Equipo Nizkor - Executive summary - World Drug Report 2016.

EXECUTIVE SUMMARY

"We reiterate our commitment to strengthen our efforts in addressing and countering emerging and persistent challenges and threats of all aspects of the world drug problem ... and we recommend the following: ... promote, as appropriate, the use and analysis of relevant, reliable and objective data ... to improve the implementation of comprehensive, integrated and balanced national drug control strategies, policies and programmes ... and encourage the sharing of best practices and lessons learned."

Outcome document of the special session of the General Assembly on the world drug problem, entitled "Our joint commitment to effectively addressing and countering the world drug problem"

The World Drug Report 2016 is published in the wake of the landmark moment in global drug policy, the special session of the General Assembly on the world drug problem. Chapter I provides a global overview of the supply of and demand for opiates, cocaine, cannabis, amphetamine-type stimulants (ATS) and new psychoactive substances (NPS), as well as their impact on health. It also reviews the scientific evidence on polydrug use, treatment demand for cannabis and developments since the legalization of cannabis for recreational use in some parts of the world. Chapter II focuses on the mechanisms of the interaction between the world drug problem and all aspects of sustainable development through the lens of the Sustainable Development Goals.

Drug use and its health consequences

Prevalence of injecting drug use, 2014 or latest available year

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Note: The boundaries and names shown and the designations used on this map do not imply official endorsement or acceptance by the United Nations. Dashed lines represent undetermined boundaries. The dotted line represents approximately the Line of Control in Jammu and Kashmir agreed upon by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by the parties. The final boundary between the Sudan and South Sudan has not yet been determined. A dispute exists between the Governments of Argentina and the United Kingdom of Great Britain and Northern Ireland concerning sovereignty over the Falkland Islands (Malvinas).

It is estimated that 1 in 20 adults, or a quarter of a billion people between the ages of 15 and 64 years, used at least one drug in 2014. Roughly the equivalent of the combined populations of France, Germany, Italy and the United Kingdom, though a substantial amount, it is one that does not seem to have grown over the past four years in proportion to the global population. Nevertheless, as over 29 million people who use drugs are estimated to suffer from drug use disorders, and of those, 12 million are people who inject drugs (PWID), of whom 14.0 per cent are living with HIV, the impact of drug use in terms of its consequences on health continues to be devastating.

With an estimated 207,400 drug-related deaths in 2014, corresponding to 43.5 deaths per million people aged 15-64, the number of drug-related deaths worldwide has also remained stable, although unacceptable and preventable. Overdose deaths contribute to between roughly a third and a half of all drug-related deaths, which are attributable in most cases to opioids. The time period shortly after release from prison is associated with a substantially increased risk of death from drug-related causes (primarily as a result of drug overdoses), with a mortality rate much higher than from all causes among the general population.

In many countries, prisons remain a high-risk environment for infectious diseases, which is a significant concern for prison health. A number of studies report high levels of drug use in prison, including the use of opiates and injecting drug use. In addition, the prevalence of HIV, hepatitis and tuberculosis among persons held in prison can be substantially higher than among the general population. However, despite the high-risk environment and scientific evidence for effective health interventions, there are significant gaps in prevention and treatment services in many prisons around the world.

PWID experience some of the most severe health-related harms associated with unsafe drug use, overall poor health outcomes, including a high risk of non-fatal and fatal overdoses, and a greater chance of premature death. One in seven PWID is living with HIV, and one in two with hepatitis C. PWID are a key at-risk population for HIV and hepatitis, with almost a third of new HIV infections outside sub-Saharan Africa occurring among PWID. Moreover, studies have found people who inject stimulants to engage in more risky sexual behaviours, resulting in a higher risk of HIV infection than for those injecting opiates.

Cannabis remains the most commonly used drug at the global level, with an estimated 183 million people having used the drug in 2014, while amphetamines remain the second most commonly used drug. With an estimated 33 million users, the use of opiates and prescription opioids is less common, but opioids remain major drugs of potential harm and health consequences. The fact that a sharp increase in heroin use has been documented in some markets (particularly North America) where it was previously declining, shows that heroin remains one of the major drugs of public health concern.

Global trends in the estimated prevalence of drug use, 2006-2014

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Source: Responses to the annual report questionnaire.
Note: Estimated percentage of adults (ages 15-64) who used drugs in the past year.
Global trends in the estimated number of people who use drugs, 2006-2014

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Source: Responses to the annual report questionnaire.
Note: Estimates are for adults (ages 15-64), based on past-year use.

