Introduction

Opioids are substances and chemical compounds extracted from the opium poppy plant, scientifically called “Papaver somniferum”. Primarily extracted for medicinal usage, opioids work on pain receptors and are usually prescribed to reduce pain and related effects on the body. The drug is administered for various pain-related medical situations, including fractures and surgeries. It is also used in various stages of cancer treatments and post-operation procedures, where the drug affects the sensory points of pain receptors, effectively relieving the patient of immediate painful sensations. Opioids affect the dopamine and oxytocin-producing neurons and force them to work on overdrive to alter the perception of the user. This is essential to its use as a pain-relief drug, but is also a desirable effect for drug users who want a state of ecstasy and artificially induced euphoria.

Although opioids are prescribed based on needs, brands and geographical locations, some of the most widely consumed are Morphine, Codeine, Methadone and Fentanyl. There are various genetic and socio-economic conditions associated with addiction, and not every user becomes addicted, but people engaging in the recreational use of opioids tend to develop tolerance after time and have to increase dosage, effectively fraying their receptors. This develops a dependence on such drugs for basic hormonal needs like oxytocin, serotonin and dopamine. This cycle is the reason for addiction and, subsequently, probable overdose.

International distribution and consumption

Opioids and opiates collectively form about 5.7% of the total international drug trade, being one of the least smuggled substances by volume. However, this does not imply that the drug is low in the ranks of consumption. According to the 2024 report of the United Nations Office on Drugs and Crime, Opioids, opiates and related drugs on average rank within the top 3 consumed illegal substances in almost every country, with virtually no difference noted between developing and developed nations (Meinhofer, 2018). There are several reasons why the disparity between the trade deficit and consumption patterns exists in the international drug trade for opioids related drugs.

Production

The production and cultivation of opium has become difficult over time, with various drives by countries to remove farms that cultivate poppy seeds. But still, supply chains are maintained for legal drug use by pharmaceutical companies, which are then also used for illicit trade. By volume, over 3 lakh hectares of land were allotted to the cultivation of opium as mentioned by the UNODC Illicit Crop Monitoring Programme. However, the number has significantly fallen to one-third of the value in 2023, due to various cleaning drives by Pakistan, Myanmar, Cambodia and various other nations in South America. According to fresh surveys, the biggest producers of opium by cultivation land volume are Afghanistan, Laos, Myanmar, Colombia and Mexico, with Afghanistan accounting for over half of the total percentage. Even big pharmaceutical companies source their supply chains from third-world countries due to cheaper labour, lower rates and weaker laws regarding the cultivation and distribution of substance-inducing plants.

The second supply chain originates from the synthetic production of opioids and opiates. Chemically produced opioids like fentanyl have taken the drug market by storm, especially by disrupting the supply chains. Synthetic drugs like fentanyl are low in volume with higher effects per dose, hence the transport chains change. It removes the need for organised crime fronts to transport high volumes of drugs, as they can be easily transported in an individual capacity. This changes the power dynamics between the traffickers who are usually credited with violence and drug-revenue-induced crimes. The consumption chains have been shifting towards synthetic drugs primarily due to the higher potency of the drug and the longer effects that it has on the body (Schnell, 2019). This preference becomes a huge problem for administrations as they have more fatal effects and is more predisposed to cause dependence and addiction.

There are three major pathways for smuggling narcotics through Afghanistan: The primary root with the heaviest traffic is the Balkan route that runs from Turkey to Europe; followed by the northern Road that goes through the Central Asian countries directly into Russia; and lastly the southern Road that Travels through South Asia into the gulf and Africa. According to reports from the United Nations, the Balkan route from Afghanistan is considered to be the central route of opiate trafficking in the world. More than 80% of the opium exported from Afghanistan runs through this route, including about half of the heroin production.


Picture 1: World opioid networks
 

Afghanistan network

The smuggling from Afghanistan involves many levels of deliveries and travelling across different border communities to reduce detection. One of the most common ways of supplying narcotics is to travel in small groups to transport a few 100 kilograms of opium on foot or with grazing animals like animals or goats which prevents detection and search. Due to the high returns from the network smugglers an higher armed protection for their safety while travelling at night. Similarly, larger networks use convoys to travel with several men to fight off law enforcement in Iran and are known to possess car bombs, automatic Rifles and in some cases, tanks along the Afghanistan-Iranian border wall. In the last four decades, over 3700 law enforcement officers from Iran have died fighting the drug traffic. Even more dangerous are the corrupt Afghan police units who are responsible for allowing drug shipments to go by and misleading the law enforcement personnel from Afghanistan and Iran.

