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CORK Bibliography: Afghanistan and Opium Poppy

31 citations. 2003 to present

Prepared: June 2012

Adelekan M. "Very effective but draconian and unacceptable": Paradox in the evaluation of a unique drug control effort in a non-western country. International Journal of Drug Policy 16(2): 110-111, 2005. (2 refs.)

This brief response addresses the position taken in the paper by Farrell et al., with regard to the implication of the law enforcement style employed by the Taliban that was able "to produce an estimated 35% reduction in poppy cultivation and 65% reduction in the potential illicit heroin supply from harvests in 2001". In the introduction, the paper states, "...this is arguably the most effective drug control enforcement action of modern times". It appears paradoxical therefore that in another breath, the paper in the discussion states "... the inhumane and draconian policies of the Taliban are clearly not something that should be replicated in free democratic society...". The authors also express their opposition to "what was the Taliban regime, and to all forms of autocratic, totalitarian and/or theocratic regimes". Putting the positive conclusion reached in the paper on the case study alongside the above negative statements on the very method that produced the impressive results could only leave the reader confused as to how best the Taliban drug control should be judged or classified. Even though the authors comment that this was outside the main objective of their study, it is my opinion that more thoughts and space should have been devoted in the paper to examining the elements in that control method that could be recommended or adopted for use elsewhere.

Copyright 2005, Elsevier Science

Arfsten DP; Moralez JF; Chester LL; Mohamad P; Weber TH. Drug use among the Afghanistan National Police: A national assessment. Military Medicine 177(1): 85-90, 2012. (12 refs.)

The Afghanistan Ministry of Interior (Mol) conducted nationwide urinary drug screening of Afghanistan National Police (ANP) officers for tetrahydrocannabinol, opiates, d-Methamphetamine, and benzoylecgonine-commonly referred to as cocaine-between November 2009 and July 2010. The testing was accomplished in concert with the Mol's Personnel Asset Inventory. ANP members used standardized kits from the United States. Of the 100,518 ANP tested, 9% (9,034) were positive for at least one of the target drugs: 80.5% (7,269) screened positive for tetrahydrocannabinol, 15.5% (1,399) for opiates, 2.5% (226) for d-Methamphetamine, and 1.5% (140) for benzoylecgonine. The drug-positive rate for ANP decreased from a high of 21% in November 2009 to 4% in June 2010 (p <= 0.001), suggesting that the newly established Mol antidrug policy and drug screening may have discouraged drug use among ANP officers. The Mol needs to continue to educate its officers on the antidrug policy, improve drug testing procedures, and take appropriate disciplinary action against offenders in order to continue to improve the effectiveness of its nascent antidrug actions.

Copyright 2012, Association of Military Surgeons US

Attaran A; Boozary A. For peace and pain: The medical legitimisation of Afghanistan's poppy crop. Journal of Epidemiology and Community Health 65(5): 396-398, 2011. (20 refs.)

Since the overthrow of the Taliban in 2001, there has been an overall increase in illicit opium production in Afghanistan and mounting human losses. The United Nations has attributed 1 million human deaths to Afghan opiates over the past decade. As the war in Afghanistan nears a crucial mark, the NATO coalition forces and Afghan people can no longer afford the same ineffective counternarcotics strategy. This commentary proposes a strategic revision that reframes Afghanistan's poppy problem as an opportunity for global public health. Specifically, The Afghan poppy crop could be repurposed away from illicit drug production, and towards manufacturing licit opioid analgesics to address unmet needs for pain palliation, particularly for diseases such as HIV/AIDS and cancer in the developing world-that is, illegal opium could be converted into legal pain medicine, solving two problems at once. We present a supply-and-demand that illustrates how this useful exchange could be made, and discuss the political opposition that now stands in the way and perpetuates the unsatisfactory status quo in Afghanistan.

Copyright 2011, BMJ Publishing Group

Clark PA; Sillup GP; Capo JA. Afghanistan, poppies, and the global pain crisis. (review). Medical Science Monitor 16(3): RA49-RA57, 2010. (20 refs.)

The World Health Organization has reported that somewhere between 30-86 million people suffer from moderate to severe pain due to cancer, HIV/AIDS, burns, wounds and other illnesses annually and do not have access to proper opiate anesthetics to control the pain. The vast majority of these people live in poor nations where medicinal opiates are either too expensive or not readily available. In this paper, it is argued that access to adequate healthcare is a human right and that adequate healthcare includes management of pain. The solution to this problem may be in Afghanistan, a country now overwhelmed with poverty and war. Afghanistan is the world's leading producer of heroin. The increase in heroin production in Afghanistan has caused the United States and the international community to begin to eradicate Afghanistan's poppy fields leading to increased poverty among poppy farmers. This paper proposed a paradigm that can be implemented in Afghanistan which would allow for Afghan farmers to continue growing their poppy crop for medicinal opiates like morphine for poor nations. The paradigm covers all parameters of medicinal opiates production including licensing, security, cultivation, harvest, and factory production of medicinal opiates. The paradigm proposed is less expensive than eradication, brings honest income to Afghan farmers and the new Afghan nation, and can eventually lead to Afghanistan acquiring a respectable role in the world community. In closing, a full ethical analysis of the paradigm is included to justify the arguments made in the paper.

Copyright 2010, International Scientific Literature

Clemens J. Opium in Afghanistan: Prospects for the success of source country drug control policies. Journal of Law & Economics 51(3): 407-432, 2008. (41 refs.)

