世界毒品报告：全球约2.75亿人吸食毒品，新冠疫情加剧毒品依赖（附《2021年世界毒品报告》电子版） - 禁毒动态 - 国家毒品问题治理研究中心（毒品犯罪与对策研究中心）.pdf

EXECUTIVE SUMMARY POLICY IMPLICATIONS WORLD DRUG REPORT 2021 © United Nations, June 2021. All rights reserved worldwide. ISBN: 9789211483611 eISBN: 9789210058032 United Nations publication, Sales No. E.21.XI.8 This publication may be reproduced in whole or in part and in any form for educational or non-profit purposes without special permission from the copyright holder, provided acknowledgement of the source is made. The United Nations Office on Drugs and Crime (UNODC) would appreciate receiving a copy of any publication that uses this publication as a source. Suggested citation: World Drug Report 2021 (United Nations publication, Sales No. E.21.XI.8). No use of this publication may be made for resale or any other commercial purpose whatsoever without prior permission in writing from UNODC. Applications for such permission, with a statement of purpose and intent of the reproduction, should be addressed to the Research and Trend Analysis Branch of UNODC. DISCLAIMER The content of this publication does not necessarily reflect the views or policies of UNODC or contributory organizations, nor does it imply any endorsement. Comments on the report are welcome and can be sent to: Division for Policy Analysis and Public Affairs United Nations Office on Drugs and Crime PO Box 500 1400 Vienna Austria Tel: (+43) 1 26060 0 Fax: (+43) 1 26060 5827 2 E-mail: wdr@un.org Website: www.unodc.org/unodc/en/data-and-analysis/wdr2021.html PREFACE In an age when the speed of information can often outstrip the speed of verification, the COVID-19 pandemic has taught us that it is crucial to cut through the noise and focus on facts, a lesson that we must heed in order to protect societies from the impact of drugs. Drug use killed almost half a million people in 2019, while drug use disorders resulted in 18 million years of healthy life lost, mostly due to opioids. Serious and often lethal illnesses are more common among drug users, particularly those who inject drugs, many of whom are living with HIV and Hepatitis C. The illicit drug trade also continues to hold back economic and social development, while disproportionately impacting the most vulnerable and marginalized, and it constitutes a fundamental threat to security and stability in some parts of the world. Despite the proven dangers, drug use persists and, in some contexts, proliferates. Over the past year, around 275 million people have used drugs, up by 22 per cent from 2010. By 2030, demographic factors project the number of people using drugs to rise by 11 per cent around the world, and as much as 40 per cent in Africa alone. There is often a substantial disconnect between real risks and public perception. In some parts of the world for example, cannabis products have almost quadrupled in potency, and yet the percentage of adolescents who perceive cannabis as harmful has dropped by as much as 40 per cent, despite the evidence linking regular use to health problems, particularly in young people, and despite the correlation between potency and harm. New psychoactive substances also continue to be a challenge, as markets witness the introduction of new drugs that are unpredictable and poorly understood. Regulatory and legislative steps have been successful in stemming the tide globally, but in low-income countries the problem is on the rise; between 2015 and 2019, South and Central America recorded a fivefold rise in the amount of new synthetic psychoactive substances seized, while seizures in Africa increased from minor to substantial amounts. Strong increases were also reported in South and Southwest Asia as well as the Near and Middle East. Meanwhile, the COVID-19 crisis has pushed more than 100 million people into extreme poverty, and has greatly exacerbated unemployment and inequalities, as the world lost 114 million jobs in 2020. In doing, so it has created conditions that leave more people susceptible to drug use and to engaging in illicit crop cultivation. Furthermore, disparities in access to essential controlled medicines around the world continue to deny relief to patients in severe pain. In 2019, four standard doses of controlled pain medication were available every day for every one million inhabitants in West and Central Africa, in comparison to 32,000 doses in North America. In parallel, drug traffickers have quickly recovered from the initial setback caused by lockdown restrictions and are operating at pre-pandemic levels once again. Access to drugs has also become simpler than ever with online sales, and major drug markets on the dark web are now worth some $315 million annually. Contactless drug transactions, such as through the mail, are also on the rise, a trend possibly accelerated by the pandemic. Communicating facts about drugs and promoting science-based interventions is an absolute necessity if we are to reduce demand and supply of drugs, while also facilitating access to controlled medicines for those in need. It is also the surest path to eliminating stigmatization and discrimination and providing adequate treatment, as seven in eight people who suffer from drug use disorders remain without appropriate care. EXECUTIVE SUMMARY, POLICY IMPLICATIONS | Preface Drugs cost lives. 1 At the UN Office on Drugs and Crime we are dedicated to pursuing and promoting fact-driven, human rights-based approaches to drug control and treatment. I am proud to present to you this World Drug Report, which embodies our commitment to raising awareness and combating misinformation. It is my hope that this report will inform policymakers, practitioners, and the general public on the facts of the world drug problem, and provide them with a powerful tool to share evidence and information, and in doing so help save and preserve lives. Ghada Waly, Executive Director United Nations Office on Drugs and Crime 3 BOOKLET EXECUTIVE SUMMARY POLICY IMPLICATIONS BOOKLET GLOBAL OVERVIEW OF DRUG DEMAND AND DRUG SUPPLY BOOKLET DRUG MARKET TRENDS: CANNABIS, OPIOIDS BOOKLET DRUG MARKET TRENDS: COCAINE, AMPHETAMINE-TYPE STIMULANTS BOOKLET WORLD DRUG REPORT 2021 COVID-19 AND DRUGS: IMPACT AND OUTLOOK CONTENTS PREFACE 3 EXPLANATORY NOTES 7 SPECIAL POINTS OF INTEREST 9 SPECIAL POINTS OF INTEREST – IMPACT OF COVID-19 12 THE WORLD DRUG PROBLEM – COMMON CHALLENGE, LOCAL DYNAMICS 16 DRUG-BY-DRUG DEVELOPMENTS IN BRIEF 18 FINDINGS AND CONCLUSIONS & POLICY IMPLICATIONS 21 ANNEX 65 GLOSSARY 83 REGIONAL GROUPINGS 85 EXECUTIVE SUMMARY, POLICY IMPLICATIONS | Contents 1 5 Acknowledgements WORLD DRUG REPORT 2021 The World Drug Report 2021 was prepared by the Research and Trend Analysis Branch, Division for Policy Analysis and Public Affairs, United Nations Office on Drugs and Crime (UNODC), under the supervision of Jean-Luc Lemahieu, Director of the Division, and Angela Me, Chief of the Research and Trend Analysis Branch, and the coordination of Chloé Carpentier, Chief of the Drug Research Section. Content overview Chloé Carpentier Angela Me Analysis and drafting Nicole Cook Philip Davis Michael Lohmuller Larissa Maier Kim Moeller Kamran Niaz Bryce Pardo Thomas Pietschmann Barbara Remberg (INCB Secretariat) Inshik Sim Antoine Vella Murat Yildiz Irmgard Zeiler Data management and estimate production Monika Barratt (RMIT University) Enrico Bisogno Diana Camerini Conor Crean Hernan Epstein Natalia Ivanova Sabrina Levissianos Virginia Macdonald (WHO) Bradley Mathers (WHO) Andrea Oterová Martin Raithelhuber Umidjon Rakhmonberdiev Francesca Rosa Ali Saadeddin Keith Sabin (UNAIDS) Tun Nay Soe Mapping Antero Keskinen Francesca Massanello Irina Tsoy Editing Joseph Boyle Jonathan Gibbons Graphic design and production Anja Korenblik Suzanne Kunnen Kristina Kuttnig Maria Moser Lorenz Perszy Administrative support Andrada-Maria Filip Iulia Lazar Review and comments The World Drug Report 2021 benefited from the expertise of and invaluable contributions from UNODC colleagues in all divisions and from the INCB Secretariat. The Research and Trend Analysis Branch acknowledges the invaluable contributions and advice provided by the World Drug Report Scientific Advisory Committee: Jonathan Caulkins Paul Griffiths Marya Hynes Vicknasingam B. Kasinather Charles Parry Afarin Rahimi-Movaghar Peter Reuter Alison Ritter Francisco Thoumi The analysis on the global situation on hepatitis C in Booklet 2 benefited from a contribution from the Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes of WHO. The analysis on purchases of drugs on the dark web in Booklet 2 is based on original data graciously shared by the Global Drug Survey team. 6 The analysis on access to pharmaceutical opioids in Booklet 3 is based on original data graciously shared by the INCB Secretariat. Booklet 5 benefited from field contributions from: Leila Ahmadi, Femi Ajayi, Gabriel Andreuccetti, Mohammad Azim Arshad, Julie Astoul, Lídia Barbosa, Ximena Belmonte, Hernando Bernal, Gulnur Bolyspayeva, Laura Castro, Leonardo Correa, Claudio Dantas Monteiro, Nara de Araujo, Siniša Durkulić, Salome Flores Sierra, Tito Herrera, Olivier Inizan, Mouhamadou Kane, Saqib Khan, Zhannat Kosmukhamedova, Camilo Andres Lopez Lagos, Rakhima Mansurova, Fred Meneses, Rezaun Mercy, Francis Negrete A., François Patuel, Laëtitia Portet, Alessandra Scalia, Borikhan Shaumarov, Inshik Sim, Bárbara Souto, Luisa Sterponi, Mirzahid Sultanov, Kavinvadee, Suppapongtevasakul, Miguel Vasquez. EXPLANATORY NOTES Countries and areas are referred to by the names that were in official use at the time the relevant data were collected. Since there is some scientific and legal ambiguity about the distinctions between “drug use”, “drug misuse” and “drug abuse”, the neutral term “drug use” is used in the World Drug Report. The term “misuse” is used only to denote the non-medical use of prescription drugs. All uses of the word “drug” and the term “drug use” in the World Drug Report refer to substances controlled under the international drug control conventions, and their non-medical use. All analysis contained in the World Drug Report is based on the official data submitted by Member States to the UNODC through the annual report questionnaire unless indicated otherwise. The following abbreviations have been used in the present booklet: ATS amphetamine-typestimulants CBD cannabidiol COVID-19 coronavirus disease Δ9-THC delta-9-tetrahydrocannabinol Eurojust European Union Agency for Criminal Justice Cooperation Europol European Union Agency for Law Enforcement Cooperation INCB International Narcotics Control Board MDMA 3,4-methylenedioxymethamphetamine NPS new psychoactive substances RMIT Royal Melbourne Institute of Technology UNAIDS Joint United Nations Programme on HIV/AIDS UNODC United Nations Office on Drugs and Crime WHO World Health Organization EXECUTIVE SUMMARY, POLICY IMPLICATIONS | Explanatory notes The designations employed and the presentation of the material in the World Drug Report do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries. 1 The data on population used in the World Drug Report are taken from: World Population Prospects: The 2019 Revision (United Nations, Department of Economic and Social Affairs, Population Division). References to dollars ($) are to United States dollars, unless otherwise stated. References to tons are to metric tons, unless otherwise stated. 7 SPECIAL POINTS OF INTEREST SPECIAL POINTS OF INTEREST FINDINGS POSSIBLE RESPONSES Cannabis is more potent but fewer young people see it as harmful » Combat misinformation about the potential impact PERCEPTION AMONG ADOLESCENTS CANNABIS HERB POTENCY of the increased strength of cannabis. » Use fact-based information to raise awareness of the potential harm from non-medical use of cannabis. » Prioritise public health over private business through a comprehensive ban on advertising. 4X INCREASE » Increase investment in research both into the harm cannabis use poses to health and the possible medical uses of the drug. 1995 2019 80 % 16 % 60 % 12 % ∆9-THC ∆9-THC 1995 2019 Rising40web-based sales could transform8 %global drug use patterns % 4% 20 % 0% INCREASE IN DRUG SALES OVER THE DARK WEB 0% 1995 2019 Europe 1995 United States o 11 t 20 017 to 02 Europeid-2 United2States 0 m mid-201 7 80 million dollars 2019 » Monitor the cannabis markets and the perception of risks associated with cannabis use. » Improve government response to drug trafficking on the internet by forging public/private partnerships with internet service providers, tech companies, shipping and mailing companies. » Control the drug supply chain on the Internet by removing drug adverts and listings and sharing information with law enforcement. nearly x4 increase 315 million dollars » Regulate cryptocurrency markets and monitor electronic payments to detect suspicious transactions and illicit financial flows from drug trafficking. » Enhance expert access to the dark web in order to take down online markets and platforms. SPECIAL POINTS OF INTEREST FINDINGS POSSIBLE RESPONSES Number of drug users in Africa is projected to rise by 40 per cent by 2030 » Implement an integrated, people-centred and human-rights based approach to empowering African societies to develop sustainable solutions to drug use. ESTIMATED NUMBER OF PEOPLE WHO USE DRUGS » Help African States define and apply innovative 2018 Population aged 15–64 (millions) North America Latin America and Caribbean Europe Africa Asia Oceania 66 17 42 60 80 4 86 83 4 ! 2030 68 19 39 PROJECTION based on growth of population aged 15–64 (millions) 2030 40% GROWTH 2018 IN THE NUMBER OF PEOPLE WHO USE DRUGS IN AFRICA and cost-effective assessment systems for regular monitoring of the drug situation on the continent. » Cultivate strong partnerships between African Member States and the United Nations system to stem the expected increase in the number of people who use drugs and the possible negative impact on health and security. SPECIAL POINTS OF INTEREST IMPACT OF COVID-19 FINDINGS POSSIBLE RESPONSES Covid-19 has triggered innovation in drug prevention and treatment services » Maintain COVID-19 adaptations to the delivery of drug-related services in order to increase accessibility and coverage of services. INNOVATION » Continuously update scientific standards to keep abreast of the acceleration of Internet-based services. » Prioritize people who use drugs and with drug use disorders for COVID-19 screening and vaccination because of their health vulnerability. Technology Contactless services Delivery systems Audio-only assessments and prescriptions Mail services for needles and syringes and naloxone Mobile outreach programmes Remote consultation Mobile outreach programmes Administration of treatment medication without face-to-face meetings Service hotlines Vending machines for sterile needle and syringes Multi-day and multi-week take-home doses of treatment medication Mobile telephone-enabled outreach programmes Vending machines for drug treatment medications Methamphetamine agonist treatment Internet-based services and training SPECIAL POINTS OF INTEREST IMPACT OF COVID-19 FINDINGS POSSIBLE RESPONSES Drug markets quickly recovered after the onset of the pandemic, but some trafficking dynamics have been accelerated during Covid-19 » Foster international cooperation for fighting the enduring problem of drug trafficking. COVID HAS ACCELERATED SOME DRUG TRAFFICKING PATTERNS » Exchange and transfer law enforcement intelligence and effective interdiction approaches and best practices. » Develop international accountability mechanisms Larger shipment size and practices for shipping and railway companies, postal services, and air cargo. » Implement real-time data monitoring systems for promptly detecting and addressing drug market changes. Increased use of private aircraft Increased use of waterway routes Contactless methods to deliver drugs to end-consumers SPECIAL POINTS OF INTEREST IMPACT OF COVID-19 FINDINGS NON-MEDICAL USE OF CANNABIS AND SEDATIVES HAS INCREASED GLOBALLY DURING THE PANDEMIC POSSIBLE RESPONSES Non-medical use of cannabis and sedatives has increased globally during the pandemic » Allocate sufficient funding in national post-covid-19 SED AT budgets for drug prevention and treatment to prevent the acceleration of increasing drug use patterns. IVE S » Prioritize scientific evidence-based prevention of drug use in post-pandemic investment. SED AT IV E » Pre-empt further increases in the number of people S who use cannabis, and the harm arising from its increasing non-medical use, through cost-effective measures such as prevention. INCREASED SE DA TI VE USE S Covid-19 fallout is likely to be felt in drug markets for years to come POST-COVID ECONOMIC CRISIS WILL HAVE GREATEST IMPACT ON DRUG MARKETS Expanding drug cultivation and trafficking More drug use food insecurity may intensify illicit drug cultivation and production a protracted economic crisis may accelerate progression to drug use disorders + + ECONOMIC CRISIS predicted » Support parents and young people in vulnerable circumstances to face the stresses of the pandemic without resorting to negative coping mechanisms. » Alleviate the negative consequences for vulnerable and marginalized population groups through postpandemic recovery plans that include housing, food supply, economic assistance and health insurance. » Increase the effectiveness of alternative development interventions to improve the conditions of rural households. THE WORLD DRUG PROBLEM COMMON CHALLENGE LOCAL DYNAMICS THE WORLD DRUG PROBLEM COMMON CHALLENGE, LOCAL DYNAMICS While cannabis trafficking and use affect all regions worldwide, other drug issues pose additional threats in different geographical locations. Cocaine high level of opioid-related overdoses increasing use of methamphetamine cocaine use manufacture of methamphetamine and opioids cocaine trafficking Opioids/Opiates Amphetamine-type stimulants (ATS) cocaine production and trafficking HIV among PWID cocaine use disorders cocaine trafficking expansion of NPS and synthetic drug markets high prevalence of HIV among people who inject drugs opiates use expanding cocaine market increasing use of ATS opiates use opiates production, trafficking and use increasing methamphetamine trafficking and use high prevalence of HIV among people who inject drugs non-medical use of tramadol increasing cocaine trafficking high prevalence of opioids use expanding ATS market methamphetamine Captagon trafficking manufacture and use opiates production large methamphetamine market heroin in transit spilling over into local heroin use high prevalence of HIV among people who inject drugs use of synthetic stimulants heroin and cocaine trafficking high prevalence of HIV among people who inject drugs high prevalence of use of stimulants (methamphetamine and cocaine) DRUG-BY-DRUG DEVELOPMENTS IN BRIEF Demand > Roughly 200 million people used cannabis CANNABIS in 2019 representing 4 per cent of the global population. > The figure is highest in North America (14.5 per cent) and lowest in Asia (2 per cent). > The number of cannabis users has increased by nearly 18 per cent over the past decade Supply > No data are available on the global illicit cultivation of cannabis but qualitative information suggests an overall expansion between 2010-2019. > Between 2009–2019, quantities seized fell by 35 per cent, largely because of dramatic declines in North America partly linked to legalization of non-medical cannabis in some jurisdictions. Key issues > Diverse