Opioid use accounts for the biggest negative health impact worldwide associated with drug consumption, according to the latest United Nations World Drug Report, a concerning trend as the opioid market becomes more diversified and opium production rises.
"Globally, there are an estimated minimum of 190,000 -- in most cases avoidable -- premature deaths from drugs, the majority attributable to the use of opioids," states the report released on June 22 by the UN Office on Drugs and Crime (UNODC).
According to the report, global opium production increased by a third during 2016, largely due to an increase in opium yields in Afghanistan, although the amount of land dedicated to opium poppy production also grew.
On a global level, heroin seizures remained stable. However, seizures spiked in 2015 in the United States, where opioid abuse is particularly acute. The country now accounts for a quarter of all drug-related deaths worldwide.
"Mostly driven by opioids, overdose deaths in the United States more than tripled during the period 1999-2015, from 16,849 to 52,404 annually, and increased by 11.4 per cent in the past year alone to reach the highest level ever recorded," the report states.
Both legal substances like fentanyl and prescription painkillers as well as illegal products such as heroin and illicit fentanyl are pushing opioid abuse and overdoses, the report found, adding that the emergence of new manifestations of fentanyl is particularly to blame for rising overdose rates.
"The opioid market is becoming more diversified: this is illustrated by the example of the United States, where the opioid market comprises a combination of internationally controlled substances, particularly heroin, and prescription medicines that are either diverted from the legal market or produced as counterfeit medicines on a large scale. These counterfeit medicines are made to look like pharmaceutical products while actually containing fentanyl and fentanyl analogues, as well as non-opioid substances such as derivatives of benzodiazepine and methylphenidate," the report says.
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The report also noted that cocaine seizures worldwide increased by 30 percent in 2015 to reach 864 tons -- the highest level ever reported. It is likely that this is linked to surging cocaine production in Colombia in recent years.
An increase in cocaine-related overdoses in the United States, where cocaine use is going up after years of decline, is also likely connected to the use of cocaine in combination with opioids. And although the number of cocaine users in Europe -- the drug's second-biggest market after the United States -- is either decreasing or stabilizing, the total amount of cocaine being consumed could nontheless be on the rise, according to wastewater analysis.
The report also noted that organized crime groups, which earn between one-third and one-fifth of their income from drug trafficking, are undergoing structural evolutions. Although large hierarchical groups still exist, European police agency Europol said that smaller, more horizontal groups now account for 30 to 40 percent of organized crime groups operating in the European Union.
Notably, East and Southeast Asia surpassed the United States to account for seizures of the most methamphetamine in 2015, with a large increase of seizures in China. Cocaine markets in Asia also appear to be growing, according to evidence cited by the report; seizures in 2015 in Asia increased by 40 percent year on year.
Recreational users of cannabis, "ecstasy," cocaine, hallucinogens and "new psychoactive substances" are increasingly buying their drugs from the dark web, an encrypted and anonymized part of the internet. The size of these sales is still relatively small, but that share is growing rapidly, according to the report.
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Although the US has the ignominious distinction of being the epicenter of the opioid abuse epidemic, the latest report from the UNODC gives some global context to the crisis. Three-quarters of opioid-related overdoses occur in other nations.
And while Mexico is now the source for the vast majority of heroin consumed in the United States, according to US law enforcement, Afghanistan's poppy fields are the main push factor behind the overall global production surge.
But the report emphasizes the growing complexity of the public health problem and law enforcement challenge posed by global opioid consumption. The number of opioid products on the world market is growing. The growth involves a combination of legal products like prescription pain killers as well as illegal ones like heroin and illicit fentanyl -- some of which are being combined by criminal organizations, sometimes unknowingly, to create lethal products.
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The report also picks up on growing evidence that fentanyl, which is between 50 and 100 times more potent than heroin, is now being cut into cocaine as well as being added heroin or counterfeit prescription pills. In 2016, 44 percent of the more than 1,300 overdose deaths in New York City involved fentanyl, according to Business Insider, and 37% of total drug overdose deaths involved cocaine and fentanyl without heroin -- an increase of 11 percent from the year before.
The flow of legal fentanyl into the Americas from China and other producing nations is a problem that the United States is attempting to address. This week, the Drug Enforcement Administration (DEA) announced that China's National Narcotics Control Commission will put tighter controls on more fentanyl-class substances in addition to those scheduled earlier this year. Until 2015, fentanyl production in China was largely unregulated, according to Science.
"We think this is a move that will ultimately save lives in the US," Melvin Patterson, a DEA spokesman, told InSight Crime.