As an overall trend at the global level, the use of cannabis has remained stable over the past three years. In some sub-regions, however, particularly North America and Western and Central Europe, cannabis use has increased. After a period of stability, since 2010 cocaine use has also been rising, mainly because of an increase in cocaine use in South America. On the other hand, the use of amphetamines appears to be stable, but that may underplay the situation in subregions, specifically East and South-East Asia, where recent information on the extent of drug use is unavailable.

Making the global picture of drug use more blurred is the fact that many people who use drugs, both occasionally and regularly, tend to be polydrug users who use more than one substance concurrently or sequentially. For example, the non-medical use of prescription drugs, synthetic stimulants and NPS in lieu of or in combination with more conventional drugs clouds the distinction between users of a particular drug, presenting an interlinked or cyclical epidemic of drug use and related health consequences in recent years.

Treatment related to cannabis use has been increasing in many regions over the past decade. In Europe, an increase in the numbers in treatment for cannabis use has been observed in several countries, despite a decline in the number of frequent (monthly) users. The proportion of people seeking treatment for the first time for cannabis use disorders remains high globally, with nearly half of the people treated for cannabis use disorders being first-time entrants. Changes in patterns of the people in treatment for cannabis use may be attributed to a number of factors, including practices in referrals by the criminal justice system and an expansion in the provision of treatment for cannabis in some countries. While there is some evidence that higher potency cannabis is now more widely available in Europe and the United States, how this might translate into greater harm for cannabis users is not clearly understood.

On average, younger people are seeking treatment for cannabis and amphetamines use disorders more than for other drugs. This reflects the trends in increasing use of cannabis and amphetamines and the resulting increase in people seeking treatment for disorders related to the use of can-nabis and amphetamines. People in treatment for opioid-or cocaine-related disorders are typically in their thirties, and, in many subregions, this reflects an ageing cohort of users in treatment and an overall decrease in the proportion of treatment demand.

Overall, men are three times more likely than women to use cannabis, cocaine or amphetamines, whereas women are more likely than men to engage in the non-medical use of opioids and tranquilizers. Gender disparities in drug use are more attributable to opportunities to use drugs in a social environment than to either gender being more or less susceptible or vulnerable to the use of drugs. Moreover, while in most surveys the prevalence of drug use among young people is reportedly higher than among adults, the gender divide in drug use is narrower among young people than among adults.

DRUG SUPPLY AND MARKETS

Trends in the quantities of drugs seized worldwide, 1998-2014

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Source: Responses to the annual report questionnaire

The most widely cultivated drug crop continues to be cannabis, which was reported by 129 countries over the period 2009-2014, far more than the 49 countries that reported opium poppy cultivation (mostly located in Asia and the Americas) and the 7 countries that reported coca cultivation (located in the Americas). Leaving aside the disparity in their respective numbers of cultivating countries, opium poppy cultivation has been decreasing in the past year while coca cultivation has been rising.

Cannabis also continues to be the most trafficked drug worldwide, while there has been a large increase in seizures of synthetic drugs. Although there were 234 substances under international control in 2014 (244 in January 2016), the bulk of trafficking (based on reported drug seizures, which reflect both law enforcement activity and drug flows) was concentrated on a far smaller number of substances. Cannabis in its various forms was intercepted in 95 per cent of reporting countries in 2014 and accounted for over half of the 2.2 million drug seizure cases reported to the United Nations Office on Drugs and Crime (UNODC) that year, followed by ATS, opioids and coca-related substances.

In all countries, more men (90 per cent of the total, on average) than women are brought into formal contact with the criminal justice system for trafficking in drugs or for possession of drugs for personal use. However, the reporting of gender-disaggregated data has improved over the years and shows an increased number of women arrested for drug-related offences in absolute terms. Nevertheless, the proportion of women in drug-related arrests, while fluctuating, showed a downward trend over the 1998-2014 period, particularly for drug trafficking-related offences.

Drug supply via the Internet, including via the anonymous online marketplace, the "dark net", may have increased in recent years. This raises concerns in terms of the potential of the "dark net" to attract new populations of users by facilitating access to drugs in both developed and developing countries.

Opiates

Main trafficking flows of heroin

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Source: UNODC, responses to annual report questionnaire and individual drug seizure database
Notes: The trafficking routes represented on this map should be considered broadly indicative and based on data analyses rather than definitive route outlines. Such analyses are based on data related to official drug seizures along the trafficking route as well as official country reports and responses to annual report questionnaires. Routes may deviate to other countries that lie along the routes and there are numerous secondary flows that may not be reflected. The boundaries shown on this map do not imply official endorsement or acceptance by the United Nations. Dashed lines represent undetermined boundaries. The dotted line represents approximately the Line of Control in Jammu and Kashmir agreed upon by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by the parties. The final boundary between the Sudan and South Sudan has not yet been determined.