cannabis products have becoming more potent yet the number of adolescents regarding the drug as harmful is declining rapidly, a trend that risks increasing the negative impact of cannabis on younger generations. > An increase in cannabis use has been observed in many countries during the pandemic. > Excluding North American data, global seizures were 36 per cent higher in 2019 than in 2009. > An estimated 20 million people used cocaine > Global manufacture doubled in output > The prevalence rate of use was the highest > The quantity seized more than doubled in COCAINE in 2019, corresponding to 0.4 per cent of the global population. in Oceania (2.7 per cent), mainly reflecting the situation in the sub-region Australia and New Zealand, and the lowest in Asia (0.07 per cent). > Global prevalence rates have remained stable over the past decade, while the number of people using the drug increased by 22 per cent largely owing to population growth. > Around 62 million people used opioids for non-medical purposes in 2019, corresponding to 1.2 per cent of the global population. > North America (3.6 per cent) has the highest prevalence, Europe the lowest (0.8 per cent). > The number of users worldwide has nearly OPIOIDS doubled over the past decade, with the increase in the last few years mainly driven by new estimates in Asia and Africa. between 2014 and 2019 to reach an estimated 1,784 tons, the highest level ever recorded. the same period, with the Americas accounting for close to 83 per cent of global quantity intercepted in 2019. > Following an upward trend over the period 2013–2017, illicit coca cultivation stabilised in 2018 and then declined for the first time in years by 5 per cent in 2019. > Following a decline in the area under illicit cultivation of opium poppy from a peak in 2017, it rebounded in 2020, rising by 24 per cent compared with the previous year, to reach 295,000 ha. > Global opium production has stabilised since 2018, amounting to 7,430 tons in 2020. > Both opium production and opiate seized have shown an upward trend over the past two decades. > Most opiate seizures are made in, or close to, the main opium production areas in Asia, which accounted for 76 per cent of all opiates seized worldwide in 2019. > Heroin trafficking was reported in 99 countries in 2019, a much higher number than those reporting trafficking in opium or morphine. > Quantities of heroin seized in Europe hit a record high in 2019, tripling since 2016, and accounting for 27 per cent of the global total. > Seizures of “pharmaceutical opioids” hit peaks in 2014 and in 2019, almost tripling since the previous year to 228 tons. > Cocaine manufacture was disrupted during the initial stages of the pandemic but returned to its typical level shortly afterwards. > The cocaine trafficking route between South America and Europe is evolving, with greater competition between traffickers pushing up the quality and reducing prices, which is likely to continue to widen the potential harm caused by the drug in Europe. > Roughly 50,000 people died from opioid overdoses in the United States in 2019, more than double the 2010 figure. Fentanyl and its analogues now are involved in most of the deaths. > North America has seen a spike in opioid overdose deaths since the onset of the pandemic. > As the result of the economic downturn triggered by the pandemic, fragile communities in areas of illicit cultivation of drugs are now increasingly vulnerable, especially in Afghanistan, where the appeal of illicit crop cultivation of opium poppy is likely to rise. > Access to pharmaceutical opioids in low- and middle-income countries is a tiny fraction of the availability in high-income countries. Demand AMPHETAMINE-TYPE STIMULANTS (ATS) > An estimated 27 million people used amphetamine type stimulants in 2019, corresponding to 0.5 per cent of the global population. > The figure was highest in North America (2.3 per cent) and lowest in Africa (0.4 per cent), though the data from Africa was patchy. > Nearly 20 million people globally are estimated to have used “ecstasy” in the past year. > Amphetamine use varies by region. Non-medical use of pharmaceutical stimulants and methamphetamine is the most prevalent in North America, methamphetamine in East and South East Asia and amphetamine predominates in Western and Central Europe and in the Near and Middle East. NEW PSYCHOACTIVE SUBSTANCES (NPS) > There are some declines in the use of NPS in North America and in Europe, but NPS use continues among some marginalized population groups. > The use of NPS appears to be rapidly emerging in some low- and middle-income countries. > The harms from NPS use, though may vary according to the type of substance, are observed/visible more at the individual rather than at the population level. Supply > More than 95 per cent of ATS laboratories uncovered between 2015 and 2019 were used to manufacture methamphetamine, and the drug accounted for 72 per cent of the total quantity of ATS seized in the same period. > The quantities of ATS seized rose by 64 per cent between 2018 and 2019 to record levels, capping an almost sixfold increase in the past decade while methamphetamine showed a tenfold increase over the same period. Key issues > Seizures of precursor chemicals under international control used in the manufacture of methamphetamine have all but collapsed in the past decade, as manufacturers continue to change the chemicals they use to bypass interdiction. > Injecting and use of stimulants is driving HIV outbreaks among people who use drugs in some sub-regions. > Ecstasy and amphetamine seizures doubled between 2015 and 2019. > Roughly 85 per cent of amphetamine laboratories dismantled worldwide between 2015 and 2019 were in Europe, along with more than half of ecstasy laboratories. > Most methamphetamine was seized in North America (49 per cent) and East and SouthEast Asia (43 per cent); most amphetamine was seized in the Near and Middle East and South West Asia (49 per cent) and in Europe (26 per cent); and most ecstasy was seized in Europe (43 per cent) and North America (21 per cent) over the period 2015–2019. > The number of NPS found at global level has been stabilizing in recent years at slightly more than 500 substances (541 in 2019) while the actual number of new psychoactive substances identified for the first time at global level declined from 213 to 71 between 2013 and 2019 > The number of NPS with opioid effects (often fentanyl analogues), have been growing strongly over the past decade and continued growing in 2018 and in 2019, though at a lesser pace than before. > Quantities of synthetic NPS seized have declined markedly, including of synthetic cannabinoids. > National and international drug control systems have succeeded in containing the spread of NPS in high-income countries where different types of legislation have been applied. > NPS markets are emerging in countries where control systems may be weaker. > The limited capacity of forensic, law enforcement and health experts to identify different NPS and their use makes it challenging for countries to adequately address the threat of NPS. FINDINGS AND CONCLUSIONS & POLICY IMPLICATIONS CANNABIS IS MORE POTENT BUT FEWER YOUNG PEOPLE SEE IT AS HARMFUL FINDINGS AND CONCLUSIONS Cannabis products have almost quadrupled in strength in the United States of America and have doubled in Europe in the last two decades. The percentage of Δ9-THC, the main psychoactive component in cannabis, rose from about 4 per cent to 16 per cent in the United States over the period 1995–2019, and from about 6 per cent to 11 per cent in Europe over the period 2002–2019. Δ9-THC is responsible for the development of mental health disorders, in long-term, heavy users of cannabis yet the percentage of adolescents perceiving cannabis as harmful has decreased by as much as 40 per cent during the same period. Surveys of schoolchildren and young adults in the United States and Europe bear out this finding. Limited evidence from other parts of the world suggests a similar pattern. Such a mismatch between the perception and the reality of the risk posed by more potent cannabis could increase the negative impact of the drug on young generations. Scientific evidence has demonstrated the harm to health caused by regular use of cannabis, particularly in young people. Evidence from surveys suggests a link between a low perception of risk and higher rates of usage. This is the case not only in Europe and the United States, but also in other parts of the world. Aggressive marketing of cannabis products with a high THC content by private firms and promotion through social-media channels; can make the problem worse. Products now on sale include cannabis flower, pre-rolled joints, vaporizers, concentrates and edibles. The potency of those products varies and can be unpredictable – some jurisdictions where cannabis use is legalized set no limit on THC content – and may be a public health concern. 22 POLICY IMPLICATIONS Combating misinformation on the impact of the use of cannabis products is crucial to enabling individuals, particularly young people, to make decisions based on an accurate perception of the risks. Awareness-raising and communication efforts that disseminate scientific information without stigmatizing people who use drugs or people with drug use disorders can help to avoid misperceptions. Messages must be fact-based and a clear distinction must be made among the effective medical uses of cannabis products for some ailments, the use of cannabis products such as CBD in the so-called wellness industry and the consequences of the non-medical use of cannabis. A comprehensive ban on advertising, promoting and sponsoring cannabis would ensure that public health interests prevail over business interests. Such a ban would need to apply across all jurisdictions. The measures could work in a way similar to the provisions of the WHO Framework Convention on Tobacco Control. More investment is needed for research into the harm that the non-medical use of cannabis poses to health and to better define the range of health conditions for which cannabis products may be an effective treatment. Global monitoring of the impact of laws that allow for the medical and non-medical use of cannabis is key. This will need to go beyond the trends in cannabis use in a single country to assessing the frequency and patterns of cannabis consumption, health and socioeconomic consequences and market developments in both the licit and the illicit sectors around the world. One important aspect to evaluate is the impact of cannabis legalization on the perception of risks associated with cannabis use, particularly among young people, beyond the countries where this legalization is taking place; it would also be critical to assess the risk perceived by young people in low-income countries. 1 PERCEPTION AMONG ADOLESCENTS OF RISK/HARM OF SMOKING CANNABIS REGULARLY Percentage Percentage 80 80 70 70 60 60 50 50 40 40 30 30 20 20 10 100 0 2019 2019 2015 2015 2017 2017 2011 2011 2013 2013 70 60 Linear (United States) 60 50 Percentage Percentage 14 14 14 12 12 12 12 10 10 10 108 8 88 66 66 44 44 22 22 00 00 50 40 40 30 30 20 20 10 100 0 1995 1995 1997 1997 1995 1995 1995 1995 1999 1999 1997 1997 1997 1997 2001 2001 1999 1999 1999 1999 2003 2003 2001 2001 2001 2001 2005 2005 2003 2003 2003 2003 2007 2007 1995 2005 2005 1995 2005 2005 2009 2009 1997 2007 2007 1997 2007 2007 2011 2011 1999 2009 2009 1999 2009 2009 2013 2013 2001 2011 2011 20112001 2011 2015 2015 2003 2013 2013 20132003 2013 2017 2017 2005 2015 2015 20152005 2015 2019 2019 2007 2017 2017 20172007 2017 2009 2009 2019 2019 2019 2019 2011 2011 2013 2013 60 50 50 40 2007 2007 2009 2009 Percep�on among adolescents of Percep�on among adolescents of risk/harm smoking cannabis regularly Europepotency Cannabis (Δ9-THCofcontent) CANNABIS POTENCY (Δ9-THC CONTENT) Percep�on among adolescents of risk/harm smoking cannabis regularly Europe United80 States Cannabis potency (Δ9-THC in cannabis herbofcontent) 16 Percep�on among adolescents of IN CANNABIS HERB risk/harm of smoking cannabis regularly United States Linear (Europe) 16 in cannabis herb 80 70 16 risk/harm of smoking cannabis Linear (Europe) 16 Linear (United States) regularly 14 Percentage Percentage Percentage Percentage 80 80 70 70 60 2003 2003 2005 2005 0 1999 1999 2001 2001 20 10 100 1995 1995 1997 1997 40 30 30 20 Europe Europe states Europe United States Europe United States Europe states United States Linear (Europe) Europe United States Linear (Europe) Europe Europe United States United States Linear trend (Europe) Linear (Europe) Linear Trend (United States) Linear trend (Europe) Linear (Europe) Linear (United States) Linear Trend (United States) Linear (United States) 23 RISING SALES OVER THE INTERNET COULD TRANSFORM GLOBAL PATTERNS OF DRUG DISTRIBUTION AND USE FINDINGS AND CONCLUSIONS Drug markets on the darknet only emerged a decade or so ago, but the main ones are now worth at least $315 million in annual sales. Although this is a tiny fraction of overall drug sales, the trend is upward, with a fourfold increase in annual sales between the beginning of the 2010s (2011–mid-2017) and more recent years (mid-2017–2020). The expansion of online drug markets to social media and popular e-commerce platforms further suggests that their accessibility is widening. While cannabis dominates darknet sales, marketing on the so-called clear web often involves NPS and substances used in the manufacture of synthetic drugs, including precursor chemicals. Vendors play a cat-and-mouse game with law enforcement by marketing their products as “research chemicals” or advertising “custom synthesis”, whereby clients can request substances not included on a list of available products. While this is a legitimate practice in the pharmaceutical industry, it may be misused by traffickers to distribute controlled substances. Rapid technological innovation, combined with the agility and adaptability of those using new platforms to sell drugs and other substances, may usher in a globalized market where more drugs become available in more locations, especially since traffickers can quickly adapt their distribution networks. This in turn will trigger accelerated changes in patterns of drug use. POLICY IMPLICATIONS Increasing the capacity of law enforcement agencies to address drug trafficking over the darknet remains a priority, but the increased use of the clear web requires innovative solutions and international cooperation. Public-private partnerships have become crucial in addressing drug trafficking on the Internet. The drug supply chain now involves Internet service providers, technology companies and shipping and mailing companies. Government responses can be effective only if they involve those actors. Joint responses by Governments and the private sector can involve controlling and removing advertisements and listings of illegal drugs on the Internet. Such initiatives should facilitate the sharing of proportionate, lawful and necessary information with law enforcement agencies, while respecting the highest ethical standards to ensure freedom of information and respect for privacy. Targeting the illicit profits and financial flows that govern drug trafficking requires strong regulation and supervision of cryptocurrency markets and monitoring of electronic payments to detect and report suspicious transactions. Such approaches are effective only if regulations are uniform and compliance is enforced in all jurisdictions, with Governments setting a “level playing field”. This will be even more important in the future as the payment for drugs sold online is likely to shift from traceable cryptocurrencies to “privacy coins”, which provide a higher degree of anonymity. The globalized drug market that is likely to develop on the Internet will require a global response, with innovative, human rights-compliant tools for law enforcement agencies to investigate the borderless virtual space. To respond to this threat, all States will need to be equipped with expert access to the darknet and the investigative capability to proactively take down online markets and platforms. The transnational nature of online drug markets requires a law enforcement capacity that is agile and can have an impact across borders, with joint investigation teams from different countries. Addressing the needs of prosecutors and judges to obtain and authorize requests for data beyond national borders is key in this context. 24 1 THE INTERNET: CLEAR WEB, DEEP WEB AND DARK WEB Internet Infrastructure consisting of a standardized set of data transfer protocols for digital information exchange. Clear web (surface web) Content indexed by standard web-search engines, accessible to anyone using the Internet. • social networks • public pages /profiles Deep web Dark web (darknets) Darknets, or overlay networks within the Internet that can only be accessed with specific software, configurations, or authorization, and often use a unique customized communication protocol. Two typical darknet types are social networks (usually used for file hosting with a peer-topeer connection), and anonymity proxy networks such as Tor via an anonymized series of connections. Content not indexed by standard web-search engines; content can be located and accessed by a direct URL or IP address but may require a password or other security access to get past public-website pages; includes many very common uses such as web mail, online banking, private or otherwise restricted access content and profiles. • online banking • social networks • restricted pages /profiles 25 NUMBER OF DRUG USERS IN AFRICA PROJECTED TO RISE BY 40 PER CENT BY 2030 FINDINGS AND CONCLUSIONS The number of drug users in Africa is projected to rise in the next decade by as much as 40 per cent, simply because of demographic changes. Although a rise in people who use drugs is predicted across the world, it is likely to be particularly pronounced in Africa because the population is younger, and drug use is higher among young people than among older people. Moreover, the population of Africa is projected to grow more quickly than that of other regions. Globally, the number of people using drugs is projected to rise by 11 per cent by 2030 because of demographic changes alone. Low-income countries account for the lion’s share of this rise. These transformations will bring challenges: an increase in the number of people who use drugs means more people with drug use disorders and therefore more need for the services that cater to them. More demand for drugs could lead to organized criminal groups increasing their activities, presenting a serious challenge for law enforcement agencies in parts of the world where the capacity to address such problems is often weaker. Existing challenges affecting Africa, such as the use of cannabis, the non-medical use of tramadol and the increased use of the continent as a transit area for cocaine and heroin trafficking, are likely to be exacerbated by an increased number of people who use drugs. POLICY IMPLICATIONS The potential surge in the number of people who use drugs in Africa is still avoidable. An effective continental response will involve massive investment in health and an expansion of evidence-based prevention programmes, particularly those focusing on family skills, life skills in school and youth participation at the community level. High-quality pharmacological and psychosocial services are also needed. People who use drugs need a plan for social reintegration that includes provision for further education, vocational skills development and employment support. Evidence-based services such as family therapy should be targeted at young people with drug use disorders. Equally, provisions need to be made for comprehensive HIV prevention, treatment and care among people who use drugs in prisons and closed settings. The UNODC Strategic Vision for Africa 2030 can support this continental response with an integrated, people-centred and human rights-based approach, empowering African societies as they develop sustainable solutions to drug-related challenges. The strategy focuses on prevention to address the drivers of threats related to drugs and transnational organized crime, supporting and strengthening societies, institutions and at-risk and vulnerable groups. It supports specific and effective responses to drug trafficking and drug use, as well as drug-related HIV prevention, treatment and care. The projected increase in drug use and the continued dynamism of drug markets demand regular monitoring of the drug situation in Africa. Data on drug use and its harm and on supply and market indicators remain limited. States need a major continental mobilization to help them define and apply innovative and cost-effective monitoring and assessment systems. This will allow them to produce and use data on drug demand and supply and ensure that national authorities have the information they need to detect emerging trends while they can still be prevented. Strong partnerships will be key in supporting Africa to stop the expected increase in the number of people who use drugs and the possible negative impact on health and security. African Member States can work closely with United Nations partners, leveraging the efficiency provided by the United Nations development system reform, to deliver more through joint United Nations programmes. 