World Drug Report 2022: Booklet 1: Executive Summary: Policy Implications

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ISBN: 9789211483758

elSBN: 9789210019545

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UNITED NATIONS OFFICE ON DRUGS AND CRIME
Vienna

World Drug Report
2022

UNITED NATIONS
New York, 2022

WORLD DRUG REPORT 2022

PREFACE

Drugs can kill.

Addiction can be an unending, agonizing struggle for
the person using drugs; suffering is needlessly
compounded when people cannot access evidence-
based care or are subjected to discrimination. The
consequences of drug use can have ripple effects that
hurt families, potentially across generations, as well
as friends and colleagues. Using drugs can endanger
health and mental health and is especially harmful in
early adolescence. Illicit drug markets are linked with
violence and other forms of crime. Drugs can fuel and
prolong conflict, and the destabilizing effects as well
as the social and economic costs hinder sustainable
development.

The whole of the international community shares the
same goals of protecting the health and welfare of
people everywhere. But too often in the debate on
drug policy approaches, we forget this basic and shared
understanding, which is rooted in the fact that drug
use for non-medical purposes is harmful.

We all want our children and loved ones to be healthy,
and we want neighbourhoods and countries to be safe.
As policymakers, we can see that illicit drug cultivation
offers no way out for impoverished communities in
the long run, that the drug trade has environmental
impacts, and that drug trafficking along with associated
corruption and illicit flows undermine the rule of law
and stability.

Solutions to these shared threats and challenges to
achieve our shared goals must also be shared and based
on evidence. It is in this spirit that | am proud to
present the World Drug Report 2022 from the United
Nations Office on Drugs and Crime.

This is the first World Drug Report of the post-pandemic
world. While countries continue to grapple with
COVID-19 and its consequences, we have emerged
from cycles of lockdowns to confront a “new normal”.
And we have found that the world post-pandemic
remains one in crisis, faced with multiple conflicts, a
continuing climate emergency and threat of recession,
even as the multilateral order is showing troubling
signs of strain and fatigue.

World drug challenges further complicate the picture.
Cocaine production is at a record high, and seizures
of amphetamine and methamphetamine have
skyrocketed. Markets for these drugs are expanding
to new and more vulnerable regions.

Harmful patterns of drug use likely increased during
the pandemic. More young people are using drugs
compared with previous generations. People in need
of treatment cannot get it, women most of all. Women
account for over 40 percent of people using
pharmaceutical drugs for non-medical purposes, and
nearly one in two people using amphetamine-type
stimulants (ATS), but only one in five in treatment for
ATS is a woman.

In the face of these multiple crises, we need to show
greater care.

Care starts with evidence-based prevention and
addressing perceptions and misperceptions of risk,
including by taking a hard look at the messages our
societies are sending to young people. UNODC
research has shown that perceptions of cannabis harms
have decreased in areas where the drug has been
legalized. At the same time, the proportion of people
with psychiatric disorders and suicides associated with
regular cannabis use has increased, together with the
number of hospitalizations. Some 40 per cent of
countries reported cannabis as the drug related to the
greatest number of drug use disorders.

Whole-of-society approaches are needed to ensure
that people, young people most of all, have the
information and develop the resilience to make good
choices and that they can access science-based
treatment and services for drug use disorders, HIV and
related diseases when they need it.

There can be no effective prevention or treatment
without recognition of the problem and the necessary
funding to address the problem. Public resources are
stretched to the limit by competing demands, but we
cannot afford to let commitment wane. We need to
promote compassion and better understanding.

Care in crises means ensuring services and essential
medicines for all, including people in emergencies and
humanitarian settings; people left behind in the
pandemic; and people facing barriers of stigma and
discrimination.

Care is also manifested in shared responsibility, and
we need to renew international cooperation to
sustainably reduce illicit crop cultivation and tackle
the criminal groups trafficking drugs.

The World Drug Report seeks to offer the data and
insights to inform our joint efforts. This year’s edition
delves into the interplay between drugs and conflict,
the impact of drugs on the environment and the effects
of cannabis legalization, and identifies dynamics to
watch, from the opiate market in light of developments
in Afghanistan to dark web drug sales.

| hope the report serves as a basis for effective
responses, and generates the support we need to
continue shedding light on different aspects of the
world drug problem, and assisting Member States to
take action and save lives.

Ghada Waly, Executive Director
United Nations Office on Drugs and Crime

EXECUTIVE SUMMARY, POLICY IMPLICATIONS | Preface

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EXECUTIVE SUMMARY

ues POLICY IMPLICATIONS

CONTENTS

PREFACE

ACKNOWLEDGEMENTS

EXPLANATORY NOTES

SPECIAL POINTS OF INTEREST

UNODC CALLS TO ACTION TO SAVE LIVES

THE WORLD DRUG PROBLEM — COMMON CHALLENGE, LOCAL DYNAMICS

25

DRUG-BY-DRUG DEVELOPMENTS IN BRIEF

REGION-BY-REGION DEVELOPMENTS

FINDINGS AND CONCLUSIONS & POLICY IMPLICATIONS

DYNAMICS TO WATCH

LATEST DATA AND TRENDS

GLOSSARY

REGIONAL GROUPINGS

EXECUTIVE SUMMARY, POLICY IMPLICATIONS | Contents

WORLD DRUG REPORT 2022

Acknowledgements

The World Drug Report 2022 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

Research, analysis and drafting
Julie Astoul

Juanita Barrera
Liliana Davalos
Philip Davis

Erik Emke

Jaqueline Garcia Yi
Jorrit Kamminga
Thomas ter Laak
Theodore Leggett
Nicholas Magliocca
Kamran Niaz
Mariana Ortega
Thomas Pietschmann
Danica Thanki
Antoine Vella

Pim de Voogt

Yulia Vorobyeva
Sonya Yee

Data management and
estimate production

Monika Barratt (RMIT University)
Enrico Bisogno

Review and comments

Diana Camerini

Conor Crean

Hernan Epstein

Natalia lvanova

Sabrina Levissianos
Virginia Macdonald (WHO)
Andrea Oterova

Martin Raithelhuber
Umidjon Rakhmonberdiev
Ali Saadeddin

Keith Sabin (UNAIDS)
Markus Schwabe

Tun Nay Soe

Mapping

Coen Bussink
Francesca Massanello
Irina Tsoy

Lorenzo Vita

Graphic design and production
Anja Korenblik

Suzanne Kunnen

Kristina Kuttnig

Maria Moser

Lorenz Perszyk

Internal coordination
and research assistance
Harvir Kalirai

Editing support
Leon Addie

Data support

Leila Ahmadi

Roberto Alvarez Teran
Rizwana Asad

Sinisa Durkulic
Antonela Guberac
Rakhima Mansurova
Bertrand Olivier
Inshik Sim
Kavinvadee Suppapongtevasakul
Heloise Wiart

Administrative support
Andrada-Maria Filip
lulia Lazar

The World Drug Report 2022 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 purchases of drugs on the dark web in Booklet 2 is based on original data graciously shared by the Global

Drug Survey team.

The analysis on access to pharmaceutical opioids in Booklet 3 is based on original data graciously shared by the INCB

Secretariat.

Booklet 5 on Drugs and the environment was made possible thanks to the generous financial contributions of France

and Germany.

Annual Report Questionnaire Focal Points

The UNODC gratefully acknowledges the continuous efforts of the Annual Report Questionnaire Focal Points in the Member
States to collate and report national data on drug demand and supply, which form the basis of the World Drug Report:

