26. Global Heroin Treatment Need and Overdose Deaths

"More than 60 per cent of drug treatment demand in Asia and Europe relate to opiates that are, especially heroin, the most deadly drugs. Deaths due to overdose are, in any single year, as high as 5,000-8,000 in Europe, and several times this amount in the Russian Federation alone."

United Nations Office on Drugs and Crime, "Addiction, Crime and Insurgency: The transnational threat of Afghan opium" (Vienna, Austria: October 2009, p. 7.

27. Trends in Treatment Admissions of People For Whom Their Primary Drug was Heroin or Other Opiates

"• Heroin was reported as the primary substance of abuse for 26 percent of TEDS admissions aged 12 and older in 2015 [Table 1.1b].

"• Sixty-seven percent of primary heroin admissions were non-Hispanic White (41 percent were males and 26 percent were females). Non-Hispanic Blacks made up 14 percent (9 percent were males and 5 percent were females). Admissions of Puerto Rican origin made up 7 percent of primary heroin admissions (6 percent were males and 1 percent were females) [Table 2.3b]. See Chapter 3 for additional data on heroin admissions.

"• Injection was reported as the usual route of administration by 68 percent of primary heroin admissions; inhalation was reported by 25 percent. Daily heroin use was reported by 63 percent of primary heroin admissions [Table 2.4b].

"• Twenty-two percent of primary heroin admissions had no prior treatment episode, and 25 percent had been in treatment five or more times previously [Table 2.5b].

"• Primary heroin admissions were less likely than all admissions combined to be referred to treatment by the court/criminal justice system (14 vs. 30 percent) and more likely to be self or individually referred (61 vs. 41 percent) [Table 2.6b].

"• Medication-assisted opioid therapy was planned for 37 percent of heroin admissions [Table 2.7b].

"• Only 17 percent of primary heroin admissions aged 16 and older were employed (vs. 25 percent of all admissions that age); 45 percent were not in labor force (vs. 39 percent of all admissions that age) [Table 2.8b].

"• Sixty-one percent of primary heroin admissions reported abuse of additional substances. Marijuana/hashish was reported by 18 percent, alcohol by 14 percent, and non-smoked cocaine by 13 percent [Table 3.8].

Opiates Other than Heroin
"• Opiates other than heroin were reported as the primary substance of abuse for 8 percent of TEDS admissions aged 12 and older in 2015 [Table 1.1b]. These drugs include methadone, buprenorphine, codeine, hydrocodone, hydromorphone, meperidine, morphine, opium, oxycodone, pentazocine, propoxyphene, tramadol, and any other drug with morphine-like effects.

"• Admissions for primary opiates other than heroin were more likely than all admissions combined to be aged 20 to 39 (74 vs. 58 percent) [Table 2.1b].

"• Non-Hispanic Whites made up approximately 82 percent of admissions for primary opiates other than heroin (43 percent were males and 39 percent were females) [Table 2.3b].

"• The usual route of administration most frequently reported by admissions of primary opiates other than heroin was oral (61 percent); next were inhalation (18 percent) and injection (16 percent) [Table 2.4b].

"• Admissions for primary opiates other than heroin were more likely than all admissions combined to report first use after age 18 (66 vs. 39 percent) [Table 2.5b].

"• Medication-assisted opioid therapy was planned for 31 percent of admissions for primary opiates other than heroin [Table 2.7b].

"• Fifty-eight percent of admissions for primary opiates other than heroin reported abuse of other substances. The most commonly reported secondary substances of abuse were marijuana/hashish (22 percent), alcohol (16 percent), and tranquilizers (12 percent) [Table 3.8]."

Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2005-2015. National Admissions to Substance Abuse Treatment Services. BHSIS Series S-91, HHS Publication No. (SMA) 17-5037. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2017, Table 1.1A, pp. 17-19.

28. Treatment Effectiveness at Reducing Levels of Drug Use

"During the course of treatment, many treatment seekers stopped using the drugs that they reported using at entry to the study. Lower rates of drug use were recorded at each follow-up. Furthermore, those that continued to use tended to use less. Most of the changes observed occurred by first follow-up. For most forms of drug use, no particular treatment modality was more associated with cessation than any other and the route into treatment (CJS or non-CJS) did not influence drug-use outcomes.

"The proportion using each drug reduced significantly between baseline and follow-up (Figure 5). Most of this change occurred by first follow-up; indeed use of some drug types increased marginally, and levels of abstinence from all drugs decreased between first and second follow-up.

