For the purposes of IDPC’s regional work, South Asia includes: Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka.
There is limited data and information on illicit drug production, trafficking, and consumption in several South Asian countries. This can be attributed to the lack of capacity for data collection and analysis, as well as the limited relevance of production, trafficking, and/or consumption for certain countries, particularly Bhutan (read more).
Accounting for 80% of the global opium production, Afghanistan is the world’s largest opium-producing and heroin-manufacturing country. Despite continued eradication efforts, 2013 marked the third consecutive year that the area under poppy cultivation has grown, with an increase of 36% since 2012 (read more). The virtually non-existent impact of counter-narcotics efforts in Afghanistan is apparent in the graph below.
According to a survey conducted in 2012, the majority of Afghan farmers growing opium poppy cite the high income derived from the sale of the crop as the main reason for cultivation. This rationale also exists for cannabis, another crop upon which Afghan farmers rely for their livelihood. Afghanistan’s illicit cultivation of cannabis and production of cannabis resin places it second only to Morocco at the global level. Until the income from licit crops becomes comparable, the 191,500 households in Afghanistan depending on opium poppy and cannabis (read more) will continue to cultivate these crops, regardless of eradication campaigns.
India has reported ketamine production (which is now prohibited under national law), as well as some manufacturing of new psychoactive substances (NPS) and amphetamine-type stimulants (ATS), the latter primarily to meet domestic demand. Illicit opium cultivation has increased significantly in recent years, particularly in North East India, to meet local demand and for export to Burma (read more), albeit at a significantly lesser extent than Afghanistan.
Although heroin produced in Afghanistan is trafficked to countries worldwide, significant amounts are destined for Eastern Europe and Central Asia where use is higher than the global average. Surplus Afghan heroin is trafficked to China, although the majority of this country’s demand is satisfied by Myanmar. Afghan heroin has recently reached new markets, namely countries in Oceania and South East Asia (read more).
The massive Afghan heroin production has found an increasingly attractive land route in the porous borders of the Golden Crescent (formed by Afghanistan, Pakistan and the Islamic Republic of Iran), particularly directly out of Pakistan. An increase in heroin seizures since 2009 indicates that Pakistan is playing an important role in trafficking Afghan heroin. Likely as a consequence of increased border control in Iran, Pakistan is now the second most cited country of provenance for heroin globally, with approximately 44% of Afghan heroin being trafficked through its borders (read more). Although the Balkan route, which goes through Iran, is still a main heroin trafficking route linking Afghanistan to the European and Russian markets, the use of the southern route, which moves heroin through the area south of Afghanistan and the Near and Middle East and Africa to reach Europe, has recently been expanding. India has been cited in some cases as the source of heroin arriving in the United States and Canada. Domestically produced heroin in India is trafficked to Bangladesh and Sri Lanka (read more).
Seizures of chemicals used to manufacture illicit substances have also been observed in South Asia. Along with China, India is the most frequently mentioned country of provenance for seized illicit shipments of precursors such as ephedrine and pseudoephedrine. Most acetic anhydride (a chemical used in the manufacture of heroin) for use in Afghanistan originates from diversions from licit markets outside of South Asia, and is increasingly trafficked through India and Pakistan.
Along with Iran, the prevalence of opiate use in Afghanistan and Pakistan is among the highest worldwide at an average of 1.5% of the adult population. This is nearly four times the prevalence of people who use opiates globally. Pakistan witnessed a concerning increase in the annual prevalence of opiate use among its population, with rates climbing from 0.7% in 2006 to 1% in 2013. In Afghanistan, there is a high level of opioid use in the urban population, with a prevalence rate of 2.6%. People who are dependent on opioids in Afghanistan will often move between different forms of the drug, combining heroin and/or opium with pharmaceutical painkillers (read more). The significant level of opiate use and dependence in Afghanistan, Pakistan and Iran is most probably related to the availability from the large production of these substances in Afghanistan. For instance, Pakistan’s highest prevalence of opiate use (in proportion with the population) is in provinces bordering the Afghan cultivation areas.
Cannabis is the most commonly used drug in Pakistan, with an annual prevalence of 3.6%. Although the level of methamphetamine use in Pakistan is very low when compared to other substances in the region, its consumption has recently been detected for the first time last year (read more).
Demand for opioids in India is primarily met by the domestic supply, often in the form of “brown sugar.” A recent exploratory study conducted by UNODC confirmed the emergence of ATS use in several parts of the India.
Finally, a report by UNODC found that compared to neighboring countries, the prevalence of illicit drug use in Maldives is not very high. Cannabis resin, opioids, and alcohol are the most commonly consumed substances in the country. The main drugs consumed in Nepal are domestically cultivated cannabis and opium. However, ATS use is reportedly on the rise in Bangladesh, Nepal, and Sri Lanka. In Bangladesh, ATS consumption is primarily in the form of methamphetamine pills, locally known as “yaba” (read more).