Ahcene Sahtout (Algeria), Djazia Dehimi (Algeria), Mohamed Oundi (Algeria), Olimpia Torres Barros (Andorra), Adrian Betti (Argentina),
Andres Quintana (Argentina), Diego Ruiz (Argentina), Armenuhi Chilingaryan (Armenia), Andrew Courir (Australia), Raphael Bayer (Austria),
Wolfgang Pfneiszl (Austria), Said Asadli (Azerbaijan), Terrance Fountain (Bahamas), Abdulrahman Ahmed Showaiter (Bahrain), Galina Pyshnik
(Belarus), Olegovich Pruchkovskiy (Belarus), Katia Huard (Belgium), Lies Gremeaux (Belgium), Nele Van Tomme (Belgium), Stéphanie Ovaere
(Belgium), Sonam Tashi (Bhutan), Tsheringc Choden (Bhutan), Ivan Aliaga Casceres (Bolivia (Plurinational State of)), Richard Jesus Lopez
Vargas (Bolivia (Plurinational State of)), Wilson Salinas Olivares (Bolivia (Plurinational State of)), Elis Viviane Hoffmann (Brazil), Livia Faria
Lopes dos Santos Oliveira (Brazil), Rodrigo Bertoglio Cardoso (Brazil), Viviane Hoffmann (Brazil), Aimi Jamain (Brunei Darussalam),
Hardiyamin Barudin (Brunei Darussalam), Radi Ignatov (Bulgaria), Slaveika Nikolova (Bulgaria), Amanda Pinke (Canada), Bobby Chauhan
(Canada), Christina Arruda (Canada), Saeid Roushan (Canada), Daniel Diaz (Chile), Emilse Pizarro (Chile), Jose Marin (Chile), Luis Medel
Espinoza (Chile), Monserrat Aranda (Chile), Yan Zheng (China; China, Hong Kong SAR), Kitty Hon (China, Hong Kong SAR), Hon Wai
(China, Macao SAR), Oscar Ricardo Santa Lopez (Colombia), Andrés Rodriguez Pérez (Costa Rica), Beatriz Murillo Paz (Costa Rica), Roger
Badou N'Guessan (Céte d'Ivoire), Hrvoje Paljan (Croatia), Lara Jezic (Croatia), Smilja Bagaric (Croatia), Gavriel Efstratiou (Cyprus), loanna
Yiasemi (Cyprus), Nasia Fotsiou (Cyprus), Katerina Horackova (Czechia), Viktor Mravcik (Czechia), Lars Petersen (Denmark), Gilda Maria
Francisco Espinal (Dominican Republic), Moises Gomez Trabous (Dominican Republic), Samanta Almeida (Ecuador), Sahar Anmed Mohamed
Farag (Egypt), Alma Cecilia Escobar de Mena (El Salvador), Carmen Morena Batres de Gracias (El Salvador), Heli Laarmann (Estonia), Katri
Abel- Ollo (Estonia), Sanna R6nka (Finland), Claire Jounet-Arenes (France), Joséphine Affres (France), Roland Hein (Germany), Saskia Jensen
(Germany), Charles Oblitei Commey (Ghana), Godlove Vanden-Bossche (Ghana), Rosemond Agbefu (Ghana), Argyro Andaraki (Greece),
Danae Manousaki (Greece), Gerasimos Papanastasatos (Greece), loannis Marouskos (Greece), loulia Bafi (Greece), Manina Terzidou (Greece),
Mario Sierra (Guatemala), Roberto Maldonado (Guatemala), Rachel Victoria Ulcena (Haiti), Paola Cristina Giron Serrano (Honduras), Anna
Péterfi (Hungary), Gergely Csaba Horvath (Hungary), Ibolya Csdk6 (Hungary), Peter Foldi (Hungary), Agus Irianto (Indonesia), Mohammad
Narimani (Iran (Islamic Republic of)), Seyed Hamzeh Madani (Iran (Islamic Republic of)), Imad Abdel Raziq Abdel Gani (Iraq), Stephen
Murphy (Ireland), Eti Kahana (Israel), Andrea Zapparoli (Italy), Elisabetta Simeoni (Italy), Yuki Maehira(Japan), Jamil Alhabibeh (Jordan),
Malak Al-mahirah (Jordan), Alma Agibayeva (Kazakhstan), Stephen Kimani (Kenya), Akyl Amanov (Kyrgyzstan), Agnese Zile-Veisberga
(Latvia), Diana Vanaga-Araja (Latvia), leva Pugule (Latvia), Zeinab Abbass (Lebanon), Jurgita Zilinskaite (Lithuania), Michel Goergen
(Luxembourg), Nadine Berndt (Luxembourg), Rita Cardoso Seixas (Luxembourg), Nikmat Yusop (Malaysia), John Testa (Malta), Victor Pace
(Malta), Corceal Sewraz (Mauritius), Martha Vazquez (Mexico), Valeria Solis (Mexico), Jasna Sekulic (Montenegro), Nevena Markovic
(Montenegro), Valentina Bodven (Montenegro), Abdelhafid EL Maaroufi (Morocco), Abderrahim Matraoui (Morocco), Ayoub Aboujaafer
(Morocco), EL Maaroufi Abdelhafid (Morocco), Mustapha El alami El Fellousse (Morocco), Nadia Chouaib (Morocco), Myint Aung
(Myanmar), Zaw Lin Oo (Myanmar), Guus Cruts (Netherlands), Martijn Mulder (Netherlands), Vincent van Beest (Netherlands), Blair
Macdonald (New Zealand), Lauren Bellamore (New Zealand), Manuel Garcia Morales (Nicaragua), Abdoul Aziz Garba Yayé (Niger),
Hamidou Amadou Insa (Niger), Ibiba Jane Odili (Nigeria), Ngozi Vivian Oguejiofor (Nigeria), Daniel Bergsvik (Norway), Ola Bilgrei (Norway),
Mahmood Al Abri Sultante (Oman), Mohamed Amin (Oman), Sayed Sijjeell Haider (Pakistan), Daysi Vargas (Panama), Rubielys Saladana
(Panama), Tatiana Tesis (Panama), Crhistian Gomez (Paraguay), Juan Pablo Lopez (Paraguay), Laura Reinoso (Paraguay), Lillian Portillo
(Paraguay), Mathias Jara (Paraguay), Sandra Morales (Peru), Corazon P. Mamigo (Philippines), Johanna Rosales (Philippines), Michael P.
Miatari (Philippines), Rebecca F. Arambulo (Philippines), Yvonne B. San Pascual (Philippines), Lukasz Jedruszak (Poland), Ana Sofia Santos
(Portugal), Elsa Maia (Portugal), Quatar ARQ (Qatar), Donghyun Kim (Republic of Korea), Yongwhee Kim (Republic of Korea), Victor Tacu
(Republic of Moldova), Ciprian Zetu (Romania), Oleg Lozhkin (Russian Federation), Saud Alsabhan (Saudi Arabia), Dusan Ilic (Serbia),
Evelyn Low (Singapore), Melvina Niroshini Andrew (Singapore), Thamaraichelvan Meyappan (Singapore), Eva Debnarova (Slovakia),
Ivana Buckova (Slovakia), Joze Hren (Slovenia), StaSa Savelj (Slovenia), Vathiswa Dlangamandla (South Africa), Elena Alvarez Martin (Spain),
Thamara Darshana (Sri Lanka), Frida Nyman (Sweden), Jennie Hagelin (Sweden), Joakim Strandberg (Sweden), Johan Ragnemalm (Sweden),
Julia Ahlin (Sweden), Barbara Walther (Switzerland), Diane Buechli (Switzerland), Marc Wittwer (Switzerland), Verena Maag (Switzerland),
Saidzoda Firuz Mansur (Tajikistan), Prang-anong Saeng-arkass (Thailand), Mouzinho T. Correia (Timor-Leste), Abi Kemeya-Abalo (Togo),
Awi Essossimna (Togo), Nadine Beeka (Trinidad and Tobago), Sheena Arneaud (Trinidad and Tobago), Murat Sarikamisli (Tirkiye),
Resul Olukman (Tiirkiye), Olena Pugach (Ukraine), Olga Davidenko (Ukraine), Vita Druzhynina (Ukraine), Amal Ahmed Ali Alzeyoudi
(United Arab Emirates), Alberto Oteo (United Kingdom of Great Britain and Northern Ireland), Kerry Eglinton (United Kingdom of Great
Britain and Northern Ireland), Maria Fe Caces (United States of America), Nicholas Wright (United States of America), Elisa Maria Cabrera
(Uruguay), Khatam Djalalov (Uzbekistan), Alberto Alexander Matheus Melendez (Venezuela (Bolivarian Republic of)), Carlos Javier Capote
(Venezuela (Bolivarian Republic of)), Elizabeth Pereira (Venezuela (Bolivarian Republic of)), Ronnet Chanda (Zambia), Ashley Verenga
(Zimbabwe), Evelyn Taurai Phillip (Zimbabwe), Anan Mohammad Hassan Theeb (State of Palestine), Mutaz Ereidi (State of Palestine),
Penny Garcia (Gibraltar)

EXECUTIVE SUMMARY, POLICY IMPLICATIONS | Acknowledgements

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.

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.

The term “seizures” is used in the World Drug Report
to refer to quantities of drugs seized, unless otherwise
specified.

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. Sex-disaggregated analysis
has been included wherever possible.

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.

The following abbreviations have been used in the
present booklet:
AIDS acquired immunodeficiency syndrome
ATS amphetamine-type stimulants
CBD cannabidiol
COVID-19 coronavirus disease
DALYs disability-adjusted life years

FAO Food and Agriculture Organization
of the United Nations

HIV human immunodeficiency virus

INCB International Narcotics Control Board

MDMA 3,4-methylenedioxymethamphetamine

NPS new psychoactive substances

P-2-P 1-phenyl-2-propanone

PWID people who inject drugs

RMIT Royal Melbourne Institute of Technology
THC tetrahydrocannabinol

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

11

WoO RL D

R EP OR T

14

UNODC CALLS TO ACTION TO SAVE LIVES

Care in crises and conflicts:

» Ensure access to the controlled medicines included
in the WHO Model List of Essential Medicines as part of
humanitarian response efforts.

» Guarantee continuity of evidence-based care, treatment
and services for drug use disorders, HIV/AIDS, hepatitis
and related infectious diseases.

» Prevent negative coping behaviours such as substance use,
especially among children and youth, through family skills

support and psychosocial support.

Leave no one behind:

» Improve the collection and analysis of data, disaggregated

by gender and age, to strengthen early warning and
evidence-based responses.

» Tailor interventions to women, youth and at-risk groups
and close treatment gaps so that everyone can access the
services they need without stigma or discrimination,

in line with the UNODC/WHO International Standards for

the Treatment of Drug Use Disorders.

» Mobilize all sectors and industries, including health, justice,

social welfare, education, media and entertainment, for a
whole-of-society-approach to strengthen evidence-based
prevention, building on the UNODC/WHO International
Standards on Drug Use Prevention.

Cooperate to contain criminal markets:

»

»

»

Step up cross-border law enforcement and criminal justice
cooperation and intelligence-sharing to disrupt transnational
trafficking enterprises.

Target increasing drug trafficking via waterways by
strengthening container control and interdiction capacities
at ports and sensitizing port authorities and commercial
shipping companies to the related risks.

Increase technical assistance to developing countries

to facilitate their engagement in international cooperation
and joint operations, including to tackle drug trafficking
on the dark web.

HEALTH HARM OF DRUGS IN THE CONTEXT OF OTHER
PSYCHOACTIVE SUBSTANCES

Substance use-related deaths in 2019 (in million)

Tobacco (risk factor) i 3.7
Alcohol use (risk factor) (I 2.4

‘ Drug use
Drug use (risk factor) J 0.5
8 ( ) accounts for

5% of all
Alcohol use disorders |) 0.17 eibenecs
related
Drug use disorders ff 0.13 deaths

0

ee

Drug use
accounts for
230 31 9% of substance
use-related

million million DALYs

Tobacco Alcohol Drugs

SPECIAL POINTS OF INTEREST

FINDINGS POSSIBLE RESPONSES

The market for cocaine is booming, with new record highs
in manufacture and high levels of use

» Tailor holistic drug-supply reduction strategies
300,000 2,000 encompassing economic development and
alternative livelihoods in countries where

3 = . errs we. .
foe aa 2 coca bush is illicitly cultivated.
o 1,500 » §
x= su
eee ce » Direct law enforcement resources to target
Gres} = eb An 9 .
$150,000 1000 § = maritime and container trafficking.
3 ie
et AD G00) a » Increase technical assistance to enhance the
Say , is)
s 500 Of capacity of law enforcement authorities to detect
8 50,000 s and interdict cocaine.

OF IguS Hala SIRIaens arepey aunieiaeraren © » Promote and facilitate post-seizure backtracking

AAR RASA ANA ARS ASA investigations with improved international
Coca bush cultivation: Plurinational State of Bolivia cooperation.

Coca bush cultivation: Peru
Coca bush cultivation: Colombia » Tackle demand by increasing investment
seeeas Global Goelbe manufacture: old Gere rehire in evidence-based prevention and research
—— Global cocaine manufacture: new conversion ratio : a :

into treating cocaine dependence.

MARKET FOR COCAINE BOOMING

5 Or SS
Record viet . ee
A decade of Bay Poe

SPECIAL POINTS OF INTEREST

FINDINGS

While the majority of people who use drugs are men,
women use some drug types nearly as much as men; and

POSSIBLE RESPONSES

women continue to be underrepresented in drug treatment

EVEN THOUGH ALMOST ONE IN TWO AMPHETAMINES USERS
IS A WOMAN, LESS THAN ONE IN FIVE PERSONS IN TREATMENT FOR
AMPHETAMINES IS A WOMAN

» Invest in research to better understand the role
of sex and gender in pathways to drug use and
drug use disorders.

» Expand gender-sensitive services for drug
treatment and HIV prevention, treatment and
care to ensure that women feel safe and not
stigmatized, can exercise their childcare
responsibilities and are supported with regard
to other needs.

DISTRIBUTION OF USERS OF SELECTED DRUGS BY SEX

85%
e : a 70% se a
@ : . : 55% 55% 53% | su %
opt ee og
27% 30% Ae a %
i f f

Opioids Cocaine Cannabis New eee ne Non- medical use ee nee Non- medical use Non- medical use
psychoactive substances _ of pharmaceutical of pharmaceutical of sedatives and
substances stimulants opioids tranquilizers

Ro ws y

@°

@ ais oe &

7

SPECIAL POINTS OF INTEREST

FINDINGS POSSIBLE RESPONSES

Young people continue to use more drugs than adults,
and have higher levels of use than in past generations

» Develop national drug prevention systems that reach
children as early as possible in their development
and focus on building resilience.

YOUNG PEOPLE CONTINUE TO USE

MORE DRUGS THAN ADULTS » Reach out to and involve adolescents, disseminating

prevention messages on social media and other
online platforms.

vf ky 6. 12) » Promote prevention and treatment options for young

= people who use drugs and young people with drug use
Be disorders that are backed by evidence, including mental
health services; screening, brief interventions and
health services referral; and family therapy.

» For children and youth that have been exposed to
drugs at a very young age and/or are in particularly
deprived circumstances, provide educational
opportunities, vocational skills training and other
socioeconomic support.