Primarily carried out in South-West Asia and, to a lesser extent, in South-East Asia and Latin America, global opium production in 2015 fell by 38 per cent from the previous year to some 4,770 tons, i.e., to the levels of the late 1990s. The decrease was primarily a consequence of a decline in opium production in Afghanistan (a decrease of 48 per cent from the previous year), mainly as a result of poor yields in the country's southern provinces. However, at 183,000 hectares, Afghanistan still accounted for almost two thirds of the global area under illicit opium poppy cultivation, which decreased by 11 per cent from the previous year to around 281,000 hectares.

UNODC estimates indicate that the global number of opiate users (i.e., users of opium, morphine and heroin) has changed little in recent years and that opiates continued to affect some 17 million people in 2014. It seems unlikely that the sharp decline in opium production in 2015 will lead to major shortages in the global heroin market given the high opium production levels of previous years. The build-up or depletion of previous years' opium inventories may be used to offset annual changes in production and maintain the supply of heroin to user markets. It may take a period of sustained decline in opium production for the repercussions to be felt in the heroin market.

Indeed, the global opiate market appears to be stable despite important regional changes. There are indications that heroin use may be undergoing a resurgence in some countries where it was previously declining. Heroin use increased in North America in the past decade, which resulted in an increase in the level of heroin-related deaths. Long-term trends, in contrast, have been stable or declining in Western and Central Europe since the late 1990s. There are early signs, however, of a surge in the heroin market, with an increase in the availability and use of heroin in some markets in Europe, as well as a major increase in the size of individual seizure cases of heroin destined for Europe. Meanwhile, based on trend perceptions reported to UNODC, the use of opioids may have grown in Africa. Overall opiate use in Asia is reported by experts to have remained largely unchanged over the period 1998-2014 whereas opiate use in Oceania has declined.

The global interception rate for opiates doubled from the period 1980-1997 (particularly after the special session of the General Assembly on the world drug problem in 1998) to the 2009-2014 period. The largest amount of opiates seized takes place in South-West Asia, followed by Europe. Accounting for 75 per cent of global opium seizures, 61 per cent of global morphine seizures and 17 per cent of global heroin seizures, the largest aggregated opiate seizures worldwide in 2014 were reported by the Islamic Republic of Iran.

The so-called "Balkan route", which supplies Western and Central Europe with Afghan opiates, through Iran (Islamic Republic of) and Turkey via South-Eastern Europe, continues to be the most important conduit for heroin trafficking. However, the so-called "southern route" (through Pakistan or the Islamic Republic of Iran by sea to the Gulf region, Africa (particularly East Africa), South Asia and, to a lesser extent, South-East Asia, the Oceania region and North America), has grown in importance. Meanwhile, opiate trafficking on the so-called "northern route", from Afghanistan to neighbouring States in Central Asia, the Russian Federation and other countries of the Commonwealth of Independent States, has started to undergo a resurgence after the decline in the period 2008-2012, while trafficking out of the Golden Triangle is on the increase, mainly due to rising levels of opium production in Myanmar after 2006. Moreover, heroin trafficking in the Americas continues to increase, with heroin and morphine seizures rising from an average of 4 tons over the period 1998-2008 to 7 tons per year over the period 20092014, in line with reported increases in opium production in Latin America over those periods.

Cocaine

Main trafficking flows of cocaine

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Source: UNODC, responses to annual report questionnaire and individual drug seizure database
Notes: The trafficking routes represented on this map should be considered broadly indicative and based on data analyses rather than definitive route outlines. Such analyses are based on data related to official drug seizures along the trafficking route as well as official country reports and responses to annual report questionnaires. Routes may deviate to other countries that lie along the routes and there are numerous secondary flows that may not be reflected. The boundaries shown on this map do not imply official endorsement or acceptance by the United Nations. Dashed lines represent undetermined boundaries. The dotted line represents approximately the Line of Control in Jammu and Kashmir agreed upon by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by the parties. The final boundary between the Sudan and South Sudan has not yet been determined.

Although global coca bush cultivation in 2014 increased by 10 per cent from the previous year, the actual area under coca bush cultivation was the second smallest since the late 1980s. Global cocaine manufacture was slightly higher than in the previous year but still 24-27 per cent lower than the peak in 2007, and thus basically back to the levels reported in the late 1990s. At the same time, there are indications that the increase in global cocaine manufacture observed in 2014 was not a one-off event and may have continued in 2015.

Cocaine trafficking via Africa may be regaining importance, and there are signs of increases in the trafficking of cocaine to Asia, particularly to East and South-East Asia and the Middle East, as cocaine seizures in Asia tripled from an average of 0.45 tons per year over the period 1998-2008 to 1.5 tons per year over the period 20092014. In Oceania, the cocaine market appears to be stabilizing, following rapid growth over the past decade.