26 1 INCREASE IN POPULATION AT MOST RISK OF DRUG USE AT MOST OFOF DRUG USE ISINCREASE HIGHEST IN IN POPULATION COUNTRIES WITH LOWRISK LEVEL INCOME IS HIGHEST IN COUNTRIES WITH LOW LEVEL OF INCOME 2030 2018 $ +43% Low-income countries $ +10% Middle-income countries $ -1 % High-income countries 27 IMPACT OF COVID-19 COVID-19 HAS TRIGGERED INNOVATION IN DRUG USE PREVENTION AND TREATMENT SERVICES FINDINGS AND CONCLUSIONS Since the COVID-19 pandemic swept the world, many tasks once conducted face to face have been carried out using Internet-based technology, telephones or the postal system. In some countries, rapid innovation has transformed what health professionals treating people who use drugs can offer. Despite some disruption to drug treatment services in the first months of the pandemic, many countries were quick to introduce telemedicine to comply with stay-at-home measures and physical-distancing rules. This enabled health-care workers to offer counselling and initial assessments over the telephone. However, in many instances, the closure of non-essential health services and movement restrictions brought about the sudden and uncoordinated discontinuation of services for people with drug use disorders during the initial lockdown periods. In addition, prescribing requirements have been simplified and patients have been given more flexibility with opioid agonist medication and some people suffering from drug use disorders have been allowed to take home methadone doses. Other practices include using vending machines to dispense opioid agonist medication and postal services to distribute sterile needles and syringes. Many of these novel approaches will need to be evaluated to better assess their effectiveness. 28 POLICY IMPLICATIONS Adaptations made as a result of COVID-19 to the delivery of services for drug use prevention and the treatment, care and rehabilitation of drug use-related disorders and HIV have great potential to increase the accessibility and coverage of services if they remain in place after the pandemic. The acceleration of Internet-based services creates a need for the updating of scientific standards on drug use prevention and the treatment, care and rehabilitation of drug use-related disorders and HIV. To ensure equal access to Internet-based services, particularly among the most marginalized, these standards will need to consider the different level of information technology literacy and access across the globe. Evidence showing the health vulnerability of people who use drugs and with drug use disorders, including of those living with infectious diseases and those in prison, point to the need to prioritize these groups for COVID-19 screening and vaccination. People who use drugs, both in the community and in prison, need to be included in national plans for pandemic response. Such plans must ensure the continuity of treatment, care and rehabilitation services for people who use drugs, both in the community and in prison. Protecting the human rights of people who use drugs and reducing stigma, discrimination and inequality must remain key objectives if public health outcomes are to be optimized during the current and future pandemics. 1 MANY COUNTRIES EXPERIENCED DISRUPTIONS TO DRUG USE MANY COUNTRIES EXPERIENCED DISRUPTIONS SERVICES DURING THE EARLY STAGES OF THE COVID-19 PANDEMIC TO DRUG USE SERVICES DURING THE EARLY STAGES OF THE COVID-19 PANDEMIC Cri�cal services for the preven�on of adverse health consequences Overdose preven�on and management Opioid agonist treatment programmes 0 10 20 30 40 50 60 70 Propor�on of countries (percentage) Par�ally disrupted Completely disrupted 29 RESILIENCE OF DRUG MARKETS DURING THE PANDEMIC HAS ONCE AGAIN DEMONSTRATED TRAFFICKERS’ ABILITY TO ADAPT QUICKLY TO CHANGED ENVIRONMENTS AND CIRCUMSTANCES. FINDINGS AND CONCLUSIONS Drug markets were temporarily disrupted in most parts of the world during the first phase of the COVID-19 pandemic, but they have recovered quickly. Nevertheless, the pandemic has triggered or accelerated some preexisting trafficking dynamics. These include larger shipment sizes and increased use of land and waterway routes, private planes, air cargo and postal parcels and contactless methods for delivering drugs to consumers, such as mail delivery. POLICY IMPLICATIONS Fostering international cooperation remains a key objective for fighting the enduring problem of drug trafficking. It is essential that law enforcement agencies operating at key border points exchange information and transfer knowledge at the regional and international levels on effective interdiction approaches and best practices. Together, they can define new strategies to improve targeted control of containers and cargo shipped along air and maritime routes. Surveillance and targeting capacity with regard to maritime, land, rail and air cargo must be improved substantially, but this can only be achieved if intelligence is effectively shared between national authorities and the private sector, such as shipping companies and commercial airlines. The development of international accountability mechanisms and best practices for shipping companies, postal services and railway operators with regard to tracking suspicious shipments would greatly increase interception capacity. This should go together with strategies aimed at addressing changes in trafficking dynamics through reinforced screening and the identification of suspicious air cargo on private and commercial aircraft. Continual changes in the routes and tactics employed by traffickers require real-time data-monitoring systems that can reinforce border management mechanisms and the knowledge of border control officials. Such systems can guide the priorities of law enforcement agencies and help to shape the training and mentoring of officers operating at major border points. 30 1 Cannabis Cocaine Heroin 2020 2019 2020 2019 2020 2019 2020 100 90 80 70 60 50 40 30 20 10 0 2019 Percentage DURING THE COVID-19 PANDEMIC THERE HAS BEEN A CLEAR CHANGE IN THE MODE OF TRANSPORTATION  OF SMALL-SCALE DRUG SEIZURES Methamphetamine Air Land Mail Sea/waterway 31 NON-MEDICAL USE OF CANNABIS AND SEDATIVES HAS INCREASED DURING THE PANDEMIC FINDINGS AND CONCLUSIONS Most countries have seen an increase in the use of cannabis and non-medical use of pharmaceutical drugs such as benzodiazepines during the pandemic. In a survey of health professionals in 77 countries, a rise in the non-medical use of sedatives was reported in 64 per cent of countries and the consumption of cannabis was reported to have increased in 42 per cent. Sufficient funding for drug use prevention and treatment responses needs to be allocated in national post-COVID-19 budgets to avoid an acceleration of the increase in the use of certain drugs observed during the pandemic. Annual health budgets need to include a dedicated percentage for drug use prevention and treatment and HIV-related issues. Changes in patterns of use of other substances were less clear, but drugs such as “ecstasy” and cocaine that are typically used in social settings were being used less frequently. This will allow the coverage of services to be expanded and the quality to be improved, ensuring that people with drug use disorders do not resort to the use of more harmful substances or methods of administration. Negative outcomes such as drug-related deaths will therefore be reduced. North America has seen a spike in opioid overdose deaths since the onset of the pandemic. For example, opioid overdose deaths in Canada were 58 per cent higher during the quarter April–June 2020 as compared with the same period in 2019. Measures related to COVID-19 are known to have increased economic deprivation and feelings of social isolation, factors that can contribute to increased drug use. 32 POLICY IMPLICATIONS Prevention is a cost-effective measure to pre-empt further increases in the number of people who use cannabis and the harm arising from its increasing non-medical use. Post-pandemic investment needs to prioritize scientific evidence-based prevention of drug use and other risky behaviours, with a special focus on the development of life skills in children and young people, parenting and family skills, and mental health services. 1 ADDICTION MEDICINE PROFESSIONALS PERCEIVED IN MOST COUNTRIES AN INCREASE IN THE USE OF CANNABIS AND  NON-MEDICAL USE OF PHARMACEUTICAL DRUGS  DURING THE EARLY STAGES OF THE PANDEMIC Alcohol Amphetamines Cannabis Cocaine Opiates Pharmaceu�cal opioids Seda�ves 0 10 20 30 40 50 60 70 80 90 100 Propor�on of countries (percentage) Decrease No change Increase No answer 33 COVID-19 FALLOUT LIKELY TO BE FELT IN DRUG MARKETS FOR YEARS TO COME FINDINGS AND CONCLUSIONS The pandemic has brought increasing economic hardship along with radical shifts in technology and dramatic alterations in social habits that are likely to affect drug patterns in the long run. Fragile communities in opium poppy and coca bush cultivation areas have become increasingly vulnerable as the pandemic has affected their livelihoods. In Afghanistan, for example, the pandemic came after a drought in 2018 and floods in 2019, meaning that many farmers were already struggling to cope. The economic crisis brought on by the pandemic will only increase the appeal of illicit crop cultivation. Rising unemployment may mean that more people are willing to work as daily labourers for opium gum and coca leaf harvesting, while drug traffickers may also find recruitment easier in a time of hardship. Meanwhile, inequality, poverty and mental health conditions are on the rise across the world, and these are known factors that push people into drug use and cause negative health consequences and a rise in drug use disorders. Changes already observed in drug use patterns, including increases in the use of cannabis and the non-medical use of pharmaceutical sedatives, are likely to accelerate the expansion of the market for these substances. This is all likely to be fuelled by innovation in the retail distribution of drugs, with street dealing becoming less prevalent as contactless methods such as online purchasing and delivery by mail – and even drones – become more common. 34 POLICY IMPLICATIONS Prevention through support to parents and young people in vulnerable circumstances, so that they can better face the stresses of the pandemic without resorting to negative coping mechanisms, will be particularly needed in the recovery phase. Effective practices include the provision of training in family skills, shelter for people suffering domestic abuse and mental health services. Post-pandemic recovery plans are opportunities to alleviate the negative consequences of the pandemic for vulnerable and marginalized groups. Communities of people who use drugs and communities engaged – or at risk of engaging – in illicit drug cultivation and production should be included in programmes involving housing, food supply, economic assistance and health insurance. Development assistance to rural villages engaged in illicit drug cultivation is crucial to prevent increased engagement in production and trafficking by people who have lost employment because of the pandemic. Long-term investment in sustainable alternative development interventions can improve the conditions of households in rural areas. If implemented early in the recovery phase, these measures could steer households away from illicit activities and prevent the migration of labour to illicit drug economies, helping to secure the progress made in recent years. Alternative development interventions can help communities to boost their skills, improve their infrastructure and move beyond basic livelihood development levels in ways that do not damage the environment. Moreover, involving the private sector can dramatically expand the profitability of products or services. Measuring the impact of these alternative development interventions will be important for strengthening the evidence base and further increasing the effectiveness of such projects. 1 THE COVID-19 PANDEMIC HAS EXACERBATED THE COVID-19 PANDEMIC HAS EXACERBATED THE FACTORS THE FACTORS THAT FUEL THE VICIOUS CYCLE THAT FUEL THE VICIOUS CYCLE O  F SOCIO-ECONOMIC OF SOCIO-ECONOMIC VULNERABILITY VULNERABILITY AND DRUG USE DISORDERS AND DRUG USE DISORDERS Conflict Poverty in 2020, between 119 and 124 million people were pushed into extreme poverty VICIOUS CIRCLE Limited education in 2020, 1.6 billion learners were affected by school closure Drug use disorder Limited employment in 2020, 255 million full-time jobs lost 35 NUMBER OF NPS EMERGING IN HIGH-INCOME COUNTRIES IS FALLING, BUT AVAILABILITY MAY BE SPREADING TO POORER REGIONS FINDINGS AND CONCLUSIONS The number of NPS emerging on the global market fell from 163 in 2013 to 71 in 2019. This reflects trends in subregions such as North America and Western and Central Europe, where the main markets for NPS first emerged a decade ago. The figures suggest that national and international control systems have succeeded in limiting the spread of NPS in high-income countries. Some high-income countries have adopted generic legislation covering possible future variants of controlled substances; others have applied analogue legislation more strictly than in the past, allowing the courts to determine whether substances have structures and effects similar to others already under national control. However, the NPS problem has now spread to poorer regions, where control systems may be weaker. For example, seizures of synthetic NPS in Africa rose from less than 1 kg in 2015 to 828 kg in 2019. There was a similar trend in Central and South America, with seizures rising from 60 kg to 641 kg over the same period. 36 POLICY IMPLICATIONS There is much to learn from the positive trend of NPS containment. Countries and regions that have more recently been exposed to the challenge of NPS can benefit greatly from increased international cooperation and the transfer of best practices from the countries that have managed to contain the problem through legislative, law enforcement and forensic efforts. Responses that have helped to contain the supply of NPS and reduce negative health consequences can be expanded to lower-income countries, some of which are increasingly vulnerable to the emergence of NPS. Those responses include early warning mechanisms that ensure a continuum of evidence-based measures from early detection to early action, post-seizure inquiries, including the formation of joint investigation teams, and training of emergency health workers on how to address cases of acute NPS intoxication. The expansion of services for people who use drugs and people with drug use disorders to people who use NPS can also help addressing the harm posed by those substances. 1 163 2013 DECREASING NUMBER OF EMERGING NEW SUBSTANCES NEW PSYCHOACTIVE SUBSTANCES BUT GEOGRAPHICAL EXPANSION 2019 71 NEW SUBSTANCES 37 COCAINE SUPPLY CHAINS TO EUROPE ARE DIVERSIFYING, PUSHING PRICES DOWN AND QUALITY UP, THREATENING EUROPE WITH A FURTHER EXPANSION OF THE COCAINE MARKET FINDINGS AND CONCLUSIONS The cocaine trafficking route between South America and Europe is the second biggest in the world, and it is evolving. Supply chains once dominated by a few organized criminal groups are changing, with many more groups involved. Much of the cocaine in Europe used to be imported through well-established channels, notably by Italian organized criminal groups and through alliances between Colombian and Spanish groups. Now, however, organizations originating in the Balkans are increasingly involved in trafficking and supply, and some are now cutting out intermediaries and sourcing cocaine directly from the production areas in the Andean region. The increased competition and efficiency of supply mean that cocaine is becoming more available and the quality is rising. The purity of cocaine available in Europe has increased by 40 per cent in the past decade, meaning that high-quality cocaine has, in effect, become cheaper per pure unit. Easier access to high-quality cocaine is likely to increase the overall number of people using cocaine and encourage those people who currently use cocaine to use more. This will continue to increase the potential harm caused by the drug. 38 POLICY IMPLICATIONS Preventing increases in the supply of cocaine from translating into more people using the substance and more associated harm needs solid investment in drug use prevention and treatment. This investment should focus on targeting people who could possibly initiate use of cocaine and on research to develop pharmacological responses. A real-time monitoring system of both supply and demand and the illicit financial flows generated by the cocaine market is also needed to better understand how to target traffickers’ profits. Preventing the threat of a further increase in the cocaine supply to Europe requires the boosting of international cooperation between the Americas and Europe and the transfer of best law enforcement practices in terms of targeting loose criminal networks and new communication tools. Such cooperation needs to include not only law enforcement but also prosecutors, and should also involve the promotion of joint investigation teams through Eurojust and Europol. 