Global and regional use of cannabis among people aged 15-16,
| @ and among the general population aged 15-64
‘’ (2020 or most recent year for which data are available)

Ay

|
un
—

Annual prevalence (percentage)
N
S)

15-64
15-64
5-16
15-64 4

5-16 [_=—_

15-64 i
5-16
15-64 fH

15-16 [4
15-64
15-16

Oceania Americas Africa Europe Asia Global

SPECIAL POINTS OF INTEREST

FINDINGS POSSIBLE RESPONSES

Different drugs pose different demands
on healthcare systems

wk

J

&

evel?

DIFFERENT MEASURES OF HARM

Share of countries reporting the drug as most harmful

Drug use disorders

Drug-related deaths
Opioids

Amphetamine-type
stimulants

Sedatives and
tranquilizers

Cocaine Drug-related treatment

New psychoactive
substances

Hallucinogens

Other drugs

»

»

»

»

»

»

Provide more resources to increase access to
evidence-based and voluntary services.

Integrate outreach, psychosocial, pharmacological,
healthcare and social support services to better
protect the health of people who use drugs and
people with drug use disorders and promote their
recovery.

Promote opioid-assisted therapy, supporting recovery
and preventing overdose, and the community-based
provision of naloxone.

Invest in research on the treatment of stimulant
use disorders, while advancing the dissemination
of effective psychosocial therapies.

Develop a clear and comprehensive methodology
to more accurately estimate the social costs of
cannabis use and its impact on public health.

Ensure that drug treatment services, as well as
HIV prevention, treatment and care, are available
in prison settings.

19

INSIGHTS

FINDINGS POSSIBLE RESPONSES

Early indications suggest that cannabis legalization has had a
wide-ranging impact on public health and safety, market dynamics,
commercial interests and criminal justice responses

»

v

Continue to monitor the impact of cannabis
legalization, in particular on public health,

IMPACT OF CANNABIS LEGALIZATION the rule of law, public safety and the parallel

illegal market, to better understand associated
ara social and economic costs.
& » Invest in research into the effects of cannabis use,
363% especially the health consequences of the use of
Products Le cannabis products with high THC content.
An
@ » Address misperceptions of the risks of cannabis
Nn

i ; z f
Public health use through evidence-based prevention messages.
F.

v

v

Crime »

v

Prioritize public health and safety as commercial
interests lobby to expand the market for legal
cannabis.

--> » Draw from the lessons learned from the tobacco,
alcohol and ultra-processed food industries as well

as the pharmaceutical industry and documented

cases where the pursuit of commercial interests has

targeted vulnerable or disadvantaged groups, and
competed with public health concerns.

v

Arrests

= Vy
‘? : bane)
e &
Replacement et Driving

Illicit market

INSIGHTS

FINDINGS POSSIBLE RESPONSES

Illicit drug economies can flourish in situations of conflict
and weak rule of law, and can, in turn, prolong or fuel conflict

»

v

Integrate drug policy approaches into conflict
and peacebuilding responses, and when addressing
CONFLICT CAN BECOME A MAGNET FOR THE ILLICIT Cli eo cud weal olay:

MANUFACTURE OF SYNTHETIC DRUGS y

v

Encourage more complex and deep investigation
of transnational crimes, aimed at revealing and
\ dismantling related financial flows that could

PS otherwise fuel the conflict.
s vd
ant nO

v

» Monitor conflict situations for emerging drug threats,
for example synthetic drugs manufacture in Ukraine.

»

v

Strengthen information-sharing and law enforcement
capacity-building to prevent and counter challenges
emerging from conflict situations.

22

INSIGHTS

FINDINGS

The impact of drugs on the environment can be significant
at the local level

CARBON FOOTPRINT OF COCAINE PRODUCTION
COMPARED WITH THE CARBON FOOTPRINT OF THE PRODUCTION
OF A SELECTION OF ALTERNATIVE CROPS

COCAINE PRODUCTION PRODUCTION OF

ALTERNATIVE CROPS

000
®
590 , 2
0.5 0.2 j
t ? )
| | 2
1 is] 1
| 3
é 2 é 5
g g g g 8
| = = c o
gs 5 s, g 8
8 8 z 5 8
ul ¢&
V4 04 eee
P< iy iu 0

kg of CO,e per kg

»

»

»

»

»

»

POSSIBLE RESPONSES

Mainstream the objective of “do no harm to the
environment” in drug policy responses.

Develop new, dedicated international standards to
systematically integrate environmental protection
into the design and monitoring of alternative develop-
ment programmes, building on recent experience

and existing tools.

Bring the environmental impact of the illicit cultivation
of plant-based drugs into the broader debate about
alternative development and agricultural production
to balance environmental concerns with commercial,
production-related objectives.

Consider specific complementary strategies that can
be adopted in alternative development programmes,
such as carbon credit schemes, payment for environ-
mental services and agroecology to strengthen their
environmental components while bringing financial
benefits.

Adopt legal frameworks that encompass the
environmentally responsible disposal of equipment
and chemicals used in the illicit manufacture of drugs,
and enhance the capacity of authorities to safely
handle and dispose of such materials, and to destroy
seized drugs.

Undertake targeted research to better understand
the extent and dynamics of the links between drug
trafficking and deforestation, and the longer-term
effects of drugs on biodiversity and on the food chain.

INSIGHTS

SYNTHESIS OF DRUGS AND GENERATION OF WASTE

°
°

PRODUCTION

Ons “Base” chemicals
Ys

a

os

rm, © “industrial” waste,
as

v (es (pre-)precursors
fay

~~
fe)
oF O

L\q

CaB|!

oc

So)

re te

aoaas)

+s

a8)

ao)

=.

i .fels

End product and
human metabolites

23

26

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

Opioids/Opiates

Amphetamine-type stimulants (ATS)

HIV among people who inject drugs

mphetamine

Dr

DRUG-BY-DRUG DEVELOPMENTS IN BRIEF
perma Sty eyissues

> Cannabis remains by far the world’s most > Cannabis cultivation is reported to be on the > Periods of lockdown during the COVID-19

CANNABIS

used drug

> An estimated 209 million people used cannabis
in 2020, representing 4 per cent of the global
population

> The number of people who use cannabis has
increased by 23 per cent over the past decade

> Use remains the highest in North America,
where 16.6 per cent of the population use
the drug

> Cannabis remains the main drug of concern for
the majority of people in treatment in Africa

> The percentage of women who use cannabis
varies across regions, among those 9 per cent
in Asia to 42 per cent in North America

> An estimated 61 million people used opioids in
2020, representing 1.2 per cent of the global
population. Half of them resided in South Asia
and South-West Asia

> Of these, an estimated 31 million people used
opiates, mainly heroin

> The level of opioid use remained stable in 2020

increase in 2020

> Seizures of cannabis resin increased to a record
high in 2020

> Seizures of cannabis herb increased substan-
tially in 2020, following a downward trend over
the last decade, driven by large decreases in
seizures in North America

> The carbon footprint of indoor cannabis
cultivation is considerably larger than that of
outdoor cannabis cultivation (between 16 to 100
times higher), mostly owing to differences in
energy consumption

> The area under opium poppy cultivation
decreased by 16 per cent in 2021, but opium
production continued its long-term upward
trend, increasing by 7 per cent from 2020

> Afghanistan continues to account for most
(86 per cent) of global illicit opium production.
Changes in opium production in the country will

pandemic drove increases in the use of
cannabis, in terms of both amounts used and
frequency of use, in 2020. Cannabis accounts
for a substantial share of global drug-related
harm, owing in part to its high prevalence rates.
Some 40 per cent of countries reported
cannabis as the drug associated with the
greatest number of drug use disorders, and 33
per cent reported it as the main drug of concern
for those in drug treatment

Early indicators point to wide-ranging impacts
of cannabis legalization in jurisdictions in North
America on public health, public safety, market
dynamics, commercial interests and criminal
justice responses

The share of women among people who misuse
pharmaceutical opioids, compared with most
other drugs, is notably high (47 per cent)

The two epidemics of non-medical use of
opioids, one related to fentanyls in North
America and the other related to the non-medi-
cal use of tramadol in North Africa, West Africa,
the Near and Middle East and South-West Asia,

® have implications for opiate markets in virtually : F
2 > The estimated number of people who used all regions of the world continue to pose ereat wee HES ;
i) opioids in 2020 was double that of 2010, owing She Balkan Rout ineth ARrack: " Africa, siete have bed a o Sere
a partly to improved data from countries with e Balkan Route remains the main trafficking the non-medical use of tramadol and relate
° large populations channel for opiates, with individual drug harms in recent years
: seizures for 2021 rebounding after being In North America, overdose deaths, driven by
> About 40 per cent of all people in drug impacted by the COVID-19 pandemic in 2020 the use of fentanyls, reached unprecedented
dresunent Ini 2020 cited-oploldsias thelr > Seizures of pharmaceutical opioids decreased in levels during the COVID-19 pandemic
primary drug of use : : ; a :
2020, interrupting a long-term upward trend. Access to pharmaceutical opioids for pain
> Opioids remain the most lethal group of drugs, However, the decrease in 2020 was mostly due management and palliative care continues to be
accounting for two thirds of deaths related to gaps in reporting coverage very unequal between low- and middle-income
directly to drugs (mostly overdoses) countries and high-income countries
> Anestimated 21.5 million people used cocaine > The level of cocaine manufacture reached a The global market for cocaine is expanding: use
in 2020, representing 0.4 per cent of the global record high in 2020, amounting to 1,982 tons has been increasing worldwide over the last
population (pure cocaine) decade, and trafficking is also on the rise, with
> North America and Europe remain the two > Seizures are increasingly being carried out record highs in manufacture and seizures
main consumer markets for cocaine coe Edi ieer Selene ae pee Markets for cocaine are also expanding outside
> Demand in Africa and Asia has risen over the times higher than in North America Ne ial cee or ey roetieg and
ms Past two decades, but regional demand > Cocaine is increasingly being trafficked by sea pate ree 6 Eas
Zz remains uneven and lack of data prevents a and via a wider geography of routes, with almost Large quantities of cocaine are trafficked from
a clear understanding of the level of use 90 per cent of quantities of eaealine Seiad Latin America to Europe through West and
fo) linked to maritime trafficking North Africa
U

> Cocaine manufacture has a sizeable carbon
footprint, significantly higher than that of the
alternative crops frequently used in alternative
development projects

> Cultivation of coca bush is also playing a role in
deforestation, in particular as a catalyst
enterprise that enables other economic
activities along the agricultural frontier

> Anestimated 34 million people used
amphetamines in 2020, representing 0.7
per cent of the global population

> Qualitative assessments suggest an increase
in the use of amphetamines in 2020

> While the prevalence of use is highest in
North America, the largest number of users
of amphetamines are found in East and
South-East Asia

> An estimated 20 million people used
“ecstasy”-type substances in 2020,
representing 0.4 per cent of the global
population

> “Ecstasy” seems to have been the drug whose
use was most affected by restrictions on
movement imposed during the COVID-19
pandemic

> The level of use of NPS is lower than that
of drugs under international control

> NPS were consumed in most countries in
2020

> The most frequently used NPS are synthetic
cannabinoid receptor agonists (“synthetic
cannabinoids”) and ketamine

> Use of NPS may be decreasing in North
America and Europe, but Eastern Europe, Asia
and, possibly, Africa are likely experiencing
mid-term increases in use

> Many users of NPS use them unknowingly,
consuming the substances as adulterants
of other drugs, sometimes with fatal
consequences

> Record-high quantities of ATS were seized in

2020, dominated by methamphetamine at
the global level

Trafficking in ATS, in particular methamphet-
amine, has spread geographically

The market for “captagon” in the Near and
Middle East continues to flourish, with seizures
reaching a record high in 2020

Seizures suggest a shift in the manufacture of
methamphetamine towards the precursors of
P-2-P and away from the use of ephedrine and
pseudoephedrine, although the use of the latter
two substances remains widespread

Traffickers continue to attempt to circumvent
existing rules and regulations and international
controls by seeking out non-controlled chemi-
cals for use as precursors, pre-precursors and
“designer precursors” in the manufacture of ATS

> Seizures of plant-based NPS, dominated by

kratom and khat, fell in 2020 from a record
high recorded in 2019.