There is a total ban on alcohol consumption in Afghanistan, as consumption is forbidden by Islam, the predominant religion in the country. There is almost no consumption of alcohol in the country. Several countries in the region have banned alcohol consumption for Muslims or restricted its use in other ways, including Bangladesh, Maldives, Pakistan and some Indian states. Due to low levels of disposable income, a high proportion of alcohol consumed in India is in the form of home-made spirits (read more). This is concerning as home-made alcohol can have significant health harms since consumers are unable to assess the quality and quantity of alcohol they are drinking.
Regional Drug Policies
Under the framework of the South Asian Association for Regional Cooperation (SAARC), the SAARC Convention on Narcotic Drugs (1990, in effect 1993) broadly signalled the need for cooperation, information exchange and common legal frameworks to tackle drug issues in the region. Yet weak institutions, inadequate funding, regional animosity, and armed conflict have all played a role in the failed realisation of this Convention. In practice, SAARC does not play an active role in the region and has recently been relatively dormant. International organisations and civil society have played a distinctive role in promoting evidence and human rights-based policies, rather than traditional harsh punitive approaches in the region.
Incarceration and death penalty for drug offences
Drug policy in South Asia is based on a zero-tolerance approach with punitive legislation that leans heavily on incarceration for people involved in drug offences. In India, recent passage of the Narcotic Drugs and Psychotropic Substances (Amendment) Bill increased the punishment for the illicit possession of small quantities of drugs from a maximum of 6 months imprisonment to 1 year. Drug use is also punishable by up to 6 months or 1 year imprisonment and/or a fine (read more). Although drug dependent people can choose to undergo treatment instead of prosecution in India, the lack of prioritisation and earnest application of this treatment provision by courts has meant that few people, if any, have benefited from this mechanism. In the Maldives, a study from 2011 found that 66% of inmates were serving a sentence for a drug-related offence, 70% of which were convicted for simple drug use. A recent survey conducted in Nepal found that 47.1% of surveyed young people who use drugs had experienced arrest and police custody and/or imprisonment as a result of their drug-related offences.
Bangladesh, India, Pakistan and Sri Lanka allow the use of the death penalty for drug offences by law. However, in practice, capital punishment is not employed (read more). Since the informal moratorium on executions in 2008, executions for drug offences have seized in Pakistan. Although death sentences for drug offences continue to be given, no executions have taken place since 2007. Bangladesh, India and Sri Lanka have legal provisions to use the death penalty for drug-related charges. In Bangladesh, the last death sentence for drug offences was in 2009, yet the last execution for drug offences is unknown. In India, there were two people on death row for drug offences as of June 2012, however, there has never been an execution for drug offences. Interestingly, as a result of a legal case launched by the Indian Harm Reduction Network (IHRN), the mandatory death penalty for drug offences prescribed in Indian law was ‘read down’ after the Bombay High Court became the first court in the world to declare the mandatory death penalty for drug offences unconstitutional in June 2011. In Sri Lanka, courts continue to sentence people to death. Although the last time an execution for drug offences was conducted is unknown, it is uncertain if capital punishment will eventually be employed for those sentenced to death in Sri Lanka (read more). Importantly, none of these countries signed on to the statement made by Iran at the High-Level Segment of the 57th session of the Commission on Narcotic Drugs in March 2014 on behalf of itself and sixteen other states in support of the death penalty for drug offences.
HIV among people who inject drugs
Together with the Middle East, South Asia has the highest prevalence of HIV among people who inject drugs globally. Emerging concentrated epidemics, in which HIV prevalence among people who inject drugs has been increasing and is projected to continue to do so, can be observed in both Afghanistan and Pakistan. In recent studies, the HIV prevalence rate in Pakistan has been recorded at over 40% with no evidence of stabilisation (read more).
The policies of several South Asian countries, including Afghanistan, Bangladesh, India, Nepal, and Pakistan, explicitly refer to harm reduction, indicating government commitment to tackling drug-related health harms. Although opioid substitution treatment (OST) and needle and syringe programmes (NSPs) are available in most South Asian countries, limited coverage inhibits the effectiveness of these harm reduction programmes. In a recent cohort study examining the spread of HIV among people who inject drugs in Pakistan, researchers reported that “underfunding compromised the quality and quantity of outreach services and the full implementation of harm reduction programs.” The researchers concluded that the absence of OST and inadequate NSP coverage undermined the success of HIV harm reduction efforts in Pakistan. NSPs are currently available in Afghanistan, Bangladesh, India, Nepal, and Pakistan. OST is available in Afghanistan, Bangladesh, India, Nepal, and Maldives. According to anecdotal reports, some psychiatrists and general practitioners in Sri Lanka prescribe methadone, despite the absence of an official OST programme. As part of a UNODC pilot programme, India used to be the only country in the region to provide OST in prisons (read more), but such services are no longer available.