Despite these regional fluctuations, the annual prevalence of cocaine use remained largely stable at the global level over the period 1998-2014, fluctuating at between 0.3 and 0.4 per cent of the population aged 15-64. However, as the population has grown, the number of cocaine users has increased, from some 14 million in 1998 to 18.8 million in 2014. Meanwhile, it is likely that there has been a decline in per capita consumption of cocaine, prompted by a decline in the amount of cocaine available for consumption over the period 2007-2014, mainly linked to a drop in cocaine production in the Andean region. In parallel, the number of heavy cocaine users in North America has declined. This points to an overall shrinking of the cocaine market, although the number of (recreational rather than regular) cocaine users in several emerging markets continues to rise.

Cannabis

Despite major changes in some regions, global cannabis consumption has remained somewhat stable in recent years. In 2014, some 3.8 per cent of the global population had used cannabis in the past year, a proportion that has remained stable since 1998. Given the global population growth, this has gone in parallel with an increase in the total number of cannabis users since 1998. The Americas, followed by Africa, remain the main production and consumption regions for cannabis herb, with about three quarters of all cannabis herb seizures worldwide taking place in the Americas in 2014, the largest amounts in North America, while Africa accounted for 14 per cent of all cannabis herb seizures and Europe for 5 per cent. On the other hand, Europe, North Africa and the Near and Middle East remain the principal markets for cannabis resin, the majority of which continues to be produced in Morocco and Afghanistan, as reflected in information provided by Member States on the sources of cannabis resin seized. Accounting for 40 per cent of the total, the largest amounts of cannabis resin seized in 2014 took place once again in Western and Central Europe.

In the United States, although outcome measures such as the burden on the health and criminal justice systems need to continue to be monitored regularly, recent data from the states that have legalized marijuana for recreational use show an increase in cannabis use, as well as in public health and public safety indicators (cannabis-related emergency room visits, hospitalizations, traffic accidents and related deaths), while cannabis-related arrests, court cases and criminal justice system referrals into treatment have declined.

Synthetics: amphetamine-type stimulants and new psychoactive substances

Interregional trafficking flows of methamphetamine, 2011-2014

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Source: UNODC, responses to annual report questionnaire.
Note: The origins of the flow arrows do not necessarily indicate the source/manufacture of methamphetamine. These arrows represent the flows as perceived by recipient countries. Flow arrows represent the direction of methamphetamine trafficking and are not an indication of the quantity trafficked. The boundaries shown on this map do not imply official endorsement or acceptance by the United Nations. Dashed lines represent undetermined boundaries. The dotted line represents approximately the Line of Control in Jammu and Kashmir agreed upon by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by the parties. The final boundary between the Sudan and South Sudan has not yet been determined.

After three years of relative stability, ATS seizures reached a new peak of more than 170 tons in 2014. Since 2009, global amphetamine seizures have fluctuated annually between about 20 and 46 tons, while "ecstasy" seizures more than doubled in 2014, to 9 tons, compared with the annual averages of 4-5 tons since 2009. For the past few years, methamphetamine seizures have accounted for the largest share of global ATS seizures annually, but, although methamphetamine is a feature of ATS markets worldwide, it is particularly dominant in East and South-East Asia and North America. Since 2009, those subregions together have annually accounted for most global methamphetamine seizures. Compared with other subregions, North America has consistently reported the largest amount of methamphetamine seizures each year, whereas between 2009 and 2014, methamphetamine seizures reported in East and South-East Asia almost quadrupled.

In Oceania, strong increases in methamphetamine seizures have been recorded since 2012. There is a growing number of users of crystalline methamphetamine in the region, as well as increased frequency of use among certain user groups, an increase in methamphetamine purity and a decline in purity-adjusted prices, all of which could aggravate the negative impact on the health of individuals and on society in general.

Large amounts of amphetamine tablets labelled with the brand name "Captagon" were reported to have been seized in the Middle East between March 2014 and November 2015. In 2013 and 2014, amphetamine seizures reported in the Middle East were mostly perceived to have originated in Lebanon and the Syrian Arab Republic. Over the same period, some countries reporting amphetamine seizures in the Middle East found that these were intended for trafficking onward to other destinations within the region.

The NPS market continues to be characterized by the large number of new substances being reported. Although data collection for 2015 is still in progress, 75 new substances have been reported to UNODC for the first time, compared with a total of only 66 new substances reported in 2014. Between 2012 and 2014, most substances reported for the first time belonged to the group of synthetic can-nabinoids, but the data reported for 2015 so far show a different pattern: firstly, almost as many synthetic cathi-nones (20) were reported for the first time as were synthetic cannabinoids (21); secondly, a wide range of substances (21) not belonging to any of the major groups identified in previous years were reported for the first time, which included synthetic opioids (e.g., fentanyl derivatives) and sedatives (e.g., benzodiazepines).