> A total of 57 countries reported seizures

of synthetic NPS in 2019-2020, almost double
the number from a decade earlier. These
seizures were small and primarily involved
ketamine, followed by synthetic cannabinoids

> The number of NPS on the market has

stabilized; 548 NPS were reported in 2020, of
which 77 were identified for the first time

> The number of NPS classified as “novel

benzodiazepines” is a growing concern. Such
NPS are often sold at low prices, sometimes in
packaging that mimics that of existing
medicines

> The gender gap in treatment is particularly
acute for women who use ATS, as women
represent almost one in two ATS users but only

one in five people in treatment for ATS disorders

> Methamphetamine manufacture and use have
continued to spread beyond the “traditional”
markets in East and South-East Asia and North
America, notably in South-West Asia, Western
Europe and South America

> The recent increase in the use and manufacture
of methamphetamine in Afghanistan is of
growing concern in South-West Asia, where
trafficking in the substance is expanding

> Waste from the manufacture of ATS is consider-
able, with its weight estimated to be between
5 and 30 times greater than the weight of the
end product. Dumping in forests and discharge
into rivers or sewers represent a significant
environmental threat for local communities

> Control systems have succeeded in containing
the spread of NPS in high-income countries,
but the geographical reach of NPS trafficking
continues to expand

> In some subregions, such as Eastern Europe
and Central Asia, NPS have become a major
drug problem

> Opioid NPS, which include fentanyl analogues,
continue to emerge. They represented the
fastest growing group of NPS identified for
the first time at the global level in 2020 and
constitute the most harmful group of NPS.

PT benand aE

29

> Use of cannabis is particularly high in West
and Central Africa, with past-year prevalence of use
of nearly 10 per cent (28.5 million people), largely
reflecting prevalence of cannabis use
in Nigeria

> Non-medical use of tramadol remains a threat,
especially in North and West and Central Africa

> The majority of opioid users in other parts of Africa are
opiate users, mostly heroin and, in a few countries, also
codeine and opium

> Cocaine use is rather widespread in West and Southern
Africa and appears to be generally increasing across the
continent, as evidenced by people in drug treatment,
though actual data is scarce

> While the use of khat, a plant-based NPS, is widespread
in East Africa, the use of synthetic NPS is mostly
reported in Southern Africa, but data are scarce about
both

> Of the 920,000 people who inject drugs in Africa,
around 100,000 or 11 per cent are living with HIV

> In North America, cannabis products with high THC
contents are proliferating; average THC levels continue
to increase while levels of CBD are falling

> Cannabis legalization in North America has taken place
in a context of an already ongoing expansion of the
cannabis market

> Opioid use in North America remains high, with 3.4 per
cent of the adult population reporting past-year use (11
million users)

> South and Central America and the Caribbean are the
subregions with the highest proportion of people in
drug treatment due to the use of cocaine products
worldwide

> Non-medical use of pharmaceutical stimulants is
comparatively high in the Americas compared to other
global regions

> There has been a significant increase in the number of
people in treatment for methamphetamine disorders in
North America in recent years

>

>

Vv

Vv

REGION-BY-REGION DEVELOPMENTS
eran Su Keyisues

North Africa is a hub for interregional
cannabis resin smuggling to Western
Europe

Africa accounted for more than half of
global quantities of pharmaceutical opioids
seized between 2016 and 2020, largely due
to the ongoing tramadol crisis

Most cocaine in Africa is seized near
coastlines. The region, in particular West
Africa, is used as a transhipment area for
cocaine from South America en route to
Europe

Heroin from South-West Asia is trafficked
through all African subregions, often via
East Africa as an entry point, onwards to
consumer markets in Western and Central
Europe

Interceptions of cannabis are declining
substantially in North America despite

a rapidly growing cannabis market, as
cannabis interdiction has become less of
a priority

Cocaine is manufactured in South America
and reached a record high in 2020 at 1,982
tons (pure cocaine)

Cocaine seizures have shifted closer
towards production sites in South America,
where total quantities seized are now three
times higher than in North America

Most of the methamphetamine manufac-
tured in North America is for consumption
within that subregion. Seizures data
suggest that laboratories may be becoming
larger and their output increasing

Seizures of methamphetamine in North
America reached a record high in 2020,
despite short-term disruptions of the
market at the onset of the COVID-19
pandemic

> Africa has a large gender gap in the use of drugs,
with 1 woman for 9 men using cannabis

> The majority of people treated for drug use disorders
in Africa are under the age of 35

> Cannabis is the drug for which most people with
drug use disorders (more than half) seek treatment in
Africa

> Africa remains a key transit region for i) cocaine in the
west, ii) heroin in the east and iii) cannabis, mostly
produced within the region, in the north

> The opioid epidemic related to non-medical use of
tramadol continues to pose great health risks,
with treatment demands for tramadol use disorders
increasing in some countries in Africa

> With an average of 42 standard daily doses per million
population, West and Central Africa remains the
subregion with the lowest access to internationally
controlled medicines for pain management and
palliative care

> The opioid epidemic related to illicitly produced
fentanyls in North America has been driving the
number of overdose deaths to record highs, with an
acceleration during the COVID-19 pandemic

> A quadruple convergence of increase in cannabis use,
increased intensity and frequency of use and high
potency of cannabis products has led to a rise in
related harm and adds a substantial burden to health
systems in jurisdictions that have legalized cannabis
in North America

> The gender gap in cannabis use is closing in North
America, where level of use is particularly high

> North America remains the main market for cocaine
globally, but the whole region is impacted by
increasing cocaine trafficking with record manufacture
in South America

> The methamphetamine market is expanding in
North America

a

ASIA

EUROPE

OCEANIA

> While methamphetamine is the main drug of concern in
East and South-East Asia, opiates, in particular opium and
heroin, predominate in South-West Asia and in South Asia,
and “captagon” (amphetamine) in the Near and Middle
East

> Methamphetamine use has risen in Afghanistan in recent

years, and accounts suggest that use of methamphetamine
and “captagon” tablets is rising in South-West Asia and the

Gulf, although no recent estimates are available
> South-East Asia has a long-established ketamine market

> The gender gap in drug use is the largest in Asia where 9
out of 100 people who used cannabis in the past year are
women

> Asia accounts for the largest number of PWID worldwide

(5.2 million), and among them of those living with hepatitis

C (2.8 million), while the highest prevalence of HIV among
PWID is found in South-West Asia

> Western and Central Europe remains the second largest
cocaine market worldwide

> Amphetamine is the second most used stimulant in Europe

after cocaine

> Recent trends point to an increase in methamphetamine
use in the region

Vv

Europe remains a major consumer market for “ecstasy”

Vv

Opioids remain the main drug type for which people are in
drug treatment in Europe, but cannabis follows closely

> Use of NPS, which appears to remain contained in Western

and Central Europe, seems to be increasing in Eastern
Europe, where it has become more common

> Past-year use of cocaine in the subregion of Australia
and New Zealand remains the highest worldwide

> However, consumption of the drug (based on wastewater
analysis) is lower than in other parts of the world,

suggesting that most users of cocaine are occasional users

> Cannabis use is significantly higher than the global
average, with prevalence of use exceeding 10 per cent
in the subregion of Australia and New Zealand

> People regularly using cannabis were likely to have
increased consumption during the COVID-19 pandemic
in Australia

> Australia and New Zealand had clear drops in use of
stimulants during periods of lockdown, potentially due
to the lack of availability

Vv

4

> The production of opiates increased in 2020
in South-West Asia and South-East Asia, with
these two subregions accounting for more
than 90 per cent of global production

Methamphetamine manufacture has
increased in Afghanistan in recent years, and
the drug is being trafficked beyond, into
South-West Asia, while seizures in the Gulf
suggest that a methamphetamine market
may emerge there, too

The market for “captagon” in the Near and
Middle East continues to flourish, with
seizures reaching a record high in 2020

There is a large manufacture of methamphet-
amine in South-East Asia. Methamphetamine
seizures in South-East Asia continued to rise
rapidly in 2020 but fell slightly in East Asia

Cocaine seizures suggest a geographical
expansion in the trafficking of cocaine to
Asia, with large seizures made in the region in
the period 2020-2021

Trafficking of cannabis, both herb and resin,
remains an issue in Western and Central
Europe, mostly intra-regional although there
are substantial imports of cannabis resin
from North Africa

Western and Central Europe remains a hub
for manufacture of synthetic drugs, in
particular “ecstasy” and amphetamine,
although there are signs of an expansion

of the manufacture of methamphetamine in
the subregion

Hydra Market, the world’s largest “Russian
speaking” darknet market, emerged as the
world’s largest market on the dark web in
2019 and remained a major player until its
dismantlement in 2022

Seizures of heroin and morphine and of
cocaine increased in 2020

Overall methamphetamine seizures were the
lowest since 2012, however, border seizures
were at a record high in 2019-2020,
suggesting a growing role of imports

Most of the methamphetamine used in the
region is manufactured within the region.
However, seizures of methamphetamine
based on P-2-P precursors became more
common in 2020, suggesting an increased
importance of imports from North America

>

>

>

>

Vv

> The effects of the ban on opium poppy cultivation,
announced in Afghanistan in April 2022, its application
and enforcement remain to be seen but changes in opium
production in Afghanistan will have implications for
opiate markets in virtually all regions of the world

The market for methamphetamine is expanding from
Afghanistan to South-West Asia and beyond

The methamphetamine market continues to expand in
South-East Asia

NPS use in Central Asia and Transcaucasia appears to
be increasing

“Captagon” tablets manufactured in the Levant continue
to supply large consumer markets in the Gulf

The opioids crisis related to the non-medical
use of tramadol in North and West Africa also extends to
the Near and Middle East

Cocaine use paused in 2020 during the COVID-19
pandemic but it appears to have rebounded in 2021 in
Western and Central Europe

THC content has increased by 50 per cent in herbal
cannabis and nearly tripled in cannabis resin over the past
decade in Western and Central Europe, causing increas-
ingly apparent health harms

There has been an increase in the number of people in
treatment for cannabis use disorders in Western and
Central Europe; around one-third of people accessing drug
treatment services are being treated for cannabis use

In Eastern Europe, the NPS market is expanding, likely
owing to the expansion of online supply, in particular of
cathinones

Drug injecting and infectious diseases contamination are
a key concern in Eastern Europe where 1.3 percent of the
population is a PWID (1.7 million), the highest prevalence
rate of PWID among the population worldwide. More than
a quarter of these PWID are living with HIV, the second
highest prevalence rate of HIV among PWID in the world

Methamphetamine has become the main drug of
concern in Oceania, where half of the people in
treatment are being treated for methamphetamine use
disorders

Annual prevalence rates of methamphetamine use in
the general population of Australia have fallen, but
among remaining users, consumption has become more
intensive and is causing greater health harms

34

THE MARKET FOR COCAINE IS BOOMING, WITH NEW
RECORD HIGHS IN MANUFACTURE AND HIGH LEVELS OF USE

pp FINDINGS AND CONCLUSIONS

Cocaine manufacture reached a record high in 2020.