Recent estimates suggest that in 2007, Afghan opiate production accounted for about 93 percent of the world's total. This article presents a framework for estimating the potential for source country drug control policies to reduce this production. It contains a first pass at estimating the potential for policy to shift the supply of opium upward, as well as a range of supply and demand elasticities. The estimates suggest that meager reductions in production can be expected through alternative development programs alone (reductions are less than 6.5 percent in all but one of the specifications presented). They also suggest that substantial increases in crop eradication would be needed to achieve even moderate reductions in production (reductions range from 3.0 percent to 19.4 percent for various specifications). The results also imply that, all else being equal, the cessation of crop eradication would result in only modest increases in opiate production (with estimates ranging from 1.6 percent to 9.6 percent).

Copyright 2008, University of Chicago Press

Farrell G; Thorne J. Where have all the flowers gone?: Evaluation of the Taliban crackdown against opium poppy cultivation in Afghanistan. International Journal of Drug Policy 16(2): 81-91, 2005. (31 refs.)

This study presents what we believe to be the first formal evaluation of the Taliban crackdown against opium poppy cultivation in Afghanistan. Afghanistan was the main source of the world's illicit heroin supply for most of the 1990s. From late 2000 and the year that followed, the Taliban enforced a ban on poppy farming via threats, forced eradication, and public punishment of transgressors. The result was a 99% reduction in the area of opium poppy farming in Taliban-controlled areas. The evaluation uses multiple comparison areas: the non-Taliban area of Afghanistan, neighbouring countries, the non-contiguous comparison area of Myanmar (Burma), and, the rest of the world. Alternative possible causes of the reduction such as drought, migration or changes in global opium markets are reviewed and excluded. It is concluded that the reduction in Afghan poppy cultivation was due to the enforcement action by the Taliban. Globally, the net result of the intervention produced an estimated 35% reduction in poppy cultivation and a 65% reduction in the potential illicit heroin supply from harvests in 2001. Though Afghan poppy growing returned to previous levels after the fall of the Taliban government, this may have been the most effective drug control action of modern times.

Copyright 2005, Elsevier Science

Fazey C . Where have all the flowers gone? Gone to opium everyone. When will they ever learn, when will they ever learn? International Journal of Drug Policy 16(2): 104-107, 2005. (16 refs.)

The author suggests they have not gone, and they never will. Farrell & Thorne (2005) agree with many authors, commentators and actual surveyors of the poppy cultivation areas that the ban actually happened and was effective insofar as the opium production in the areas controlled by the Taliban was effective. However, Farrell and Throne are seen as na�ve as to why the Taliban stopped production. This author suggests that the UN's power is reliant on member states, It may appear that UNDCP had a role in negotiating with the Taliban, the reality was different. In effect, it could negotiate, but not settle. The authors say, "In 1997 the then head of UNDCP, Pino Arlacchi, brokered a deal with the Taliban. In return for the elimination of opium poppy, the UN would provide $25 million per year for ten years in development assistance to Taliban areas." This reflected a naivety on behalf of Pino Arlacchi, then newly appointed as Executive Director of UNDCP, who believed that he could do what he liked without the formal authority of the Commission on Narcotic Drugs (CND). He thought that he was following the policy that the USA wanted, which was the eradication of opium in Afghanistan. But the USA did not want this at that time. The USA was not even the UNDCP's largest donor, although by virtue of being the only super-power, it was able to wield much power in the UN by a stick-and-carrot diplomacy. The abolition of opium growing in Afghanistan was not a high priority for the USA in the late 1990s. Arlacchi made the grave error of believing the rhetoric of the "war on drugs", with its unrealistic and unattainable goal of a "drug-free" world, and by 2008 "Member States should have made real progress in eliminating or reducing significantly crops of opium, coca and cannabis." This was stated at opening session of the Special Session of the General Assembly on illicit drugs. But at the same Assembly, the Member States were not quite so keen for such a commitment and changed the wording in their Political Declaration to commit themselves to working with UNDCP "to develop strategies with a view to eliminating or reducing significantly the illicit cultivation of the coca bush, the cannabis plant and the opium poppy by the year 2008" The UNDCP clearly had not got the resources to keep up its side of the alleged bargain. The authors themselves give the game away here. "Although some development projects were begun in Afghanistan, they were terminated in 2000 due to lack of financing from the UN, as well as continuing extensive poppy cultivations," they say. The UN did not finance because the UN did not have the money from any major donor. No country was interested. Nevertheless, the authors claim that the Taliban produced "the most effective drug control enforcement of modern times". Afghan heroin was not much of a concern to the USA because its markets were mainly in Europe. Besides, the USA had a vested interest in a stable Afghanistan, because of the projected route of pipelines for natural gas and for oil through the country. Brutalisation of a population is not an answer to the drug problem. Production worldwide is out of control, and, in the opinion of this author, only demand reduction can ease the misery of those who become dependent on drugs

Copyright 2005, Elsevier Science

Gibson A; Degenhardt L; Day C; McKetin R. Recent trends in heroin supply to markets in Australia, the United States and Western Europe. International Journal of Drug Policy 16(5): 293-299, 2005. (52 refs.)

Heroin causes its users and the community a disproportionate amount of harm, and evidence suggests that heroin markets have increased in scale over recent decades. Most of the world's heroin is produced in South West (SW) Asia (Afghanistan in particular) and South East (SE) Asia (especially Myanmar), with a much smaller proportion produced in South America. The ban on opium production in Afghanistan in 2000 resulted in a substantial decrease in global opium production for the following year and a sharp increase in the wholesale price of opium in Afghanistan. The current paper examines the price of wholesale and retail heroin in the context of general heroin market conditions in Western Europe, the United States and Australia over the time that this reduction in opium supply occurred. Little evidence was found of a price shift in these three heroin markets as a consequence of the decrease in opium production in Afghanistan. There was no consequent shift in the overall price of heroin in either Europe or the United States. Although Australia did experience dramatic disruption to its heroin supply in 2001, and a large increase in the price of heroin, this change was not directly attributable to the reduction in opium production in Afghanistan. Australian heroin markets are supplied predominantly by SE Asia and the shortage of heroin and consequent price rise was related to regional drug supply factors including local law enforcement activities. In conclusion, the drastic reduction in global opium production witnessed in 2000 did not directly impact on the prices of heroin in these three established heroin markets. This observation highlights the complexity of factors influencing drug prices in destination heroin markets and suggests caution in anticipating clear retail level impacts following changes in drug production.