Significant quantities of NPS seized have been reported over the past few years. The global market for synthetic NPS continues to be dominated by synthetic cannabinoids (seizures of 32 tons), with North America (specifically the United States with 26.5 tons of seizures) accounting for the largest quantities seized worldwide in 2014, out of the global total of 34 tons (excluding plant-based NPS and ketamine). However, global seizures of synthetic cathi-nones have been steadily increasing since they were first reported in 2010, with seizures tripling to 1.3 tons in 2014 from the previous year.

UNODC monitoring of NPS since 2008 has so far shown a rather dynamic supply situation with elements of persistence (a small number of substances emerge, spread and stay for several years) and change (a considerable number of substances appear for a short time or only locally).

THE WORLD DRUG PROBLEM AND SUSTAINABLE DEVELOPMENT

"We welcome the 2030 Agenda for Sustainable Development, and we note that efforts to achieve the Sustainable Development Goals and to effectively address the world drug problem are complementary and mutually reinforcing."

Outcome document of the special session of the General Assembly on the world drug problem, entitled "Our joint commitment to effectively addressing and countering the world drug problem"

The world drug problem is intertwined with all aspects of sustainable development. The analysis of the drug problem, and the response thereto, through the lens of the Sustainable Development Goals reveals the mechanisms of this interaction. All areas of sustainable development, as identified in the 17 Sustainable Development Goals, shape the nature and dynamic of the drug problem. At the same time, the impact of the drug problem, and the response thereto, on development can be observed at the individual, community and national levels. In analysing those linkages, the 17 Sustainable Development Goals have been divided into five broad areas: social development, economic development, environmental sustainability, peaceful, just and inclusive societies, and partnership.

Social development

Sustainable Development Goal 10. Reduce inequality within and among countries

The failure to accept or understand that drug dependence is a health condition feeds the cycle of marginalization that often affects people with drug use disorders, making their recovery and social integration more challenging. Furthermore, stigmatizing attitudes towards people who use drugs, which may extend to staff in health-care services, can affect the delivery of effective treatment to those who most need it.

The health impact of drug use increases with development

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Sources: Human development index from the United Nations Development Programme (UNDP); data on burden of disease (disability-adjusted life years) are from the Institute for Health Metrics and Evaluation, University of Washington, GBD Compare, 2015. Available from http://vizhub.healthdata.org/gbd-compare.

Health

Sustainable Development Goal 3. Ensure healthy lives and promote well-being for all at all ages

The Global Burden of Disease Study indicates that opi-oids, cocaine, amphetamines and cannabis together accounted for almost 12 million life years lost due to premature death or disability in 2013, of which more than 8 million were linked to opioid use disorders. One of the risk factors for the negative health impact of drugs stems from their mode of administration. Injecting drug use, in particular, carries a much greater risk of overdose and infection, including the transmission of blood-borne viruses, such as HIV and hepatitis C, than does smoking, swallowing, snorting or inhaling drugs. Drug use may have repercussions on the health of society in general as PWID may become a group through which sexually transmitted diseases are passed on to other subgroups and the general population. Some studies also corroborate the hypothesis that the use of certain stimulants (whether injected or not) may also influence sexual behaviour itself, thereby increasing the likelihood of high-risk behaviour and sexual transmission — a pattern that raises concern particularly in the case of specific at-risk groups such as men who have sex with men.

Among its targets, Sustainable Development Goal 3 explicitly includes strengthening "the prevention and treatment of substance abuse, including narcotic drug abuse". Drug policies based on scientific evidence can, through measures such as prevention and treatment, mitigate the negative health impact of drug use. But when policies are not appropriately tuned to the principles of the international drug control conventions, they can undermine the accessibility of controlled drugs for both medical and research purposes. Three quarters of the global population still have little or no access to medicines containing narcotic drugs and have inadequate access to treatment for moderate to severe pain. The importance of the accessibility of essential medicines, which typically include controlled drugs such as morphine, codeine, diazepam and phenobarbital, has been recognized in target 3.b of the Sustainable Development Goals.

The world drug problem and sustainable development: a complex relationship

Women, girls and youth

Drug use undermines the aspect of sustainable development related to gender equality and the empowerment of women and girls. There are marked differences between male and female drug users in terms of preferred drugs and drug-related vulnerabilities. Coupled with the fact that users of several drug types are predominantly male, this leads to a danger that the entire continuum of care may fail to cater adequately for the needs of female drug users, who also have a lack of access to such services.