"The proportion of treatment seekers using heroin, crack, cocaine, amphetamine or benzodiazepines decreased between baseline and follow-up by around 50 per cent; the proportion using non-prescribed methadone or other opiates such as morphine, decreased by considerably more; but the proportion using cannabis or alcohol decreased by considerably less.The proportion who reported each drug to be causing problems fell substantially for all drug types, suggesting that continued use was often, in the client’s view, non-problematic."

Andrew Jones, et al., "Research Report 24: The Drug Treatment Outcomes Research Study (DTORS): Final Outcomes Report" (London, England: UK Government, Home Office Ministry, Research, Development & Statistics Directorate, December 2009), p. 10.

29. Estimated Global Opium Poppy Cultivation and Opium Production

"The total area under opium poppy cultivation worldwide is estimated to have increased by some 37 per cent to almost 420,000 ha from 2016 to 2017, primarily reflecting an increase in the cultivation of opium poppy in Afghanistan. With 328,000 ha under opium poppy cultivation, Afghanistan accounted for more than three quarters of the estimated global area under illicit opium poppy cultivation in 2017, a record level.

"By contrast, opium poppy cultivation in Myanmar, the country with the world’s second largest area under opium poppy cultivation (accounting for 10 per cent of the global estimated area in 2017), declined over the period 2015–2017 by some 25 per cent to 41,000 ha, the lowest level since 2010.

"Global opium production increased by 65 per cent to 10,500 tons in 2017, the highest level since UNODC started estimating global opium production on an annual basis at the beginning of the twenty-first century.1 The surge in global production primarily reflects an 87 per cent increase in opium production in Afghanistan to a record high of 9,000 tons, equivalent to 86 per cent of estimated global opium production in 2017. The increase in production in Afghanistan was not only due to an increase in the area under poppy cultivation but also to improving opium yields. There is no single reason for the massive increase in opium poppy cultivation in Afghanistan in 2017 as the drivers are multiple, complex and geographically diverse, and many elements continue to influence farmers’ decisions regarding opium poppy cultivation. A combination of events may have exacerbated rule-of-law challenges, such as political instability, corruption, a lack of government control and security. The shift in strategy by the Afghan Government — focusing its efforts on countering anti-government elements in densely populated areas — may have made the rural population more vulnerable to the influence of anti-government elements. A reduction in the engagement of the international aid community may also have hindered socioeconomic development opportunities in rural areas.2

"As a result of the massive increase in opium production in 2017, opium prices fell in Afghanistan by 47 per cent from December 2016 to December 2017. However, the price of high-quality Afghan heroin decreased by just 7 per cent over the same period, which may be an indication that heroin manufacture to date has increased far less than opium production.3 Of the 10,500 tons of opium produced worldwide in 2017, it is estimated that some 1,100–1,400 tons remained unprocessed for consumption as opium, while the rest was processed into heroin, resulting in an estimate of between 700 and 1,050 tons of heroin manufactured worldwide (expressed at export purity), 550–900 tons of which were manufactured in Afghanistan."

World Drug Report 2018. United Nations publication, Sales No. E.18.XI.9.

30. Estimated Global Opium Production, 2012

"Afghanistan maintained its position as the lead producer and cultivator of opium globally. With a global total of over 236,000 hectares under cultivation, illicit cultivation of opium poppy reached peak levels in 2012, surpassing the 10-year high recorded in 2007. This was mainly the result of increases in Afghanistan and Myanmar (the two main producers). A preliminary assessment of opium poppy cultivation trends in Afghanistan in 2013 revealed that such cultivation is likely to increase in the main opium growing regions, which would be the third consecutive increase since 2010.62 Mexico remained the largest grower of opium poppy in the Americas. An overview of global potential production of opium and manufacture of heroin, as well as country data on opium poppy cultivation and eradication and opium production can be found in Annex II.
"The fluctuations which characterized opium production in Afghanistan in recent years, also affected Europe, the main market for opiates. Heroin use decreased in Western and Central Europe, which can be ascribed to a change in the structure of the market, which has seen decreased supply, increased law enforcement activity and an ageing user population, combined with an increase in the availability of treatment. However, the same does not apply to the non-medical use of prescription opioids."

UNODC, World Drug Report 2013 (United Nations publication, Sales No. E.13.XI.6), p. 30.