1 COCAINE SUPPLY CHAIN TO EUROPE HAS BECOME MORE EFFICIENT, COCAINE SUPPLY CHAINI TO EUROPE HAS BECOME MORE EFFICIENT, RESULTING RESULTING N GREATER SUPPLY, A PURER PRODUCT IN GREATER SUPPLY, A PURER PRODUCT AND INCREASED AVAILABILITY AND INCREASED AVAILABILITY More organized crime groups Increased market competition More cocaine reaching Europe Purity increase 2018 40% 2015 2013 2011 39 DEEPENING DRUG PROBLEM IN AFGHANISTAN RISKS EXACERBATING REGIONAL THREAT FINDINGS AND CONCLUSIONS Afghanistan reported a 37 per cent increase in the amount of land used for illicit cultivation of opium poppy during 2020 compared with the previous year. It was the third highest figure ever recorded in the country and accounted for 85 per cent of the global total of opium production in 2020. The increase follows a trend that has seen the global area under opium poppy cultivation rise over the past two decades, particularly after 2009. Afghanistan is also now becoming a major source for methamphetamine in the region. In neighbouring the Islamic Republic of Iran, the proportion of Afghan-origin methamphetamine seized increased from less than 10 per cent in 2015 to more than 90 per cent in 2019. Seizures in Afghanistan increased almost sevenfold in 2019 as compared with a year earlier. This came even as air strikes in Taliban-held border regions wiped out dozens of methamphetamine laboratories in a single day in 2019. The expansion of methamphetamine manufacture adds complexity to the illicit drug economy of Afghanistan and increases the threat to countries in the region and beyond. Political instability could further increase the vulnerability of local communities to both the production of opium and the manufacture of methamphetamine. The health consequences of the surge in methamphetamine manufacture in Afghanistan are already beginning to affect the country. Young people are now exposed not only to the largest supply of opiates in the world in one of the largest illicit drug economies, but also to an increasingly diversified market of synthetic drugs. Surveys show a relatively high proportion of young people reporting recent methamphetamine use. POLICY IMPLICATIONS Afghanistan is a prime example of how politics, security and narcotics interlink. With politics and security being discussed during the current peace negotiations, the illicit economy as an important wealth creator is not to be overlooked. In the meantime, strengthening alternative livelihoods will help to reduce opium cultivation, build community resilience in uncertain times and stem outward migration. Beyond this, regional cooperation is crucial among the countries immediately affected by the expansion of both opiates and synthetic drugs. Strengthening international cooperation with Afghanistan is today more important than ever, given that international troops will soon be leaving the country. Identifying targets, supporting regional counter-narcotics operations and proposing regional action plans are now a priority for setting responses to the trafficking of drugs originating in Afghanistan. The drug problem faced by Afghanistan has regional and global roots and ramifications. At the national level, Afghanistan needs support to provide sustainable and viable alternative livelihoods to rural communities, to strengthen interdiction through poppy eradication and to promote counter-narcotic campaigns. The country also needs help to increase capacity to disrupt manufacturing and trafficking networks, as well as to improve governance and security. It faces the task of addressing negative health consequences related to the drug use problem that is now growing in complexity with the increased use of synthetic drugs, particularly among young people. At the regional level, countries need support in the use of advanced investigative techniques in controlled delivery operations, backtracking investigations and money-laundering and financial investigations aimed at dismantling criminal organizations involved in trafficking drugs and their precursors in the region. Law enforcement education and training institutions need to operate under international standards in the identification and analysis of forensic evidence to track the movement of illicit drugs and their precursor chemicals in West and Central Asia. It would be particularly effective to provide support in addressing the diversion of precursor chemicals required in heroin and methamphetamine manufacture. Regional and subregional law enforcement cooperation platforms, including the Central Asian Regional Information and Coordination Centre,theTriangularInitiativeanditsJointPlanningCell,andtheAfghanistan– Kyrgyzstan–Tajikistan Initiative, need to be strengthened. 40 Developments in Afghanistan call for improved analysis of the impact of the illicit drug economy and more comprehensive monitoring of the drug market, particularly methamphetamine and the chemicals used in its manufacture. 1 400,000 8,000 300,000 6,000 200,000 4,000 100,000 2,000 0 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Opium produc�on (tons) 10,000 Opium poppy cul�va�on (hectares) GLOBAL PRODUCTION OF OPIUM REMAINS AT HIGH LEVEL  GLOBAL PRODUCTION OF OPIUM REMAINS AT HIGH LEVEL WITH AFGHANISTAN ACCOUNTING FOR 85 PER CENT WITH AFGHANISTAN ACCOUNTING FOR 85 PER CENT 0 Area under opium poppy cul�va�on Opium produc�on: other countries Lao PDR opium produc�on Opium produc�on: Mexico Opium produc�on: Myanmar Opium produc�on: Afghanistan 41 METHAMPHETAMINE SEIZURES HAVE ROCKETED BUT ITS PRECURSORS ARE LARGELY UNDETECTED FINDINGS AND CONCLUSIONS While the amount of methamphetamine seized increased threefold between 2011 and 2019, seizures of its internationally controlled precursors declined by 99 per cent over the same period. The internationally controlled precursor chemicals seized in 2011 would have been enough to manufacture 700 tons of the drug, seven times the amount of methamphetamine intercepted that year. By 2019, the amount of precursor chemicals seized had fallen to an equivalent of 10 tons of methamphetamine, whereas a much higher quantity of the drug, 325 tons, was seized. This dynamic is down to the agility of traffickers in changing the chemicals they use, to bypass interdiction. Criminal groups in Afghanistan are known to use the Ephedra plant, which is not internationally controlled, to produce the precursor ephedrine while in North America and Western Europe they use non-controlled chemicals to manufacture the precursor P-2-P, which is then used to make methamphetamine. The capacity, know-how and versatility of traffickers in swapping the chemicals and tweaking their processes is challenging the capacity of Member States to control precursors. The low proportion of precursors intercepted could also be caused by law enforcement agencies placing a higher priority on the seizure of the end drug product than on the seizure of its components. POLICY IMPLICATIONS The partnership between Governments and the private sector has become essential in the control of precursors of synthetic drugs, including methamphetamine. It helps to identify the possible diversion of non-controlled precursors from the licit supply chain. Regular monitoring by national authorities, together with the private sector, can allow law enforcement to develop the same agility as traffickers and to quickly change targets in their precursor control strategy, in particular towards non-controlled chemicals. Forensic laboratories with the capacity to conduct confirmatory testing on suspected drugs and chemicals can also generate important information about methamphetamine, including its chirality and purity, that would allow the synthesis routes and the origin of precursor chemicals to be traced. The establishment and strengthening of networks of central authorities that regulate precursor chemicals based on source, transit and destination countries can facilitate information-sharing and initiate joint backtracking investigations. These networks can also raise awareness of non-controlled chemicals used in the manufacture of ATS. Mechanisms that support front-line officers at border checkpoints in areas with high trafficking levels can also enhance transnational capacity to disrupt flows of controlled and non-controlled chemicals in manufacturing areas. Finally, there is a need to improve the regular monitoring of methamphetamine consumption with cost-effective methods such as the analysis of wastewater. This type of analysis can also help to identify potential clandestine manufacture at the local level. 42 1 THE GLOBAL INTERCEPTION OF METHAMPHETAMINE HAS INCREASED OVERMETHAMPHETAMINE THE YEARS WHILE THE INTERCEPTION OF ITS WHILE SEIZURES IS GROWING INTERNATIONALLY CONTROLLED PRECURSORS HAS DECLINED IN MYANMAR INTERCEPTION OF ITS INTERNATIONALLY CONTROLLED PRECURSORS IS DECLINING 600,000 500,000 400,000 300,000 200,000 100,000 2019 2018 2017 2016 2015 2014 2013 2012 2011 0 2010 Kilograms of methamphetamine equivalents 700,000 Methamphetamine precursors Methamphetamine 43 PHARMACEUTICAL DRUGS USED TO TREAT OPIOID USE DISORDERS HAVE BECOME MORE AVAILABLE FINDINGS AND CONCLUSIONS The two pharmaceutical opioids most commonly used to treat people with opioid use disorders, methadone and buprenorphine, have become increasingly accessible over the past two decades. The amount available for medical use has increased sixfold since 1999, from 557 million daily doses in that year to 3,317 million by 2019. This is a positive sign that science-based pharmacological treatment is more available now than in the past. However, as with other pharmaceutical opioids, there are large differences across countries and regions. The availability of these substances is generally high in North America, Western and Central Europe and in the most-developed parts of Oceania. Many countries in Africa and Asia, however, reported either limited availability or no availability of either. This results in a varying coverage of opioid agonist treatment for drug use disorders. The availability of the substances for medical purposes can reflect factors including a country’s income level, the use of such substances for analgesic purposes or the number of people with opioid use disorders. It can also be affected by policies relating to opioid agonist treatment. 44 POLICY IMPLICATIONS The encouraging trend of increased availability of methadone and buprenorphine provides an opportunity for accelerating science-based treatment of drug use disorders and making opioid agonist treatment more widely available. Special efforts should be made in countries where availability remains low, while continuing efforts to prevent the diversion of such substances to illegal markets. Drug treatment should be available to all in need, including people with drug use disorders in prisons and other closed settings. Approaches adopted during the COVID-19 pandemic have shown that access to opioid agonist therapy can be maintained even in challenging situations through low-threshold services and the scale-up of take-home therapy. 1 MORE MOREDOSES DOSESOF OFPHARMACEUTICAL PHARMACEUTICAL DRUGS DRUGS COMMONLY COMMONLY  USED USEDTO TOTREAT TREATPEOPLE PEOPLEWITH WITHOPIOID OPIOID USE USE DISORDERS DISORDERS HAVE BECOME GLOBALLY AVAILABLE HAVE BECOME GLOBALLY AVAILABLE 4,000 Methadone Buprenorphine 3,000 2,500 2,000 1,500 1,000 2018 2016 2014 2012 2010 2008 2006 2004 2002 0 2000 500 1998 Millions of S-DDD 3,500 45 PATIENTS IN SEVERE PAIN IN POORER COUNTRIES STILL SUFFER FROM MEDICATION SHORTAGES FINDINGS AND CONCLUSIONS In 2019, medical professionals in West and Central Africa had access to 4 standard doses of controlled pain medication every day per 1 million inhabitants. In North America, the figure was about 32,000 doses. Patients with acute or chronic pain from serious illnesses such as cancer endure unnecessary suffering on a large scale. The shortages in supply were not limited to Africa. Parts of Asia, Oceania, Central and South America and the Caribbean also reported availability that was less than 1 per cent of that of North America. Overall, the availability of pharmaceutical opioids for each person in low- and middle-income countries was less than 1 per cent of that in high-income countries in 2019. This is despite 84 per cent of the world’s population living in low and middle income countries. 46 POLICY IMPLICATIONS Following the basic tenets of the drug conventions, countries and the global community need to strike a better balance in providing access to controlled medications to manage pain while avoiding the development of a market for the non-medical use of such medications. Countries need to address the barriers to equitable access to medications for pain management and palliative care by reviewing policies, addressing challenges in the supply chain, supporting health workers and raising awareness among the general public to increase access to controlled medicines while preventing diversion and non-medical use. During the pandemic, accessibility to controlled medications to manage pain has been particularly critical to support patients who contracted the virus and those who could not access proper care in hospitals because of the virus. INCB, UNODC and WHO have called upon Governments to ensure that the procurement and supply of controlled medicines during the pandemic meets the needs of patients, both those who have COVID-19 and those who require internationally controlled medicines for other conditions. S-DDD per day per 1 million inhabitants 20,000 15,000 10,000 5,000 0 North America Australia and New Zealand Western and Central Europe GLOBAL AVERAGE 3,242 Near and Middle East/ South-West Asia 1,594 South-Eastern Europe 1,401 Eastern Europe 478 East and South-East Asia 344 Central Asia and Transcaucasia 305 South America 247 Southern Africa 237 Central America 174 South Asia 136 East Africa 94 Caribbean 77 North Africa 76 Melanesia, Polynesia and Micronesia 86 West and Central Africa 4 1 CRITICAL LOW AVAILABILITY OF CONTROLLED PAIN  MEDICATION IN LOW- AND MIDDLE-INCOME COUNTRIES 30,000 31,826 25,000 17,147 12,160 47 NUMBER OF PEOPLE USING DRUGS HAS RISEN 22 PER CENT IN THE PAST DECADE FINDINGS AND CONCLUSIONS Roughly 275 million people globally have used drugs in the past year, up from 226 million in 2010. This 22 per cent increase was partly due to a 10 per cent rise in the global population. Health-care systems are facing an increasingly tough task, with estimates suggesting that about 36 million people were suffering from drug use disorders in 2019, up from an earlier estimate of 27 million in 2010. This represents a rise from 0.6 to 0.7 per cent of the global population. Although the number of people with drug use disorders has increased, the availability of treatment interventions has remained low. Just one in eight of those suffering from a drug use disorder received professional help in 2019. Shortages in these services were felt most of all in poorer countries. This is despite overwhelming evidence that the cost of treating drug use disorders is much lower than the cost of untreated drug dependence. The rise in people using drugs and suffering drug use disorders has gone together with the arrival of hundreds of synthetic drugs on the market, and with a dramatic expansion of the non-medical use of opioids. Moreover, some drugs are more potent than they were a decade ago. All of this increases the risk to individual users and adds to the burden of health-care systems. 48 POLICY IMPLICATIONS Prevention remains the best first-line approach to reducing drug use and drug use disorders. The most effective approaches are those that contribute to the positive engagement of young people with their families, schools and communities, creating all-inclusive and safe neighbourhoods. Communities and civil society organizations — including organizations and networks of people who use drugs, people in recovery and other people affected by drugs—can greatly support prevention and treatment efforts. They should be included, supported and empowered in all aspects of the design, implementation, monitoring and evaluation of service delivery. The increased number of people with drug use disorders globally calls for the scaling up of evidence-based interventions that take a multifactorial approach. Such interventions should be integrated within the overall health-care delivery system and should address the needs of those in vulnerable circumstances, including women, children and adolescents and people in contact with the criminal justice system. Protecting and promoting the human rights of people who use drugs by treating them with dignity, removing stigma and providing equal access to health and social services need to be the underlying principles of all interventions related to drug use prevention and treatment. 1 THE NUMBER OF PEOPLE WITH DRUG USE DISORDERS  WAS IN 2019 33 PER CENT HIGHER THAN IN 2010 400 350 250 200 150 100 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 0 2007 50 2006 Millions 300 Number of people who use drugs Number of people with drug use disorders 49 FENTANYLS REMAIN THE PHARMACEUTICAL OPIOIDS MOST SEIZED IN TERMS OF DOSES, WITH NORTH AMERICA DOMINATING THESE SEIZURES FINDINGS AND CONCLUSIONS The amounts of fentanyl and its analogues seized globally have risen rapidly in recent years, and by more than 60 per cent in 2019 compared with a year earlier. Overall, these amounts have risen more than twentyfold since 2015. The largest quantities were seized in North America. Elsewhere in the world, other pharmaceutical opioids (codeine and tramadol) predominate. Over the period 2015–2019, the largest quantities of tramadol seized were reported in West and Central Africa; they accounted for 86 per cent of the global total. Codeine was intercepted in large quantities in Asia, often in the form of diverted cough syrups. In terms of weight seized, other pharmaceutical opioids far outweigh fentanyls. However, when expressed in terms of standard daily doses, fentanyl accounted for 63 per cent of the pharmaceutical opioids seized in 2019. This figure rises to 83 per cent when all the different fentanyl mixtures and analogues are included. The seizure pattern of pharmaceutical opioids reflects the different illegal markets that feed the non-medical use of pharmaceutical opioids in different regions. The impact of these illegal markets is clear in the harm that these substances pose to health. 50 POLICY IMPLICATIONS Large parts of the illegal markets that feed the non-medical use of pharmaceutical opioids are supplied by illegally manufactured opioids; reducing these illegal markets requires increased international cooperation and law enforcement capacity to dismantle transnational drug trafficking groups. In North America, where fentanyls are not generally diverted from the legal medical market and people often consume them inadvertently as a cutting agent of other drugs, attempts to reduce the illegal market need to concentrate on dismantling criminal groups and stopping illegal manufacturing, particularly through precursor control. The situation in West, Central and North Africa is more complex. While the illegal market for tramadol remains supplied by illegal manufacturing, there is a specific demand related to the non-medical use of tramadol. The distinction between the illegal and legal markets for medicines is blurred, and there is a large informal market for medicines. This environment is also characterized by limited access to essential medicines. In this context, law enforcement actions and international cooperation remain essential to dismantle relevant criminal groups, but they are not sufficient. More needs to be done to determine the right balance between providing access to essential medicines and avoiding non-medical use. Prevention campaigns need to be designed to make people more aware of the benefits of using opioids such as tramadol for medical use, and the harm they pose when they are used for non-medical purposes. 