Licit and illicit opium cultivation

A striking dichotomy of the nearly global criminalization of illicit opiate use is that opiates remain widely used in modern medicine and surgery, widely prescribed by physicians and other providers, and legally cultivated for these purposes. Drugs used in modern medicine and derived from the opium poppy include morphine, Demerol, codeine, and methadone, to name only a few (Physicians' Desk Reference, 2005). Anyone who has had major surgery, or the kind of severe pain associated with bone fractures, cancer, and dental emergencies, has likely known the extraordinary power of these agents to control human pain. They remain, for the most severe pains we suffer, the ultimate remedy - few of us who die in hospital will die without their benefit. But in their power lies their danger - as the Akha have told us. Opiates are highly addictive for humans precisely because the human nervous system is so richly endowed with opiate-like receptors - the famous endorphins, which were actually named for endogenous opiates (Heiss and Herholz, 2006). We are hard-wired for opiates. Yet we seek to isolate and punish those who grow opiates, but who do so out of the control of the "licit" market.

Illicit cultivation of opiates is concentrated, according to the terminology of the UN Office for Drugs and Crime, in a few chaotic and/or closed states; Afghanistan, Burma, and Laos together accounted for more than 90 percent of all illicit opium poppy cultivation in 2004 (UNODC, 2005). Licit cultivation, as we have seen, is concentrated in Australia, India, and Turkey. Licit growers produce their valuable crop under international treaty law, and are not seen as a threat to global security or health. Indeed, few people, even those concerned with the HIV epidemic among drug users, know that licit poppy cultivation continues in 2006. In contrast, the illicit growers have faced sanctions (in the case of

Burma) and nearly constant conflict with the international community. Yet illicit opiate volumes have increased in the past decade (UNODC, 2005). Afghanistan, in particular, has seen steadily increasing poppy production over 25 years of war and conflict (see Figure 3.6). The one exception to this was the year 2001, when the then leader of the Taliban regime, Mullah Omar, issued an Islamic Edict (Fatwa) against poppy cultivation. In 2002 the crop was again enormous, and the 2005 crop was estimated at 6100 metric tonnes of opium base - by far the world's highest single yield (UNODC, 2006). While the position of the UN and its members has been characterized as "zero tolerance" for illicit drug cultivation, there has been at least one proposal put forward regarding a new approach to the problem of Afghan heroin. The Senlis Council, a European-based narcotics policy organization, has proposed a feasibility study of transitioning Afghan opium from the illicit to the licit side of poppy cultivation (Senlis Council, 2006). One of their primary justifications for suggesting this change is a reported global shortage of opiates for pain relief. They make the novel suggestion that if the first world is serious about treating AIDS in Africa, and about relieving the pain of terminal AIDS and other fatal diseases in African and other developing country populations, the worldwide supply of opiates must dramatically increase, and their cost be reduced (Senlis Council, 2004). There is certainly evidence that the shortage of affordable pain medications for the poor globally, at least, is all too real.

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80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06

Soviet Period

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Taliban Period : Transitional : Government

Figure 3.6 Afghanistan opium production from 1980 to 2005, in metric tones. Modified from UNODC (2006).

Chris Beyrer, Shruti Mehta and Stefan David Baral Punitive drug laws and disease spread

While producing narcotics has isolated countries like Burma, Afghanistan, and Colombia, laws and policies regarding use of these agents have operated at individual and community levels in perhaps even more profound ways. Harsh penalties for possession or use have been used by many governments in attempts to deter use and punish users. These approaches have often served to drive users underground, where they are harder to reach and more likely to engage in riskier behaviors in efforts to avoid arrest. Wodak and Lurie examined the contrasting approaches of Australia's relative tolerance and use of harm-reduction approaches and the policies of strict prohibition in the US, and found that the US policies were significant drivers of IDU risks (Wodak and Lurie, 1997). Related work has shown how policies toward illicit drug use, including police harassment and harsh sentencing laws for possession of small volumes, have driven HIV spread in Russia and Ukraine (Malinowska-Sempruch et al., 2004).

These same forces are likely to be involved in the spread of HCV and HBV in marginalized and criminalized drug-using populations as well, although it is clearly in the HIV realm that more work on these unintended consequences of drug policies has been done. It is also clear that harsh policies on possession and use drive incarceration rates, as we have shown in Thailand, and that incarceration has played further roles in the social ecology of these diseases and behavior interactions (Beyrer et al., 2003).

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