Copyright 2005, International Harm Reduction Association Inc.

Griffin N; Khoshnood K. Opium trade, insurgency, and HIV/AIDS in Afghanistan: Relationships and regional consequences. Asia-Pacific Journal of Public Health 22(Supplement 3): 159S-167S, 2010. (43 refs.)

Global health and conflict studies share key linkages that have important research and policy implications but for which data are currently lacking. This analytical review examines the ongoing conflict in Afghanistan, using it as a basis to develop a conceptual framework that integrates security and public health concepts. The analysis draws on recent peer-reviewed and gray literature to assess the interrelationship among 3 variable clusters and their impact on the emergence of the HIV epidemic in Afghanistan. The evidence suggests that there is a complex indirect relationship linking illicit opium trade, the ongoing insurgency, and forced and spontaneous migration to the emergence of an injection drug use-driven HIV epidemic in Afghanistan. These findings demonstrate a clear need for an integrated cross-disciplinary and regional approach to the emerging threat of HIV/AIDS in Afghanistan, to inform more balanced and effective policy making in this and other regions of strategic global import.

Copyright 2010, Sage Publications

International Narcotics Office on Drugs and Crime. The Opium Economy in Afghanistan: An International Problem. Vienna Austria: , 2005

Afghanistan currently produces nearly 90% of all poppy used to produce heroin world wide. This report from the United Nations Office on Drugs and Crime is organized into three sections. Section I considers the dimensions of the problem in terms of production and trafficking, the relation to trade and income generated by poppy production, and drug use problems within Afghanistan. Section 2 considers the origins of the problem of the opium economy, its historical roots, the relationship to poverty and agriculture within the country, and its relationship to financial markets within Afghanistan. the third section considers the impact of poppy production on the region: the nature of drug trafficking, the growing problems of regional drug use, the relationship to HIV/AIDS. The conclusion considers steps needed to address the problem: including alternative crops for poppy farmers, jobs, education, financial structures to replace poppy as a basis for credit, and also law enforcement initiatives.

Copyright 2005, Project Cork

Jelsma M . Learning lessons from the Taliban opium ban. International Journal of Drug Policy 16(2): 98-103, 2005. (30 refs.)

A series of concluding comments can be made with regards to the desirability, sustainability, likely impacts and possible side effects of current attempts to reproduce the 'success' of the Taliban opium ban. Humanitarian consequences and sustainability: An FAO/WFP assessment made shortly after the impact of the Taliban ban already warned that unless immediate and commensurate international support would be provided people would be forced to revert to poppy cultivation: "Clearly, as these various groups have suffered serious economic consequences as a result of the abandonment of poppy cultivation, the country's already tenuous economy has experienced a significant setback. The pertinent question is whether and for how long this ban can be sustained". It lasted one year. Opium cultivation in Afghanistan by 2004 reached an unprecedented 131,000 ha -- due to low opium yield per hectare resulting in an output of 4200 tonnes. Still today, many families are entrapped in the vicious cycle of debt accumulation caused by the ban and reinforced by eradication operations more recently. Unintended consequences: In the case of a sudden supply interruption, the burden of finding short-term solutions to their craving will fall upon opium and heroin user groups, first in the region and later on further down the supply chain. Given the current state of health support systems and treatment programmes across the region, those users unable to simply quit their habit or addiction will be forced to use strongly adulterated heroin or opt for 'licit' pharmaceutical replacements. In health terms, this is not likely to result in an improvement. The potential consequences of such shifts (increased injection and related HIV/AIDS risks, Proxyvon and OxyContin-type epidemics, etc.) should be analysed carefully in order to prepare adequate health assistance programmes. The prevailing assumption that reducing supply automatically reduces problems related to drug consumption is false and will have to be challenged. Dynamics between the licit-illicit opiate markets: Proxyvon and OxyContin should be looked at to re-think the merits of simplistic supply-side interventions and deadline thinking around the 'elimination' of the traditional opium/heroin market. At the same time, the discussion about the well-intended arguments of the 1960s lying behind the '80:20 rule' and the privileged position of a limited number of 'traditional' opium cultivating countries in the licit opiates market should be re-opened in view of subsequent developments. Possibilities for countries like Afghanistan and Burma to acquire a place in the expanding market of licit opiates should be discussed openly in the context of considered attempts to reduce their role in the illicit market.

Copyright 2005, Elsevier Science

Kuo I; Strathdee SA . After the flowers are gone...what happens next? International Journal of Drug Policy 16(2): 112-114, 2005. (20 refs.)