Trafficking of cocaine likely continued to increase in 2020 despite
the pandemic as global cocaine seizures (unadjusted for purity)
increased to a new record high of 1,424 tons.

Trafficking by sea, mainly in shipping containers, is growing, account-
ing for nearly 90 per cent of cocaine seized globally in 2021.

Seizure data suggest that trafficking is expanding to other regions
outside the two main markets, North America and Europe, with
increased levels of trafficking to Africa and Asia.

Multiple indicators point to an overall increase in cocaine use over
the past decade and early indications suggest that use is rising again
in 2021 after a decline during the pandemic.

POLICY IMPLICATIONS

Tailor holistic drug-supply reduction strategies encompassing eco-
nomic development and alternative livelihoods in countries where
coca bush is illicitly cultivated. Target responses more effectively by
improving the evidence base on the short- and long-term impacts
of measures such as forced and voluntary crop eradication.

Direct law enforcement resources to target maritime and container
trafficking.

Increase technical assistance to enhance the capacity of law enforce-
ment authorities to detect and interdict cocaine in Africa and Asia,
in locations where cocaine trafficking may be relatively new or inter-
diction capacities low.

Promote and facilitate post-seizure backtracking investigations with
improved international cooperation to identify and dismantle trans-
national organized criminal groups involved in drug trafficking and
related financial flows.

Tackle demand by increasing investment in evidence-based preven-
tion to improve awareness, particularly among youth, of the health
harms posed by cocaine. Invest in health interventions, as well as
research into treating cocaine dependence.

SIGNIFICANT INDIVIDUAL COCAINE SEIZURES IN TRANSIT REGIONS OR EMERGING
COCAINE MARKETS: AFRICA AND ASIA, 2020-2021

©O.@ Ps SYRIAN ARAB

Ce LEBANON zs REP,” 4
mdRocco. > TUNISIA, sean ~ (ISLAMIC
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: “JORDAN M J .

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SAUDIARABIACNAR t
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ARAB EMIRATES jacao, China

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GAMB ~@ - f iy J a
GUINEA-BISSA\ rh : ;
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V\ MALAYSIA
UGANDA MALDIVES Ped
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°
\ UNITED REP. SEYCHELLES

Cocaine seizures (kg) = OF TANZANIE

2020-2021

<1

eer — “Zimeaswe MOZAMBIQUE
>10- 100 »

>100 - 1,000

‘e) >1,000 - 8,200 a? SOUTH “
AFRICA\ ©
Excluded from analysis 6

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The boundaries and names shown and the designations used on this map do not imply official endorsement or acceptance by the united nations. dotted line represents

approximately the line of control in jammu and kashmir agreed upon by india and pakistan. the final status of jammu and kashmir has not yet been agreed upon by the
parties.

36

WHILE THE MAJORITY OF PEOPLE WHO USE DRUGS ARE MEN,
WOMEN USE SOME DRUG TYPES NEARLY AS MUCH AS MEN; AND

WOMEN CONTINUE TO BE UNDERREPRESENTED IN DRUG TREATMENT

PP FINDINGS AND CONCLUSIONS

The large majority of people who use drugs continue to be men, but
women make up more than 40 per cent of people who use ATS and
who engage in non-medical use of pharmaceutical stimulants, phar-
maceutical opioids, sedatives and tranquillizers.

Women who use drugs tend to progress to drug use disorders faster
than do men.

The gender treatment gap remains a global problem and is particu-
larly acute for women who use ATS. Almost one of every two past-year
ATS users is a woman, but only one in five people in treatment for
ATS disorders is a woman.

Cannabis, the most used drug worldwide, is also used more by men
than by women, but the gender gap is narrowing, notably in North
America, where the level of use is particularly high.

POLICY IMPLICATIONS

Invest in research to better understand the role of sex and gender
in pathways to drug use and drug use disorders in relation to different
drugs and to better inform prevention strategies that effectively
respond to vulnerabilities and risk factors.

Expand gender-sensitive services for drug treatment and HIV
prevention, treatment and care, following the UNODC/WHO
International Standards for the Treatment of Drug Use Disorders
and ensuring that women seeking to access services feel welcome.
Provide such interventions to ensure that women feel and are safe
and not stigmatized, can exercise their childcare responsibilities and
are supported with regard to other social, economic or legal needs,
have access to sexual and reproductive health care and can receive
support to address trauma and comorbid mental health disorders,
giving priority care to pregnant women.

PEOPLE WHO USE DRUGS BY SEX

Users of cannabis by sex and region

5
SS ry ee oe ae ie

@ 633% 58% 66%

—
29% 34%
ie)
12% . 20% 20 20% ‘
i ? f

Africa Asie Answalia Crribeen canal South south: East North West and
and New Zealand America America Europe America Central Europe

Users of selected drug groups by sex

70% Be eRe
55% 53%
° 45% 3 47% = 49%

rh fi tt ft 4

Opioids Cocaine Cannabis NeW Petasrape Norerredeal use Fone te Non-medical use Nomemredteal use
psychoactive substances —_ of pharmaceutical of pharmaceutical of sedatives and
substances stimulants opioids tranquilizers

37)

38

YOUNG PEOPLE CONTINUE TO USE MORE DRUGS
THAN ADULTS, AND HAVE HIGHER LEVELS OF USE THAN

IN PAST GENERATIONS

pp FINDINGS AND CONCLUSIONS

The majority of people being treated for drug use disorders in Africa
and Latin America are under the age of 35.

Young people aged 15-16 have a global annual prevalence of canna-
bis use of 5.8 per cent, compared with 4.1 per cent of the population
aged 15-64.

Young people typically report a higher level of drug use than do
adults, and in many countries drug use levels among young people
are higher today than in past generations.

POLICY IMPLICATIONS

Develop national drug prevention systems that reach children as
early as possible in their development and focus on building resilience
in accordance with the UNODC/WHO International Standards on
Drug Use Prevention, helping the children of today grow into the
healthy adolescents of tomorrow.

Reach out to and involve adolescents, disseminating prevention
messages on social media and other online platforms to counter the
use of these channels for promoting drug use and facilitating the
illicit drug supply, in order to minimize drug-related harms and
discourage consumption.

Promote prevention and treatment options for young people who
use drugs and young people with drug use disorders that are backed
by evidence, including:

> Mental health services for people with mental health disorders
diagnosed at an early age, along with support to their families
in managing the situation regarding such disorders, including
through parenting skills training;

> Screening, brief interventions and health services referral, main-
streamed in the community and in education systems;

> Family therapy.

For children and youth that have been exposed to drugs at a very
young age and/or are in particularly deprived circumstances, such
as street children, provide educational opportunities, vocational
skills training and other socioeconomic support.

GLOBAL CANNABIS USE ACCORDING TO AGE AND GENDER

39)

40

DIFFERENT DRUGS POSE DIFFERENT
DEMANDS ON HEALTHCARE SYSTEMS

I FINDINGS AND CONCLUSIONS

Opioids remain the most lethal drugs. In North America, fentanyls
are driving overdose deaths to new record highs: 91,799 overdose
deaths were recorded in the United States in 2020, and the
provisional estimate for 2021 is 107,622 deaths. Canada reported a
95 per cent increase in opioid overdose deaths in the first year of
the coronavirus disease (COVID-19) pandemic.

While cannabis is rarely associated with direct drug-related mortal-
ity, it accounts for a substantial share of global drug-related harm,
due in large part to its high prevalence rates. Some 40 per cent of
countries reported cannabis as the drug related to the greatest
number of drug use disorders, and 33 per cent reported it as the
main drug for those in drug treatment.

Increases in cannabis use are posing new burdens to health-
care systems. In Africa and some countries in Latin America and the
Caribbean, the largest proportion of people in drug treatment are
those seeking help for cannabis use disorders.

As the potency of cannabis products has increased, together with
regular and frequent cannabis use, cannabis use disorders and psy-
chiatric comorbidities have also risen in Western Europe. Cannabis
use accounted for 31 per cent of people who entered specialized
drug treatment services in the European Union in 2019.

But there are clear regional differences in the primary drug reported
by people entering drug treatment: in Eastern and South-Eastern
Europe and in most of Asia, opioid use disorders were the leading
cause for people in drug treatment; in most of Latin America, it was
cocaine use disorders; and in East and South-East Asia and Australia
and New Zealand, it was ATS, in particular methamphetamine.

POLICY IMPLICATIONS

Provide more resources to increase access to evidence-based
and voluntary services, in accordance with the UNODC/WHO Inter-
national Standards for the Treatment of Drug Use Disorders.

Integrate outreach, psychosocial, pharmacological, health-care and
social support services to better protect the health of people who
use drugs and people with drug use disorders and promote their
recovery, while developing quality assurance mechanisms to pro-
mote effectiveness, and ensure that services are humane and avoid
punishment or stigmatization.

To prevent opioid overdose deaths, promote opioid-assisted therapy,
supporting recovery and preventing overdose, as well as the
community-based provision of naloxone, allowing for the safe,
on-the-spot management of opioid overdoses.

Invest in research on the treatment of stimulant use disorders, while
advancing the dissemination of psychosocial therapies that have
been found to be effective, such as contingency management,
cognitive behavioural therapy and family therapy.

As more people are initiating the use of and regularly using canna-
bis, and the costs of cannabis use to public health systems may be
higher than generally assumed, develop a clear and comprehensive
methodology to more accurately estimate the social costs of
cannabis use and its impact on public health.

In order to leave no one behind in the provision of drug-related
health services, ensure that drug treatment services, as well as
HIV prevention, treatment and care, for people who use drugs are
available in prison settings.

TRENDS IN PRIMARY DRUG OF CONCERN IN PEOPLE
IN TREATMENT FOR DRUG USE DISORDERS

100
90
80
70
60
50
40
30
20
10
0

2

a

Proportion of all drug treatments
(percentage)

w own oS ny oS wn
a Sc sal Sol a

o Oo Oo oo 9 fe) te) jo}
N N

wn oO

et ON

> eS,

NN

Africa North South and Central Eastern and Westernand Oceania
America America and the South-Eastern Central

Caribbean Europe Europe

N NNN N

mCannabis Opioids = Cocaine = Amphetamine-type stimulants @ Other drugs

GLOBAL BURDEN OF HARM DUE TO OPIOID USE DISORDERS

(a) wp

=

Opioids account for Opioids account for Opioid use disorders
cost an estimated

12.9 million
6 9 % 40% years of “healthy” life lost

due to disability and
premature death in 2019

of deaths due to drug use of treatment equivalent to 71% of years
disorders (direct drug-related for drug use disorders of “healthy” life lost due to
deaths) in 2019 in 2020 drug use disorders

44

EARLY INDICATIONS SUGGEST THAT CANNABIS LEGALIZATION HAS HAD A

WIDE-RANGING IMPACT ON PUBLIC HEALTH AND SAFETY, MARKET DYNAMICS,

COMMERCIAL INTERESTS AND CRIMINAL JUSTICE RESPONSES

© FINDINGS AND CONCLUSIONS

Cannabis legalization appears to have accelerated the upwards trends
in reported daily use of the drug, with a pronounced increase in
reported frequent use of high-potency products among young adults.

In contrast, the prevalence of cannabis use among adolescents has
not changed much.

The proportion of people with psychiatric disorders and suicides
associated with regular cannabis use has increased, as has the
number of hospitalizations due to cannabis use disorders.