1 THE SHARP INCREASE IN THE SEIZURES OF FENTANYL IN NORTH AMERICA HAS LEAD GLOBAL SEIZURES OF PHARMACEUTICAL OPIOIDS TO BE DOMINATED BY FENTANYL I N TERMS OF STANDARD DOSES (2019). 601 500 241 Other Pethidine 5.0 2.4 0.2 0.2 0.1 Hydromorphone 69 55 Oxycodone Fentanyl-mix Tramadol 0 Codeine 100 134 Buprenorphine 127 Licit morphine 200 Methadone 295 300 Carfentanil 400 Fentanyl Millions of S-DDD 600 Controlled at the interna�onal level Not controlled at the interna�onal level 51 GLOBAL AREA UNDER COCA CULTIVATION DECLINES BUT COCAINE MANUFACTURE HITS RECORD HIGH FINDINGS AND CONCLUSIONS Global cocaine manufacture doubled in output between 2014 and 2019 to reach an estimated 1,784 tons in 2019, the highest level ever. Over the same period, seizures of cocaine more than doubled. Meanwhile, wastewater analysis showed a marked increase in the amounts of cocaine consumed per capita in Europe, one of the two main global markets. This all points to a surge all along the cocaine supply chain. However, the rate of increase in manufacture has slowed. While the year-on-year increase in manufacture in 2016 stood at 37 per cent, it was just 3.5 per cent in 2019. Moreover, the area under coca bush cultivation declined globally by 5 per cent in 2019, largely driven by the first significant fall in cultivation in six years in Colombia. Despite that, the country is still by far the largest source of cocaine globally. The area under cultivation remained stable in Peru and increased in the Plurinational State of Bolivia. The slowing rate of growth in cultivation had suggested that subsequent years would see cocaine manufacture decline. However, the COVID-19 pandemic and the resulting socioeconomic fallout may increase the vulnerabilities of farmers and create incentives to continue producing coca leaf. POLICY IMPLICATIONS International assistance for farmers in the coca bush-growing areas of the Andean region remains a fundamental pillar in reducing illicit cultivation and production in those areas. The strategies that have proved to be effective include providing crops and other alternative livelihoods that grant food security, and agroforestry solutions that open up export markets for sustainable farming and reduce conflict levels among coca farmers. Large-scale cocaine smuggling out of the Andean countries calls for strengthened international cooperation by law enforcement agencies, particularly on land and sea routes for trafficking established in response to restrictions to air travel after the COVID-19 outbreak. An improvement in container control could be helpful. The Parana-Paraguay waterway system, for example, needs increased controls at the ports connecting several countries to the Atlantic, a route that has been rapidly growing in importance. New strategies are needed to address the high number of clandestine and domestic ports in the area that are increasingly used for alternative trafficking routes. The increased use of light aircraft to transport cocaine across South America during the COVID-19 pandemic calls for the control of general aviation to be strengthened. Technical assistance is particularly effective in areas such as regulation of pilot licensing and recording of transactions involving aircraft parts and aviation fuel. Further assistance is required at the forensic level, particularly with regard to building laboratory capacity for chemical footprint analysis that can ultimately support both domestic and international criminal investigations into cocaine trafficking. Strategies that promote alternative livelihoods to coca bush cultivation and coca production must also involve strengthening institutions and improving access to the services they provide. The timely monitoring of coca bush cultivation and cocaine manufacture and trafficking, including related illicit financial flows, remains a priority. Along with this, innovative tools and geospatial analysis must be used to enhance understanding of the drivers of the coca economy and its links with the legal economy in areas along the supply chain. 52 1 AFTER REACHING A RECORD HIGH IN THE GLOBAL AREA UNDER  COCA CULTIVATION, LAST ESTIMATE SHOWS A 5 PER CENT DECLINE, BUT COCAINE MANUFACTURING IS STILL ON A RISE 250,000 1,500 200,000 1,000 150,000 100,000 500 0 2019 50,000 Cocaine manufacture at 100 per cent purity (tons) 2,000 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Coca bush cul�va�on (hectares) 300,000 0 Coca bush cul�va�on: Colombia Coca bush cul�va�on: Plurina�onal State of Bolivia Global cocaine manufacture: new conversion ra�o Coca bush cul�va�on: Peru Global cocaine manufacture: old conversion ra�o 53 SECURITY GAPS IN AREAS WHERE METHAMPHETAMINE IS MANUFACTURED ARE LIKELY DRIVING MARKET EXPANSION IN SOUTH-EAST ASIA AND NORTH AMERICA FINDINGS AND CONCLUSIONS The methamphetamine market is still expanding in South-East Asia and North America, with manufacture moving to geographical areas in Myanmar where there is instability and to areas in Mexico where there is a strong presence of organized criminal groups. In South-East Asia and Mexico, methamphetamine manufacture is connected with violence and insecurity. However, many aspects of the institutional and financial mechanisms of this connection remain largely unexplored. In the period 2015–2019, more than 90 per cent of the methamphetamine seized globally was seized in South-East Asia and North America. In North America, seizures increased eightfold, to 153 tons, between 2009 and 2019. In the same period, there was an elevenfold increase in seizures in South-East Asia, to 141 tons. In South-East Asia, providing support to countries surrounding Myanmar is crucial given the current volatile situation. It is also important to strengthen capacity in neighbouring countries to stop flows of chemicals into areas where drugs are produced and manufactured. The growth of methamphetamine trafficking in North America has come at the same time as so-called product innovations that have seen the drug take a variety of forms: powder, crystals, solutions and tablets that resemble MDMA or falsified pharmaceuticals. Manufacturers in North America are also increasingly mixing fentanyls with other drugs, contributing to a sharp rise in methamphetamine-related deaths in recent years. In South-East Asia, falling prices of methamphetamine products combined with rising seizures suggests that supply may have outstripped demand in the subregion. Organized criminal groups are taking advantage of loose controls over precursor chemicals and sometimes slow cooperation across borders. This has brought profound changes to the illicit drug markets in South-East Asia and the Pacific. Manufacture of the drug has been consolidated in the Golden Triangle region of Myanmar, where a decrease in the opium market has been observed together with increased manufacture of and trafficking in methamphetamine. Security problems and limited access to these areas are posing significant challenges. 54 POLICY IMPLICATIONS 1 4,500,000 600 4,000,000 3,500,000 500 3,000,000 400 2,500,000 2,000,000 300 1,500,000 200 1,000,000 100 2020 2019 2018 2017 0 500,000 0 Pseudoephedrine (number of tablets) 700 2016 Ephedrine (kilograms) SEIZURES OF METHAMPHETAMINE PRECURSORS INTERNATIONALLY CONTROLLED, MYANMAR Ephedrine Pseudoephedrine 55 OVERDOSES INVOLVING FENTANYLS CONTINUE TO DRIVE THE OPIOID CRISIS IN NORTH AMERICA FINDINGS AND CONCLUSIONS Almost 50,000 people died from overdose deaths attributed to opioids in the United States in 2019, more than double the 2010 figure. By comparison, in the European Union, the figure for all drug-related overdoses (mostly relating to opioid use) stood at 8,300 in 2018, despite the larger population. However, the opioid crisis in North America is evolving. The number of deaths attributed to heroin and the non-medical use of pharmaceutical opioids such as oxycodone or hydrocodone has been declining over the past five years. The crisis is now driven mainly by overdose deaths attributed to synthetic opioids such as fentanyl and its analogues. Among the reasons for the large number of overdose deaths attributed to fentanyls is that the lethal doses of them are often small when compared with other opioids. Fentanyl is up to 100 times more potent than morphine. The impact of fentanyl is illustrated even further by the fact that more than half of the deaths attributed to heroin also involve fentanyls. Synthetic opioids also contribute significantly to the increased number of overdose deaths attributed to cocaine and other psychostimulants, such as methamphetamine. 56 POLICY IMPLICATIONS To help prevent overdose deaths in North America, it is vital that those who are opioid dependent, including those in prison or recently released from prison, have access to proper treatment and services. Access to methadone and buprenorphine needs to be ensured; increasing the availability of take-home naloxone can save many lives. Furthermore, scaling up the training of people likely to witness an overdose – including peers, family members, first responders and the police – and equipping them with naloxone has been shown to be effective. Achieving this kind of coverage will involve tackling barriers that include cost and stigma. 1 5,876 2019 5,417 2018 5,444 2017 4,055 2016 2015 2014 2013 2012 2011 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 2010 Number IN THE UNITED STATES, NUMBER OF OVERDOSE DEATHS  ATTRIBUTED TO HEROIN AND PHARMACEUTICAL OPIOIDS A  LONE ARE DECREASING BUT THOSE ATTRIBUTED TO THE S  AME SUBSTANCES MIXED WITH FENTANYLS ARE INCREASING Pharmaceu�cal opioids Deaths involving pharmaceu�cal opioids and other synthe�c opioids (fentanyls) 8,746 9,068 2018 2019 8,091 2017 5,781 2016 2015 2014 2013 2012 2011 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 2010 Number Deaths involving pharmaceu�cal opioids without other synthe�c opioids Heroin Deaths involving heroin and synthe�c opioids (fentanyls) Deaths involving heroin without other synthe�c opioids 57 OPIOID USE CONTINUES TO ACCOUNT FOR THE LARGEST BURDEN OF DISEASE ATTRIBUTED TO DRUGS FINDINGS AND CONCLUSIONS The burden of disease caused by drug use continues to increase in terms of both premature deaths and the number of healthy years of life lost owing to disability. The greatest harm from drugs is associated with the use of opioids, in particular, with users acquiring HIV or hepatitis C through unsafe injecting practices. In 2019, 18 million years of healthy life were lost owing to drug use disorders; opioid use accounted for 70 per cent of the total. Deaths related to drug use disorders have nearly doubled over the past decade, far outstripping any increase in the number of users, suggesting that drug use has become more harmful. In 2019, half a million deaths were attributed to drug use. More than half of the deaths were due to liver cancer, cirrhosis and other chronic liver diseases resulting from hepatitis C, but the increase reflects, in part, the rise in overdose deaths attributed to use of opioids such as fentanyls. The situation is exacerbated by the continued low availability of evidence-based interventions such as opioid agonist treatment, naloxone for opioid overdose management, and prevention and treatment of hepatitis C. This is especially the case in poorer countries. More positively, the past decade has seen a decline in deaths attributed to HIV and AIDS among people who use drugs. 58 POLICY IMPLICATIONS Prevention strategies addressing opioid use, overdose deaths and health issues that may arise from unsafe injecting practices are essential for reducing the burden of disease. Partnerships between first responders, public health institutions and public safety authorities can help advance prevention efforts. Such efforts can increase public awareness, share relevant data to identify at-risk individuals and communities and facilitate referrals to treatment and social services. Reducing the health burden of opioids requires a significant scale-up of evidence-based interventions to deal with opioid use disorders, especially opioid agonist treatment and prevention of overdose and management of overdose cases. It also requires scaling up interventions for preventing blood-borne infections and widening the availability of hepatitis C treatments for people who use drugs. 1 THE NUMBER OF DEATHS AND HEALTHY YEARS LOST OWING THE NUMBER OF DEATHS AND HEALTHY YEARS LOST TO OWING TO DISABILITY CAUSED BY DRUG USE CONTINUE INCREASE TO DISABILITY CAUSED BY DRUG USE CONTINUE TO INCREASE 500,000 450,000 Deaths 350,000 300,000 250,000 200,000 150,000 100,000 2008 2010 2012 2014 2016 2018 2008 2010 2012 2014 2016 2018 2002 2002 2006 2000 2000 2006 1998 1998 2004 1996 1996 2004 1994 1994 35 30 1992 0 1990 50,000 DALYs 25 20 15 10 0 1992 5 1990 Years of "healthy" life lost (millions) Number 400,000 HIV/AIDS Other drug use disorders Cocaine use disorders Amphetamine use disorders Other Hepa��s C (liver cancer, cirrhosis and other chronic liver diseases) Opioid use disorders Cannabis use disorders Self-harm 59 BURDEN OF DISEASE REMAINS HIGH AMONG PEOPLE WHO INJECT DRUGS FINDINGS AND CONCLUSIONS There were more than 11 million people who inject drugs globally in 2019, of whom 1.4 million are living with HIV and 5.6 million with hepatitis C. Almost 1.2 million people live with both. Their primary risk of disease comes from sharing contaminated injecting equipment. There has been a decline in the number of years lost to the virus in terms of premature deaths and disability related to drug use. However, people who inject or use drugs are 29 times more likely to acquire HIV than the general population. They accounted for 1 in 10 new infections in 2019, according to UNAIDS estimates. In recent years, there have been localized outbreaks of HIV in countries across Europe and North America. 60 POLICY IMPLICATIONS Reducing the negative health impact of drug use requires the full implementation of a comprehensive package of HIV and hepatitis services. This includes the provision of needle-syringe programmes and opioid agonist therapy, the supply of naloxone and the treatment of hepatitis C. All this will have to be done on a scale that can be easily, voluntarily and confidentially accessed by all people who use drugs, including within prisons and other closed settings. Targeted advocacy among health-care providers and law enforcement can help to reduce the stigma and discrimination felt by people who use drugs. Moreover, gender-specific HIV- and hepatitis C-related services should be provided for women who use drugs. 1 MORE THAN 11 MILLION PEOPLE INJECT DRUGS 11. 2 million people inject drugs 5.6 million people who inject drugs are living with hepatitis C 1.4 million people who inject drugs are living with HIV 1. 2 million people who inject drugs are living with HIV and hepatis C 61 ANNEX Annual prevalence of the use of cannabis, opioids and opiates, by region and globally, 2019 Region or subregion Africa East Africa Opioids (opiates and prescription opioids) Cannabis Number (thousands) Prevalence (percentage) Number (thousands) Best Lower estimate Upper 46,950 28,150 64,080 6.41 3.85 8.75 9,050 Opiates Prevalence (percentage) Number (thousands) Prevalence (percentage) Best Best Best Best Best Lower Upper Lower Upper Lower Upper Lower Upper Lower Upper estimate estimate estimate estimate estimate 6,360 12,140 1.24 0.87 1.66 3,580 1,430 7,910 0.49 0.20 1.08 - - - - - - - - - - - - - - - - - - 7,850 6,900 9,170 5.26 4.63 6.15 1,580 1,060 2,100 1.06 0.71 1.41 1,580 1,060 2,100 1.06 0.71 1.41 - - - - - - - - - - - - - - - - - - West and Central Africa 26,790 14,610 30,360 9.40 5.12 10.65 - - - - - - 520 140 980 0.18 0.05 0.34 Americas 59,130 57,510 62,220 8.77 8.53 9.23 12,580 11,310 13,730 1.86 1.68 2.04 2,550 1,850 3,270 0.38 0.27 0.49 North Africa Southern Africa Caribbean 970 500 2,650 3.41 1.77 9.35 - - - - - - - - - - - - Central America 1,000 340 1,750 3.12 1.08 5.48 - - - - - - - - - - - - North America 47,120 46,950 47,290 14.53 14.47 14.58 11,790 10,690 12,630 3.63 3.30 3.89 2,280 1,690 2,800 0.70 0.52 0.86 South America 10,050 9,720 10,530 3.47 3.35 3.63 600 540 680 0.21 0.19 0.23 220 130 310 0.08 0.05 0.11 Asia 61,460 24,340 95,170 2.01 0.80 3.11 35,750 15,250 47,850 1.17 0.50 1.56 21,540 9,170 29,550 0.70 0.30 0.97 Central Asia and Transcaucasia 1,520 450 2,500 2.58 0.77 4.25 570 500 660 0.97 0.85 1.12 570 490 660 0.97 0.83 1.11 East and South-East Asia 19,330 8,710 24,010 1.19 0.54 1.48 3,290 2,420 4,020 0.20 0.15 0.25 3,290 2,420 4,020 0.20 0.15 0.25 South-West Asia/ Near and Middle East 10,780 7,740 12,830 3.34 2.40 3.98 10,310 8,480 12,840 3.19 2.63 3.98 5,690 4,090 8,050 1.76 1.27 2.49 South Asia 29,830 7,440 55,830 2.82 0.70 5.27 21,590 3,850 30,340 2.04 0.36 2.86 11,990 2,170 16,830 1.13 0.21 1.59 Europe 29,610 28,260 31,590 5.45 5.20 5.82 3,610 3,430 3,800 0.66 0.63 0.70 3,080 2,900 3,270 0.57 0.53 0.60 Eastern and South-Eastern Europe 4,630 3,350 6,540 2.07 1.49 2.92 1,730 1,640 1,810 0.77 0.73 0.81 1,490 1,410 1,570 0.67 0.63 0.70 Western and Central Europe 24,980 24,910 25,050 7.83 7.81 7.85 1,880 1,790 1,990 0.59 0.56 0.62 1,590 1,490 1,700 0.50 0.47 0.53 Oceania 3,220 3,170 3,340 12.00 11.78 12.42 660 580 740 2.47 2.17 2.76 30 20 30 0.11 0.08 0.12 Australia and New Zealand 2,360 2,360 2,360 12.14 12.14 12.14 - - - - - - - - - - - - Melanesia - - - - - - - - - - - - - - - - - - Micronesia - - - - - - - - - - - - - - - - - - Polynesia - - - - - - - - - - - - - - - - - - 200,380 141,430 256,400 3.98 2.81 5.09 61,650 36,940 78,260 1.22 0.73 1.55 30,780 15,370 44,040 0.61 0.31 0.87 GLOBAL ESTIMATE ANNEX | Drug use Table 1 1 65 WORLD DRUG REPORT 2021 Table 2 Annual prevalence of the use of cocaine, amphetamine-type stimulants and “ecstasy”, by region and globally, 2019 Region or subregion Amphetaminesb and prescription stimulants Cocainea Number (thousands) Prevalence (percentage) Number (thousands) Prevalence (percentage) Number (thousands) Prevalence (percentage) Best Lower estimate Best estimate Lower Upper Best estimate Lower Upper Best estimate Lower Upper Best estimate Lower Upper Best estimate Lower Upper 1,950 520 4,260 0.27 0.07 0.58 2,720 690 5,810 0.38 0.10 0.82 1,890 100 8,270 0.26 0.01 1.13 East Africa - - - - - - - - - - - - - - - - - - North Africa 407 311 483 0.27 0.21 0.32 - - - - - - - - - - - - Southern Africa - - - - - - - - - - - - - - - - - - 431 71 967 0.15 0.02 0.34 780 50 1,810 0.28 0.02 0.66 - - - - - - 9,180 11,470 1.54 1.36 1.70 8,710 8,190 9,460 1.30 1.22 1.41 3,620 3,460 3,790 0.54 0.51 0.56 Africa West and Central Africa Upper Americas 10,360 Caribbean 180 80 320 0.63 0.29 1.14 - - - - - - 60 30 100 0.23 0.10 0.36 Central America 310 140 520 0.96 0.44 1.62 310 190 440 0.98 0.61 1.41 60 20 110 0.17 0.07 0.33 North America 6,880 6,740 7,030 2.12 2.08 2.17 7,380 7,330 7,420 2.29 2.27 2.30 2,890 2,880 2,890 0.89 0.89 0.89 South America 2,990 2,220 3,610 1.03 0.77 1.24 770 650 900 0.27 0.23 0.31 610 520 690 0.21 0.18 0.24 Asia 2,030 1,620 2,600 0.07 0.05 0.08 12,670 11,920 13,500 0.42 0.39 0.44 9,930 1,880 17,980 0.32 0.06 0.59 Central Asia and Transcaucasia - - - - - - - - - - - - - - - - - - East and South-East Asia 780 530 1,030 0.05 0.03 0.06 9,860 9,510 10,280 0.61 0.59 0.64 3,670 1,220 6,120 0.23 0.08 0.38 South-West Asia/ Near and Middle East 160 30 440 0.05 0.01 0.14 640 350 920 0.17 0.11 0.29 2,180 410 3,940 0.67 0.13 1.22 South Asia 1,060 1,060 1,060 0.10 0.10 0.10 1,970 1,960 1,970 0.19 0.19 0.19 - - - - - - Europe 5,000 4,630 5,520 0.92 0.85 1.02 2,510 2,050 3,070 0.46 0.38 0.56 3,550 3,000 4,600 0.65 0.55 0.85 580 220 1,070 0.26 0.10 0.48 - - - - - - 780 280 1,780 0.35 0.12 0.79 Western and Central Europe 4,430 4,410 4,450 1.39 1.38 1.39 1,950 1,700 2,300 0.61 0.53 0.72 2,770 2,720 2,820 0.87 0.85 0.89 Oceania 730 700 730 2.70 2.60 2.73 340 310 350 1.27 1.16 1.33 590 550 600 2.18 2.05 2.22 Australia and New Zealand - - - - - - 240 240 250 1.26 1.22 1.30 550 540 560 2.84 2.79 2.90 Melanesia - - - - - - - - - - - - - - - - - - Micronesia - - - - - - - - - - - - - - - - - - Polynesia - - - - - - - - - - - - - - - - - - 20,060 16,650 24,580 0.40 0.33 0.49 26,950 23,160 32,190 0.54 0.46 8,990 35,240 0.39 0.18 0.70 Eastern and South-Eastern Europe GLOBAL ESTIMATE Sources: UNODC estimates based on annual report questionnaire data and other official sources. 