This is a response to the article by Farrell and Thorne in this issue on the Taliban and opium poppy cultivation in Afghanistan. We agree with the authors that while the Taliban's opium ban appears to have been primarily responsible for the dramatic drop in heroin production, the oppressive policies the Taliban used to enforce its opium ban cannot be endorsed. In fact, few regimes have inflicted such abhorrent drug control measures. One of us witnessed first-hand the distorted limbs of young Afghan boys who had their hands broken and tied in grotesque positions as punishment for their drug use. In an evaluation of the effect of law enforcement on the heroin market in Australia, Weatherburn and Lind found that heroin interdiction seemed to have no significant effect on heroin price or perceived availability, rates of crime, or entry into methadone maintenance treatment. Other studies conducted in Australia where a well-documented heroin drought occurred in early 2001 revealed that while heroin prices did increase significantly, a large proportion of heroin injectors did not stop injecting drugs but merely switched to the injection of cocaine and methamphetamine, which were more readily available. On the other hand, a few positive aspects of the heroin drought in Australia were observed. Day and Topp found that the number of needles exchanged during the period of the heroin drought dropped significantly, suggesting that some injection drug users gave up injecting altogether. A decrease in heroin overdoses was also detected within that time period. Another serious consequence of changes in the drug supply is the transition of non-injection drug users to injection drug use. A classic example of this situation occurred in Southeast Asia and Hong Kong in the 1960s and 1970s. Many opium smokers began injecting heroin because it was perceived as being more cost-effective. A similar situation occurred in Madras, India whereby transitions from heroin smoking ("chasing the dragon") to injection of pharmaceutical drugs (e.g., buprenorphine) was facilitated in part by the scarcity of heroin. In light of these observations, the Taliban's vigorous suppression of opium production in Afghanistan may not have led to dramatic reductions in drug use. Although studies are lacking to document the extent of injection and non-injection heroin use in Afghanistan, there are reportedly several hundred heroin users in Kabul (personal communication, Dr. Naqibullah Safi, 2004). An indirect consequence of a supply reduction approach is that most governments readily adopt such strategies at the expense of interventions aimed at demand reduction. Though several scholars have argued that a supply control approach is costly and has limited effectiveness, it remains the main focus of global drug policies. One may contend that supply reduction has its place in the war on drugs; however, we believe that a failure to support harm reduction programmes can lead to disastrous health consequences for drug users and the communities in which they live.

Copyright 2005, Elsevier Science

Labrousse A. The Farc and the Taliban's connection to drugs. Journal of Drug Issues 35(1): 169-184, 2005. (20 refs.)

The author explores the drug links maintained by a Marxist guerrilla and a fundamentalist Islamic group (chosing these because they are greatly dissimilar) and the resulting consequences. The conclusion is that beyond the manifest differences deriving from geographical, political, and ideological contexts, a number of similarities exist between the Taliban and the FARC's relationship to drug production and trafficking. While both movements have denied any direct involvement with trafficking, each undoubtedly benefited substantially from the processing and trading of illicit products. In fact, the gradually deepening involvement at increasingly advanced stages appears inevitable, once it has been accepted that profits are being obtained through illicit cultivation, the first stage in the chain of drug production. Indeed, it would be both illogical and unfair for armed movements to halt their involvement at this stage. Illogical because without buyers and without chemical processing, the peasants' production would offer no economic incentive; unfair because only the peasants, rather than the traders and the drug traffickers who make the most profits, would pay a tax to the armed groups. Perhaps the leaders of the FARC and the Taliban have followed this logic in the belief that those struggling for a transformation of society should be the ones to administer this industry rather than others who are mere profiteers. To answer the question that prompted this discussion, one can estimate that the FARC and the Taliban serve as examples illustrating the inevitable relationship that develops between "ideological" armed movements lacking any real financial assets and the drug trade. Validating this assertion would be difficult because of the very limited number of countries that combine armed struggle with the existence of illicit cultivation on any important scale.(n5) In at least two cases, however, the links between armed groups and drugs have been similar to the one found in the case of the FARC: the communist party in Myanmar (PCB) and heroin until 1989 (Litner, 1994) and the Shinning Path in Peru until 1993 (Labrousse, 1996). Currently in Myanmar, the groups linked to drugs are led by mere warlords and have no ideological motivation, even though they sometimes invoke aspirations to a national identity, as in the case of Khun Sa (Labrousse, 2004). The only exception is the Kachin organization (KIO), which attempts to preserve the autonomy of a part of its state, even though it has entered into some agreements with the Burmese government. However, during the last 10 years, it has drastically limited opium production in the areas under its control.(n6) In many other cases (African countries, the Philippines, Nepal) where cannabis is the only drug produced, guerrillas make agreements with the peasants, and possibly with the buyers of marijuana, but not with true criminal organizations. The assertion that a possible generalization can be made regarding the inevitability of a relationship between a politico-military organization and the chain of drug production is not, at present, validated by many examples. However, it can be applied to groups as different as the Islamic Taliban on the one hand, and to Marxist organizations such as the FARC on the other.

Copyright 2005, Journal of Drug Issues, Inc. Used with permission

Larance B; Ambekar A; Azim T; Murthy P; Panda S; Degenhardt L et al. The availability, diversion and injection of pharmaceutical opioids in South Asia. Drug and Alcohol Review 30(3): 246- 254, 2011. (96 refs.)

Aims. To provide an overview of the availability of pharmaceutical opioids and the evidence on the extent of diversion and injection in South Asia. Methods. This paper reviews existing peer-reviewed and 'grey' literature on the extramedical use and injection of pharmaceutical opioids in Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka. Results. Reports indicate that prescribing for all types of pain is inadequate. There is a paucity of empirical data across South Asia regarding the mechanisms and extent of the diversion and misuse of pharmaceutical opioids, although the problem is widely acknowledged. India is believed to account for significant large-scale diversion within the region and further afield through poor regulation of licit opioid production and pharmacies. A recent decline in use of natural opiates has been accompanied by an increase in pharmaceutical opioid misuse and increasingly, injection, particularly in Bangladesh, India, Nepal and Pakistan. The medications are typically buprenorphine preparations and/or other lower potency opioids, such as codeine, nalbuphine and dextropropoxyphene. Opioid substitution treatment and needle-syringe programs are available in some countries, but better coverage is needed. Studies identify a lack of comprehensive knowledge regarding HIV and high prevalence of risk behaviours among at-risk populations in the region. Conclusions. It is imperative for the region to rapidly facilitate access to opioids for the treatment of pain and opioid dependence, ensuring effective systems that maintain quality care, regulate and monitor retail pharmacies, and minimise diversion. Prevention of HIV among people who inject pharmaceutical opioids is essential.

