Opium, a substance obtained from the flower of the opium poppy plant, is a precursor to opioid painkillers and illicit drugs, including heroin. Heroin is a highly intoxicating, dangerous, and addictive street drug, its abuse associated with a number of severe health conditions and the spread of infectious diseases. The costs associated with heroin abuse incur a loss to the US economy of over $20 billion each year.
Afghanistan has been the world's primary source of opium for over two decades, often providing 90% or more of the global supply. The country's conditions are optimal for the cultivation of poppies: the hardy, drought-resistant plants can thrive despite Afghanistan's harsh climate. Because the country suffers from weak government and infrastructure and mired in perpetual conflict, opium can often be cultivated without legal interference. Warlords control various regions of the country, using massive proceeds from opium to purchase weapons, expand their militias and cement their grip. It is also vastly more profitable than other crops and therefore appealing to impoverished farmers.
Since the US-led NATO invasion in 2001, opium production has dramatically increased and is now higher than it was at any point prior to the invasion. The current government is ineffective at controlling the cultivation of poppies, with many corrupt officials accepting bribes to look the other way, or being involved in drug trafficking themselves. Eradication programs and incentive programs to encourage the growth of other crops have had only temporary successes, and the cultivation of opium has not appreciably slowed as a result. Afghanistan continues to supply most of the world's heroin, supporting the drug abuse of millions of heroin users, and being implicated in thousands of heroin-related deaths and HIV infections.
A Primer on Opium
WHAT IS OPIUM?
Opium is a narcotic substance derived from the opium poppy, Papaver somniferum, an annual plant that can be grown in a variety of soils. To obtain opium, shallow cuts are made in the raw pods of the poppy, causing it to exude a milky white latex substance. This dries into a brown resin, and is then scraped off (1). This is raw opium, containing up to 26% morphine, although the morphine content may vary depending on the variety of the poppy. It also contains codeine and other drugs in small quantities.
HOW OPIUM BECOMES HEROIN
The raw opium is processed into morphine base through acid-base extraction, steaming it, or using various organic solvents. This turns it into a brown paste that can be pressed into bricks and dried, and this can either be smoked or processed further to create heroin. Another chemical reaction turns the morphine into diamorphine, or heroin, which is then purified. Over time, the purity of heroin sold on the streets has increased from an average of 10% purity or less, to 50-60%.
OPIUM THROUGH HISTORY
As early as 3400 BC, the effects of opium were known to the Sumerians, who called it Hul Gil – the “joy plant” (2). Opium was traded extensively in the Mediterranean by 1300 BC, and its use has remained common worldwide to the present day. In 460 BC, Hippocrates recognized the value of its medical properties, and by 1500 AD, its medical uses became well-known in Europe in the form of laudanum, a tincture of opium containing morphine and codeine. In the 19th century, trade disputes between China and the British Empire involving opium erupted into the First and Second Opium Wars. The chemist C.R. Alder Wright was the first to synthesize heroin from morphine in 1874.
HEROIN IN THE MODERN ERA
By the mid-1800s, opium had begun to be recognized as a dangerous and addictive substance, and by the mid-1900s, most countries had outlawed the unlicensed manufacture, use, and sale of morphine, heroin, and other opioid drugs (2). While heroin has legitimate medical uses as a strong painkiller, it is one of the most highly controlled and regulated substances, and it is four to five times as strong as morphine (3). For this reason, it has a very high potential for addiction.
Heroin and its Effects
Opioid drugs are usually derived from opium, and they are some of the most common painkillers: morphine, codeine, hydrocodone (Vicodin), oxycodone (Oxycontin), hydromorphone (Dilaudid), oxymorphone (Opana), and others (4). These drugs are manufactured by pharmaceutical companies, sourced from licensed poppy farms, and prescribed to patients through legitimate channels, and are only abused as a result of drug-seeking behavior or diversion to the black market.
Further opioid drug information and revisions:
- Fentanyl does appear to be wholly synthetic, and can be made without the use of opium poppies.
- Pethidine also appears to be synthetic and does not require poppies.
The remainder listed do appear to be ultimately derived from poppies:
- Morphine is present in poppies.
- Codeine is also present in poppies.
- Hydrocodone is derived from codeine.