In addition to insufficient coverage of harm reduction services, repressive legal and policy frameworks and high levels of stigma towards people who use drugs pose substantial barriers. Provided by both NGOs and governments, gender-specific harm reduction services are available in Bangladesh, India, and Nepal (read more). In Pakistan, UNODC has been supporting the implementation of gender-specific harm reduction services for several years. Services targeted towards youth are absent in South Asia. A recent study conducted in Nepal found that 68% of respondents felt that drug services were not youth friendly. This is a barrier to effective harm reduction provision, especially given that drug use among young people in Nepal has been increasing (read more).
Drug treatment services
Frequent reports of alleged forced detention in rehabilitation centres and inhumane practices in such centres presents a bleak scenario for health and human rights concerns in Nepal. Most of the surveyed young people who use drugs in Nepal reported that they face issues of forced and compulsory services, reducing their willingness to access harm reduction services (read more). It is common practice for people who use drugs to be forcibly brought to such centres, where ill treatment and torture practices are used under a “no pain, no gain” rationale (read more).
Much like harm reduction services, there is a lack of adequate coverage of drug treatment services throughout the region. In India for example, demand for drug treatment services is very high, leading people who use drugs and their families to opt for treatment that may not be evidence-based or respectful of human rights. Although facilities under the Ministry of Health and those funded by the Ministry of Social Justice and Empowerment are mandated to follow the Minimum Standards of Care, this is the minority of drug treatment services. The majority are privately owned and operated, and are therefore not subject to quality assurance measures and government rules and regulations. The Narcotic Drugs and Psychotropic Substances Act in India needs amendment to reflect pressing issues such as consent to treatment and minimum treatment standards (read more).
The government in Afghanistan has failed to provide treatment services. This is most evident in the government’s national budget which sets aside an amount that averages to £1.25 per user per year to help drug dependent people. Afghans seeking drug treatment find themselves on waiting lists for services that are understaffed, lack adequate supplies, and have rudimentary programmes (in which the entire treatment may simply be going “cold turkey”). As a result, most leave treatment before the end of the first week (read more).
Since 2006, forced eradication has been the key pillar of international supply reduction efforts in Afghanistan. As statistics indicate, crop eradication efforts have failed to supress the illicit cultivation of opium and production of heroin in Afghanistan. This is despite the massive investment of funds from foreign states and UNODC (read more), including US$ 7.55 billion spent by the United States since 2002. Widespread corruption and weak institutions create a favourable environment for illicit drug cultivation and production in Afghanistan. This, combined with the absence of other viable income options for farmers, creates a situation in which Afghanistan will undoubtedly continue to create enough supply to meet the global demand for opiates.
Beyond a failure to eradicate illicit drug cultivation and production, drug policy in Afghanistan has had significant negative repercussions. Increased instability, violence, and civilian fatalities related to eradication efforts are just some of the devastating outcomes linked to this policy (read more). An emphasis on forced crop eradication has meant that resources have not been devoted to meaningful alternative and human development, as well as prevention, treatment, and harm reduction. Rather than a counter-narcotics strategy that is dominated by international advisers who often have had little understanding of the Afghan dynamic, Afghanistan needs a strategy that is drafted by Afghans and has at its core an emphasis on local needs, the growth of local capacities, and engagement with Afghan civil-society groups, NGOs, and academics (read more).
In India, there has been a minor reduction in opium cultivation as a result of government crop eradication efforts. However, like in Afghanistan and other places with illicit crop cultivation, eradication has had a particularly negative impact on poorer areas and most often proves counterproductive as farmers replant crops out of economic necessity.
Drugs and insurgency
A significant amount of research indicates that the simplistic concept of “narco-terrorism” misrepresents the relationship between illicit drugs and insurgency in Afghanistan (read more). Contrary to popular belief, Afghanistan opium cultivation and heroin production are not central economic enablers of the Taliban. A UNODC report estimates that only between 10% and 15% of the Taliban’s funding comes from drugs, indicating that reducing illicit drug cultivation, processing, and trafficking in Afghanistan would only have a “minimal impact on the insurgency’s strategic threat” (read more). Additionally, the report indicates that the drug money the Taliban receives represents only about 5% of the approximately $3 billion per year generated by opiates within Afghanistan. The majority of this revenue is captured by traffickers, government officials, the police, and local and regional power brokers – many of which are actors either tolerated or supported by the United States and NATO-ISAF (read more).
Nevertheless, the United States continues to assert that there is a “well-documented link between opiates and the insurgency” as “more than a third of the Taliban’s income comes from opium” (read more). This is not only problematic because it provides a justification for harmful counter-narcotics efforts in Afghanistan, but also because it absolves the United States and NATO of their own role in fomenting insurgency in Afghanistan by the presence of foreign troops in the country as well as their attacks on civilians (read more). A recent work by the US Army War College ‘Strategic Studies Institute’ has also noted the incentives crop eradication places on supporting local insurgent groups. Although eradication is intended to weaken insurgent groups by curtailing their financial resources, it frequently has the opposite effect as local populations that feel the government has destroyed their livelihoods may increase their support for insurgent groups (read more). Evidently, counter-insurgency and counter-narcotics are often incompatible tasks, if not directly conflicting (read more).
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