Cannabis products have diversified, and average levels of THC in the
various cannabis products have continued to increase, to levels up
to 60 per cent in some markets.

The growing influence and investments of large corporations,
including those in the alcohol and tobacco sectors, is evident in the
legal cannabis industry. Tax revenues from the legalized market have
continued to rise. The illegal cannabis market is shrinking in some
jurisdictions, but it continues to exist alongside legal markets.

Legalization has led to a major reduction in the number and rates
of arrest of people for cannabis-related offences. However, since
possession of cannabis remains a criminal offence for minors, legal-
ization has not led to a substantial reduction in youth arrest rates.

POLICY IMPLICATIONS

Continue to monitor the impact of cannabis legalization, in partic-
ular on public health, the rule of law, public safety and the parallel
illegal market, to better understand associated social and economic
costs.

Invest in research into the effects of cannabis use, especially the
health consequences of the use of cannabis products with high THC
content, including on youth, women and women during
pregnancy.

Address misperceptions of the risks of cannabis use through evi-
dence-based prevention messages, targeting youth in particular.

Prioritize public health and safety as commercial interests lobby to
expand the market for legal cannabis. Draw from the lessons learned
from the tobacco, alcohol and ultra-processed food industries, as
well as the pharmaceutical industry and documented cases where
the pursuit of commercial interests has targeted vulnerable or dis-
advantaged groups, and competed with public health concerns.

IMPACT OF CANNABIS LEGALIZATION

=

re

Products ©
7
@- | x

Public health

Crime

bb. “9

Arrests Economy

<9 i

e fs
Replacement et Driving

Illicit market

45

46

THE IMPACT OF DRUGS ON THE ENVIRONMENT
CAN BE SIGNIFICANT AT THE LOCAL LEVEL

I FINDINGS AND CONCLUSIONS

The impact of illicit drugs on the environment is not significant at
the global level, but the effects can be significant in terms of the
local, community or individual-level impact.

Available studies suggest that drug supply chains have a large carbon
footprint impact per quantity produced. For example, 1 kilogram of
cocaine has a carbon footprint 30 times greater than 1 kilogram of
cocoa beans.

The carbon footprint of cannabis grown indoors is, mainly due to its
energy use, an average of 16 to 100 times greater than that of out-
door cannabis.

Illicit drug crop cultivation often takes place in fragile ecosystems
that have a protected status, such as national parks and forest
reserves, and it can act as a driver or catalyst of deforestation. Defor-
estation associated with illicit coca cultivation can be substantial.

For some communities, the amount of drug waste produced during
the manufacture of synthetic drugs can be substantial. The waste
generated during the synthesis process of synthetic drugs such as
amphetamine, methamphetamine and MDMA is between 5 and 30
times the volume of the end product. The use of pre-precursors and
pre-pre-precursors increases the amount of waste.

The dumping and discharge of waste created in drug manufacture
can have an impact on the soil, water and air, with indirect effects
on organisms, animals and the food chain.

Cleaning of seized synthetic drug-related waste, storage sites or
manufacturing laboratories is costly and can create risks for public
safety.

Some alternative development projects have included environmen-
tal protection components, such as reforestation and agroforestry,
while others have pioneered instruments such as carbon credits and
schemes involving payment for environmental services.

POLICY IMPLICATIONS

Mainstream the objective of “do no harm to the environment” in
drug policy responses at the global, national and local levels to
minimize their environmental impact and contribute directly or
indirectly to the protection of the environment and biodiversity, and
climate change mitigation.

Develop new, dedicated international standards to support Member
States and the international community in systematically integrating
environmental protection into the design and monitoring of alter-
native development programmes.

Such standards can build on recent experience and existing tools,
such as the FAO Voluntary Guidelines on the Responsible Gover-
nance of Tenure of Land, Fisheries and Forests in the Context of
National Food Security of 2012, the United Nations Guiding Princi-
ples on Alternative Development of 2013 and the FAO environmental
and social management guidelines of 2015.

Guiding standards should seek to bring the environmental impact
of the illicit cultivation of plant-based drugs into the broader debate
about agricultural production. Alternative development programmes
should balance environmental concerns with commercial, produc-
tion-related objectives, considering choices between intensive
agriculture and organic farming, land sparing and land sharing, and
small- and large-scale farming.

Specific complementary strategies that can be adopted in alterna-
tive development programmes include carbon credit schemes,
payment for environmental services and agroecology, approaches
that can strengthen the environmental components of programmes
while also bringing other benefits such as income generation and
access to new markets.

Adopt legal frameworks that encompass the environmentally respon-
sible disposal of equipment and precursors and other chemicals used
in the clandestine manufacture of drugs, and enhance the capacity
of law enforcement authorities to safely handle and dispose of such
materials, as well as to destroy seized drugs.

Undertake targeted research to better understand the extent and
dynamics of the links between drug trafficking and deforestation,
including in relation to illicit cattle ranching and other money-laun-
dering-related investment. The longer-term effects of drugs on
biodiversity require closer examination, including to determine the
effects of long-term or chronic exposure of wildlife to drugs, their
metabolites or drug waste in wildlife ecosystems, as well as effects
along the food chain, for example, the impacts on people who con-
sume exposed fish.

DISTRIBUTION OF FACTORS ROUTES OF SYNTHETIC DRUG
CONTRIBUTING TO THE CARBON FOOTPRINT PRODUCTION
OF COCAINE PRODUCTION WASTE TO THE ENVIRONMENT

IN THE REGIONS OF CATATUMBO
AND PUTUMAYO, COLOMBIA

y

Drugs
£hb Transportation LY

y
| Transport/distribution

y
Consumption

y
Human excretion

y

Wastewater treatment plant =i

y

BI m
-~_] Groundwater
7@-.

60% 2% 14% 24%

Cultivation Alkaloid Alkaloid Waste
extraction purification from disposal
coca paste

48

ILLICIT DRUG ECONOMIES CAN FLOURISH IN SITUATIONS
OF CONFLICT AND WEAK RULE OF LAW, AND CAN, IN TURN,

PROLONG OR FUEL CONFLICT

PP FINDINGS AND CONCLUSIONS

Illicit drug economies can flourish in situations of conflict and weak
rule of law, and can, in turn, prolong or fuel conflict.

Plant-based drugs such as cocaine and opiates have been used in
the past by parties to finance conflict, for example, in Colombia and
Afghanistan.

Parties to a conflict have also used the illicit drug trade to generate
income by levying “taxes” on the drug trade, for example, in the
Sahel.

Information from the Middle East and South-East Asia suggests that
conflict situations can act as a magnet for the manufacture of syn-
thetic drugs, which can be manufactured anywhere; this effect may
be greater when the conflict area is near large consumer markets.
The number of dismantled amphetamine laboratories in Ukraine
rose from 17 in 2019 to 79 in 2020, the highest number of seized
amphetamine laboratories reported in any country in 2020. The
laboratories were likely to have been small, but the high number
seized before the war indicates capacity to produce synthetic drugs
in the country, which could expand as the conflict persists.

Conflicts may also disrupt and shift drug trafficking routes, as seen
during the Yugoslav wars with heroin trafficking routes through the
Balkans (which remain among the key trafficking routes for opiates
from Afghanistan), and more recently in Ukraine, where, accounts
suggest, drug trafficking may have decreased since early 2022.

POLICY IMPLICATIONS

Integrate drug policy approaches into conflict and peacebuilding
responses, and when addressing crises and weak rule of law, to stop
organized crime and other groups from exploiting conflict situations
and prevent the illicit drug trade from contributing to violence and
instability.

Encourage more complex and deep investigation of transnational
crimes, aimed at revealing and dismantling related financial flows,
with a view to minimizing the potential for using the proceeds of
illicit drug manufacture and trafficking to fuel conflicts.

Monitor conflict situations for emerging drug threats: seizure data
suggest that heroin trafficking through Ukraine, as well as amphet-
amine manufacture in the country, had been increasing prior to the
start of the war in February 2022. Continuing conflict may have dis-
rupted and/or displaced these flows.

Strengthen information-sharing and law enforcement capacity-
building to prevent and counter challenges emerging from conflict
situations, in neighbouring countries but also in areas that may serve
as alternate drug trafficking routes.

WEAK RULE OF LAW IN CONFLICT SITUATIONS
PROVIDES OPPORTUNITIES TO THE ILLICIT DRUG TRADE

4 drug trafficking routes
O are distrupted

existing plant-based
drugs production is

used to finance the

conflict a3 ‘
al

parties to the conflict
benefit by taxing the

drug trade

Lr
o

illicit drug
economies flourish

Cc

conflict acts as a“magnet”
for the manufacture of synthetic
drugs

SOME EVIDENCE IS EMERGING ON THE LONG-TERM
OUTCOME OF FORCED AND VOLUNTARY ERADICATION

DYNAMICS TO WATCH

Data assessing the effectiveness and sustainability of different meth- areas that did not — is projected to disappear altogether, sug-
ods of eradicating illicit drug crops remain scant. A matched gesting that one-off forced eradication yields no long-term
difference-in-differences analysis to estimate the effects of forced benefits.

and voluntary eradication on areas of coca cultivation in Colombia
found the following:

Vv

Voluntary eradication, conducted in coordination with alternative
development interventions, led to an initial increase in
cultivation due to “perverse incentive” effects (as some farmers
may begin to illicitly cultivate drug crops in order to participate
in the project). But over time, illicit drug crop cultivation
decreased at a greater rate in areas with voluntary eradication
and alternative development than in areas without. The
“eradication gain” is projected to continue increasing over the
next decade.

> Forced eradication resulted in an initial decrease in illicit drug
crop cultivation due to the direct removal of coca bush. How-
ever, subsequently, cultivation increased at a higher rate that
in similar areas where no forced eradication took place. Over
the next 10 years, the “eradication gain” — the gap in illicit drug
crop cultivation between areas that underwent eradication and

SOME EVIDENCE IS EMERGING ON THE LONG-TERM OUTCOME
OF FORCED AND VOLUNTARY ERADICATION

roe,

Forced eradication

resulted in an initial decrease in illicit drug crop
cultivation due to the direct removal of coca bushes.
However, cultivation later increased at a higher rate
compared to similar areas where no
forced eradication took place.

52

CHANGES IN OPIUM PRODUCTION IN AFGHANISTAN
WILL HAVE IMPLICATIONS FOR OPIATE MARKETS IN
VIRTUALLY ALL REGIONS OF THE WORLD

DYNAMICS TO WATCH

Future developments in the global opiate market largely depend on
the situation in Afghanistan, which accounted for 86 per cent of
illicit opium production in 2021.

Global opium production has followed a long-term upward trend
over the past two decades, and in 2021 production was up 7 per cent
from the previous year, primarily as a result of higher opium yields
in Afghanistan. The 2021 harvest took place from April to July, before
the takeover by the de facto Taliban authorities in August.

The socioeconomic conditions faced by people in Afghanistan,
who are experiencing a prolonged humanitarian crisis,
may act as an incentive to increase illicit opium poppy cultivation.
Opium prices have risen since the beginning of August 2021, which
may also have an impact.

The effects of the ban on opium poppy cultivation, announced in
Afghanistan in April 2022, and its application and enforcement
remain to be seen, but changes in opium production in Afghanistan
will have implications for opiate markets in virtually all regions of
the world.