- Hydromorphone is derived from morphine.
- Oxycodone and oxymorphone are derived from thebaine, an alkaloid present in poppies.
While some heroin (diamorphine) is produced for legitimate medical purposes, it is not referred to as heroin in that context. The term is most commonly used to describe illegally manufactured heroin, produced and distributed without the proper license or oversight. Heroin is, by and large, an illegal street drug that exists outside of official channels from start to finish.
The use of heroin induces a high degree of calm, relaxation and euphoria, and it has been described by anthropologist Michael Agar as “the perfect whatever drug”. In addition to its painkilling effects, heroin users have also described a “safe and warm” feeling, as well as a “floating, dream-like state” (5).
However, heroin can also cause vomiting, constipation, and disruption to the sex drive. As it induces respiratory depression, it can cause users to stop breathing, and they are at risk of choking on their own vomit (5). Overdose is common, as the purity of heroin sold on the street may fluctuate significantly, and users may unintentionally take a stronger dose than they can tolerate. 21.6% of heroin users die as a result of an overdose (6). The risk of misjudging a dose is substantial, as heroin users rapidly develop a tolerance to the drug, requiring more and more to achieve the same effects. While their heroin use may have initially been for the purposes of “getting high”, they eventually find that they need it simply to function in their everyday life. A study in The Lancet has found that heroin is one of the most addictive drugs, as well as one of the most dangerous (7).
THE RELATIVE DANGERS AND ADDICTIVE POTENTIAL OF RECREATIONAL DRUGS
Heroin users take the drug via smoking (vaporizing it and inhaling the fumes), injecting it intravenously, snorting it, or swallowing it. While IV heroin usage is common, it comes with a variety of serious risks (8). The sharing of needles by heroin users can spread HIV, hepatitis, and other blood-borne diseases. Repeated injection can lead to the development of abscesses, vein scarring, and arterial hematomas, which can result in gangrene, ischemia and hemorrhage. Blood clots can form due to impurities in injected heroin, cutting off the supply of blood to vital organs and potentially causing limb loss, organ damage, brain damage or death.
WITHDRAWAL AND TREATMENT
Withdrawal from heroin can have effects that increase in severity depending on the extent of the user's drug abuse. The symptoms of withdrawal can include chills, sweating, muscle and bone pain, tremors, cramps, a rapid heartbeat, itching, weakness, vomiting, diarrhea, and flu-like symptoms. Among the psychological effects of withdrawal are depression, panic attacks, anxiety, insomnia, dizziness and depression (9). In severe cases, dehydration, cardiac arrhythmia, seizures and strokes can occur. Some heroin users in withdrawal may even attempt suicide. These withdrawal symptoms can last from two days to two months.
Relapse after detoxification is common – 87% of users will relapse even after clinical treatment (29). Even after 15 years of abstinence, a quarter of heroin users will relapse (6). Treatment for heroin addiction can involve substituting the opioids methadone or buprenorphine for heroin (10). These drugs help meet the needs of patients who have become accustomed to high doses of opioids, but without the euphoric effects and “high” of heroin. When patients feel they are at a low risk of using heroin again, their dose of methadone or buprenorphine may be tapered off and eventually stopped. In certain countries such as Britain, Denkark, Holland, Switzerland and Germany, heroin itself may be prescribed to heroin users for whom methadone or buprenorphine have failed. Some areas have also launched harm-reduction initiatives such as providing sterile injection equipment to heroin users, or offering medical supervision to those using heroin (11). These serve to reduce the risk of transmitted diseases or death from overdose..
The Economic and Social Costs of Heroin Use
EXPENSES ASSOCIATED WITH HEROIN ADDICTION
A 2001 study in Drug and Alcohol Dependence analyzed the yearly cost of heroin addiction in the United States in 1996. Researchers found a total cost of $21.9 billion, broken down into the areas of medical care, social welfare, productivity loss, and criminal activities (12).
SUMMARY OF ECONOMIC COSTS ASSOCIATED WITH HEROIN USE
$862 million in expenses were due to treatment in substance abuse facilities for heroin addicts, and another $330 million was accounted for by inpatient treatment in general hospitals. A total of $1.24 billion in expenses were due to the medical costs associated with treating heroin addiction directly. Another $3.57 billion was spent on the treatment of complications due to heroin addiction, such as AIDS, tuberculosis, hepatitis, and pregnancy complications.