Copyright 2011, Wiley-Blackwell

Macdonald D. Drugs in Afghanistan: Opium, Outlaws and Scorpion Tales. London: Pluto Press, 2007

Afghanistan's poppy fields produce more heroin than all other countries combined. Most accounts of the drugs trade concentrate on the impact of trafficking on the West. Yet the truth is that drug addiction is also a problem within Afghanistan. This book explores the devastating impact that the drugs trade has had on the Afghan people. The author was a drug advisor to the UN and the Ministry of Counter Narcotics in Afghanistan for several years. This book separates the facts from the myths surrounding the cultivation, production and consumption of drugs, providing a detailed analysis of the history of drug use within the country, and examines the impact of over 25 years of continuous war and conflict, showing how continuing poverty and instability has led to an increase in drug consumption. He considers the recent rise in the use of pharmaceutical drugs, resulting in dangerous chemical cocktails. The author also analyses the effect of Afghanistan's drug trade on neighbouring countries.

Copyright 2008, Project Cork

Macdonald D. Blooming flowers and false prophets: The dynamics of opium cultivation and production in Afghanistan under the Taliban. International Journal of Drug Policy 16(2): 93-97, 2005. (20 refs.)

In Afghanistan reliable research data have been replaced by what amounts to little more than anecdotes. According to UNODC, in 2002 there were 74,000 ha planted with poppy (UNODC, 2002) while for the same year the US claimed there were only 30,750 ha (US Department of State, 2003), less than 50% of the UNODC figure. This also meant, according to US figures, cultivation had doubled by 2003 as their estimate for that year was 61,000 ha. At best, statistics on opium cultivation and production in Afghanistan serve as crude indicators of the ground realities. One continuing problem is the tendency for politicians to seek 'quick fix' solutions to complex social problems, for journalists to seek fast and easy soundbites to sell stories, and for commentators to focus on the "success" of the Taliban ban in eradicating poppy cultivation in 2001 while ignoring the complex historical, political and socio-economic motivations and dynamics that led up to it in the first place. Success of Taliban: Apart from being based on a suspect definition of what constitutes acceptable legal standards and their legitimate enforcement, the contention that the Taliban ban was "the most effective drug control enforcement action of modern times" somewhat misses the point. It should not be the role of law enforcement to focus on the eradication of poppy fields, its main role should be to focus on trafficking and drug processing. But the scale of the problem in Afghanistan is so great that neither the general police nor the Counter Narcotics Police (CNPA) is able to carry out eradication, so currently the work is to be carried out by a new paramilitary Central Poppy Eradication Force. The history of opium cultivation and illicit drug production from 1994 to 2001 saw a radical shift in Taliban policy from initial tolerance, if not encouragement, of farmers to cultivate poppy, resulting in a steady overall increase in cultivation and production levels up to 2000, as well as direct profit to the Taliban from the drug trade. The Taliban always had an ambivalent attitude towards drugs, probably born out of their need for hard cash. The ban and its temporary nature, then, can reasonably be interpreted as a deliberate strategy on the part of influential members of the Taliban to profit from existing stockpiles and/or to offload stockpiles that had been building up over previous years. Little more than a year after the total ban, announced that the ban had been lifted by the Taliban. This points to why the total ban of 2000 was initiated by the Taliban in the knowledge that it could be no more than a temporary unsustainable measure and why its enforcement is of little significance for any future drug control strategy in Afghanistan, except to serve as a negative example, or as Farrell and Thorne themselves say, "a theoretical limiting case" (Farrell & Thorne, 2004, p. 11). The main consequence of the ban, apart from producing large profits for the Taliban, was to increase the debt burden of many Afghan farmers who had been permitted by the Taliban to grow opium unimpeded over the previous years. If the Taliban had continued with the ban they would have run the risk of a revolt from the many farmers who were left more debt-ridden because of the ban.

Copyright 2005, Elsevier Science

Maguet O; Majeed M. Implementing harm reduction for heroin users in Afghanistan, the worldwide opium supplier. (editorial). International Journal of Drug Policy 21(2, Special Issue): 119-121, 2010. (12 refs.)

Afghanistan has suffered decades of war, occupation and unrest. It is also the world's greatest producer of opium and drug production and trafficking account for a third of the total Afghan economy. Currently alongside the "War on Terrorism", the control and eradication of opium production and related trafficking is a main concern of the international community. However, this focus on supply reduction has meant scant attention has been paid to increasing drug use problems within the country; it is estimated there are up to 25,000 opium users and 20,000 heroin users in Kabul city. Drug use is often a response to war, poverty and under-development, however, street opium and heroin manufactured in the country are widely available, affordable and of high purity. This paper documents the efforts of non-governmental organisations to promote and develop harm reduction and treatment services for problem drug users in Afghanistan in this difficult context.

Copyright 2010, Elsevier Science

McCoy AW. The stimulus of prohibition: A critical history of the global narcotics trade. IN: Steinberg MK; Hobbs JJ; Mathewson K, eds. Dangerous Harvest: Drug Plants and the Transformation of Indigenous Landscapes. New York: Oxford University Press, 2004. pp. 24-114. (350 refs.)

This chapter provides a critical review of the history of drug prohibition efforts. Prohibition has been the major single effort to address drug problems. It briefly reviews the efforts at drug control going back to the early 1900s. The major focus is upon the efforts by the United Nations and United States over the last three decades of the 20th century. The author makes the case that the very efforts to legally prohibit drug use, have the opposite effect or stimulating drug availability. This is related to a number of factors. For one, the size of the drug market is such that it is a critical commody for many countries. Also, the demand for drugs remains relatively constant, whatever the supply. If governments are successful in eradicating drug production in a particular area, given the ease of growing poppy or coca, production simply moves elsewhere. The illegal status of drugs, creates an underground economic structure that is willing/able to corrupt govenment officials at many levels in the country where the drug is produced. The situation in Laos and Afghanistan are examined. The failure of the US government to pay indigenous people to grow alternative crops is described, as well as the unintended impact of not considering the role of drug production when intervening in developing countries.

