World Drug Report 2023 – Part 2 – Asrar Qureshi’s Blog Post #886

World Drug Report 2023 – Part 2 – Asrar Qureshi’s Blog Post #886

Dear Colleagues!  This is Asrar Qureshi’s Blog Post #886 for Pharma Veterans. Pharma Veterans  aims to share knowledge and wisdom from Veterans for the benefit of Community at large. Pharma Veterans Blog is published by Asrar Qureshi on  WordPress, the top blog site. Please email to asrar@asrarqureshi.com for publishing your contributions here.

Credit: Baqir Zaidi

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UNODC - United Nations Office on Drugs and Crime has published World Drug Report 2023 (link at the end) which shows where the world is vis-à-vis drugs and crime. I am reproducing here the highlights of the report in summarized way.

Key Message #4 – Large inequalities remain in the availability of pharmaceutical opioids for medical consumption, and treatment of drug abuse.

The issues with opioid abuse besides, inequality exists even in the availability of these pharmaceutical products between high-income and low-income countries. Opioids are important for the relief of moderate to severe pain but some 86% of the world’s population lives without adequate access to pharmaceutical opioids for pain relief and care. 

Nevertheless, some progress has been made in recent years, showing some increases in availability in low- and middle-income countries. Overall progress was also made with regard to the availability of methadone and buprenorphine over the last two decades, two opioids which are used not only as analgesics but also as opioid agonist medication in the treatment of opioid use disorders. 

Despite the positive developments there remains an extremely wide diversity in the availability of opioids for medical purposes worldwide. Although a number of countries in North America, Oceania and Western Europe continue to have high levels of availability, most other countries have extremely low levels of availability of opioids for medical purposes, notably countries in Africa and Asia.

Pakistan has its own situation. Decades ago, opioids like pentazocine, buprenorphine, dextropropoxyphene containing painkillers were freely available on the market. Then our ministries got active, and these products were taken off the market, or severely restricted. People can still buy some of these on the black market, but not even on prescription. What is not understood is that the addicts shall pay more to get these things and they know where to get these, but ordinary patients neither have access nor money to buy medicines for legitimate use.

An estimated 39.5 million people worldwide were suffering from drug use disorders in 2021, but only 1 in 5 people with drug use disorders received drug treatment.

Barriers in accessing treatment are multiple but women are most affected. Women who use drugs tend to progress to drug use disorders faster than men but they continue to be underrepresented in drug treatment. This gap is particularly high for women who use amphetamine-type stimulants. Almost 1 in 2 users of amphetamine-type stimulants is a woman but only 1 in 4 people in treatment is a woman. In addition to the family expectations and responsibilities that they face, women may experience further barriers in accessing treatment that include increased social stigma, and prejudice. Women of certain population groups, for example, trauma and violence survivors, those with comorbidities, sex workers, prisoners or members of ethnic minorities, face more severe vulnerabilities, including higher levels of stigma and discrimination.

Key Message #5 – Liver diseases attributed to hepatitis C are a main cause of drug-related deaths, whereas opioids account for most overdose deaths.

Deaths related to the use of drugs were estimated at about 500,000 in 2019, 17.5 per cent more than in 2009. Liver diseases attributed to hepatitis C are a major cause of drug-related deaths, accounting for more than half of the total number of deaths attributed to the use of drugs. Drug overdoses account for a quarter of drug-related deaths. 

Opioids continue to account for the most severe drug-related harm, including fatal overdoses, when used non-medically. At the global level, two thirds of direct drug-related deaths are due to opioids, and in some subregions the proportion can be as high as three quarters of such deaths. 

Key Message #6 – Young people are more vulnerable to drug use than adults are.

In 2021, 5.3 per cent of 15–16-year-olds worldwide (13.5 million individuals) had used cannabis in the past year. The adolescent brain is still developing and drug use can have long-term negative effects. Early drug use initiation can lead to faster development of dependence than in adults and other problems in adulthood. 