Sustainable Development Goal 5. Achieve gender equality and empower all women and girls

Women affected by drug dependence and HIV are more vulnerable and more stigmatized than men. They suffer from co-occurring mental health disorders to a greater extent than men, and they are more likely to have been victims of violence and abuse. Women often also bear a heavy burden of violence and deprivation associated with the drug dependence of family members, hindering the achievement of the sustainable development target of eliminating all forms of violence against all women and girls. Female offenders and prisoners, especially those with drug use disorders, face particular hardship as, in many instances, criminal justice systems are not yet equipped for the special needs of women.

Drug use often affects people during their most productive years. When youth become trapped in a cycle of drug use, and even in the drug trade itself, as opposed to being engaged in legitimate employment and educational opportunities, distinct barriers are effectively raised to the development of individuals and communities.

Economic development

Sustainable Development Goal 1. End poverty in all its forms everywhere

The toll taken by the drug problem may vary in size and shape across countries, both developed and developing, but in one way or another it affects all. Vulnerability to drugs, be it in terms of cultivation, production, trafficking or use, exists in countries at all levels of development.

The relationship between economic development and drugs is particularly evident in the case of the illicit cultivation of drug crops. In rural areas, socioeconomic elements such as poverty and a lack of sustainable livelihoods are important risk factors leading farmers to engage in illicit cultivation. They are also manifestations of poor levels of development which, alongside other development issues linked to security and governance, are enabling elements of large-scale illicit cultivation.

The impact of income on drug use depends on the type of drug

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Source: World Bank (for income levels) and UNODC estimates based on responses to the annual report questionnaire and other official sources (for drug use data).
* Including prescription stimulants.

Higher socioeconomic groups have a greater propensity to initiate drug use than lower socioeconomic groups, but it is the lower socioeconomic groups that pay the higher price as they are more likely to become drug dependent

Poverty also has strong links with drug use, albeit in a complex and mutually reinforcing manner. Indeed, the brunt of the drug use problem is borne by people who are poor in relation to the societies in which they live, as can be seen in stark terms in the wealthier countries. More broadly, there is a strong association between social and economic disadvantage and drug use disorders. This pattern can also be seen when looking at different reflections of marginalization and social exclusion, such as unemployment and low levels of education.

Beyond development, a multitude of factors, including geographic location, play a role in shaping the drug problem in a given country. Proximity to a drug-producing area or a major drug trafficking route can, for example, explain the above-average rates of opiate use in the Near and Middle East and South-West Asia, and use of cocaine, including "crack" cocaine, in South America and West Africa. A breakdown of national data on people who use drugs, based on income level, shows, however, that "high-income" countries tend to have a higher prevalence of past-year drug use across the drug categories. Drugs that can command a relatively high price, and ultimately higher profits for traffickers, find an easier foothold in countries with relatively higher levels of per capita income. In the case of substances such as cocaine and heroin, the level of economic development contributes to the formation of consumer markets that are large in terms of both number of users and total revenue.

Different levels of socioeconomic well-being within individual countries also have an effect on the type of drugs used. For example, in the United States, the association between drug use and unemployment is much stronger in the case of "crack" cocaine than other types of cocaine.

Drug markets tend to be influenced by local idiosyncrasies in both developed and developing countries, but sizeable markets for certain substances, notably cocaine and synthetic substances, have taken hold in developed countries before subsequently expanding to developing countries. Prime examples are the emergence of "ecstasy" and other hallucinogens in North America and Europe, as well as the ongoing proliferation of the consumption of NPS in Europe, Japan and North America. The relationship between development and the drug problem thus needs to be viewed in dynamic terms.

Coca cultivation and deforestation in perspective

Environmental sustainability

Sustainable Development Goal target 15. 5. Take urgent and significant action to reduce the degradation of natural habitats, halt the loss of biodiversity and, by 2020, protect and prevent the extinction of threatened species

Illicit crop cultivation often occurs in forested areas and contributes to deforestation when it results in the clearing of woodland. Moreover, illicit crop cultivation frequently takes place in biodiversity hotspots hosting a large number of species with a limited habitat, some of which are protected areas. It tends to occur close to the agricultural frontier, which demarcates the border between pristine forest and developed areas, and can result in the clearing of forests. Although empirical evidence and rigorous analysis do not support the claim that illicit cultivation is the major driver of deforestation, research does suggest that a lack of rural development drives the phenomenon. Analysis has shown, moreover, that drug trafficking can have a direct impact on deforestation through the construction of infrastructure such as landing strips and illegal roads, as well as indirectly through the privatization of public land to create "narco-estates". When eradication induces a displacement of the location of drug crops it may result in deforestation as farmers react to eradication initiatives and seek places out of the reach of law enforcement.