Picture 2: Afghanistan opium routes

One of the key supplies that traffic is required is precursor chemicals from Central Asia or Europe into Afghanistan. This chemical is called acetic anhydride, which is an important component of making heroin and other opiates. While the legal trade for medicine is procured through regular channels, the authorities in Afghanistan estimated that 85% of the acetic anhydride comes from Iran into the country.

Considering the volatile governance under the Taliban rule, Afghanistan has become a part of the drug network that is extremely difficult to deal with. Weak administrative systems and corrupt oversight lead to a lack of law enforcement, which allows such a prosperous drug network to flourish. The opiate trade in Afghanistan is not just due to the administrative fallacies and the rule of the Taliban, but originates from decades of economic degradation and lack of employment, which forces people to engage in illegal cultivation of opium and drug trafficking. While the administrative loopholes can be blamed for the ongoing opiate overflow, the only way to deal with the rampant trafficking is to address the core socio-economic issues and triggers.

Myanmar and the Golden Triangle Trade Network

The growth of synthetic drug production in Myanmar is centred around the functioning of the Shan state, which is a semi-autonomous region situated in the hilly terrains of the country. The functioning of drug traffic in the Shan state is part of an organised crime network primarily dealing with drug trafficking, online scams and money laundering, which generates significant profits for the region.

According to several UNODC reports, the hilly region plays an important role in the sustenance of the drug trade. Due to the lack of law and enforcement in the treacherous mountainous paths, the production and smuggling of synthetic narcotic materials from Myanmar has earned it a spot on the Golden Triangle.

 Picture 3: Golden Triangle (Image Credits: VOA)

The Golden Triangle is a convergence between Myanmar, Laos and Thailand, making it a closed network of one of the largest opium-producing regions of the world. The cultivation of opium poppy is enclosed within the functioning of the local economy, with many farmers supporting it as their main source of income. This opium is then supplied to various Laboratories across the Shan state from where it is smuggled into Thailand, China, Australia and other regions.

A key function of the opiate trade in Myanmar is the ethnic military groups that partake in the patrolling of the region. Many reports from interim committees show that the Shan State Army and the United Wa State Army have become part of the drug trafficking network, utilising the profits from it to fund the armed revolutions. The United Wa State Army is often alleged to be running the methamphetamine operations in Myanmar. Due to this heavily organised network, the farmers of opium receive commendable rates for their produce, which is then heavenly taxed by the pro-government groups, from which they keep their share of the profits. The lack of administrative organisation, unethical abuse of power and corruption have created a conducive environment in Myanmar for one of the most radical synthetic drug trade operations to fester. After the crackdown by the Taliban on opiate production in Afghanistan, production and Myanmar has skyrocketed to cover the gap. According to various reports, the cost of producing a yaba, which is the local name for a Math pill, has increased by 27%. The high incomes are lucrative to the local farmers who are not able to earn a living wage by farming for a regular crop supply. Overall, the economic decline of the Shan state is partially responsible for such a lucrative trade market supporting the political economy.

Mexico and North American Trafficking Routes

Mexico is the third largest smuggling network all over the world, managing the Pacific, Caribbean and European routes through the support of cartels. The large shore and easier connectivity to all the major International waterways allow the cartels and criminal groups to utilise the containerised illicit cargo modes of drug trafficking using speed boats, EMIS submersibles and dispatch ships.

They utilise several high-end methods like a blind hook, which involves attaching crates of opiates and marijuana to normal travelling vessels without the knowledge of the crew, torpedos and underwater containers, speed boats and stolen semi-submersibles to carry up to 6 tons of cargo at once.

The updated list of captures by the Mexican naval authorities regarding drug smuggling and inclusive confiscations is listed below:

• Cocaine: 10,505.49 kg

• Marijuana: 1,028.8 kg

• Methamphetamines: 195.9 kg

• Chemical Precursors: 244,927 kg

• Confiscated Boats: 8

• Semi-submersibles: 4

• Arrested Individuals: 35

Regional shift

Illicit drug trade initially affected the third-world countries in Central Asia, Eastern Europe, South America and Africa, in both consumption and production. However, the shift from natural to synthetic opioids has shifted the focus on these patterns, which now tend to move towards the developed nations. Countries like South Africa and various nations in Central Europe and the Asia Pacific have become the centre for production due to lax government regulations over pharmaceuticals, lower regulations on trade and a higher presence of pharma companies. These potent drugs are then transported to North America and Western Europe for distribution, where the consumption has almost tripled for opioids since 2019.