CHANGES IN OPIUM PRODUCTION IN AFGHANISTAN
WILL HAVE AN IMPACT ON VIRTUALLY ALL REGIONS OF THE WORLD

CONSEQUENCES

‘1

° Unchanged levels of opiate use
¢ The market reacts to supply and demand
¢ Farmers diversify into other crops

54

METHAMPHETAMINE CONTINUES
TO EXPAND BEYOND TRADITIONAL MARKETS

DYNAMICS TO WATCH

Methamphetamine manufacture and use have continued to expand
beyond “traditional” markets in East and South-East Asia and North
America, notably in South-West Asia and in Latin America.

Methamphetamine manufacture and use have risen in Afghanistan
in recent years, and the drug is being trafficked to the wider region.
Accounts suggest that use of methamphetamine and “captagon”
tablets is rising in South-West Asia and beyond, in particular in Iraq,
although no recent estimates are available. Seizures in the Gulf
suggest that a methamphetamine market may emerge there, too.

The dramatic expansion of methamphetamine markets is illustrated
in Mexico, for example, where treatment admissions for the drug
have outnumbered those for alcohol, and where people entering
treatment for methamphetamine use disorders increased by 218 per
cent from 2013 to 2020.

Seizures of the drug and its growing popularity among some user
groups suggest that a methamphetamine market is also expanding
in Western and Central Europe.

Clandestine laboratories are becoming bigger and are manufacturing
larger quantities.

METHAMPHETAMINE MARKETS CONTINUE TO EXPAND BEYOND TRADITIONAL MARKETS

THE “CAPTAGON” MARKET CONTINUES TO FLOURISH

DYNAMICS TO WATCH

The market for “captagon’, an illicitly manufactured substance
containing various concentrations of amphetamine, continues to
flourish in the Near and Middle East, with seizures reaching a record
high in 2020.

The departure point for trafficking continues to be in the Levant
(the Syrian Arab Republic and Lebanon), with destinations in the
Gulf countries reached either directly by land and sea, or indirectly

through Europe and possibly North Africa. Recent seizures in East
Asia and West Africa point to further geographical expansion of the
“captagon” market.

MAIN TRAFFICKING ROUTES FOR COUNTERFEIT "CAPTAGON" IN THE MIDDLE EAST AND NORTH AFRICA

ITALY
Salerno de ;
Gioia Tauro GREECE TURKIYE
sd pte ene =
Latakia : SYRIAN ARAB

TUNISIA

Zuwarah Al-Khoms
Misrata

ALGERIA

Legend

———p land routes
——+> searoutes
see > costal routes
ett air routes
> CHAD
© Trafficking hub
(drugs, migrants, weapons)

»- Main airports of seizures

at: Main ports of seizures

Khartoum

SUDAN

Tartus REP.

™~

Basra

a “ayy Kuwarr
; = ay RAIN Jebel Ali
yeaa Dot ATA Abu Dhabi

Sources: UNODC elaboration, based on a number of sources including responses to the annual report questionnaire, UNODC Drug Monitoring Platform, UNODC Technical report on trafficking of drugs in Iraq (forthcoming) and Global Initiative on Transnational Organized Crime.
The boundaries and names shown and the designations used on this map do not imply official endorsement or acceptance by the United Nations, Final boundary between the Republic of Sudan and the Republic of South Sudan has not yet been determined.

55

56

DRUG MARKETS ON THE DARK WEB CONTINUE TO
BE VOLATILE AND SHOW GEOGRAPHICAL EXPANSION

DYNAMICS TO WATCH

While darknet markets continue to account for a very small share
of drug transactions, their use has been growing over the past
decade, and markets are no longer restricted to Western countries
as they also affect Eastern Europe, Latin America, Asia and Africa.

Although sales volumes on the dark web have fluctuated over the
years, reflecting the frequent emergence and demise of individual
darknet markets, available data suggest that drug-related sales on
the dark web increased in 2020 from 2019, and a smaller increase
was observed in 2021.

Research shows a marked increase in people reporting purchasing
drugs on the dark web over the period from January 2014 to January
2021 followed by a decline until January 2022, likely because some
darknet markets were dismantled by the authorities or underwent
exit scams, while alternative platforms, such as social media and
encrypted messenger services, may have also played a role.

DAILY SALES (MINIMUM, MOSTLY DRUGS) ON 38 MAJOR
GLOBAL DARKNET MARKETS, 2011-2021

Dollars per day

vel il
sel jl
Oo fo
oy oy
Ss iS
oc Ss
=.

Nov-2011
Feb-2013
Jul-2013
Dec-2013
May-2014
Oct-2014
Mar-2015
Aug-2015
Jan-2016
Jun-2016

© Silk Road
@ Empire

® Silk Road 2
~ Cannazon

— Agora
@ Hydra Market

oOo nm ~ © 0 O D ep (Ss) fo) ‘sl esl AN
a a a be | om! a ca a N N N N N N
Ss iS ie) 1s) i=) te =) Ss SS oO Ss | S&S S&S
Kl sme ta Tosi te abe mas TT ota a Gt a
> — oo) = [S) et — ob c > [=
Q > o Oo Q
zetegatrgsosge28 22 4
© Evolution = Alphabay © Dream Market
_ White House DarkOde ® Other markets

TRAFFICKING IN SYNTHETIC DRUGS IS GROWING
FASTER THAN TRAFFICKING IN PLANT-BASED DRUGS

DYNAMICS TO WATCH

Trafficking in synthetic drugs, notably ATS, is growing faster than _— Precursors used in the manufacture of synthetic drugs continue to
trafficking in plant-based drugs over the past two decades, accord- _— change rapidly as chemicals become controlled and pre-precursors
ing to global seizure data. and “designer precursors” emerge.

Global seizures of ATS rose rapidly over the previous decade. Meth-
amphetamine seizures rose fivefold; amphetamine, fourfold; and
“ecstasy”, threefold.

LONG-TERM TRENDS IN QUANTITIES OF DRUGS SEIZED, 1998-2020

2,500
— ATS
= 2.000 —— Opioids
S st eeees Opioids estimates
" 1500 —— Opiates
a — Cocaine
= 1,000 — Cannabis
oO
TS
{s
a 500
0

1998
2000
2002
2004
2006
2008
2010
Z0U2
2014
2016
2018
2020

Si

58

PEOPLE WHO USE DRUGS WERE LESS ABLE TO ACCESS
DRUG TREATMENT SERVICES DURING THE COVID-19
PANDEMIC, WHILE DRUG USE RISKS INCREASED

DYNAMICS TO WATCH

There are signs that drug use patterns may have become more harm-
ful during the pandemic. At the same time, there was less access to
services (prevention, treatment and prevention of infectious diseases
and overdose) for people who use drugs.

Data show the shortage in drug treatment provision during 2020 in
all regions.

More recent data from studies into the early impact of the COVID-
19 pandemic on drug use show the frequency of cannabis use and
the quantities used have increased, while the number of users has
remained stable.

Relapse, as well as the risk of relapse and drug use-related risk
behaviours, increased in several countries during the pandemic.

Women who use drugs may be disproportionately affected by the
pandemic.

The decrease in the use of the drugs particularly consumed at rec-
reational venues during the pandemic was likely short-lived, and
early data suggest that such use may have already rebounded.

IMPACT OF THE COVID-19 PANDEMIC ON DRUG USE

Increases in overall cannabis consumption,
mostly due to increased frequency and
quantity used by existing users rather
than recruitment of new users

a Ar Decreases in drug use of adolescents
@ S which coincided with lockdown
G2 @ | periods

Regular drug use less affected, but users
with drug use disorders more often
experienced withdrawal and relapse.
Greater willingness to access treatment
was not met with sufficient service
availability

@ | Lower COVID-19 vaccination uptake in
SS , .
people who use drugs despite them being
a priority group for this intervention,
vA & associated with lower trust in the medical
system and access barriers

oF

@ Temporary decreases of drug use at

|
5)

Increases in non-medical use of
sedatives, such as benzodiazepines,
tranquilizers and other psychiatric
pharmaceuticals

(0) recreational venues during lockdowns,
in particular MDMA

Service provision was disrupted with
drug use prevention, drug-related
treatment and other services for
people who use drugs experiencing
closures, limited capacity and/or
lower in-person attendance

Innovation in service delivery
(such as tele-medicine) may be
used also after the pandemic, but
need more research for successful
implementation

ONE IN EVERY 18 PEOPLE WORLDWIDE USED A DRUG IN 2020,
26 PER CENT MORE PEOPLE THAN A DECADE EARLIER

om | LATEST DATA AND TRENDS

In 2020, 1in every 18 people aged 15-64 worldwide - an estimated
284 million people (5.6 per cent of the population) — had used a drug
in the past 12 months.

The number of people who used drugs (284 million) in 2020 was 26
per cent higher than in 2010, partly because of world population
growth.

The coverage of interventions for the treatment of drug use disor-
ders remains low overall. Implementation of scientific evidence-based
drug prevention interventions remains low as well, especially in
middle- and low-income countries.

GLOBAL ESTIMATES OF THE NUMBERS OF DRUG USERS IN MILLIONS (2020)

Cannabis Opioids

60

Amphetamines Cocaine “Ecstasy”

34 ox 20
(29-41) (18-26) (9-36)

THERE CONTINUES TO BE GREAT INEQUALITY IN THE
AVAILABILITY OF PHARMACEUTICAL OPIOIDS FOR

MEDICAL CONSUMPTION

LATEST DATA AND TRENDS

Large disparities remain in the availability of pharmaceutical opioids
for medical consumption despite a global increase in available doses
over the last two decades. The number of standardized defined daily
doses of opioids (controlled under the 1961 Single Convention) avail-
able per 1 million inhabitants in North America in 2020 was 7,500
times higher than in West and Central Africa, even after the decline
in availability in North America since 2013.

The largest quantities of pharmaceutical opioids available for med-
ical consumption in 2020, as expressed in standard doses, were of
codeine, followed by hydrocodone and, excluding preparations,
hydrocodone, followed by fentanyl, methadone, buprenorphine,
oxycodone and morphine.

NORTH AMERICA HAS 7,500 TIMES MORE DOSES OF PAIN MEDICATION*
THAN WEST AND CENTRAL AFRICA

1%

NORTH AMERICA

*opioids controlled under the Single Convention of 1961

&

WEST AND
CENTRAL AFRICA

a

61

THE NUMBER OF PEOPLE WHO
INJECT DRUGS REMAINS HIGH

| LATEST DATA AND TRENDS

An estimated 11.2 million people worldwide injected drugsin2020. __ with hepatitis C (an estimated 5.5 million people), while 1.1 million

One in every eight people who injected drugs (PWID) were living EMV ID were livite botiwldellWand hepatitls

with HIV (1.4 million people), and nearly half of PWID were living

MORE THAN 11 MILLION PEOPLE INJECT DRUGS

—

people who inject drugs are
living with hepatitis C

1.4 million people who inject drugs are
(1in 8) living with HIV

le ‘a lion people who inject drugs are
(1 in 10) living with HIV and hepatis C

\

62

COCAINE MANUFACTURE AND TRAFFICKING

ARE INCREASING

LATEST DATA AND TRENDS

According to the latest estimates, cocaine manufacture grew 11 per

cent from 2019 to a new record high of 1,982 tons in 2020, while
trafficking of cocaine continued to increase in 2020.

GLOBAL CULTIVATION
2020

700 ha 328,011x
on | Change from
Ms o previous year
pA iim 0%
|__|
GLOBAL SEIZURES

2020

of varying purity

Change from
previous year

& +4.5%

Women fulfil a wide range of roles in the global cocaine supply chain,
including working in coca cultivation, transporting small quantities
of drugs, selling to consumers and smuggling into prisons.

