tors such as the local accessibility, availability and price of In the United States, the shift in the opioid market towards the opioids. heroin is also evidenced by high availability and lower prices of heroin. Also, fluctuations in the heroin market, In the United States, where over 5 million people abused reflected in the price of heroin since 2007, appear to have prescription pain relievers in 2010,120 those with the most compensated for the use of other opioids, notably Oxy- severe dependency on pharmaceutical opioids were found Contin, with the price of heroin correlating strongly with to be 7.8 times more likely to have used heroin in the past the past-month use of OxyContin (see figure 28). year.121 In 2012, people in the United States who had ever used heroin were almost five times more likely to have used In line with these findings, according to the United States pain relievers, for other than medical purposes, than people Drug Enforcement Agency, law enforcement officials in the general population, and about one third had mis- nationwide have noted prescription opioid abusers switch- used OxyContin, a commercial brand of oxycodone. Con- ing to heroin because it was cheaper and/or more easily versely, among people who had ever used OxyContin, obtained than prescription drugs. Given the variable levels almost one quarter had also used heroin.122 Another study of heroin purity, the replacement of heroin with prescrip- compared admissions rates for overdoses from prescription tion opioids is also fraught with risks of overdose. In several opioids and heroin between the years 1993 and 2009 and places in the United States, heroin overdoses have increased found that overdose from one strongly predicted an over- substantially. For example, in Minneapolis-Saint Paul, dose from the other — evidence that the markets of heroin overdoses tripled in the span of one year, rising from 16 overdoses in 2010 to 46 overdoses in 2011.124

120 United States, Department of Health and Human Services, National These changes in the heroin market have been concurrent Institute on Drug Abuse, “Topics in Brief: Prescription Drug Abuse” with national measures to control the misuse of prescrip- (December 2011), available at www.drugabuse.gov/publications/ topics-in-brief/prescription-drug-abuse. tion drugs. In 2010, OxyContin was modified to make it 121 C. M. Jones, “Heroin use and heroin use risk behaviors among non- a controlled-release formulation so that it could no longer medical users of prescription opioid pain relievers — United States, 2002-2004 and 2008-2010”, Drug and Alcohol Dependence, vol. 132, Nos. 1 and 2 (September 2013), pp. 95-100. 123 G. J. Unick and others, “Intertwined epidemics: national demo- 122 UNODC estimates based on data from the National Survey on Drug graphic trends in hospitalizations for heroin-and opioid-related over- Use and Health of the Substance Abuse and Mental Health Services doses, 1993-2009”, PLOS ONE, vol. 8, No. 2 (2013). Administration and extracted from the Substance Abuse and Mental 124 United States, Department of Justice, Drug Enforcement Adminis- Health Data Archive, hosted by the Inter-university Consortium for tration, “National Drug Threat Assessment Summary” (November Political and Social Research at the University of Michigan. 2013). 127 126 125 drug. treatment listed fentanylas their primary amphetamine: ates andheroin toillicitlymanufactured fentanyland usershave switchedfrominjecting drug home-madeopi- of prescription opioids.In Estonia,over thepastdecade, Europe appearstohave resulted inanincrease intheuse In contrast,thedeclining availability of of heroin inparts doubled. tanyl and hydromorphone use went up and heroin use had 35.6 per cent to 12.8 per cent), but as a replacement, fen- decrease inOxyContinmisuseamongtheclients(from after theformulationchangefound that ithadledtoa undergoing treatment foropioiddependencebefore and heroin. AUnited States-based studyof2,566patients were foundtobe switching to other opioids, including tion period(2009-2011),duringwhichOxyContinusers these measures canalso beseeninastudyover thetransi- or injected. andsnorted be crushed Tangible impactsof Research attheUniversityofMichigan. hosted bytheInter-university ConsortiumforPoliticalandSocial SAMHDA (SubstanceAbuseandMentalHealthDataArchive) Mental HealthServicesAdministrationandextractedfrom on DrugUseandHealth(NSDUH)oftheSubstanceAbuse Source: UNODCestimatesbasedondatafrom NationalSurveys Fig. 29.