66 "Ecstasy" 0.65 19,570 1 Table 3 Estimated number and prevalence (percentage) of people who inject drugs and those living with HIV among this group, by region, 2019 Region or subregion Estimated number HIV among people who inject drugs Prevalence (%) Low Best High 590,000 950,000 1,760,000 0.08 0.13 0.24 East Africa 90,000 260,000 680,000 0.05 0.13 West and Central Africa 280,000 360,000 520,000 0.10 Southern Africa 100,000 150,000 180,000 North Africa 110,000 180,000 America 1,880,000 North America Data coverage of estimated number of people who inject drugs High 67.9% 52,000 103,000 300,000 10.9 82.9% 0.35 58.8% 11,000 43,000 124,000 16.3 87.6% 0.13 0.18 77.2% 14,000 17,000 27,000 4.6 88.5% 0.10 0.14 0.17 62.9% 21,000 32,000 63,000 21.8 59.2% 390,000 0.08 0.12 0.26 65.6% 6,000 12,000 86,000 6.7 83.8% 2,350,000 2,920,000 0.28 0.35 0.43 87.3% 112,000 176,000 269,000 7.5 93.6% 1,590,000 1,800,000 2,020,000 0.49 0.56 0.62 100% 96,000 125,000 158,000 6.9 100% Caribbean 40,000 90,000 210,000 0.14 0.33 0.76 31.3% 4,000 13,000 26,000 14.0 31.8% South America 240,000 440,000 660,000 0.08 0.15 0.23 81.9% 12,000 37,000 83,000 8.5 82.9% Central America 10,000 20,000 30,000 0.04 0.06 0.09 57.7% 300 600 1,400 3.4 32.9% 3,920,000 5,210,000 6,530,000 0.13 0.17 0.21 95.1% 382,000 588,000 821,000 11.3 98% Central Asia and Transcaucasia 350,000 370,000 400,000 0.59 0.63 0.68 93.5% 23,000 26,000 31,000 7.0 93.5% East and South-East Asia 1,970,000 3,030,000 4,000,000 0.12 0.19 0.25 95.1% 135,000 277,000 434,000 9.1 98.7% South-West Asia 620,000 760,000 910,000 0.30 0.36 0.43 100% 163,000 218,000 275,000 28.6 100% Near and Middle East 40,000 90,000 260,000 0.03 0.08 0.23 42% 1,800 3,300 10,600 3.8 55.4% South Asia 950,000 950,000 960,000 0.09 0.09 0.09 100% 59,000 64,000 70,000 6.7 100% Europe 2,370,000 2,570,000 2,830,000 0.44 0.47 0.52 90% 514,000 537,000 573,000 20.9 100% Eastern Europe 1,690,000 1,710,000 1,740,000 1.24 1.26 1.27 100% 437,000 447,000 457,000 26.1 100% South-Eastern Europe 80,000 90,000 130,000 0.09 0.11 0.15 100% 4,900 5,800 7,700 6.2 100% Western and Central Europe 600,000 770,000 960,000 0.19 0.24 0.30 83% 73,000 84,000 108,000 11.0 99.9% Oceania 100,000 100,000 110,000 0.37 0.38 0.41 72.3% 1,400 1,800 2,000 1.8 72.3% 8,860,000 11,180,000 14,150,000 0.18 0.22 0.28 89.4% 1,060,000 1,410,000 1,970,000 12.6 96% Global High Prevalence (%) Best estimate Best Asia Best Estimated number Low Africa Low Data coverage of population aged 15-64 ANNEX | Drug use and HIV People who inject drugs Sources: Responses to the annual report questionnaire; progress reports of the Joint United Nations Programme on HIV/AIDS (UNAIDS) on the global AIDS response (various years); the former Reference Group to the United Nations on HIV and Injecting Drug Use; published peer-reviewed articles; and government reports. Note: Prevalence of people who inject drugs is the percentage of the population aged 15–64 years. 67 Table 4 Illicit cultivation of opium poppy, 2009–2020 (hectares) 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Afghanistan (best estimate) 123,000 123,000 131,000 154,000 209,000 224,000 183,000 201,000 328,000 263,000 163,000 224,000 lower bound a 102,000 104,000 109,000 125,000 173,000 196,000 163,000 182,000 301,000 242,000 149,000 202000 upper bound 137,000 145,000 155,000 189,000 238,000 247,000 202,000 221,000 355,000 283,000 178,000 246000 1,900 3,000 4,100 6,800 3,900 6,200 5,700 5,395 5,327 4,925 4,624 .. lower bound a 1,100 1,900 2,500 3,100 1,900 3,500 3,900 upper bound 2,700 4,000 6,000 11,500 5,800 9,000 7,600 Myanmar (best estimate) b, c 31,700 38,100 43,600 51,000 57,800 57,600 55,500 .. 41,000 37,300 33,100 29,500 lower bound a 20,500 17,300 29,700 38,249 45,710 41,400 42,800 30,200 29,700 25,800 21,000 upper bound 42,800 58,100 59,600 64,357 69,918 87,300 69,600 51,900 47,200 42,800 50,400 356 341 338 313 298 387 595 462 282 663 .. .. 19,500 14,000 12,000 10,500 11,000 17,000 26,100 25,200 30,600 28,000 21,500 .. WORLD DRUG REPORT 2021 SOUTH-WEST ASIA a SOUTH-EAST ASIA Lao People’s Democratic Republic (best estimate) b, g a a SOUTH AND CENTRAL AMERICA Colombia (best estimate) Mexico (best estimate) d, e, f lower bound a 21,800 20,400 22,800 21,200 15,500 upper bound a 30,400 30,000 38,400 34,800 27,500 OTHER Other countries e TOTAL (best estimate) 9,479 12,221 16,390 12,282 13,293 11,585 8,549 54,641 8,792 11,815 14,656 40,855 185,935 190,662 207,428 234,895 295,291 316,772 279,444 286,698 414,001 345,703 236,880 294,355 lower bound 152,935 149,762 169,928 189,444 245,201 269,872 240,644 257,996 368,401 310,021 211,619 259,894 upper bound 211,835 233,662 249,328 287,952 338,309 372,272 318,744 333,396 459,701 382,121 247,587 323,187 185,930 190,660 207,430 234,900 295,290 316,770 279,440 286,700 414,000 345,700 236,880 294,350 TOTAL (best estimate, rounded) Sources: Afghanistan: Until 2018, Afghanistan Opium Surveys were conducted by the Ministry of Counter-Narcotics (MCN) of Afghanistan and the United Nations Office on Drugs and Crime (UNODC). Data for 2019-2020 was obtained from the UNODC Illicit Crop Monitoring Programme. Lao People’s Democratic Republic: Up till 2015, national illicit crop monitoring system supported by the United Nations Office on Drugs and Crime (UNODC). Data from 2016 onwards from Lao National Commission for Drug Control and Supervision. Myanmar: national illicit crop monitoring system supported by the United Nations Office on Drugs and Crime (UNODC). Colombia: Government of Colombia. Mexico: up to 2014, estimates derived from surveys by the Government of the United States of America (international narcotics control strategy reports); for 2015 onwards, joint Mexico/ UNODC project entitled “Monitoring of the illicit cultivation on Mexican territory”. Note: Two dots indicate that data were unavailable. Information on estimation methodologies and definitions can be found in the online methodology section of the World Drug Report 2021. a) Bound of the statistically derived confidence interval. b) May include areas that were eradicated after the date of the area survey. c) In 2020, the opium poppy cultivation survey covered Shan and Kachin States. 46 sample locations were available in Shan and Kachin States (compared to 84 locations in 2019), which increased uncertainty around area and production estimates. Estimates for 2014, 2015, 2018 included area estimates for Kayah and Chin states. In the absence of information on Kayah and Chin, the 2019, 2020 national area estimate uses latest available cultivation estimates (2018) for Chin and Kayah states. National estimates for 2014, 2015, 2018, 2019, 2020 are therefore not directly comparable with other years. 68 d) Up to 2014, the estimates for Mexico are sourced from the Department of State of the United States. The Government of Mexico does not validate the estimates provided by the United States as they are not part of its official figures and it does not have information on the methodology used to calculate them. e) The figures for 2015, as published in the World Drug Report 2016 (United Nations publication, Sales No. E.16.XI.7), have been revised owing to a statistical adjustment processed by UNODC. The 2015 figures refer to the period July 2014–June 2015 and are not comparable with subsequent years, due to the updates in the methodology implemented from the 2015–2016 period onwards. f) The figures for 2016, 2017, 2018 and 2019 are based on the estimation periods July 2015–June 2016, July 2016–June 2017 and July 2017–June 2018, July 2018–June 2019 respectively. g) Data from 2016 onwards are not comparable to prior years. h) Data for 2018 from U.S. State Department, International Narcotics Control Strategy Report 2020. Table 5 1 Potential production of oven–dry opium, 2009–2020 (tons) 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 lower bound 4,000 3,600 5,800 3,700 5,500 6,400 3,300 4,800 9,000 6,400 6,400 6,300 a 3,000 4,800 2,800 4,500 5,100 2,700 4,000 8,000 5,600 5,600 5,400 upper bound a 4,200 6,800 4,200 6,500 7,800 3,900 5,600 10,000 7,200 7,100 7,200 92 .. 48 48 44 41 .. .. SOUTH-EAST ASIA Lao People’s Democratic Republic (best estimate) b, f 11 18 25 41 23 g 7 11 15 18 11 51 84 upper bound g 16 24 36 69 35 133 176 Myanmar (best estimate) b, h 330 580 610 690 870 670 647h 550 520 508 405 lower bound 213 350 420 520 630 481 500 395 410 380 289 upper bound 445 820 830 870 1,100 916 820 706 664 672 685 9 8 8 8 11 12 17 13 7 18 .. .. 425 300 250 220 225 360 .. lower bound ANNEX | Opium SOUTH-WEST ASIA Afghanistan (best estimate) j SOUTH AND CENTRAL AMERICA Colombia (best estimate) k 419 404 492 450 440 lower bound a 265 251 288 267 286 upper bound a 572 557 695 633 595 Mexico (best estimate) c, e, i OTHER Other countries (best estimate) d TOTAL (best estimate) 178 224 290 172 182 201 147 711 143 168 227 708 4,953 4,730 6,983 4,831 6,810 7,735 4,659 5,976 10,239 7,600 7,616 7,413 lower bound (published) 3,894 5,783 3,738 5,558 6,205 3,713 4,927 8,881 6,507 6,670 6,467 upper bound 5,576 8,214 5,539 8,052 9,423 5,632 7,153 11,599 8,727 8,462 8,259 4,730 6,980 4,830 6,810 7,740 4,660 5,980 10,240 7,600 7,620 7,410 TOTAL best estimate (rounded) 4,950 Sources: Afghanistan: Until 2018, Afghanistan Opium Surveys were conducted by the Ministry of Counter-Narcotics (MCN) of Afghanistan and the United Nations Office on Drugs and Crime (UNODC). Data for 2019 was obtained from the UNODC Illicit Crop Monitoring Programme. Lao People’s Democratic Republic and Myanmar: national illicit crop monitoring system supported by the United Nations Office on Drugs and Crime (UNODC). Colombia: National illicit crop monitoring system supported by UNODC. Since 2008, production was calculated based on updated regional yield figures and conversion ratios from the Department of State and the Drug Enforcement Administration of the United States of America. Mexico: Up till 2014, estimates derived from surveys by the United States Government; from 2015 onwards national illicit crop monitoring system supported by UNODC. Note: Two dots indicate that data were unavailable. Information on estimation methodologies and definitions can be found in the online methodology section of the World Drug Report 2021. a) Bound of the statistically derived confidence interval. b) Based on cultivation figures which may include areas eradicated after the date of the area survey. c) Up to 2014, the estimates are sourced from the Department of State of the United States. The Government of Mexico does not validate the estimates provided by the United States as they are not part of its official figures and it does not have information on the methodology used to calculate them. e) The figures from 2015 on have been updated with newly available data. The joint Mexico/UNODC project “Monitoring of the illicit cultivation on Mexican territory” collected yield data for the first time in the 2017/2018 period. The production figures presented are based on: (1) annual estimates of area under cultivation, established by the joint project of the Government of Mexico and UNODC; (2) yield data collected in an initial survey in the 2017/2018 period. UNODC and Mexico are jointly working on continuously expanding the scope and quality of yield data collected. For methodological reasons, the figures shown for 2015-2018 are not comparable with the figures over the period 1998-2014. f) Production estimates for the period 2016–2019 are based on cultivation estimates for the period 2016–2019 and average yields per ha reported over the 2012–2014 period. g) Bound of the statistically derived confidence interval, with the exception of 2015. The figures for 2015 represent independently derived upper and lower estimates; the midpoint was used for the calculation of the global total. h) Estimates for 2014, 2015, 2018 include estimates for Kayah and Chin states. In the absence of information on Kayah and Chin, the 2019 national potential production estimate uses latest available (2018) cultivation estimates for Kayah and Chin states and the 2019 weighted national average yield (15.4 kg/ha). National estimates for 2014, 2015, 2018 and 2019 are therefore not directly comparable with other years. i) The figures for 2015, 2016, 2017, 2018, and 2019 are based on the estimation periods July 2014–June 2015, July 2015–June 2016, July 2016–June 2017, July 2017–June 2018, and July 2018–June 2019 respectively. j) Data on the potential opium production for 2019 and 2020 was obtained brom the UNODC Illicit Crop Monitoring Programme. The same methodology was used as in previous years for yield measurement and estimation of potential opium production. The results for the year 2019 were not validated by the Government of Afghanistan and are not recognized by the Government as its official estimate. k) Production estimates for 2018 based on cultivation estimates by the U.S. State Department International Narcotics Control Strategy Report 2020 and average yields reported for the years 2015–2017. 69 WORLD DRUG REPORT 2021 Table 6 Global manufacture of heroin from global illicit opium production, 2009–2020 (tons) 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Total potential opium production 4,953 4,730 6,983 4,831 6,810 7,735 4,659 5,976 10,270 7,618 7,616 7,413 Potential opium not processed into heroin 1,680 1,728 3,400 1,850 2,600 2,450 1,360 2,510 1,100–1,400 1,225–1,525 1,180–1,480 1,177–1,477 Potential opium processed into heroin 3,273 3,002 3,583 2,981 4,210 5,285 3,299 3,466 8,870–9,170 6,093–6,393 6,136–6,436 5,936–6,236 Total potential heroin manufacture 427 383 467 377 555 544 319 368 677–1,027 468–718 2019 474–724 2020 454–694 Notes: The calculation shows the potential amount of heroin that could have been manufactured out of the opium produced in a given year; it does not take into account changes in opium inventories, which may add to or reduce the amount of heroin entering the market in that year. Afghanistan and Myanmar are the only countries for which the proportion of potential opium production not converted into heroin within the country is estimated. For Myanmar, these estimates were available only for 2018 and 2019. For all other countries, for the purposes of this table, it is assumed that all opium produced is converted into heroin. The amount of heroin produced from Afghan opium is calculated using two parameters that may change: (a) the amounts of opium consumed as raw opium in the region; and (b) the conversion ratio into heroin. The first parameter’s estimate is based on consumption data in Afghanistan and neighbouring countries. For the second parameter, from 2005 to 2013, a conversion ratio of opium to morphine/heroin of 7:1 was used, based on interviews conducted with Afghan morphine/heroin “cooks”, on an actual heroin production exercise conducted by two (illiterate) Afghan heroin “cooks”, documented by the German Bundeskriminalamt in Afghanistan in 2003 (published in Bulletin on Narcotics, vol. LVII, Nos. 1 and 2, 2005, pp. 11–31), and United Nations Office on Drugs and Crime (UNODC) studies on the morphine content of Afghan opium (12.3 per cent over the period 2010–2012, down from 15 per cent over the period 2000–2003). Starting from 2014, a different approach to the conversion was adopted, reflecting updated information on morphine content and a different method for taking purity into account. The revised approach uses a ratio of 18.5 (range: 17.5–19.6) kg of opium for 1 kg of 100 per cent pure heroin base (see Afghanistan Opium Survey 2014, UNODC, November 2014). In addition, the conversion into export-quality heroin assumes purity to be between 50 and 70 per cent. For more details, see “Afghanistan Opium Survey 2017 – Challenges to sustainable development, peace and security” (UNODC, May 2018). The amount of heroin produced in Myanmar in 2018 , 2019 and 2020 was calculated by subtracting the estimated unprocessed opium for consumption from the total opium production and using a conversion factor of 10:1. The unprocessed opium in Myanmar was based on the total unprocessed opium in East Asia and the relative cultivation levels of Lao PDR and Myanmar (see Transnational Organized Crime in East Asia and the Pacific – A Threat Assessment, UNODC, 2013 and Transnational Organized Crime in Southeast Asia: Evolution, Growth and Impact 2019, UNODC, 2019). For further information, please refer to the Methodology chapter (section 4.3) of the Myanmar Opium Survey 2018 (UNODC, January 2019) and the Myanmar Opium Survey 2019 (UNODC, February 2020). For countries other than Afghanistan, a “traditional” conversion ratio of opium to heroin of 10:1 is used. The ratios will be adjusted when improved information becomes available. Figures in italics are preliminary and may be revised when updated information becomes available. Table 7 Global illicit cultivation of coca bush, 2009–2019 (hectares) 2009 2010 2011 2012 2013 1905 2015 2016 2017 2018 2019 Bolivia (Plurinational State of) 30,900 31,000 27,200 25,300 23,000 20,400 20,200 23,100 24,500 23,100 25,500 Colombia a 73,000 62,000 64,000 48,000 48,000 69,000 96,000 146,000 171,000 169,000 154,000 Peru b 59,900 61,200 64,400 62,500 60,400 49,800 42,900 40,300 43,900 49,900 54,100 54,700 155,600d 133,700 120,800 132,300 156,500 213,000 245,400 246,200 234,200 Peru c Total 163,800 154,200 Sources: Plurinational State of Bolivia: national illicit crop monitoring system supported by the United Nations Office on Drugs and Crime (UNODC). Colombia: national illicit crop monitoring system supported by UNODC. Peru: national illicit crop monitoring system supported by UNODC. Note: Different area concepts and their effect on comparability were presented in the World Drug Report 2012 (United Nations publication, Sales No. E.12.XI.1) (p. 41–42). Efforts to improve the comparability of estimates between countries continue; since 2011 the net area under coca bush cultivation on the reference date of 31 December was estimated for Peru, in addition to Colombia. The estimate presented for the Plurinational State of Bolivia represents the area under coca cultivation as interpreted on satellite imagery. a) Net area on 31 December. b) Figures represent the area under coca cultivation as interpreted on satellite imagery (without deductions for subsequent eradication). c) Net area on 31 December, deducting fields eradicated after satellite imagery was taken. 