GLOBAL PRODUCTION

2020
O
1,982 tons Change from
at 100% purity previous year
a +11%

GLOBAL NUMBER OF USERS
2020
re
Tih
21 million

63

64

THE TWO EPIDEMICS OF NON-MEDICAL USE OF OPIOIDS —- FENTANYL IN
NORTH AMERICA AND TRAMADOL IN NORTH AND WEST AFRICA, THE MIDDLE
EAST AND SOUTH-WEST ASIA —- CONTINUE TO POSE GREAT HEALTH RISKS

od | LATEST DATA AND TRENDS

Trafficking of synthetic opioids continues. Tramadol accounted for
55 per cent of reported quantities of pharmaceutical opioids seized
in 2016—2020, followed by codeine (38 per cent), mostly seized in
the form of cough syrups, as well as fentanyl and its analogues
(3 per cent). However, when those seizure amounts are converted
into defined daily doses, the order of importance becomes clear: 90
per cent of defined daily doses of synthetic opioids seized in 2020
were of fentanyls.

The two epidemics of non-medical use of opioids, one related to
illicitly manufactured fentanyls in North America and the other one
involving non-medical use of tramadol in North and West Africa, the
Near and Middle East and South-West Asia, continue to pose great
health risks.

In Africa, non-medical use of tramadol has likely been spreading, as
reflected in increasing drug treatment demand in some countries.
There is indication of non-medical use of tramadol in other regions
as well, in particular South Asia, South-East Asia, Central Asia, North
America and Europe.

In the United States and Canada, overdose deaths, predominantly
driven by use of fentanyls, remain at record high levels. Fentanyls
are typically laced with heroin or other adulterated drugs, and they
are also sold in falsified medicines. Use of fentanyls has been reported
by several other countries, although currently, there are no indica-
tions of an epidemic of non-medical use and related health
consequences outside North America. However, fentanyls remain
a potential threat in opioid markets. The spread of fentanyls could
occur rapidly if market dynamics were to result in the shortage of
the main opioid used in any of the markets.

MAIN HEALTH CONSEQUENCES OF NON-MEDICAL OPIOID USE

After 2 years (median)

(Australian and US studies)

Between 10-90% will
progress to injecting use
and will transition in and

out of injecting.

$y

(studies from US and Europe)

+)

Almost half of users
will develop opioid use
disorders and over 20% will
develop dependence
syndrome.

(Australian and US studies)

Fes

Almost half of users will
personally experience
non-fatal overdose and
many more may witness
one ina fellow user.
People who use opioids (systematicreview)
for non-medical purposes

Opioid users may
experience other somatic
risks, for example: opioid-
induced bowel syndrome,

opioid-induced hyperalgesia,
opioid-associated liver
fibrosis, opioid-related
leukoencephalopathy and
opioid amnestic syndrome.

(review of literature)

Within 1 or 2 further years
(median)

(Australian and US studies)

Bc id

a
Contracting hepatitis C If untreated, liver damage,
(about half of PWID, global estimate) liver failure, cirrhosis,
liver cancer, and even

R death may follow.
Some users will contract HIV

(12.4% of PWID, global estimate) ] 1

PREMATURE

fa / DEATH ~—\

/ Mortality rate is about \

In an optimal situation, / 10-20 times higher in \
users will enter treatment epee \
at this stage and circle | Galleiclussisitteinenmong |

in and out of treatment \ the general population of |
seeking improvement | the corresponding age |
in their state. | and sex. A quarter to
(based on Zurich study) half of opioid users
followed up for 20
years were
deceased at that
time.

About a third of users | (European study, |
will cease the non-medical | review of literature) |
use of opioids within \
30 years. Substitution
treatment improves
outcomes, incarceration
worsens them.

(review of literature)

65

METHAMPHETAMINE IS BEING TRAFFICKED
IN GREATER QUANTITIES AND TO MORE REGIONS

a | LATEST DATA AND TRENDS

Trafficking of methamphetamine continues to increase in volume = Quantities of methamphetamine seized grew fivefold between 2010
and to spread. and 2020. In the two largest markets for methamphetamine, North
America and East and South-East Asia, seizures reached a record

The number of countries reporting seizures of methamphetamine high in in 2020.

rose from 84 countries in the period 2006-2010 to 117 countries in
the period 2016-2020, suggesting a significant geographical spread
in trafficking of the drug.

QUANTITIES OF METHAMPHETAMINE SEIZED, BY REGION AND SUBREGION, AND REPORTED
QUALITATIVE TRENDS IN METHAMPHETAMINE TRAFFICKING, 1998-2020

220
400
350 200 S
al
a 3
5 300 180 38
c a
S556 3
5
eo 160 =
6 3
#& 200 5
3 140 4
= 20
ds) i150) ee = §
e a 2
= 120 &
100 =
50 [ hl 100
ED dsacal :
(eo) fon) (=) tel (el (ea) sop Wel We) [p= el te ) Ge) GSI Gel ssp We) We) [es ee S)
aoe ooo ceo Oo ec @ eel a a =! = Sl =! = 2 N
oem eeooeoeoe eooeeoee ee eee ee 2S
=) tS) St ST OS) SS SN SOR) OSS) OS SS OS ORS OS So)
mas Africa - seizures mes East and South-East Asia - seizures
ms Oceania - seizures mam Other Americas - seizures
mem Europe - seizures mam North America - seizures
mmm Other Asia - seizures --- Methamphetamine trafficking trends index

NPS CONTINUE TO EMERGE AND
THE NPS MARKET CONTINUES TO EXPAND

® LATEST DATA AND TRENDS

The largest seizures of synthetic NPS in 2020 were reported = NPS opioids are among the most harmful groups of NPS. The
by countries in East and South-East Asia. number of opioid NPS found on markets worldwide grew from
The spread/of synthetic NPS'In the period 2015—2o20has 14st Ne substance in 2003%0 86 substances In 2020,

been particularly pronounced in countries in Eastern Europe _—In 2020, synthetic opioids were the third largest group of
and Central Asia and Transcaucasia. NPS in terms of the number of substances reported by

A recent trend in Latin America and the Caribbean is the Memperststes:
emergence of blotting papers (“stamps”) containing various
NPS with hallucinogenic effects.

NPS MARKET EXPANDING PARTICULARLY IN EASTERN EUROPE AND CENTRAL ASIA AND
AT A SMALLER LEVEL IN AFRICA AND LATIN AMERICA AND THE CARRIBEAN

67

68

OPIUM PRODUCTION CONTINUED TO INCREASE AS
OPIATE SEIZURES REACHED A NEW RECORD HIGH

od | LATEST DATA AND TRENDS

Global opium production continued its long-term upward trend,
increasing 7 per cent from 2020 to 2021, to 7,930 tons, although the
global area under opium poppy cultivation fell by 16 per cent to
246,800 ha in 2021. The increase was largely attributable to greater
opium yields in Afghanistan, which resulted in an 8 per cent increase
in opium production. Global heroin manufacture remains stable at
an estimated 495-755 tons.

Global seizures of opiates increased by 40 per cent from 2019 to
2020, reaching a new record high.

GLOBAL CULTIVATION —_changerom
2021 ui

-16%

a

345,600x

GLOBAL PRODUCTION _ “henge from

previous year

2021 mn

-= +7%

7,930 tons of opium \
EY 6,438-6,738 &
; =<
(4 a

495-755 tons
of heroin produced

1,177-1,477 tons
consumed as opium

GLOBAL SEIZURES*
2020

w
Pharmaceutical Morphine Heroin Opium

opioids

*Quantities seized have not been adjusted for purity.

Change from previous year

eo 83% t +22% t. 19% t, 37%

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).

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.

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 Psy-
chiatric Association, or the International Classification
of Diseases and Related Health Problems (tenth revi-
sion) 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.

GLOSSARY

69

WORLD DRUG REPORT 2022

70

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.

REGIONAL GROUPINGS

The World Drug Report uses a number of regional and
subregional designations. These are not official desig-
nations, and are defined as follows:

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

> 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, Céte d’lvoire, 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

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, Curagao, Guadeloupe, Martinique,
Montserrat, Puerto Rico, Saba, Netherlands, Sint
Eustatius, Netherlands, Sint Maarten, Turks and
Caicos Islands and United States Virgin Islands

> 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

> South America: Argentina, Bolivia (Plurinational
State of), Brazil, Chile, Colombia, Ecuador, Guyana,
Paraguay, Peru, Suriname, Uruguay, Venezuela
(Bolivarian Republic of) and Falkland Islands
(Malvinas)

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, Singa-
pore, Thailand, Timor-Leste, Viet Nam, Hong Kong,
China, Macao, China, and Taiwan Province of
China

> 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

> South Asia: Bangladesh, Bhutan, India, Maldives,
Nepal and Sri Lanka

EUROPE

> Eastern Europe: Belarus, Republic of Moldova,
Russian Federation and Ukraine

REGIONAL GROUPINGS

val

WORLD DRUG REPORT 2022

> South-Eastern Europe: Albania, Bosnia and
Herzegovina, Bulgaria, Croatia, Montenegro,
North Macedonia, Romania, Serbia, Ttirkiye* and
Kosovo?

> 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, Faroe Islands. Gibraltar and
Holy See

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

a Further to the communication dated 31 May 2022 from the
permanent mission addressed to the Executive Office of the
Secretary-General, the country name was changed from the
former name of the Republic of Turkey (former short form:
Turkey), with immediate effect. The World Drug Report 2022 was
prepared before that date and thus uses the former name in its
reporting and analysis, except for the maps that were finalized
more recently.

b References to Kosovo shall be understood to be in the context of
Security Council resolution 1244 (1999).

ZEN
\ UNODC UNODC I)

Wey United Nations Office on Drugs and Crime Resea rch GY

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 2022 provides an in-depth
analysis of global drug markets and examines the nexus between drugs and the environ-
ment within the bigger picture of the Sustainable Development Goals, climate change and
environmental sustainability.

Booklet 1 summarizes the four subsequent booklets by reviewing their key findings and
highlighting policy implications based on their conclusions. Booklet 2 provides an overview
of the global demand for and supply of drugs, including an analysis of the relationship
between illicit drug economies and situations of conflict and weak rule of law. Booklet 3
reviews the latest trends in the global markets for opioids and cannabis at the global and
regional levels, and includes a discussion of the potential impact of changes in opium poppy
cultivation and opium production in Afghanistan, and an analysis of early indications of
the impact of cannabis legalization on public health, public safety, market dynamics and
criminal justice responses in selected jurisdictions. Booklet 4 presents the latest trends in
and estimates of the markets for various stimulants - cocaine, amphetamines and “ecstasy”
— and new psychoactive substances, both at the global level and in the most affected
subregions, including an analysis of different coca bush eradication strategies and a focus
on the expansion of the methamphetamine market in South-West Asia. Booklet 5 delves
into the nexus between drugs and the environment, providing a comprehensive overview
of the current state of research into the direct and indirect effects of illicit drug crop
cultivation and drug manufacture, as well as drug policy responses on the environment.

The World Drug Report 2022 is aimed not only at fostering greater international coopera-
tion to counter the impact of the world drug problem on health, governance and security,
but also, with its special insights, at assisting Member States in anticipating and address-
ing threats from drug markets and mitigating their consequences.

The accompanying statistical annex is published on the UNODC website:
www.unodc.org/unodc/en/data-and-analysis/world-drug-report-2022.html

ISBN: 9789211483758

7892 11°483758