Information provided by Estoniaintheannualreport questionnair (Lisbon, N EMCDDA, “Fentanyl inEurope: EMCDDA trendspotter study” formulation ofOxyContin”, New England Jour Cicero T. J.,Ellis M.S. and Surratt H.L.,“Effect ofabuse-deterrent (2012). 367 (2012),pp. 187-189. Past-month prevalence of heroin use 125

(percentage) OxyContin use in the United States, population aged outlier year 2007) year outlier bothheroin and OxyContin (not considering Line ofexcluding best fit, past monthusers of bothheroin and OxyContin Line ofexcluding best fit, past-monthusers of OxyContin Excluding past-monthusersboth of heroinand OxyContin Including past-month users of both heroin and Correlationof heroinuse versus 0.04 0.06 0.08 0.10 0.12 0.14 past-month prevalence among OxyContin useintheUnitedStates, Correlation ofheroin useversus population aged12orolder ovember 2012). past 126 .501 .502 0.25 0.20 0.15 0.10 0.05 in2012,87.5percentoftheclients - Past month prevalenceamong - month prevalence of Oxycontin use use Oxycontin of prevalence month 2007 2012 (percentage) 12 or older, nal ofMedicine , vol. , 2006-2012 2006

- 127

Also, e 133 land suggestthatdomestically produced “home bake” — a cost 40-50Australian dollars. an equivalent amountofheroin atretail priceswouldhave 60 mgofoxycodone cost20-30Australian dollars,while Australia, in 2011 and 2012 shows that a tablet containing of pricedata forheroin andoxycodone in Queensland, cantly, displacingmorphineinsomecases. substitute. In particular, useofoxycodone increased signifi and someconsumersresorted toprescription opioidsasa patterns, supply drop and a consequent change in consumption land. In 2001, the heroin market in Australia a underwent inAustraliaA similartrend canbeobserved andNew Zea- taining codeine. preparation made from over-the-counter medicines con such asacetylatedopiumanddesomorphine,ahome-made replacement withlocalandreadily available substances Federation, decreased availability ofheroin ledtoitspartial heroin inEstoniaandFinland. reports thatfentanylandbuprenorphine have displaced related tofentanylanditsderivatives. in overdose deathsinEstonia,80percentofwhichwere between 2011and2012,there wasa38percentincrease 134 132 131 129 128 in other regionsopioid use can be observed for which These trends intheoverlap ofheroin andprescription heroin.alternative tocostlyimported involving prescription painkillers — remains a cheaper locally produced substancemadefrom achemicalprocess 130

280-284. Australia”, and others,“Prescription ofopioidanalgesics andrelated harmsin on medicalprescriptions ofthesesubstances.See Amanda Roxburgh ferentiated intoappropriate prescribing useandnon-medical use— p. 69.Similar trends alsoemergefrom data—whichcannotbedif- in intheAustraliansurveyed Illicit Drug Reporting System, presented former. lars per100mg),despitethegreater size ofthepurchase unitofthe was doubletheper-unitpriceof“homebake” (50 New Zealand dol- heroin duringthereporting yearsof imported 2011and2012,which (approximately 807United States dollars,using2012exchange rates) New Zealand reported aprice of1,000Ne ian Crime Commission,Illicit Data Report Drug 2011-12. higher relative to oxycodone. Price and purity data from the Austral- tion (ifitcouldbequantified)wouldrender thepriceofheroin even discount” possiblyarisingfrom thisdiscrepancy, butsuchacorrec- of bulkingagents). The comparisondoesnotcorrect forthe“bulk higher than the relevant purchase unit for oxycodone (60 mg, net would beequivalent to121-151mgofpure oxycodone, whichis times thatofoxycodone. Under thoseassumptions,0.25gofheroin quantities notlargerthan2g),andapotencyforheroin of2.67-3.33 purity inQ ofagramheroin inQueensland,quarter takingintoaccounta This comparisonisbasedonapriceof100Australian dollarsfora Assessment based Research Centre, University ofNew South Wales, 2013). in Australia, 2001to2013(Sydney, National Drug andAlcohol Amanda Roxburgh andothers,Trends U inDrug World Report 2013. Drug Report oftheInt EMCDDA, “Drugnet Europe 85”(Januar INCB/2012/1). Trends Use inDrug andRelated Harms inAustralia, 2001to2013, 131 inwhichmostindicatorsofheroin usedeclined Medical Journal ofAustralia, vol. 195,No. 5(2011),pp. ueensland of18.1percent(median)attheretail level (for 130 ernational Narcoticsernational Control Board for 2012 on data on morphine and oxycodone injection 133 129 Price datafrom New Zea- Similarly, intheRussian w Zealand dollarspergram 134 y-March 2014). 132 128 se andRelated Harms D. Opiates:overview A comparison Acomparison INCBnow (E/ - - 33 WORLD DRUG REPORT 2014 34 1. RECENT STATISTICS AND TREND ANALYSIS OF THE ILLICIT DRUG MARKET