Third-world countries like Afghanistan, Pakistan and various South Asian countries have not shifted to the synthetic version of opioids due to the cheaper and readily available heroin and plant-based drugs. The same has been observed in Russia, China and Iran, where cultivated drugs have had a hold on the market due to non-porous rules on pharmaceutical production and lower individual income rates.

Involvement of Big Pharma

The historic case of Purdue Pharma forms the perfect example to showcase how big pharma companies have played a significant role in increasing the production, distribution and consumption of opioids. The problem of Opioid Use Disorder (OUD) is not limited to illegal consumption but is also exacerbated by regular consumption of regular, over-the-counter prescription drugs in regulated markets. Purdue Pharma, due to an oversight by FDA regulations, started an overall trend of marketing campaigns that minimised the effects of opioid usage in drugs like codeine and maximised benefits. Alarming statistics suggest that opioid overprescription has been a key factor in the US opioid crisis. Opioid addiction is also a big problem among physicians themselves. Nevertheless, despite a consistent decline in opioid prescription in the USA since 2013, the number of deaths continues to increase, indicating that other causes have become equally or more important, such as the incursion and popularity of synthetic opioids obtained from the illegal market and clandestine laboratories. These marketing campaigns allowed higher numbers of prescriptions, and the usage preference also shifted, towards more opioid-dependent drugs (Barnett et al., 2017). The oversight and profit-maximising tendencies of big pharma companies have rendered the common public in the US and subsequently the rest of the world dependent on opioids.

Throughout US history, most of the medical sphere has been influenced by legal Pharmaceutical suppliers. During the 19th Century, opioid addiction increased due to doctors prescribing opium and morphine to Civil War veterans without any medicated condition. Practice slowly and gradually started applying to other patients who suffered from pain and physical symptoms of Mental Health issues. Similarly, after heroine was introduced in 1890 as a treatment for respiratory diseases, it was utilised as a supplement for morphine addiction. Cocaine also had many medical uses before becoming a substance of abuse. After the Harrison Act of the US Constitution, heroin and cocaine became illegal products, which shifted the focus of prescribed medication towards synthetic alternatives. The notable pattern of the problem is that regularly utilised medications, which proved effective for certain physical conditions, became abusable drugs due to over-prescription and over-utilisation.

Several measures have been proposed by the Stanford-Lancet Commission to tackle the opioid crisis, including better drug regulation, education (including the safe disposal of opioids and awareness of harmful effects), restrictions on opioid prescription, and promotion of prevention campaigns, for example, the need for creating healthy environments as a strategy to reduce opioid addiction.

In the established context of medical history, the contemporary US opioid epidemic is just a repetition of history, which is influenced by the pharmaceutical industry. Online prescribing operates in a regulatory grey area, allowing some pharmacies to exploit legal loopholes, evade oversight, and dispense prescription-only medicines without sufficient safeguards. These loopholes enable patients to obtain large quantities of high-risk drugs without their General Practitioner’s knowledge. Physicians, widely trusted by their patients, prescribed opioid analgesics under the assumption that they were safe and effective. However, a lack of awareness about their true addictive potential, combined with aggressive marketing campaigns targeting medical professionals, led to a rapid escalation from legitimate medical use to dependency and abuse (Alpert et al., 2019; Evans et al., 2019; Finkelstein et al., 2018).

According to economic models of addiction through rationality, the consumption of a drug is a consequence of making informed choices rather than mindless consumption. Behavioural economics also postulates that drug users struggle with self-control and are prone to regret their continuous use. To support this hypothesis, a theory by Rabin and Burnheim suggested that addicted people often spend on regular, common goods to reduce future Temptation and accessibility to drugs.It can be deduced that the use of illicit drugs depends on the variables of price, supply, and behavioural patterns of consumption.

India

In India, most lower-income deaths are not thoroughly investigated to give a rate of opioid-induced deaths, and there have been only two surveys to promptly analyse the availability and consumption of the same. In 2019, the first study showed that the consumption rate of opioids in India is three times the world average, with the worst-affected states being Uttar Pradesh, Mizoram and Punjab. India suffers from an opioid epidemic, but the causes and distribution channels significantly differ. The dependence and usage are not pharmaceutical yet, with the prevalence of heroin-induced drugs. There are various reasons for this consumption pattern, including lower income rates and a lack of pharmaceutical infrastructure and medical facilities.

This does not imply that the risk of opioids related mortality is small. The common public health knowledge gives significant insights into the usage of plant-based opioids, some of which are readily available to the common public at dirt-cheap prices. The fatality rate of such substances is higher, primarily because of the low-quality ingredients and methods (infected needles) that are used. This makes India susceptible to opioid-adjacent fatal health issues like HIV and Hepatitis B that spread rapidly due to the contamination of objects of consumption.