Costs associated with the criminal status of heroin, such as policing, legal expenses, incarceration, and cost to crime victims, totaled $5.22 billion. A further $11.5 billion in productivity costs were due to mortality, unemployment, incarceration and lowered earnings tied to heroin addiction. Another $99 million was due to welfare expenses connected with heroin use.
PREVALENCE OF ABUSE
This study estimated that there were 600,000 heroin addicts in the United States in 1997. The Office of National Drug Control Policy further estimated that in 1995, there were 810,000 hardcore heroin users and 320,000 occasional users in the United States (12).
LEGAL STATUS OF HEROIN
Heroin is classified as a Schedule I drug under the US Controlled Substances Act, making it among the most highly controlled drugs (13). First-time offenders trafficking heroin can face prison sentences so lengthy that they are de facto life sentences, due to multiple charges being brought for each sale.
Afghanistan's Conflicts and the Global Heroin Supply
A STATE OF PERPETUAL WAR
Since 1991, the Asian nation of Afghanistan has been the world's primary producer of illicit opium – as of last year, it accounts for 75% of the global heroin supply (14). The country's soil and climate are conducive to growing opium, and due to its extensive poverty, a significant skilled and unskilled labor force is readily available. Many areas of Afghanistan lack basic infrastructure such as roads, electricity and irrigation – conditions well-suited to growing the hardy, drought-resistant poppy, whose opium products can be stored indefinitely and do not spoil (15). Most importantly, Afghanistan has been an unstable country embattled by world superpowers and warring factions since the Soviet Union's invasion began in 1979. This conflict has fueled the unchecked production of opium in Afghanistan and its distribution around the world.
During the Soviet invasion, the Afghan government lost control of a number of provinces, and warlords came to power in these regions, using proceeds from the sales of opium to cement their power and purchase weaponry (16). These “freedom fighters”, or Mujahideen, were backed by the United States in order to counter the Soviet invasion (17). Charles Cogan, the CIA's former director of this operation, has acknowledged that this negatively impacted drug control efforts (18):
“Our main mission was to do as much damage to the Soviets. We didn't really have the resources or the time to devote to an investigation of the drug trade,' he told Australian television. I don't think that we need to apologize for this. Every situation has its fallout. There was fallout in terms of drugs, yes, but the main objective was accomplished. The Soviets left Afghanistan.”
Before the invasion, the nation's opium production was minimal and limited to the region. Yet within two years, Afghanistan and its borderlands with Pakistan were supplying 60% of heroin in the United States, and were the largest heroin producer in the world. The number of heroin addicts in Pakistan also soared from almost zero in 1979 to 1.2 million in 1985. The ongoing conflict in Afghanistan allowed opium production to shift from Pakistan into Afghanistan during the 1980s (18).
9/11: THE CONFLICT ESCALATES
In 2000, Taliban leader Mullah Mohammed Omar agreed to work with the United Nations to combat heroin production, announcing that the growing of opium poppies was un-Islamic. Poppy fields were eradicated, and those in violation of the ban were punished publicly. This campaign successfully reduced opium production in Taliban-controlled areas by 99%, making 2001 the only year in recent decades when Afghanistan was not the world's top producer of opium (19). However, it is believed that the Taliban and other factions may have taken advantage of this scarcity by stockpiling opium and selling it at very high prices.
The relationship between security and opium cultivation (hectares)
AN ECONOMIC ADDICTION
For this reason, the economy of Afghanistan has become highly dependent on proceeds from opium sales, and there is a reluctance to destroy the opium fields for fear of the financial impact on the entire country. In 2006, 2.9 million Afghans were involved in the production of opium – almost 10% of the country's population (15). Opium accounted for 52% of the country's gross national product (GNP), a total of $2.7 billion (21). However, Afghan farmers themselves see only 20% of that, as most of this money goes to drug traffickers (15).
Due to all of these factors – the unique fit of Afghanistan's environment and infrastructure with opium poppy cultivation, the country's ongoing state of conflict, its ineffective and corrupt government, the need for the cooperation of warlords in fighting the Taliban, and the economic reliance of the country and its farmers on opium proceeds – initiatives to discourage growing poppies in Afghanistan have proven to be largely ineffective.