Copyright 2007, Project Cork

Mullen RD. Afghanistan in 2008. State building at the precipice. Asian Survey 49(1): 28-38, 2009. (23 refs.)

The state-building endeavor in Afghanistan came to the brink in 2008 with the Taliban insurgency taking control of some southern districts, high poppy production fueling the illicit economy, widespread charges of corruption, and a looming humanitarian disaster. Afghans increasingly became disillusioned by high civilian casualties and the government's failure to provide improved socioeconomic conditions. By year's end, there was also increased pressure for negotiations with moderate Taliban elements.

Copyright 2009, University of California Press

Nasir A; Todd CS; Stanekzai MR; Bautista CT; Botros BA; Scott PT et al. Implications of hepatitis C viremia vs. antibody alone on transmission among male injecting drug users in three Afghan cities. International Journal of Infectious Diseases 15(3): E201-E205, 2011. (33 refs.)

Objectives: To assess differences between injecting drug users (IDUs) with hepatitis C virus (HCV) viremia and IDUs with HCV antibody (Ab) or no evidence of prior infection in three Afghan cities. Methods: IDUs in Hirat, Jalalabad, and Mazar-i-Sharif completed questionnaires and rapid testing for blood-borne infections including HCV Ab. HCV Ab was confirmed with a recombinant immunoblot assay (RIBA); RIBA-positive specimens underwent reverse transcriptase polymerase chain reaction (RT-PCR) for HCV. Risk behaviors associated with viremia were assessed with site-controlled ordinal regression analysis. Results: Of 609 participants, 223 (36.6%) had confirmed HCV Ab. Of 221 with serum available for PCR evaluation, 127 (57.5%) were viremic. HCV viremia prevalence did not differ by site (range 41.7-59.1%; p = 0.52). Among all IDUs, in age and site-controlled ordinal regression analysis, HCV was independently associated with HIV co-infection (adjusted odds ratio (AOR) 7.16, 95% confidence interval (CI) 4.41-11.64), prior addiction treatment (AOR 1.95, 95% CI 1.57-2.42), ever aspirating and re-injecting blood (AOR 1.62, 95% CI 1.18-2.23), prior incarceration (AOR 1.60, 95% CI 1.04-2.45), and sharing injecting equipment in the last 6 months (AOR 1.35, 95% CI 1.02-1.80). Conclusion: HCV viremia was present in many participants with prior HCV infection and was associated with some injecting risk behaviors, indicating a substantial risk for transmission. Current harm reduction programs should aim to improve HCV awareness and prevention among IDUs in Afghanistan as a matter of urgency.

Copyright 2011, Elsevier Science

Todd C; Abed A; Scott P; Safi N; Earhart K; Strathdee S. A cross-sectional assessment of utilization of addiction treatment among injection drug users in Kabul, Afghanistan. Substance Use & Misuse 44(3): 416-430, 2009. (34 refs.)

The purpose of this study was to describe prior use of detoxification and addiction-treatment programs among injection drug users (IDUs) in Kabul, Afghanistan. From 2005-2006, IDUs (n = 464) recruited into this cross-sectional study completed an interviewer-administered questionnaire and whole blood rapid testing with fingerstick samples for HIV, syphilis, and hepatitis C antibody and B surface antigen testing. Participants were predominantly male (99.8%), Afghan (98.9%), and had little formal education. Correlates of detoxification and addiction treatment were identified with logistic regression. The majority (94.0%, n = 435) felt great/urgent need for treatment, of whom 56.3% (n = 245) reported inability to access treatment. Prior detoxification was associated with new needle use with each injection (AOR = 1.91, 95% CI: 1.12-3.26) and prior incarceration (AOR = 1.81, 95% CI: 1.04-3.13). The study's limitations are noted. Rapid scale-up and subsidy of needle and syringe programs and opioid agonist treatment is urgently needed in Kabul.

Copyright 2009, Taylor & Francis

Todd CS; Abed AMS; Scott PT; Botros BA; Safi N; Earhart KC et al. Correlates of receptive and distributive needle sharing among injection drug users in Kabul, Afghanistan. American Journal of Drug and Alcohol Abuse 34(1): 91-100, 2008. (25 refs.)

We describe receptive and distributive needle/syringe sharing among injection drug users (IDUs) in Kabul, Afghanistan. In this cross-sectional study, IDUs completed an interviewer-administered questionnaire. Logistic regression identified correlates of needle sharing in the last six months. Receptive and distributive sharing in the last six months were reported by 28.2% and 28.7% of participants, respectively, and were both independently associated with reported difficulty obtaining new syringes (Receptive sharing: AOR=2.60, 95% CI: 1.66-4.06; Distributive: AOR=1.56, 95% CI: 1.02-2.39). Receptive and distributive sharing are common among IDU in Kabul; scaling up availability of sterile, no-cost injecting equipment is urgently needed.

Copyright 2008, Taylor & Francis

Todd CS; Nasir A; Stanekzai MR; Fiekert K; Rasuli MZ; Vlahov, D. et al. Prevalence and correlates of HIV, syphilis, and hepatitis B and C infection and harm reduction program use among male injecting drug users in Kabul, Afghanistan: A cross-sectional assessment. Harm Reduction Journal 8: article 22, 2011. (31 refs.)