70 d) The global coca cultivation figure was calculated with the “area as interpreted on satellite imagery” for Peru in 2011. Method of eradication Unit 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Bolivia (Plurinational State of) manual hectare 6,341 8,200 10,509 11,044 11,407 11,144 11,020 6,577 7,237 11,174 9,205 Colombia manual hectare 60,565 43,804 35,201 30,456 22,121 11,703 13,473 17,642 52,001 59,978 94,606 spraying hectare 104,772 101,940 103,302 100,549 47,052 55,532 37,199 0 0 0 0 Peru manual hectare 10,025 12,033 10,290 14,171 23,785 31,205 35,868 30,150 23,025 25,107 25,526 Ecuador manual hectare 6 3 14 .. .. .. .. .. .. .. .. manual plants 57,765 3,870 55,030 122,656 41,996 15,874 45,266 20,896 10,100 3,818 .. Source: United Nations Office on Drugs and Crime annual report questionnaire and government reports. ANNEX | Coca/cocaine 1 Table 8 Reported eradication of coca bush, 2009–2019 Note: The totals for Bolivia (Plurinational State of) and Peru include voluntary and forced eradication. Reported eradication refers to the sum of all areas eradicated in a year, including repeated eradication of the same fields. Two dots indicate that data are not available. Table 9 Potential manufacture of 100 per cent pure cocaine, 2009–2019 (tons) 2009 Bolivia (Plurinational State of) a Colombia b, c, d Peru a Total b, c, d 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 .. .. .. .. .. .. .. .. .. .. .. 488 424 384 333 290 368 499 810 1,058 1,120 1,137 .. .. .. .. .. .. .. .. .. .. .. 1,188 1,134 1,090 997 902 869 977 1,335 1,647 1,723 1,784 Sources: Plurinational State of Bolivia: calculations based on coca leaf yield surveys by the United Nations Office on Drugs and Crime (UNODC) (Yungas de La Paz) and scientific studies by the Drug Enforcement Administration of the United States of America (Chapare). Colombia: UNODC/Government of Colombia. Peru: calculations based on coca leaf to cocaine conversion ratio from scientific studies by the Drug Enforcement Administration. Notes: Figures in italics are subject to revision. Two dots indicate that data are not available. Information on estimation methodologies and definitions can be found in the online methodology section of the World Drug Report 2021. a) Owing to a lack of updated conversion factors in Bolivia (Plurinational State of) and Peru, no final estimates of the level of cocaine production can be provided. Detailed information on the ongoing revision of conversion ratios and cocaine laboratory efficiency is available in the World Drug Report 2010 (United Nations publication, Sales No. E.10.XI.13), p. 249. b) Values for Colombia for 2014–17 have been revised, using an improved methodology, to take into account the participation of new actors in the processing chain from coca leaf to cocaine. The same methodology was used for 2018. Thus, the values for 2014-18, and hence the global total for the same years, may not be directly comparable to earlier years. c) Conversion of areas under coca cultivation into coca leaf and then into cocaine hydrochloride, taking yields, amounts of coca leaf used for licit purposes and cocaine laboratory efficiency into account. Current global aggregates are based on “new” conversion ratios representing the most recent data available to UNODC. See World Drug Report 2010 (United Nations publication, Sales No. E.10.XI.13, p. 249) for a discussion of “new” and “old” conversion factors and detailed information on the ongoing revision of conversion ratios and cocaine laboratory efficiency. d) With respect to data published in the World Drug Report 2016 (United Nations publication, Sales No. E.16.XI.7), the following amendments have been made: (i) totals for 2009–2012 have been revised to rectify minor inaccuracies in data processing. 71 Table 10 WORLD DRUG REPORT 2021 Year 72 Cannabis cultivation, production and eradication, latest year available from the period 2013–2019 Country / Territory Product Outdoors/ indoors Area Area cultivated eradicated (ha) (ha) Harvestable area (ha) 10,000 Production Plants (tons) eradicated Sites eradicated 2012 Afghanistan resin outdoors 2016 Albania herb outdoors 1,400 2,536,288 2017 Albania herb Indoors 7,766 2017 Albania herb outdoors 66,927 500 2017 Albania herb outdoors 33,177 379 2018 Albania herb Indoors 2,716 2014 Algeria resin outdoors 5,205 2,522 2016 Armenia herb outdoors 0.50 a 2017 Armenia herb outdoors 0.50 a 2018 Armenia herb Indoors 1,025 36 2016 Australia herb indoors 31,266 408 1,021 0.50 0.00 757 20 0.50 0.00 2,547 21 2016 Australia herb outdoors 22,257 2017 Australia herb indoors 78,310 433 2017 Australia herb outdoors 31,431 948 2018 Australia herb indoors 2018 Australia herb 2015 Austria 2013 1.00 a 1.00 0.00 outdoors 0.80 a 0.80 0.00 herb outdoors 3.00 a 3.00 0.00 Azerbaijan herb outdoors 23.95 a 23.95 0.00 2014 Azerbaijan herb outdoors 17.50 a 17.50 0.00 2017 Azerbaijan herb outdoors 0.25 a 0.25 336,791 2015 Bahamas herb outdoors 17,270 2012 Bangladesh herb outdoors 39,848 2013 Bangladesh herb outdoors 35,012 2014 Bangladesh herb outdoors 35,988 2015 Bangladesh herb outdoors 39,967 2016 Bangladesh herb outdoors 47,104 2017 Bangladesh herb outdoors 69,989 2016 Belarus herb indoors 2016 Belarus herb oudoors 2017 Belarus herb indoors 2017 Belarus herb oudoors 2018 Belarus herb indoors 2018 Belarus herb oudoors 263.96 38,492 542 19,981 1,120 8,469 151 14,889 195 28 123.80 1,945 125.90 2,283 106.30 2,469 32 42 2015 Belgium herb indoors 345,518 2015 Belgium herb outdoors 4,885 1,164 93 2017 Belgium herb indoors 415,728 1,175 2017 Belgium herb outdoors 848 59 2018 Belgium herb indoors 421,326 944 62 2018 Belgium herb outdoors 935 2015 Belize herb outdoors 50,897 2017 Bhutan herb outdoors 2016 Bolivia (Plurinational State of) herb outdoors 14.60 35 2017 Bolivia (Plurinational State of) herb outdoors 14.00 52 2018 Bolivia (Plurinational State of) herb outdoors 13.36 52 2016 Bosnia and Herzegovina herb indoors 39.00 1,680.00 1.00 a 1.00 0.00 2016 Bosnia and Herzegovina herb outdoors 2017 Bosnia and Herzegovina herb indoors 2017 Bosnia and Herzegovina herb outdoors 0.02 a 0.02 0.00 2018 Bosnia and Herzegovina herb indoors 0.02 a 0.02 0.00 100,000 12 1 1 539 53 6 Country / Territory Product Outdoors/ indoors Area Area cultivated eradicated (ha) (ha) 0.02 a 0.02 Harvestable area (ha) Production Plants (tons) eradicated 2018 Bosnia and Herzegovina herb outdoors 2014 Brazil herb outdoors 44.01 0.00 1,364,316 1,580 2017 Brazil herb outdoors 117.51 1,910,451 2018 Brazil herb outdoors 68.31 968,145 2015 Bulgaria herb indoors 2015 Bulgaria herb outdoors 1 Sites eradicated 12 604 323 130.00 60.00 55 37.77 9,488 10.00 2017 Central African Republic herb outdoors 250,000 22 2016 Chile herb indoors 26,988 2,740 2016 Chile herb outdoors 58,950 264 2017 Chile herb indoors 50,414 2,408 2017 Chile herb outdoors 194,694 202 2018 Chile herb indoors 66,007 2,357 183,185 318 2018 Chile herb outdoors 2016 China herb outdoors 2018 China herb outdoors 2016 Colombia herb outdoors 135.00 2017 Colombia herb outdoors 173.71 2018 Colombia herb outdoors 59.66 2016 Costa Rica herb indoors 2016 Costa Rica herb outdoors 2017 Costa Rica herb indoors 2017 Costa Rica herb outdoors 2018 Costa Rica herb indoors 2018 Costa Rica herb outdoors 9.80 ANNEX | Cannabis Year 1,390,000 710 17.59 678.00 5 2,122,244 201 2 14.30 215 4 11.41 11.41 1,346,273 208 2016 Côte d’Ivoire herb outdoors 2017 Côte d’Ivoire herb outdoors 5 2018 Côte d’Ivoire herb outdoors 104 1 2016 Czechia herb indoors 53,549 229 2016 Czechia herb outdoors 4,111 2017 Czechia herb indoors 50,925 2017 Czechia herb outdoors 3,467 0.25 1 305 2018 Czechia herb outdoors 6,581 2015 Denmark herb indoors/outdoors 14,560 97 2016 Denmark herb indoors/outdoors 13,217 105 2017 Denmark herb indoors/outdoors 34,801 65 2014 Dominican Republic herb outdoors 111 8 6.00 a 6.00 0.00 0.21 2016 Ecuador herb outdoors 224 34 2017 Ecuador herb outdoors 397 10 2018 Ecuador herb indoors 127 30 2018 Ecuador herb outdoors 13,891 4 2015 Egypt herb/resin outdoors 2017 Egypt herb/resin outdoors 2018 Eswatini herb outdoors 3,000,000 210 2017 Georgia herb indoors 186 91 2017 Georgia herb outdoors 2016 El Salvador herb outdoors 140.00 126.00 1,500.00 1,069.50 430.50 0.01 0.02 a 0.02 0.00 93 19 1.00 227 25 837 2014 France herb outdoors 158,592 2018 France herb outdoors 138,561 2017 Georgia herb indoors 2017 Georgia herb outdoors 2018 Georgia herb indoors 0.01 0.02 0.02 0.05 0.00 186 91 93 19 927 443 73 WORLD DRUG REPORT 2021 Year 74 Country / Territory Product Outdoors/ indoors 2018 Georgia herb outdoors 2015 Germany herb indoors Area Area cultivated eradicated (ha) (ha) 0.10 0.10 Harvestable area (ha) Production Plants (tons) eradicated 0.00 Sites eradicated 406 98 135,925 786 2015 Germany herb outdoors 9,136 127 2017 Germany herb indoors 85,226 573 2017 Germany herb outdoors 2016 Greece herb indoors 16,554 2016 Greece herb oudoors 39,151 2017 Greece herb indoors 19,498 2017 Greece herb oudoors 27,409 2018 Greece herb indoors 6,913 2018 Greece herb oudoors 43,684 95 2016 Guatemala herb outdoors 2017 Guatemala herb outdoors 3.50 a 9.00 3.81 2018 Guatemala herb outdoors 129.00 a 129.00 0.00 2015 Guyana herb outdoors 20.00 9.40 10.60 2016 Honduras herb indoors 7 2 2016 Honduras herb oudoors 24,253 19 2017 Honduras herb oudoors 2018 Honduras herb oudoors 720,426 67 2016 China, Hong Kong SAR herb indoors 329 1 2016 Hungary herb indoors 5,000 3 2016 Hungary herb outdoors 2,000 20 2013 Iceland herb indoors 6,652 323 2016 India herb outdoors 3,414.74 2017 India herb outdoors 3,445.90 2018 India herb outdoors 3,430.12 2016 Indonesia herb outdoors 482.00 a 482.00 0.00 2017 Indonesia herb outdoors 89.00 a 89.00 0.00 738,020 14 2018 Indonesia herb outdoors 76.23 a 76.23 0.00 1,455,390 13 2018 Iran (Islamic Republic of) herb indoors 2016 Ireland herb indoors 7,273 2017 Ireland herb indoors 9,046 2018 Ireland herb indoors 7,186 2014 Italy herb indoors 51,534 639 2014 Italy herb outdoors 70,125 1,134 2017 Italy herb indoors 56,125 1,161 59.58 a 59.59 3,138,298 1.61 1,000.00 427 6,033,345 150 5,189,422 368 419,700 19 0.00 6,687,376 0.04 50 2017 Italy herb outdoors 209,510 401 2012 Jamaica herb outdoors 456 382 2016 Kazakhstan herb outdoors 18.00 a 18.00 0.00 170,000 202 2017 Kazakhstan herb outdoors 12.30 a 12.30 0.00 930,774 91 2016 Kenya herb outdoors 12.00 8,747 46 2017 Kenya herb outdoors 2018 Kenya herb outdoors 2015 Kyrgyzstan herb outdoors 5,014.00 1,276.37 0.10 4,662 0.10 517 5,014.00 2018 Kyrgyzstan herb outdoors 49,942 12.00 2016 Latvia herb indoors 457.69 818.68 557 35 2016 Latvia herb outdoors 78 6 2017 Latvia herb indoors 798 34 2017 Latvia herb outdoors 66 15 2018 Latvia herb indoors 152 17 2018 Latvia herb outdoors 1,152 34 Country / Territory Product Outdoors/ indoors Area Area cultivated eradicated (ha) (ha) 2015 Lebanon herb outdoors 3,500.00 2017 Lebanon Kif outdoors 40,772.00 4,205.70 Harvestable area (ha) Production Plants (tons) eradicated 1 Sites eradicated 3,500.00 2018 Lebanon herb outdoors 2016 Lithuania herb indoors 4,205.70 2017 Lithuania herb indoors 8 2017 Lithuania herb outdoors 7 2018 Lithuania herb indoors 2015 Madagascar herb outdoors 11.00 21,325 2017 Madagascar herb outdoors 9.00 57,708 2013 Malta herb indoors 2016 Mexico herb outdoors 5,478.42 6,574.1 38,432 2017 Mexico herb outdoors 4,193.34 5,032.0 34,523 4 3 27 2018 Mexico herb outdoors 2013 Mongolia herb outdoors 15,000.00 4,000.00 2,263.71 11,000.00 2,716.47 2018 Mongolia herb outdoors 15,000.00 173.00 14,827.00 2016 Morocco herb outdoors 2016 Morocco plant outdoors ANNEX | Cannabis Year 28,873 4,000 4,000 33 35,652.83 47,000.00 395.00 46,605.00 2016 Morocco resin outdoors 713.00 2017 Morocco herb outdoors 35,702.90 2017 Morocco plant outdoors 2017 Morocco resin outdoors 714.06 2018 Morocco herb outdoors 23,699.80 2018 Morocco plant outdoors 2018 Morocco resin outdoors 2014 Myanmar herb outdoors 15.00 10.00 5.00 2018 Nepal herb outdoors 235.87 235.87 0.00 2016 Netherlands herb 2017 Netherlands herb 2018 Netherlands 2018 47,500.00 523.00 47,500.00 46,977.00 47,500.00 423.58 3 5,000.00 2,358,700 335 indoors 994,068 5,856 indoors 883,163 5,538 herb indoors 516,418 3,482 Netherlands herb outdoors 2016 New Zealand herb indoors 18,903 2016 New Zealand herb outdoors 104,725 2017 New Zealand herb indoors 19,992 2017 New Zealand herb outdoors 19,559 2018 New Zealand herb indoors 19,313 2018 New Zealand herb outdoors 22,660 2014 Nicaragua herb outdoors 2016 Nicaragua herb outdoors 431 0.30 1,507.00 3,014 607 30 275,000 2017 Nicaragua herb outdoors 2016 Nigeria herb outdoors 718.78 994,787 2017 Nigeria herb outdoors 317.12 65 2018 Nigeria herb outdoors 3,660.64 2015 Norway herb indoors 0.04 2017 North Macedonia herb indoors 2017 North Macedonia herb outdoors 2018 North Macedonia herb outdoors 2.51 2016 Oman herb outdoors 0.50 a 0.50 0.00 5 3 2013 Panama herb indoors 0.50 a 0.50 0.00 37 2 2013 Panama herb outdoors 10.50 a 10.50 0.00 78,633 2 2016 Paraguay herb outdoors 2016 Paraguay plant outdoors 5,656,266 4 4,000 30 168 220 4.04 2,264 4,527 1,298.50 1,298.50 a 1,298.50 0.00 75 WORLD DRUG REPORT 2021 Year 76 Country / Territory Product Outdoors/ indoors Area Area cultivated eradicated (ha) (ha) Harvestable area (ha) Production Plants (tons) eradicated Sites eradicated 2016 Paraguay resin outdoors 2017 Paraguay plant outdoors 1,462.00 1.15 36,550,000 2016 Peru herb outdoors 87.83 1,429,749 2017 Peru herb outdoors 61.30 4,671,387 47 2018 Peru herb outdoors 91.80 1,716,751 46 337 2016 Philippines herb outdoors 8.67 24,635,153 2017 Philippines herb outdoors 4.82 221,035 27 2018 Philippines herb outdoors 12.39 869,682 186 2016 Poland herb indoors 146,755 1,403 2016 Poland herb indoors/outdoors 4,585 219 2017 Poland herb indoors 448 10 2017 Poland herb indoors/outdoors 2018 Poland herb indoors/outdoors 118,382 1,274 2017 Portugal herb indoors/outdoors 22,910 158 2018 Portugal herb indoors/outdoors 8,706 139 2013 Republic of Korea herb outdoors 2014 Republic of Moldova herb outdoors 100.00 0.15 54 8,072 59.00 41.00 10,000.00 200,548 2017 Republic of Moldova herb outdoors 2.57 257,236 2018 Republic of Moldova herb outdoors 0.71 86,926 2014 Republic of Moldova herb indoors 41.00 2016 Romania herb indoors 2016 Romania herb outdoors 2017 Romania herb indoors 2017 Romania herb outdoors 2018 Romania herb indoors 2018 Romania herb outdoors 0.11 2016 Russian Federation herb indoors 0.66 2016 Russian Federation herb outdoors 2016 Albania herb outdoors 2,536,288 2017 Albania herb Indoors 7,766 2017 Albania herb outdoors 66,927 500 2017 Albania herb outdoors 33,177 379 2018 Albania herb Indoors 2,716 2014 Algeria resin outdoors 2016 Armenia herb outdoors 0.50 a 0.50 0.00 757 20 2017 Armenia herb outdoors 0.50 a 0.50 0.00 2,547 21 2018 Armenia herb Indoors 1,025 36 2016 Australia herb indoors 31,266 408 1,021 1,433 6.99 7.61 41 42 1.90 7.61 a 61 1,875 46 4,905 32 3,903 39 1,882 98 788 0.00 68.64 1,143 5,205 2,522 2016 Australia herb outdoors 22,257 2017 Australia herb indoors 78,310 433 2017 Australia herb outdoors 31,431 948 2018 Australia herb indoors 2018 Australia herb outdoors 2019 Australia herb indoors 2019 Australia herb 2015 Austria herb 1.00 a 1.00 0.00 0.80 a 0.80 0.00 outdoors 0.04 a 0.04 0.00 outdoors 3.00 a 3.00 0.00 1.72 38,492 542 19,981 1,120 50,837 86 4,755 1 2013 Azerbaijan herb outdoors 23.95 a 23.95 0.00 8,469 151 2014 Azerbaijan herb outdoors 17.50 a 17.50 0.00 14,889 195 2017 Azerbaijan herb outdoors 0.25 a 0.25 336,791 2015 Bahamas herb outdoors 17,270 2013 Bangladesh herb outdoors 35,012 263.96 Country / Territory Product Outdoors/ indoors Area Area cultivated eradicated (ha) (ha) Harvestable area (ha) Production Plants (tons) eradicated 2014 Bangladesh herb outdoors 35,988 2015 Bangladesh herb outdoors 39,967 2016 Bangladesh herb outdoors 47,104 2017 Bangladesh herb outdoors 69,989 2016 Belarus herb indoors 2016 Belarus herb oudoors 2017 Belarus herb indoors 2017 Belarus herb oudoors 2018 Belarus herb indoors 2018 Belarus herb oudoors 2019 Belarus herb indoors 2019 Belarus herb oudoors 1 Sites eradicated 28 123.80 1,945 125.90 2,283 106.30 2,469 117.60 2,182 32 42 28 2015 Belgium herb indoors 345,518 2015 Belgium herb outdoors 4,885 93 2016 Belgium herb indoors 327,216 1,012 2016 Belgium herb outdoors 1,395 34 2017 Belgium herb indoors 415,728 1,175 1,164 2017 Belgium herb outdoors 848 59 2018 Belgium herb indoors 421,326 944 62 2018 Belgium herb outdoors 935 2015 Belize herb outdoors 50,897 2017 Bhutan herb outdoors 2016 Bolivia (Plurinational State of) herb outdoors 14.60 35 2017 Bolivia (Plurinational State of) herb outdoors 14.00 52 2018 Bolivia (Plurinational State of) herb outdoors 13.36 52 2019 Bolivia (Plurinational State of) herb outdoors 22.50 50 2016 Bosnia and Herzegovina herb indoors 39.00 1,680.00 1.00 a 2016 Bosnia and Herzegovina herb outdoors 2017 Bosnia and Herzegovina herb indoors 2017 Bosnia and Herzegovina herb outdoors 2018 Bosnia and Herzegovina herb 2018 Bosnia and Herzegovina herb 30.00 a 1.00 0.00 0.02 a 0.02 0.00 indoors 0.02 a 0.02 0.00 outdoors 0.02 a 0.02 0.00 100,000 1 1 53 1,580 12 6 2019 Bosnia and Herzegovina herb outdoors Brazil herb outdoors 44.01 1,364,316 2017 Brazil herb outdoors 117.51 1,910,451 2018 Brazil herb outdoors 68.31 968,145 74.53 2019 Brazil herb outdoors Bulgaria herb indoors 2015 Bulgaria herb outdoors 2017 Central African Republic herb outdoors 2016 Chile herb 2016 Chile 2017 Chile 12 539 2014 2015 ANNEX | Cannabis Year 475.70 1,585,759 604 651 323 37.77 9,488 10.00 250,000 22 indoors 26,988 2,740 herb outdoors 58,950 264 herb indoors 50,414 2,408 130.00 60.00 55 2017 Chile herb outdoors 194,694 202 2018 Chile herb indoors 66,007 2,357 2018 Chile herb outdoors 183,185 318 2019 Chile herb indoors 31,711 1,856 199,523 212 2019 Chile herb outdoors 2016 China herb outdoors 2018 China herb outdoors 710 2016 China, Hong Kong SAR herb indoors 329 9.80 1,390,000 1 77 WORLD DRUG REPORT 2021 Year 78 Country / Territory Product Outdoors/ indoors Area Area cultivated eradicated (ha) (ha) 2019 China, Hong Kong SAR herb indoors 2016 Colombia herb outdoors 135.00 2017 Colombia herb outdoors 173.71 2018 Colombia herb outdoors 59.66 2019 Colombia herb outdoors 39.34 2016 Costa Rica herb indoors 2016 Costa Rica herb outdoors 2017 Costa Rica herb indoors 2017 Costa Rica herb outdoors 2018 Costa Rica herb indoors 2018 Costa Rica herb outdoors 2019 Costa Rica herb indoors 2019 Costa Rica herb outdoors Harvestable area (ha) Production Plants (tons) eradicated Sites eradicated 1,693 17.59 678.00 5 2,122,244 201 2 14.30 215 4 11.41 11.41 1,346,273 208 11.56 11.56 1,419,495 224 2 2016 Côte d’Ivoire herb outdoors 2017 Côte d’Ivoire herb outdoors 5 2018 Côte d’Ivoire herb outdoors 104 2019 Côte d’Ivoire herb outdoors 4,848 2016 Czechia herb indoors 53,549 2016 Czechia herb outdoors 4,111 2017 Czechia herb indoors 50,925 2017 Czechia herb outdoors 3,467 2018 Czechia herb outdoors 6,581 2019 Czechia herb indoors 26,925 2019 Czechia herb outdoors 5,526 2015 Denmark herb indoors/outdoors 14,560 97 2016 Denmark herb indoors/outdoors 13,217 105 2018 Denmark herb indoors/outdoors 14,171 99 2019 Denmark herb indoors/outdoors 14,338 79 2014 Dominican Republic herb outdoors 2017 Denmark herb indoors/outdoors 0.25 6.00 a 6.00 1 0.00 0.21 1 229 305 258 111 8 34,801 65 2016 Ecuador herb outdoors 224 34 2017 Ecuador herb outdoors 397 10 2018 Ecuador herb indoors 127 30 2018 Ecuador herb outdoors 13,891 4 2015 Egypt herb/resin outdoors 140.00 2017 