The use of cannabis among 15–16-year-olds varies by region, from less than 3 per cent in Asia to over 17 per cent in Oceania but in most regions the proportion of adolescents using the drug is higher than in the general population aged 15–64. Similar prevalence in the two age groups was only recorded in Africa, where the population is young.

Key Message #7 – A Surge is seen in supply and demand.

The world is currently experiencing a prolonged surge in both supply and demand of cocaine. Coca bush cultivation covered 315,500 ha in 2021, representing a marked increase from 2020, and total cocaine production reached 2,304 tons, which was the seventh consecutive year-on-year increase. Both are record highs. On the demand side, the population of cocaine users, estimated at 22 million in 2021, has been growing gradually but steadily. 

The criminal actors involved, including both groups at source and those orchestrating trafficking to destination markets, have diversified in line with the dynamics of competition, specialization and collaboration, ultimately leading to more efficient supply chains, in particular to Western and Central Europe. 

Although global cocaine market continues to be concentrated in the Americas and in Western and Central Europe (with very high prevalence also in Australia), in relative terms it appears that the fastest growth, albeit building on very low initial levels, is occurring in developing markets found in Africa, Asia and South-Eastern Europe.

Global methamphetamine manufacture, trafficking and use remains concentrated in East and South-East Asia and North America, with the two subregions accounting for almost 90 per cent of methamphetamine seized globally in the period 2017–2021. 

Manufacture of methamphetamine is no longer restricted to the established markets, with the detection of clandestine methamphetamine laboratories in SouthWest Asia, South Asia and Africa. There are increasing signs of large methamphetamine manufacture in Afghanistan and expanded trafficking through South Asia for markets in Oceania, Europe and elsewhere. In recent years, consumption of methamphetamine increased in South-Eastern Europe, whereas data for Western and Central Europe suggest a stabilization in 2020 and 2021.

The bulk of global illicit opium production continues to take place in a limited number of countries, notably in Afghanistan. In 2022, production in Afghanistan reached 6,200 tons, equivalent to 80 per cent of the estimated global production (7,800 tons),and was followed in volume by Myanmar (795 tons) and Mexico (504 tons ). Although the global area under opium poppy cultivation increased by more than 26 per cent from the previous year, global opium production declined marginally (3 per cent) over the same period. This was due to less opium being produced in Afghanistan (10 per cent less) as a consequence of droughts in early 2022. The 2023 opium harvest in Afghanistan may see a drastic drop following the 2022 national drug ban, with possible global consequences. Early reports suggest reductions in poppy cultivation in Afghanistan. 

Continued reports and seizure events involving methamphetamine originating in Afghanistan suggest that the drug economy in that country is no longer exclusively dominated by illicit cultivation and trafficking of opiates. Ongoing changes in Afghanistan are likely to have far-reaching effects on global drug markets, as the country has remained a key source of heroin for world markets for decades. Sharp disruptions in the supply of poppy and heroin could have severe effects for those who use drugs, as well as for impoverished farmers who have come to rely on the illegal opiate economy.

Key Message #8 – A complex and dynamic relationship exists between drugs and conflict.

When conflicts have erupted in areas with sizeable drug production or trafficking activities, the parties to the conflict have exploited them, either through direct involvement or through the “taxation” of such activities. In some conflict areas, the drug economy and instability are linked through a vicious cycle in which weak rule of law facilitates the expansion of the drug economy, which can, in turn, provide financial resources for maintaining or expanding the conflict. 

The links between drugs and instability in Haiti and the Sahel are examples of drug markets that fuel and have been fuelled by the violence and the governance vacuum that characterize conflict situations. In Ukraine, the current armed conflict seems to have disrupted existing and emerging trafficking routes for heroin and cocaine but there are signs that it could also trigger an expansion of the manufacture of and trafficking in synthetic drugs, given the know-how that existed in the country before the conflict.

To be Concluded…

Reference:

https://www.unodc.org/res/WDR-2023/WDR23_Exsum_fin_DP.pdf