Background: A nascent HIV epidemic and high prevalence of risky drug practices were detected among injecting drug users (IDUs) in Kabul, Afghanistan from 2005-2006. We assessed prevalence of HIV, hepatitis C virus (HCV), hepatitis B surface antigen (HBsAg), syphilis, and needle and syringe program (NSP) use among this population. Methods: IDUs were recruited between June, 2007 and March, 2009 and completed questionnaires and rapid testing for HIV, HCV, HBsAg, and syphilis; positive samples received confirmatory testing. Logistic regression was used to identify correlates of HIV, HCV, and current NSP use. Results: Of 483 participants, all were male and median age, age at first injection, and duration of injection were 28, 24, and 2.0 years, respectively. One-fifth (23.0%) had initiated injecting within the last year. Reported risky injecting practices included ever sharing needles/syringes (16.9%) or other injecting equipment (38.4%). Prevalence of HIV, HCV Ab, HBSAg, and syphilis was 2.1% (95% CI: 1.0-3.8), 36.1% (95% CI: 31.8-40.4), 4.6% (95% CI: 2.9-6.9), and 1.2% (95% CI: 0.5-2.7), respectively. HIV and HCV infection were both independently associated with sharing needles/syringes (AOR = 5.96, 95% CI: 1.58-22.38 and AOR = 2.33, 95% CI: 1.38-3.95, respectively). Approximately half (53.8%) of the participants were using NSP services at time of enrollment and 51.3% reported receiving syringes from NSPs in the last three months. Current NSP use was associated with initiating drug use with injecting (AOR = 2.58, 95% CI: 1.22-5.44), sharing injecting equipment in the last three months (AOR = 1.79, 95% CI: 1.16-2.77), prior incarceration (AOR = 1.57, 95% CI: 1.06-2.32), and greater daily frequency of injecting (AOR = 1.40 injections daily, 95% CI: 1.08-1.82). Conclusions: HIV and HCV prevalence appear stable among Kabul IDUs, though the substantial number having recently initiated injecting raises concern that transmission risk may increase over time. Harm reduction programming appears to be reaching high-risk drug user populations; however, monitoring is warranted to determine efficacy of prevention programming in this dynamic environment.

Copyright 2011, BioMed Central

Todd CS; Safi N; Strathdee SA. Drug use and harm reduction in Afghanistan. Harm Reduction Journal 2: e-article 13, 2005. (46 refs.)

Opium has been cultivated in Afghanistan since 1100 A.D., although production has steadily increased since 1979. Currently, Afghanistan produces three-quarters of the global opium supply, with injection drug use and HIV currently following the opium trade route through Central Asia. Although systematic studies are lacking, heroin use appears to be on the rise in Afghanistan. The purpose of this paper is to briefly provide historical background and current statistics for drug production and use in Afghanistan, to discuss the new government's policies towards problem drug use and available rehabilitation programs, and to assess Afghan harm reduction needs with consideration of regional trends.

Copyright 2005, Biomed Central

Todd CS; Stibich MA; Stanekzai MR; Rasuli MZ; Bayan S; Wardak SR et al. A qualitative assessment of injection drug use and harm reduction programmes in Kabul, Afghanistan: 2006-2007. International Journal of Drug Policy 20(2): 111-120, 2009. (21 refs.)

Background: The purpose of this paper was to examine the context of injection drug use in Kabul, Afghanistan among injection drug users (IDUs) utilising and not utilising needle and syringe programmes (NSPs). Methods: Following identification of themes from eight focus group discussions, free-lists were used for further exploration with both NSP using (n = 30) and non-NSP using (n = 31) IDUs. Results All participants were male, had been injecting for 5 years (mean), and most (95%) had been refugees in the past decade. Main reasons for sharing syringes were convenience and lack of availability and did not vary based on NSP use, Drug users perceived alienation from the community, evidenced by names used for drug users by the community which convey social stigma and moral judgment. Health risks were the principal stated risk associated with drug use, which was mentioned more frequently by NSP users. Harm reduction services available in Kabul are perceived to be insufficient for those in need of services, resulting in under utilisation. The limited scope and distribution of services was frequently cited both as an area for improvement among NSP using IDU or as a reason not to use existing programmes. Conclusions: While some positive differences emerged among NSP-using IDU, the current context indicates that both rapid scale-up and increased variety of services, particularly in the realm of addiction treatment, are urgently needed in this setting.

Copyright 2009, Elsevier Science

Trace M . The Taliban and opium cultivation in Afghanistan. International Journal of Drug Policy 16(2): 79-80, 2005. (6 refs.)

This is a response to the article in this issue by Farrell and Thorne on the Taliban and poppy cultivation in Afghanistan. To understand the real lessons from this episode, we need to address four questions -- was the eradication real and effective; if so, how was it achieved; what was the immediate impact; and what has happened since? Was it real? The clear answer from Farrell and Thorne is yes. They describe a 99% reduction in the area of poppy cultivation in Taliban controlled areas between 1999 and 200. Also as Macdonald (2005) points out, seemingly authoritative estimates of poppy cultivation come up with widely diverging figures --the UN and US estimates for hectares under cultivation in Afghanistan during this period paint significantly different pictures. How was it achieved? Farrell and Thorne postulate that the key factors were the clear statement banning opium cultivation (fatwa) that emerged from the country's religious leader at the time, and the swift and draconian punishments meted out to those found to be contravening the fatwa. Disagreements emerge, however, when we try to assess the lessons for eradication efforts elsewhere. Adelekan (2005), while acknowledging the unacceptability of many of the methods employed by the shuras, rightly points out the importance of widespread community acceptance of the policy of eradication, and the need to avoid corruption of those charged with implementation. These seem to be factors that have been notably absent in efforts to tackle cultivation in other areas -- for example Colombia. Too it is hard to avoid the conclusion that the extreme and sometimes arbitrary nature of the punishments under the Taliban regime were the principal factor in gaining the compliance of peasant farmers. What was the impact? The most immediate, and significant impact was, as Jelsma (2005) testifies, on the peasant opium growers themselves. Within a year, a traditional and culturally embedded source of income (and, critically, security for credit) was removed from tens of thousands of families with, as one would expect in one of the poorest countries in the world, lasting damage to economic activity and community cohesion. The question that needs to be asked is -- was it worth it? Many would argue that, even if the result of this social upheaval in a poor country created a heroin shortage in rich countries, the price in terms of the suffering in Afghanistan was too high to pay. There is conflicting data regarding prices in Iran and Turkey, but very little evidence of an impact on price and availability in Europe. There are some indications that traffickers offset the higher wholesale prices by reducing the purity of the product on sale, but apart from this, the pattern of Heroin use in Europe remained essentially unchanged. What has happened since? We now know that the reduction in cultivation of opium in Afghanistan in 2000/2001 was not maintained. It would seem that market factors, and the realities of life in poor agricultural economies, have prevailed. Serious questions have therefore to be asked about the wisdom of pouring so much political and financial resource into a programme that disrupts the livelihood of some of the poorest people on earth, while creating so little benefit to others.

