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Tracking opiate and opioid abuse around the world

December 19, 2013

BY: Holly Johnson

Note from the editor: This is the third of a four-part series exploring drug trends around the world. Check back soon for the final article, which examines cocaine use.

The use of opiates is nothing new, with historical proof of opiate use dating as far back as 3400 B.C. Since then, poppy fields became part of Assyrian culture before passing onto the Babylonians and Egyptians. Elsewhere in the world, ancient cultures were harvesting opium for their own reasons, including pain relief and trade. And although the production of opium has waned throughout the centuries since, it still remains commonplace to this day, with dire consequences.

Drugs derived from the poppy flower are much different today, mainly due to advances in modern medicine and the addition of opioids. Opiates and opioids are structurally similar, yet created in different ways. Opiates are a group of drugs derived from a poppy plant, are considered "natural" since their active ingredients occur in nature. Morphine and codeine are perhaps the most recognizable opiates. Opioids like hydrocodone (Vicodin), oxycodone (Oxycontin) and heroin are semi- or fully-synthesized to be similar to opiates. However, opioid is often used an umbrella term to describe both. Opioids and opiates are commonly prescribed for pain relief. Unfortunately, because they activate the brain's reward system and cause feelings of euphoria, they can be highly addictive.

* The UNODC classifies opiates as heroin and opium and opioids as opium, heroin and prescription opioids.

Opiate and opioid trends overseas

According to the United Nations Office on Drugs and Crime, there were between 12 and 21 million opiate users* worldwide in 2009, with the bulk of use attributed to heroin. Europe and Asia accounted for the highest percentage of opiate use with low estimates of at least 2.1 million users in East/South-East Europe, 1 million users in West/Central Europe, 320,000 in Central Asia, 2.8 million in East/South-East Asia, 1.94 million in the Near and Middle East, and 1.38 million in South Asia.

The UNODC reports that there is reason to suspect a decline or stabilization of heroin use in most parts of Europe. However, experts are concerned that heroin is being replaced with prescription opioids, which creates a similar set of problems within those communities. However, as the European Monitoring Centre for Drugs and Drug Addiction reports, the decline in European opiate use could be due to strong treatment efforts by member countries. And although trends can vary from country to country, data from the 10,000 reporting treatment centers all over Europe shows a significant decrease in heroin clients seeking first-time treatment from 2007 to 2011.

Opium production remains high in Asia, mainly due to the high level of continued cultivation in Afghanistan as well as increased efforts in Myanmar. According to the UNODC's "World Drug Report 2013," opioid use is highly prevalent in China as well, where the number of registered heroin users rose from 1.06 million in 2010 to 1.24 million in 2011.

Across Africa, approximately 890,000 to 3,210,000 individuals used opiates in 2009, with the highest percentage of use taking place in West and Central Africa. The UNODC also noted that heroin use is likely on the rise in Africa, although it's difficult to know for sure due to unreliable reporting and missing data. Meanwhile, opiate use in the Caribbean, Central America, South America and North America remained relatively low with approximately 1,180,000 to 1,910,000 opiate users reported in 2009.

Opioid use surges in the U.S.

A new study from the John Hopkins Bloomberg School of Public Health shows the U.S. is currently going through a period of intense prescription opioid use, with no apparent improvement in pain management for users.

"There is an epidemic of prescription opioid addiction and abuse in the United States," notes Dr. G. Caleb Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness.

The study analyzed trends from 2000 to 2010 by studying patients seeking medical treatment for non-cancer pain. The researched uncovered that patients treated with opioids were not showing improvement of their pain, yet continued to seek additional or higher levels of opioids for treatment. "This suggests that efforts to improve the identification and treatment of pain have backfired, due to an over-reliance on prescription opioids that have caused incredible morbidity and mortality among patients young and old alike," said Alexander.

According to the UNODC, the U.S. also faces a serious heroin problem, with 71 percent of all opioid-related hospital admissions related to heroin use in 2008. However, as the UNODC noted, treatment for heroin use has remained stable in the U.S. at a time when treatment for prescription opioids has increased dramatically since 1998.

Mortality rates and trafficking

According to a recent report by the UNODC, "Opioid overdose: preventing and reducing opioid overdose mortality," opioid overdose was the main cause of 99,000 to 235,000 deaths worldwide in 2010. However, the UNODC does report difficulty gathering mortality data from all countries, which makes it challenging to provide any concrete numbers. However, it is known that opioid overdose rates are directly related to the availability of the drugs, both illicit and prescribed. That's why many countries have stepped up their efforts in tracking and seizing opiates and opioids sold on the illegal market.

In 2009, officials seized 653 metric tons of opium and 76 metric tons of heroin globally, with the largest seizures occurring in Iran and Turkey, and along the Balkan route from Afghanistan to West and Central Europe. Iran seized the largest percentage of all opiate-related drugs in 2009, accounting for 89 percent of opium seizures, 68 percent of morphine seizures and 33 percent of heroin seizures globally.

In late 2010 and early 2011, the United Kingdom reported a substantial increase in heroin from Pakistan seized at its borders. However, from 2010 to 2012, Pakistan reported an especially high percentage of
maritime seizures of heroin, suggesting that the usual flow of illicit drugs has been compromised in some way. According to the UNODC, an increase in seizures may have been enough to convince traffickers to develop alternate routes for trafficking to the European market.

Meanwhile, illicit drug seizures in the U.S. are on the rise, with the 1.4 metric tons of heroin seized in 2007 ballooning to 2.4 metric tons in 2009. As the UNODC pointed out, the U.S. Drug Enforcement Agency attributes the increase in heroin to increased production in parts of Mexico. Seizures along the U.S/Mexico border have reportedly skyrocketed -- from the 404 kilograms seized in 2007 to over 642 kilograms seized in 2009.

For additional statistics and analysis of global opiate and opioid use, visit the sources below.

Sources:

"As Opioid Use Soars, No Evidence of Improved Treatment of Pain," John Hopkins Bloomberg School of Public Health, September 16, 2013, http://www.jhsph.edu/news/news-releases/2013/alexander-opiod-pain-use.html

"Opioid overdose: preventing and reducing opioid overdose mortality," United Nations Office on Drugs and Crime, 2013, https://www.unodc.org/docs/treatment/overdose.pdf

"Opium Throughout History," PBS Frontline, http://www.pbs.org/wgbh/pages/frontline/shows/heroin/etc/history.html

"The Opium/Heroin Market," United Nations Office on Drugs and Crime, 2011, http://www.unodc.org/documents/data-and-analysis/WDR2011/The_opium-heroin_market.pdf

"Trends in heroin use in Europe -- what do treatment demand data tell us?" European Monitoring Centre for Drugs and Drug Addiction, May 28, 2013, http://www.emcdda.europa.eu/topics/pods/trends-in-heroin-use

"What are Opioids?" National Institute on Drug Abuse, http://www.drugabuse.gov/publications/research-reports/prescription-drugs/opioids/what-are-opioids

"World Drug Report 2013," United Nations Office on Drugs and Crime, 2013, http://www.unodc.org/unodc/secured/wdr/wdr2013/World_Drug_Report_2013.pdf