EU Drug Market: Heroin and other opioids — Global context
This resource is part of EU Drug Market: Heroin and other opioids — In-depth analysis by the EMCDDA and Europol.
It is estimated that in 2021, there were around 60.4 million people engaged in non-medical opioid use worldwide, of whom 31.5 million were users of opiates (mainly heroin). The estimated global average of opiate use in 2021 was 0.6 %. South Asia is the largest consumer market for opiates worldwide, with 1.1 % prevalence of opiate use, almost twice the estimated global average (UNODC, 2023a).
According to the United Nations Office on Drugs and Crime (UNODC), there are currently two epidemics involving the non-medical use of opioids globally, namely of illicitly manufactured fentanyl in North American and of tramadol in North and West Africa, the Middle East and Southwest Asia (UNODC, 2022a). The US opioid epidemic has been characterised by four waves: the rise in prescription opioid overdose deaths (starting in the 1990s); the rise in heroin overdose deaths (starting in 2010); the rise in synthetic opioid overdose deaths, particularly involving fentanyl (starting in 2013) (CDC, 2023); and the increase in overdose deaths from the use of multiple substances, particularly illicitly produced fentanyl derivatives, in which stimulants play a significant role (from 2015) (Ciccarone, 2021; Friedman and Shover, 2023). Between 1999 and 2021, nearly 645 000 people in the United States died from an overdose involving any opioid, including prescription and illicit opioids. In 2021 alone, there were about 70 600 overdose deaths involving synthetic opioids other than methadone (primarily fentanyl) (CDC, 2023).
Globally, the area under illicit poppy cultivation increased by 26 % in 2022, reaching approximately 316 000 hectares (up from 250 000 hectares in 2021) (UNODC, 2022b). Illicit opium cultivation occurs in a number of countries worldwide, spread across three main regions:
- Southwest Asia (mainly Afghanistan and, to a lesser extent, India and Pakistan), supplying Europe, Africa, Southwest Asia, East Asia including China, the Middle East and Oceania,
- Southeast Asia (mainly Myanmar and, to a considerably lesser extent, Laos), mainly supplying Southeast Asia, China and Oceania,
- the Americas (especially Mexico, but also Colombia and Guatemala), mainly supplying the Americas.
Illicit poppy cultivation also takes place in some small areas in the EU (see Section Opiate production in Europe: a relatively rare occurrence). However, until recently, the vast majority of the global illicit opium poppy cultivation (74 %) and opium production (80 %) has occurred in Afghanistan. Based on 2023 data, the situation has drastically changed. Myanmar has been consistently a distant second, but in 2023, emerged as a leading global producer due to changes in Afghanistan (UNODC, 2023d).
Since 2016, the quantities of opiate drugs seized worldwide have maintained high levels, with 2017 and 2020 surpassing the 2016 peak. In 2021, global seizures of opium were reported to have decreased by 10 % (to 892 tonnes); illicit morphine to have increased by 4 % (to 47 tonnes); seizures of heroin to have decreased by 1 % (to 112 tonnes); and seizures of medicines containing opioids to have increased by 154 % (to 356 tonnes) (UNODC, 2023a).
Countries neighbouring Afghanistan accounted for the bulk of global illicit opiates seized in 2021, with Iran reporting 94 % of the amount of global opium seized, 78 % of morphine and 23 % of heroin and Pakistan reporting 4 % of all opium seized, 22 % of morphine and 9 % of heroin seizure that year (UNODC, 2023a,b).
While the manufacture of synthetic opioids takes place globally, large-scale production has been associated with a few key countries, such as China, India, Mexico and Russia. China in particular has a history as a key source country for a range of new psychoactive substances and chemicals related to synthetic drug production, including synthetic opioids (see, for example, EMCDDA, 2021c, 2022d; NPR, 2020). However, a number of recent legislative changes in China appear to have led to changes in the production and supply of these drugs and associated chemicals. In particular, the imposition of generic control measures on fentanyl in China in 2019 appears to have led to a sharp decrease in the quantity of fentanyl-related substances of alleged Chinese origin seized globally (INCB, 2021a). This, however, appears to have led to a shift in supply, whereby chemical and pharmaceutical businesses (or individuals within them) based in China now ship precursors to Mexican criminal networks that synthesise the end-consumer products (predominantly fentanyl and its derivatives) for North American markets (RAND, 2022).
References
Consult the list of references used in this module.