limited data are available. In Afghanistan, a survey in urban Fig. 30. Coca bush cultivation 2003-2012 households showed that over half the women surveyed who reported opioid use (64 per cent) were combining heroin 200,000 and/or opium with pharmaceutical painkillers, and 9 per 175,000 cent of opioid-using women used only a prescription 150,000 opioid.135 In recent years, the misuse of tramadol (a lower 125,000 potency opioid) has also been reported.136 in parts of 100,000 75,000 Africa, the Middle East and Asia. Hectares 50,000 What is clear is that the people who are dependent on 25,000 opioids will move between the different opioids, inter- 0 changing one for another, all the while increasing their

risks of serious health consequences. However, in the pres- 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 ence of accessible and evidence-based treatment, the situ- Bolivia (Plurinational State of) ation can be prevented, while supply reduction efforts Peru alone are likely to induce a balloon effect where one con- Colombia trolled substance is replaced by another. Source: Bolivia: 2002: CICAD and US Department of State, INCSR. Since 2003: National Illicit Crop Monitoring System sup- ported by UNODC. Colombia: National Illicit Crop Monitoring E. COCAINE: OVERVIEW System supported by UNODC. Peru: National Illicit Crop Monitor- ing System supported by UNODC. Cultivation and production Seizures Coca bush cultivation, which remains limited to Plurina- tional State of Bolivia, Colombia and Peru, continued to Globally, cocaine seizures have slightly increased over the decline in 2012 with the net area under coca bush cultiva- past year, going up to 671 tons in 2012, compared with tion on 31 December 2012 totalled 133,700 ha, a decline 634 tons in 2011, driven largely by increased seizures in of 14 per cent from the previous year’s estimates and the South America139 (418 tons in 2012 compared with 362 Seizures of cocaine worldwide and in tons in 2011) and in Western and Central Europe, another lowest levels since the beginning of available estimates in selected countries, 2003-2012 1990. That decline was driven mainly by a 25 per cent major cocaine market, where seizures increased from 63 decline in coca bush cultivation in Colombia, from an tons in 2011 to 71.2 tons in 2012. Seizures of cocaine worldwide and in estimated 64,000 ha in 2011 to 48,000 ha in 2012. How- Seizures of cocaine worldwide900 and in ever, those figures refer to the net area under coca cultiva- selected countries, 2003-2012 Fig.selected 31. Seizures countries, of cocaine 2003-2012800 worldwide and in tion on 31 December of the year given. In 2012, the selected countries,700 2003-2012 Colombian Government manually eradicated 34,486 ha 600 900 of cultivation and conducted aerial spraying of 100,549 900 500

800 Tons ha. The addition of geographical data available on the pres- 800 400 700 ence of coca bush cultivation shows that 135,000 ha had 700 300 600 137 600 200 been under cultivation at some point during 2012. The 500 500 100 greatest reduction in coca bush cultivation in Colombia Tons

Tons 400 400 0 took place in the departments of Nariño, Putumayo, 300 Guaviare and Cauca.138 The decline in coca bush cultiva- 300 200 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 200 tion observed in the Plurinational State of Bolivia contin- 100 100 Rest of the world ued in 2012 (25,300 ha in 2012 compared with 27,200 0 0 Central America and Caribbean ha in 2011) and in Peru, where it declined to 60,400 ha Western and Central Europe 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

from 62,500 ha in 2011. As a result, the estimated global 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 North America Rest of the world production of cocaine has also declined. In Colombia, the Rest of the world South America Central America and Caribbean potential production of pure cocaine was estimated at 309 Central America and Caribbean Colombia Western and Central Europe tons, the lowest level since 1996. (For details see tables on Western and Central Europe United States North America coca bush cultivation and production estimates in annex.) North America South America South America Colombia Colombia 135 United States, Department of State, Bureau for International Narcot- Source: UNODC annualUnited report States questionnaire and other official ics and Law Enforcement, Demand Reduction Program Research sources.United States Brief, “Afghanistan National Urban Drug Use Survey” (December Note: Includes seizures of cocaine salts, coca paste, cocaine base and 2012). crack cocaine. 136 World Drug Report 2013 and Report of the International Narcotics Board Control for 2012 (E/INCB/2012/1). 137 UNODC, Government of Colombia, Colombia: Coca cultivation 139 However, there remains the possibility of double-counting of quanti- survey 2012 (June 2013). ties of cocaine seized, considering that there are joint operations con- 138 Ibid. ducted by national agencies together with agencies of other countries.