Copyright 2005, Elsevier Science

United Nations Office on Drugs and Crime (UNODC), Kabal. Afghanistan Opium Survey 2007. Executive Summary. Vienna Austria: United National Office on Drugs and Crime, 2007. (0 refs.)

The Foreward to this Summary notes that in 2007 Afghanistan cultivated 17% more hectares of opium, an incrase of 17% over the prior year. The favorable weather conditions allowed production of 34% greater tons of opium in the prior year, making the country the exclusive supplier of the world's heroin, 93% of the global market. Regional differences in production are highligted. The nature of the drug trade is also described and its association with insurgency. Charts and tables are used to present the data.

Copyright 2008, Project Cork

United Nations Office on Drugs and Crime (UNODC). Afghanistan: Opium Assessment 2003. Vienna: United Nations Office on Drugs and Crime, 2003. (17 refs.)

During the second half the 1990s Afghanistan became the world's largest source of illicit opium and its derivative, heroin. In recent years the country has produced more than 3,000 metric tons of opium annually (over 2/3 of the world's production.) In 2001, following the ban imposed by the former Taliban regime, an abrupt decline of illicit opium cultivation interrupted a two-decade increase. It also stimulated a subsequent 10-fold increase in opium prices. After the fall of that regime, cultivation resumed at a level in 2002 and started to spread outside the traditional areas. A new ban in 2002 has had poor compliance. This report provides data on estimates of cultivation, yield, potential opium production, opium prices, farmers, and the potential value of opium derived income. A fact sheet summarizes this data. Among the findings is that in 2003, the income of Afghan opium farmers and traffickers was about $2.3 billion, an amount equivalent to half the legitimate gross national product of the county.

Copyright 2004, Project Cork

United Nations Office on Drugs and Crime (UNODC). Afghanistan. Farmers' Intentions Survey 2003/2004. Vienna: United Nations Office on Drugs and Crime, 2004. (0 refs.)

This report shows that the opium production problem will continue to present challenges to the Afghan government. Two farmers out of three interviewed, shortly before planting time, stated they intended to increase significantly their opium poppy cultivation in 2004. This was the case through out the country, with the availbility of land often appearing to be the only limiting fact. Persistent poverty, high opium prices and access to credit through traffickers (by advance sale of the future harvest) are the main reasons for continuing opium production. The report includes three section: (1) intended changes in opium poppy cultivation and villages involved in poppy production; (2) factors influencing intended changes in 2004, the reasons for or for not cultivating poppies; awareness of the opium poppy ban, anticipated changes in cultivation and land area under cultivation; the income generated in comparison to wheat; and sources of poppy seed. Data is summarized in 40 tables.

Copyright 2004, Project Cork

United Nations Office on Drugs and Crime; Afghan Transition Government, Counter Narcotics Directorate. Afghanistan Opium Survey 2004. Vienna Austria: United National Office on Drugs and Crime, 2004. (0 refs.)

The Preface to this report notes that in 2004, opium cultivation in Afghanistan increased by two-thirds. It was only bad weather and disease that prevented the yield from being a bumper crop. The yield was only 17% above the prior year's production, approximately 4,200 tons, with a value of $2.8 billion, and representing about 60% of Afghanistan's gross domestic product. Afghan poppy represents an estimated 87% of the global yield. The economics of poppy production are highlighted, with opium clearly more profitable than other crops. Data is presented in detail by province. The report is organized into two major sections. The first sets forth the findings in terms of production levels, prices, characteristics of farmers, income to farmers and income to country, and possible approaches to eradication. The second section describes the methodology employed.

Copyright 2005, Project Cork

United Nations Office on Drugs and Crime; Macdonald D. An Assessment of Problem Drug Use in Kabul City. Community Drug Profile #5. Vienna: United Nations Office on Drugs and Crime, 2003. (0 refs.)

Between 1998 and 2001, from a base in Pakistan, the UNDCP developed a drug control strategy and program of development assistance that included drug control monitoring, poppy crop reduction and demand reduction (including drug prevention, treatment, rehabilitation, and social reintegration.) The Community Drug Profile Series provides assessments of specific drug probems and at-risk groups within Afghan comminities. This report focuses on Kabul. This report provides estimates of drug use in the population, the nature and patterns of use, the problems associated with use, and the treatment provided in the city's treatment facility. The following drugs are discussed individually: opium; heroin; hashish; and pharmaceutical agents. The data in this report are derived from various sources -- health care providers , police estimates, treatment programs, as well as interviews with key informants. The patterns of use are described, and cultural factors which influence use, e.g. such as injection is less likely than is smoking to draw attention to the user and is thus sometimes preferred.

Copyright 2004, Project Cork