In the growing opioid crisis, Punjab, Uttar Pradesh and Mizoram are some of the worst-affected states in terms of consumption. Culminating from a weak regulatory system, easy availability and the acceptable use of synthetic drugs create this unique festering ground for a very profitable illicit trade.

Punjab has always been a centre for the opioid epidemic in India, largely due to the Geographic proximity to Pakistan and Afghanistan borders. Heroine is the primary drug used, according to the Magnitude of Substance Use reports in India. 8% of Punjab's population was calculated to be consuming opioids in some other form in 2019. Applied by domestic manufacturers, tramadol and fentanyl have become a major problem in the addiction rates in rural areas among youngsters. Weak law enforcement paired with unemployment and declining economic growth leads to resilient supply chains and high consumption rates.

Mizoram is supplied by the Myanmar opium production chain with injectable intravenous opioids that have become a primary consumption drug among youngsters. Drug consumption has also led to an increase in bloodborne diseases due to a lack of sterile injections and a failing healthcare system. The region is also affected by social acceptance of opium and limited opportunities for proper employment, which increases the risk towards drug consumption.

Developments in International Efforts

Different trends will emerge due to the current shift in the consumption of illicit drugs, especially opioids. With the change in consumption patterns towards pharmaceutical and synthetic alternatives, there is a predicted reduction of focus by the US and other European countries in the war on drugs in Central Asia and South America, to focus on internal production and distribution. This will reduce the operability of international organisations like UNODC, which receives most of its funding and personnel for drug combating from the US, Canada and France. This is particularly a harmful possibility as this will push the third-world countries deeper into plant-based opioid production and consumption, which also subsequently funds terrorism and human trafficking, among others (cases of Afghanistan and Myanmar). Such developments will have a detrimental effect on the public health and geopolitics of the already fragile nations, further endangering the local populations and increasing violent radicalisation. Although organised crimes due to previously popular drug cartels would reduce, armed non-state actors would benefit from the lower global focus.

Shortcomings in the current efforts

The combat against opioids has seen involvement from government, intra-government agencies and non-profit organisations, which has addressed the problems from various angles like political, socio-economic and public health. Shortage of funds and personnel, and political resistance to changing the supply chains have caused significant blockages to the measures. There are various economic 66and legal restrictions to disruption of supply chains too, as many big corporations depend on the opioid trade for revenue and support.

Recommendations

The reduction in Opioid Use Disorder (OUD) requires focus on two fronts, international and national. Synthetic production requires creating more non-porous borders to prevent the import and sale of these substances. Marketing efforts and regulatory affairs by the pharma companies also have to be kept a close eye on to promote good governance and industry practices. Apart from the reduction in production and consumption chains, the governments of countries also have to invest heavily in awareness and educational campaigns to empower the people to make the right choices. This is crucial in countries like India, where off-brand pharma companies work in larger volumes with threadbare regulatory affairs.

Conclusion

The war on drugs has forever changed as more and more drug production shifts towards regularly consumed products and synthetic means, as it increases the addiction rate and fatality of the substances. The drug trade has shifted from cartels and gangs to organised fronts of pharmaceutical companies that focus more and more on profit maximisation and bad industry practices. In a world that is dominated by influential capitalistic ventures that will prioritise profits over the health of the common population, it becomes increasingly difficult to view the drug trade as just a criminal activity, but more as a political and socio-economic consequence.

References

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Jayawardana, S., Forman, R., & Berterame, S. (2021). Global consumption of prescription opioid analgesics between 2009-2019: a country-level observational study. eClinicalMedicine, 42.

Meinhofer, A. (2018). Prescription Drug Monitoring Programs: The Role of Asymmetric Information on Drug Availability and Abuse. American Journal of Health Economics, 4(4), 504-526.

Opioid crisis: addiction, overprescription, and insufficient primary prevention. (2023). The Lancet Regional Health – Americas, 23.

Schnell, M. (2019). The Opioid Crisis: Tragedy, Treatments and Trade-offs. Institute for Economic Policy Research (SIEPR), Policy brief.

S. Jalali, M., & Botticelli, M. (n.d.). The opioid crisis: a contextual, social-ecological framework. Health Research Policy and Systems.

UN Office. (n.d.). Statistical Annex. UN Office on Drugs and Crime.

UN Office. (n.d.). UNODC Drug Prevalence Report. UN Office on Drugs and Crime. https://dataunodc.un.org/dp-drug-use-prevalence-regional