The disposal of chemicals used in the illicit manufacture of cocaine and opiates can also have negative consequences on the environment, contributing to pollution and health hazards in rural communities. In the case of synthetic drugs, the consequences in urban settings not only pose health risks but may also have an impact on the urban and industrial environment.

Peaceful, just and inclusive societies

Violence, rule of law, corruption, illicit financial flows

Globally, there is no clear-cut relationship between drug supply and violence

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Source: UNODC Homicide Statistics (2015). Available at www. unodc.org/unodc/en/data-and-analysis/homicide.html.

Sustainable Development Goal 16. Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels

Among the targets associated with Sustainable Development Goal 16, those related to reducing violence, strengthening the rule of law and access to justice, and fighting organized crime, economic crime (corruption and bribery) and illicit financial flows, all have significant links with the world drug problem and the response to it.

The connection between drug trafficking and violence in Latin American countries^a is not an automatic one

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Sources: Estimates of the flow of cocaine based on United States, Office of National Drug Control Policy, "Cocaine Smuggling in 2010", January 2012; homicide data from UNODC Homicide Statistics (2016). Available at www.unodc.org/unodc/en/data-and-analysis/homicide.html.
a Data were available for 13 countries.
b All flows are expressed per capita.

Different stages of the drug problem result in different manifestations of violence. Drug use may lead to violence related to the psychoactive effects of drugs, as well as to crime committed in order to obtain funds for purchasing drugs. The intensity of drug-related violence is greatest, however, when associated with drug trafficking (systemic violence), as the example of Latin America shows. The traumatic effects of violence can also increase vulnerability to drug use.

Almost one in five sentenced prisoners is serving time for a drug offence

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Source: Note by the Secretariat on world crime trends and emerging issues and responses in the field of crime prevention and criminal justice (E/CN.15/2016/10).

Yet drug trafficking and production do not necessarily produce violence, as illustrated by the low levels of homicide in transit countries affected by the opiate trafficking routes in Asia. Characteristics of the market and drug trafficking organizations may explain variations: market competition can generate violence in illicit markets, while differences in the internal structure of trafficking networks, which may be characterized by varying degrees of cohe-siveness and hierarchy, can also play a role.

The profits associated with the drug trade are a key motivation for non-State armed groups, including terrorist organizations, to engage in or facilitate drug trafficking. In a number of countries, resources generated in illicit markets such as drug markets have played a role in complicating and extending armed conflicts, often increasing their overall lethality. In general, the drug trade flourishes where State presence is weak, where the rule of law is unevenly applied and where opportunities for corruption exist. At the same time, the wealth and power of drug trafficking organizations provide them with resources to buy protection from law enforcement agents, from politicians and the business sector, thereby reinforcing corruption.

Profit is generated across the entire chain of drug production and distribution, but it is at the final stage that it tends to be highest. A recent UNODC study estimated that almost half of the profit made along the major heroin trafficking route from Afghanistan to Europe was generated in the four largest European consumer markets: France, Germany, Italy and the United Kingdom. Nevertheless, the size of the illicit economy associated with drugs, relative to the licit economy, tends to be higher in drug-producing countries, partly because of their relatively smaller economies. This is particularly pronounced in the case of Afghanistan, where, according to UNODC estimates, the total value of the illicit opiate economy was $2.8 billion in 2014 — equivalent to 13 per cent of the country's gross domestic product (GDP). The laundering of such illegal proceeds occurs through many different channels, from small, decentralized techniques such as the use of money orders or remittances, to sophisticated uses of front businesses. These forms of illicit financial flows are essential for the survival of criminal groups and constitute a major threat to sustainable development.

Partnership

Sustainable Development Goal 17. Strengthen the means of implementation and revitalize the global partnership for sustainable development

Sustainable Development Goal 17 has a strong link with the principles of international cooperation and shared responsibility, embedded in the drug control conventions.

But when analysed together, donor development assistance and donor assistance in drug-related sectors show opposing trends: official development assistance has increased overall, whereas assistance in drug-related sectors has actually decreased significantly since 2008.

How do drug interventions impact sustainable development?

Drug supply and demand reduction efforts

Efforts to eliminate illicit crop cultivation can impact the income source and employment opportunities of farmers and farm labourers. Research has also shown that such efforts have positive development outcomes in the affected communities only if they include development measures to ensure alternative livelihoods and restore security and rule of law. Examples in Colombia and Peru have shown that effective alternative development programmes can weaken the population's ties with armed groups and drug trafficking.

Law enforcement interventions aim to restore the rule of law, the cornerstone of governance and sustainable development, and can also influence the availability of drugs in illicit markets, not only by reducing supply through interdiction but also by increasing the risk for traffickers, which raises the price of drugs in consumer markets. However, enforcement activities by authorities can also generate violence, particularly when they affect the internal and external structure of illegal markets. Research suggests that targeting enforcement and policing on both the protagonists and the elements in the drug trafficking chain that generate the greatest profit and the most violence can be particularly effective in reducing violence. On the other hand, strategies that focus on rapidly disrupting drug trafficking organizations and reducing violence in the short term can sometimes lead to more violence.