Egypt herb/resin outdoors 126.00 2016 El Salvador herb outdoors 227 25 2019 Estonia herb indoors 1.00 979 27 2019 Estonia herb outdoors 66 2 2018 Eswatini herb outdoors 3,000,000 210 1,500.00 1,069.50 430.50 2018 France herb outdoors 138,561 2014 France herb outdoors 158,592 837 2017 Georgia herb indoors 186 91 2017 Georgia herb outdoors 93 19 2017 Georgia herb indoors 2017 Georgia herb outdoors 2018 Georgia herb indoors 2018 Georgia herb outdoors 2015 Germany herb indoors 0.01 0.02 a 0.02 0.00 0.01 0.02 0.02 0.10 0.10 186 91 0.00 93 19 927 443 0.00 406 98 135,925 786 0.05 2015 Germany herb outdoors 9,136 127 2016 Germany herb indoors 79,599 712 Country / Territory Product Outdoors/ indoors Area Area cultivated eradicated (ha) (ha) Harvestable area (ha) Production Plants (tons) eradicated 1 Sites eradicated 2016 Germany herb outdoors 18,414 108 2017 Germany herb indoors 85,226 573 2017 Germany herb outdoors 2016 Greece herb indoors 16,554 2016 Greece herb oudoors 39,151 2017 Greece herb indoors 19,498 2017 Greece herb oudoors 27,409 2018 Greece herb indoors 6,913 2018 Greece herb oudoors 2016 Guatemala herb outdoors 2017 Guatemala herb outdoors 3.50 a 3.81 2018 Guatemala herb outdoors 129.00 a 129.00 2019 Guatemala herb outdoors 150.00 a 84.26 65.74 2015 Guyana herb outdoors 20.00 9.40 10.60 2016 Honduras herb indoors 7 2 2016 Honduras herb oudoors 24,253 19 2017 Honduras herb oudoors 2018 Honduras herb oudoors 720,426 67 2019 Honduras herb oudoors 228,542 46 2016 Hungary herb indoors 5,000 3 2016 Hungary herb outdoors 2,000 20 2013 Iceland herb indoors 6,652 323 2016 India herb outdoors 3,414.74 2017 India herb outdoors 3,445.90 2018 India herb outdoors 3,430.12 95 43,684 9.00 59.58 a 59.59 3,138,298 1.61 0.00 1,000.00 427 6,033,345 150 5,189,422 368 3,447,979 127 419,700 19 ANNEX | Cannabis Year 0.00 6,687,376 2019 India herb outdoors 2016 Indonesia herb outdoors 482.00 a 9,023.27 482.00 0.00 2017 Indonesia herb outdoors 89.00 a 89.00 0.00 738,020 14 2018 Indonesia herb outdoors 76.23 a 76.23 0.00 1,455,390 13 2019 Indonesia herb outdoors 103.20 a 84.50 18.70 845,000 25 2018 Iran (Islamic Republic of) herb indoors 2016 Ireland herb indoors 7,273 2017 Ireland herb indoors 9,046 2018 Ireland herb indoors 7,186 2019 Ireland herb indoors 8,576 2014 Italy herb indoors 51,534 639 2014 Italy herb outdoors 70,125 1,134 2017 Italy herb indoors 56,125 1,161 2017 Italy herb outdoors 209,510 401 2019 Italy herb indoors 68,266 169.00 0.04 50 2019 Italy herb outdoors 2016 Kazakhstan herb outdoors 18.00 a 18.00 0.00 170,000 155,275 202 2017 Kazakhstan herb outdoors 12.30 a 12.30 0.00 930,774 91 2016 Kenya herb outdoors 12.00 8,747 46 2017 Kenya herb outdoors 2018 Kenya herb outdoors 2019 Kenya herb outdoors 0.25 a 2015 Kyrgyzstan herb outdoors 5,014.00 1,276.37 0.10 4,662 0.10 517 0.25 0.00 130 1 5,014.00 2018 Kyrgyzstan herb outdoors 49,942 12.00 2016 Latvia herb indoors 457.69 818.68 557 35 2016 Latvia herb outdoors 78 6 79 WORLD DRUG REPORT 2021 Year 80 Country / Territory Product Outdoors/ indoors Area Area cultivated eradicated (ha) (ha) Harvestable area (ha) Production Plants (tons) eradicated Sites eradicated 2017 Latvia herb indoors 798 34 2017 Latvia herb outdoors 66 15 2018 Latvia herb indoors 152 17 2018 Latvia herb outdoors 1,152 34 2019 Latvia herb indoors 932 34 2019 Latvia herb outdoors 61 12 2015 Lebanon herb outdoors 3,500.00 2017 Lebanon Kif outdoors 40,772.00 4,205.70 3,500.00 2018 Lebanon herb outdoors 2016 Lithuania herb indoors 4,205.70 2017 Lithuania herb indoors 8 2017 Lithuania herb outdoors 7 2018 Lithuania herb indoors 2015 Madagascar herb outdoors 11.00 21,325 2017 Madagascar herb outdoors 9.00 57,708 2013 Malta herb indoors 2016 Mexico herb outdoors 4 3 27 5,478.42 6,574.1 38,432 2017 Mexico herb outdoors 4,193.34 5,032.0 34,523 2018 Mexico herb outdoors 2,263.71 2,726.47 28,873 2013 Mongolia herb outdoors 15,000.00 4,000.00 11,000.00 2018 Mongolia herb outdoors 15,000.00 173.00 14,827.00 2016 Morocco herb outdoors 2016 Morocco plant outdoors 2016 Morocco resin outdoors 713.00 2017 Morocco herb outdoors 35,702.90 2017 Morocco plant outdoors 2017 Morocco resin outdoors 714.06 2018 Morocco herb outdoors 23,699.80 2018 Morocco plant outdoors 2018 Morocco resin outdoors 2019 Morocco plant outdoors 4,000 4,000 33 35,652.83 47,000.00 47,500.00 395.00 523.00 47,500.00 46,605.00 46,977.00 47,500.00 423.58 21,048.71 135.50 20,913.21 2019 Morocco resin outdoors 2014 Myanmar herb outdoors 15.00 10.00 5.00 596.03 2018 Nepal herb outdoors 235.87 235.87 0.00 3 5,000.00 2,358,700 335 2016 Netherlands herb indoors 994,068 5,856 2017 Netherlands herb indoors 883,163 5,538 2018 Netherlands herb indoors 516,418 3,482 2018 Netherlands herb outdoors 2019 Netherlands herb indoors 556,802 3,285 431 2019 Netherlands herb outdoors 2016 New Zealand herb indoors 18,903 350 2016 New Zealand herb outdoors 104,725 2017 New Zealand herb indoors 19,992 2017 New Zealand herb outdoors 19,559 2018 New Zealand herb indoors 19,313 2018 New Zealand herb outdoors 22,660 2019 New Zealand herb indoors 18,052 2019 New Zealand herb outdoors 2014 Nicaragua herb outdoors 2016 Nicaragua herb outdoors 275,000 2017 Nicaragua herb outdoors 994,787 607 15,269 0.30 1,507.00 3,014 30 Country / Territory Product Outdoors/ indoors Area Area cultivated eradicated (ha) (ha) 2016 Nigeria herb outdoors 718.78 2017 Nigeria herb outdoors 317.12 3,660.64 Harvestable area (ha) Production Plants (tons) eradicated 1 Sites eradicated 65 2018 Nigeria herb outdoors 2017 North Macedonia herb indoors 2017 North Macedonia herb outdoors 2018 North Macedonia herb outdoors 2015 Norway herb indoors 2016 Oman herb outdoors 0.50 a 0.50 0.00 5 3 2013 Panama herb indoors 0.50 a 0.50 0.00 37 2 2013 Panama herb outdoors 10.50 a 10.50 0.00 78,633 2 2016 Paraguay herb outdoors 5,656,266 4 168 220 2.51 0.00404 0.04 2,264 4,527 4,000 30 1,298.50 1,298.50 a 1,298.50 0.00 2016 Paraguay plant outdoors 2016 Paraguay resin outdoors 2017 Paraguay plant outdoors 1,462.00 36,550,000 2016 Peru herb outdoors 87.83 1,429,749 2017 Peru herb outdoors 61.30 4,671,387 47 2018 Peru herb outdoors 91.80 1,716,751 46 337 1.15 2016 Philippines herb outdoors 8.67 24,635,153 2017 Philippines herb outdoors 4.82 221,035 27 2018 Philippines herb outdoors 12.39 869,682 186 149.35 2019 Philippines herb outdoors 2,345,650 137 2016 Poland herb indoors 146,755 1,403 2016 Poland herb indoors/outdoors 4,585 219 2017 Poland herb indoors 448 10 2017 Poland herb indoors/outdoors 2018 Poland herb indoors/outdoors 118,382 1,274.00 2019 Poland herb indoors 2,840 2 2019 Poland herb indoors/outdoors 5,124 17 2017 Portugal herb indoors/outdoors 22,910 158 2018 Portugal herb indoors/outdoors 8,706 139 2019 Portugal herb indoors/outdoors 12,077 131 2013 Republic of Korea herb outdoors 8,072 2014 Republic of Moldova herb indoors 2014 Republic of Moldova herb outdoors 100.00 59.00 2017 Republic of Moldova herb outdoors 0.15 2.57 257,236 2018 Republic of Moldova herb outdoors 0.71 86,926 2019 Republic of Moldova herb outdoors 2016 Romania herb indoors 2016 Romania herb outdoors 2017 Romania herb indoors 2017 Romania herb outdoors 2018 Romania herb indoors 2018 Romania herb outdoors 2019 Romania herb indoors 2019 Romania herb outdoors 2016 Russian Federation herb indoors 2016 Russian Federation herb outdoors 2017 Russian Federation herb indoors 2017 Russian Federation herb outdoors 2018 Russian Federation herb indoors 2018 Russian Federation herb outdoors ANNEX | Cannabis Year 54 41.00 41.00 10,000.00 200,548 61 143,537 1,433 6.99 41 42 1,875 46 4,905 32 3,903 39 0.11 1,882 98 0.49 2,096 39 787 44 1.90 0.66 7.61 a 7.61 159.00 a 159.00 9.34 a 7.47 788 0.00 68.64 1,143 0.00 30.07 5,379 0.87 1,990 1.87 1.87 16,212 81 WORLD DRUG REPORT 2021 Year Country / Territory Product Outdoors/ indoors Area Area cultivated eradicated (ha) (ha) Harvestable area (ha) Production Plants (tons) eradicated Sites eradicated 2019 Russian Federation herb indoors 0.72 2019 Russian Federation herb outdoors 161.10 2,112 2015 Serbia herb outdoors 2013 Sierra Leone herb outdoors 2016 Slovakia herb indoors 2017 Slovakia herb outdoors 2019 Slovakia herb indoors 1,611 41 2014 Slovenia herb indoors 9,223 118 3,571 0.05 190.00 190.00 190 3 385 2.00 a 2.00 0.00 2,299 31 2014 Slovenia herb outdoors 1,844 2017 Slovenia herb indoors 10,259 78 2015 Spain herb indoors 244,772 108 135,074 44 2015 Spain herb outdoors 2014 Sudan herb outdoors 8.00 a 8.00 0.00 345.00 2017 Sudan herb outdoors 1,250.00 a 1,250.00 0.00 205.00 2018 Sudan herb outdoors 7,744.00 a 1,452.00 6,292.00 774,400.00 2014 Sweden herb indoors 2015 Sweden herb outdoors 2017 Sweden herb 2018 Sweden herb 2016 Switzerland 2017 Switzerland 2016 100 1,500,000 3 10,000 56 indoors 5,100 44 indoors 1,642 herb indoors 11,386 herb indoors 71,750 Thailand herb outdoors 1.00 a 1.00 0.00 7.50 2019 Thailand herb outdoors 1.50 a 1.50 0.00 45.00 2019 Togo herb outdoors 0.06 2015 Trinidad and Tobago herb outdoors 0.31 2016 Ukraine herb outdoors 2017 Ukraine herb outdoors 166.90 483,000 2019 Ukraine herb outdoors 47.00 1,800,000 2,135 2016 United States of America herb indoors 406,125 1,865 2016 United States of America herb outdoors 4,940,596 5,513 2017 United States of America herb indoors 303,654 1,399 182.00 91.00 a 91.00 83 1 4,790 53 375,925 58 1 0.00 2017 United States of America herb outdoors 3,078,418 4,062 2018 United States of America herb indoors 596,149 1,618 3,847 2018 United States of America herb outdoors 2,221,837 2019 United States of America herb indoors 770,472 1,437 2019 United States of America herb outdoors 3,232,722 3,850 2016 Uruguay herb indoors 661 2017 Uruguay herb indoors 1,926 2019 Uruguay herb indoors 2016 Uzbekistan herb outdoors 0.20 a 0.20 0.00 586 2017 Uzbekistan herb outdoors 0.20 a 0.20 0.00 618 2018 Uzbekistan herb indoors 0.13 a 0.13 0.00 519 2019 Uzbekistan herb outdoors 0.11 a 0.11 0.00 2018 Venezuela herb oudoors 2015 Viet Nam herb oudoors 1,654 417 13,891 1.00 Sources: United Nations Office on Drugs and Crime annual report questionnaire, government reports and and international narcotics control strategy reports of the United States of America. a) Estimate of total area under cannabis cultivation. 82 4 GLOSSARY amphetamines — a group of amphetamine-type stimulants that includes amphetamine and methamphetamine. annual prevalence — the total number of people of a given age range who have used a given drug at least once in the past year, divided by the number of people of the given age range, and expressed as a percentage. coca paste (or coca base) — an extract of the leaves of the coca bush. Purification of coca paste yields cocaine (base and hydrochloride). “crack” cocaine — cocaine base obtained from cocaine hydrochloride through conversion processes to make it suitable for smoking. cocaine salt — cocaine hydrochloride. drug use — use of controlled psychoactive substances for non-medical and non-scientific purposes, unless otherwise specified. fentanyls — fentanyl and its analogues. new psychoactive substances — substances of abuse, either in a pure form or a preparation, that are not controlled under the Single Convention on Narcotic Drugs of 1961 or the 1971 Convention, but that may pose a public health threat. In this context, the term “new” does not necessarily refer to new inventions but to substances that have recently become available. opiates — a subset of opioids comprising the various products derived from the opium poppy plant, including opium, morphine and heroin. opioids — a generic term that refers both to opiates and their synthetic analogues (mainly prescription or pharmaceutical opioids) and compounds synthesized in the body. GLOSSARY amphetamine-type stimulants — a group of substances composed of synthetic stimulants controlled under the Convention on Psychotropic Substances of 1971 and from the group of substances called amphetamines, which includes amphetamine, methamphetamine, methcathinone and the “ecstasy”-group substances (3,4-methylenedioxymethamphetamine (MDMA) and its analogues). 1 problem drug users — people who engage in the high-risk consumption of drugs. For example, people who inject drugs, people who use drugs on a daily basis and/or people diagnosed with drug use disorders (harmful use or drug dependence), based on clinical criteria as contained in the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) of the American Psychiatric Association, or the International Classification of Diseases and Related Health Problems (tenth revision) of WHO. people who suffer from drug use disorders/people with drug use disorders — a subset of people who use drugs. Harmful use of substances and dependence are features of drug use disorders. People with drug use disorders need treatment, health and social care and rehabilitation. harmful use of substances — defined in the International Statistical Classification of Diseases and Related Health Problems (tenth revision) as a pattern of use that causes damage to physical or mental health. dependence — defined in the International Statistical Classification of Diseases and Related Health Problems (tenth revision) as a cluster of physiological, behavioural and cognitive phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state. 83 WORLD DRUG REPORT 2021 84 substance or drug use disorders — referred to in the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) as patterns of symptoms resulting from the repeated use of a substance despite experiencing problems or impairment in daily life as a result of using substances. Depending on the number of symptoms identified, substance use disorder may be mild, moderate or severe. prevention of drug use and treatment of drug use disorders — the aim of “prevention of drug use” is to prevent or delay the initiation of drug use, as well as the transition to drug use disorders. Once a person develops a drug use disorder, treatment, care and rehabilitation are needed. The World Drug Report uses a number of regional and subregional designations. These are not official designations, and are defined as follows: > South America: Argentina, Bolivia (Plurinational State of), Brazil, Chile, Colombia, Ecuador, Guyana, Paraguay, Peru, Suriname, Uruguay, Venezuela (Bolivarian Republic of) and Falkland Islands (Malvinas) AFRICA > East Africa: Burundi, Comoros, Djibouti, Eritrea, Ethiopia, Kenya, Madagascar, Mauritius, Rwanda, Seychelles, Somalia, South Sudan, Uganda, United Republic of Tanzania and Mayotte > North Africa: Algeria, Egypt, Libya, Morocco, Sudan and Tunisia ASIA > Central Asia and Transcaucasia: Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan > East and South-East Asia: Brunei Darussalam, Cambodia, China, Democratic People’s Republic of Korea, Indonesia, Japan, Lao People’s Democratic Republic, Malaysia, Mongolia, Myanmar, Philippines, Republic of Korea, Singapore, Thailand, Timor-Leste, Viet Nam, Hong Kong, China, Macao, China, and Taiwan Province of China > Southern Africa: Angola, Botswana, Eswatini, Lesotho, Malawi, Mozambique, Namibia, South Africa, Zambia, Zimbabwe and Reunion > West and Central Africa: Benin, Burkina Faso, Cabo Verde, Cameroon, Central African Republic, Chad, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, Sao Tome and Principe, Senegal, Sierra Leone, Togo and Saint Helena > South-West Asia: Afghanistan, Iran (Islamic Republic of) and Pakistan > Near and Middle East: Bahrain, Iraq, Israel, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Syrian Arab Republic, United Arab Emirates, Yemen and State of Palestine AMERICAS > Caribbean: Antigua and Barbuda, Bahamas, Barbados, Cuba, Dominica, Dominican Republic, Grenada, Haiti, Jamaica, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Trinidad and Tobago, Anguilla, Aruba, Bonaire, Netherlands, British Virgin Islands, Cayman Islands, Curaçao, Guadeloupe, Martinique, Montserrat, Puerto Rico, Saba, Netherlands, Sint Eustatius, Netherlands, Sint Maarten, Turks and Caicos Islands and United States Virgin Islands 1 REGIONAL GROUPINGS GLOSSARY REGIONAL GROUPINGS > South Asia: Bangladesh, Bhutan, India, Maldives, Nepal and Sri Lanka EUROPE > Eastern Europe: Belarus, Republic of Moldova, Russian Federation and Ukraine > South-Eastern Europe: Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Montenegro, North Macedonia, Romania, Serbia, Turkey and Kosovo1 > Central America: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama > North America: Canada, Mexico, United States of America, Bermuda, Greenland and Saint-Pierre and Miquelon 1 References to Kosovo shall be understood to be in the context of Security Council resolution 1244 (1999). 85 WORLD DRUG REPORT 2021 > Western and Central Europe: Andorra, Austria, Belgium, Cyprus, Czechia, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Monaco, Netherlands, Norway, Poland, Portugal, San Marino, Slovakia, Slovenia, Spain, Sweden, Switzerland, United Kingdom of Great Britain and Northern Ireland, Holy See, Faroe Islands and Gibraltar OCEANIA > Australia and New Zealand: Australia and New Zealand > Polynesia: Cook Islands, Niue, Samoa, Tonga, Tuvalu, French Polynesia, Tokelau and Wallis and Futuna Islands > Melanesia: Fiji, Papua New Guinea, Solomon Islands, Vanuatu and New Caledonia > Micronesia: Kiribati, Marshall Islands, Micronesia (Federated States of), Nauru, Palau, Guam and Northern Mariana Islands 86 Vienna International Centre, PO Box 500, 1400 Vienna, Austria Tel: +(43) (1) 26060-0, Fax: +(43) (1) 26060-5866, www.unodc.org Consisting of five separate booklets, the World Drug Report 2021 provides an in-depth analysis of the global drug markets and paints a comprehensive picture of the measurable effects and potential impact of the COVID-19 crisis on the world drug problem. Booklet 1 summarizes the four subsequent booklets by reviewing their key findings and highlighting their policy implications. Booklet 2 offers a projection of the impact of population growth on drug use by 2030 and gives a global overview of the supply of and demand for drugs, including their health impact and the trafficking of substances over the Internet. Booklet 3 provides an analysis of the global markets for cannabis and opioids, both in terms of supply and use, and includes an overview of the latest developments in countries with measures regulating the non-medical use of cannabis; it also discusses the overlaps between the various opioids and looks at access to pharmaceutical opioids for medical use. Booklet 4 contains the latest trends in and estimates of the markets for stimulants – cocaine, methamphetamine, amphetamine and “ecstasy” – both at the global level and in the most affected subregions. Booklet 5 presents an early assessment of the impact of the COVID-19 pandemic on drug markets by looking at how it has affected drug supply and demand dynamics, including in terms of health consequences and how drug service provision has adapted to the new situation in many countries; the booklet closes with a look at how the pandemic may influence long-term changes in the drug markets. The World Drug Report 2021 is aimed not only at fostering greater international cooperation to counter the impact of the world drug problem on health, governance and security, but also, with its special focus on the impact of the COVID-19 pandemic, at assisting Member States in anticipating and addressing challenges that may arise in the near future. The accompanying statistical annex is published on the UNODC website: www.unodc.org/unodc/en/data-and-analysis/wdr2021.html