The Failure of Modern Opium Control Efforts
A NATIONAL PROBLEM
Afghanistan has now relied heavily on opium proceeds for over 30 years, and it has become deeply entrenched in Afghan society. Ending this massive opium trade may take just as long, and it is not a straightforward problem with an easy solution. Jean-Luc Lemahieu, chief of the UN Office on Drugs and Crime for Afghanistan, has stated that the eradication of opium could take one or two decades (22).
Over $6 billion has been invested in anti-opium initiatives in Afghanistan over the past decade, with little effect. Opium crop eradication efforts have not shown any correlation with the amount of opium produced – the quantity of opium grown in the country has continued to spiral out of control despite ground-based eradication initiatives, and is now higher than at any point prior to the NATO invasion. The production of opium peaked in 2007 at 8,200 metric tons (23), and although it has declined since then, it has now been increasing for three years in a row (14). Even when poppy harvests are limited by a season of poor weather, this simply raises the price of opium, and thus the profits that can be made from selling it (24). This then provides an incentive for farmers to recoup their losses in the next season.
What small successes there have been are limited and unlikely to be sustainable. In Helmand province, the core of Afghanistan's opium production, a joint American and British mission provides jobs programs, incentives, and supplies for farmers to begin growing alternative crops. The Afghan government has also engaged in an aggressive eradication program. Since the initiative began, a decrease of 33% has been seen in opium production (24). However, these troops will soon pull out of Afghanistan, and these incentive programs will end if Western nations do not renew them. Farmers have begun to move out of this well-patrolled area, choosing to grow opium in desert areas instead. Cash incentives have been offered to provinces which completely eradicate all poppies, but three provinces (Balkh, Faryab and Takhar) are at risk of losing their poppy-free status this year (14). Supporting the concern that opium production will again soar when troops leave, over 70% of opium cultivation in Afghanistan now takes place in three provinces subject to the “surge” of troops, who have now returned home (14). A UN report has stated: “Poppy cultivation is not only expected to expand in areas where it already existed in 2012, but also in new areas or areas where poppy cultivation was stopped.” (25)
Afghanistan's Ministry of Counternarcotics is very underfunded – despite requesting $11 million from international donors, they have received only $300,000 this year (14). Their minister estimates that the Taliban made $155 million from opium in 2012 (22). While some have suggested legalizing the production of opium and selling it for legitimate medical purposes (26), illicit opium is still worth more than licit opium, and the demand would still exist for illicit opium to be processed into heroin. For example, in 2000, the price for licit opium in India was $13 – 29 per kilogram, but $155 – 206/kg for illicit opium. Legal opium sales may not be sufficient to fulfill farmers' economic needs, and there would still be a financial incentive to produce illicit opium.
AN ENDLESS CYCLE WITH GLOBAL FALLOUT
Altogether, there appears to be no end in sight for the out-of-control cultivation of illicit opium in Afghanistan. A lack of effective counternarcotics program has allowed the opium trade to grow steadily every year, and NATO operations in Afghanistan have only exacerbated the problem. As opium is cultivated in unstable areas, and its proceeds fund warlords who use this funding to maintain control over these areas to grow more opium, the cycle is self-perpetuating – and its impact spans continents.
While the Afghan opium trade has led to 1.5 million residents of Afghanistan regularly using opium drugs (27), the opium cultivated has also been Europe's primary source of heroin for over 10 years, and there are another 1.5 million opioid “problem users” in Europe (28). Opioids have been associated with about 70% of Europe's 7,000 drug-related deaths in 2005. Over 570,000 opioid users in Europe have required clinical treatment for their addiction. 49,000 drug seizures have taken place, primarily in the UK, Spain, Germany, France and Greece, with a total of 19.4 tons of heroin seized. And as of 2012, Russia consumes 70 tons of Afghan heroin yearly, supplied through former Soviet republics (30). Among the 2.5 million Russian addicts, 90% use heroin produced from Afghan opium. The fallout of this IV drug use is grim: of the 980,000 HIV-positive Russian residents, four fifths were infected via dirty needles. 30,000 heroin users die in Russia each year.