Prevention, early intervention treatment, care, recovery, rehabilitation and social integration measures, and the entire continuum of care for people who use drugs, when based on scientific evidence, reduce drug use and thus its impact on public health, which is one of the most important components of the well-being of society. Some of the above measures have also been shown to decrease a range of other risky behaviours such as aggressiveness and truancy. The benefits affect both people who use drugs themselves and society in general, and such efforts have proved effective in preventing, for example, HIV and viral hepatitis.

Drug demand reduction interventions are effective when they rely on evidence-based measures, including those aimed at minimizing the adverse public health and social consequences of drug use, such as appropriate needle and syringe programmes, opiate substitution therapy, antiret-roviral therapy and other relevant interventions that prevent the transmission of HIV, viral hepatitis and other blood-borne diseases associated with drug use. Compulsory confinement in drug treatment centres, on the other hand, often worsens the already problematic lives of people who use drugs and people with drug dependence, particularly the youngest and most vulnerable.

Criminal justice systems and the costs of drug policies

As in the case of law enforcement operations in general, when operations are implemented by impartial, transparent and efficient institutions in compliance with human rights standards, they promote the rule of law and equal justice. But when law enforcement operations go against those principles, incentives may be created for indiscriminate repression and for the violation of citizen rights.

On the basis of limited available data, globally more than three quarters of all those held in prison for drug-related offences have been convicted for drug trafficking and less than a quarter for offences related to personal consumption. There are differences across jurisdictions in terms of definitions, prosecutorial discretion or types and severity of sanctions for drug offences. In some regions, countries exercise more punitive approaches, which may result in incarceration, when dealing with people apprehended for minor drug offences, such as possession of small quantities of drugs for personal consumption. On the other hand, several countries have chosen to limit punishment by adopting alternative measures to incarceration or punishment in minor personal consumption cases without aggravating circumstances (for example, fines, warnings, probation or counselling). The excessive use of imprisonment for drug-related offences of a minor nature is ineffective in reducing recidivism and overburdens criminal justice systems, preventing them from efficiently coping with more serious crime. The provision of evidence-based treatment and care services to drug-using offenders, as an alternative to incarceration, has been shown to substantially increase recovery and reduce recidivism.

Cost of drug policies

Many of the costs arising both directly and indirectly from the drug problem can be quantified in monetary terms. Several economic studies have done so, and their results show that the cost ranged between 0.07 and 1.7 per cent of GDP of the countries studied. Moreover, the majority of countries studied registered a high percentage of overall costs attributable to drug demand and supply reduction interventions (such as prevention, treatment and law enforcement), as opposed to productivity losses and any other indirect costs. It is important to bear in mind that, although those economic studies generally take into account a wide variety of costs, which arise directly and indirectly out of the drug problem, this is usually limited to costs that can be quantified in monetary terms. The non-tangible costs, such as loss of life and impaired quality of life, are frequently not quantified, and when quantified it is usually with reference to a non-monetary metric, such as years of life lost or years lived with a disability. While such studies can be very useful in assessing the economic toll taken on society because of drugs, other considerations also need to come into play when assessing the impact of the world drug problem and in devising policy responses.

Impact of development on the world drug problem

Development can reduce the vulnerability of farmers to engaging in illicit cultivation and production and can bring sustainable reduction in drug cultivation. However, if development interventions are not sensitive to the vulnerabilities of communities to specific drug issues, they may inadvertently trigger dynamics that increase illicit cultivation, as shown by the example of large development programmes in the early 1960s and 1970s in the Andean region.

Initiatives that facilitate trade and ease trade barriers are employed to promote economic development, but globalization may also have ramifications for drug trafficking. By fostering the expansion of trade and global transportation networks, trade openness can also facilitate the cooperation and the formation of alliances among criminal organizations across different countries and, in some cases, reduce the opportunity for law enforcement agencies to monitor international trade.

The geographical spread of the use of certain drugs, such as cocaine and synthetic drugs, is less concentrated today than it was in the past, while Europe, North America and Oceania are increasingly affected by the consumption of NPS. At the same time, rapid economic growth is taking place in large parts of the world where certain drugs are still virtually unknown. It is therefore crucial to bear in mind the potential ramifications of development on drug use, and the experience of developed countries can be enlightening in this regard.

23Jun16

Executive summary - World Drug Report 2016

[Source: United Nations Office on Drugs and Crime - UNODC, Vienna, 23Jun16]

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