GLOBAL OVERVIEW: DRUG DEMAND DRUG SUPPLY © United Nations, June 2021. All rights reserved worldwide. ISBN: 9789211483611 eISBN: 9789210058032 United Nations publication, Sales No. E.21.XI.8 This publication may be reproduced in whole or in part and in any form for educational or non-profit purposes without special permission from the copyright holder, provided acknowledgement of the source is made. The United Nations Office on Drugs and Crime (UNODC) would appreciate receiving a copy of any publication that uses this publication as a source. Suggested citation: World Drug Report 2021 (United Nations publication, Sales No. E.21.XI.8). No use of this publication may be made for resale or any other commercial purpose whatsoever without prior permission in writing from UNODC. Applications for such permission, with a statement of purpose and intent of the reproduction, should be addressed to the Research and Trend Analysis Branch of UNODC. DISCLAIMER The content of this publication does not necessarily reflect the views or policies of UNODC or contributory organizations, nor does it imply any endorsement. Comments on the report are welcome and can be sent to: Division for Policy Analysis and Public Affairs United Nations Office on Drugs and Crime PO Box 500 1400 Vienna Austria Tel: (+43) 1 26060 0 Fax: (+43) 1 26060 5827 E-mail: [email protected] Website: www.unodc.org/unodc/en/data-and-analysis/wdr2021.html PREFACE 2 Drugs cost lives. unemployment and inequalities, as the world lost 114 million e c In an age when the speed of information can often outstrip the jobs in 2020. In doing, so it has created conditions that leave efa more people susceptible to drug use and to engaging in illicit r speed of verification, the COVID-19 pandemic has taught us P that it is crucial to cut through the noise and focus on facts, a crop cultivation. W | lesson that we must heed in order to protect societies from the Furthermore, disparities in access to essential controlled VIE impact of drugs. medicines around the world continue to deny relief to patients R E in severe pain. In 2019, four standard doses of controlled pain V Drug use killed almost half a million people in 2019, while drug O use disorders resulted in 18 million years of healthy life lost, medication were available every day for every one million L inhabitants in West and Central Africa, in comparison to 32,000 A mostly due to opioids. Serious and often lethal illnesses are B doses in North America. O more common among drug users, particularly those who inject L G drugs, many of whom are living with HIV and Hepatitis C. In parallel, drug traffickers have quickly recovered from the initial setback caused by lockdown restrictions and are operating The illicit drug trade also continues to hold back economic and at pre-pandemic levels once again. Access to drugs has also social development, while disproportionately impacting the become simpler than ever with online sales, and major drug most vulnerable and marginalized, and it constitutes a markets on the dark web are now worth some $315 million fundamental threat to security and stability in some parts of annually. Contactless drug transactions, such as through the the world. mail, are also on the rise, a trend possibly accelerated by the Despite the proven dangers, drug use persists and, in some pandemic. contexts, proliferates. Over the past year, around 275 million Communicating facts about drugs and promoting science-based people have used drugs, up by 22 per cent from 2010. By 2030, interventions is an absolute necessity if we are to reduce demographic factors project the number of people using drugs demand and supply of drugs, while also facilitating access to to rise by 11 per cent around the world, and as much as 40 per controlled medicines for those in need. It is also the surest path cent in Africa alone. to eliminating stigmatization and discrimination and providing There is often a substantial disconnect between real risks and adequate treatment, as seven in eight people who suffer from public perception. In some parts of the world for example, drug use disorders remain without appropriate care. cannabis products have almost quadrupled in potency, and yet At the UN Office on Drugs and Crime we are dedicated to the percentage of adolescents who perceive cannabis as harmful pursuing and promoting fact-driven, human rights-based has dropped by as much as 40 per cent, despite the evidence approaches to drug control and treatment. linking regular use to health problems, particularly in young people, and despite the correlation between potency and harm. I am proud to present to you this World Drug Report, which embodies our commitment to raising awareness and combating New psychoactive substances also continue to be a challenge, misinformation. as markets witness the introduction of new drugs that are unpredictable and poorly understood. Regulatory and legislative It is my hope that this report will inform policymakers, steps have been successful in stemming the tide globally, but practitioners, and the general public on the facts of the world in low-income countries the problem is on the rise; between drug problem, and provide them with a powerful tool to share 2015 and 2019, South and Central America recorded a fivefold evidence and information, and in doing so help save and rise in the amount of new synthetic psychoactive substances preserve lives. seized, while seizures in Africa increased from minor to substantial amounts. Strong increases were also reported in South and Southwest Asia as well as the Near and Middle East. Meanwhile, the COVID-19 crisis has pushed more than 100 Ghada Waly, Executive Director million people into extreme poverty, and has greatly exacerbated United Nations Office on Drugs and Crime 3 WORLD DRUG REPORT 2021 T E L EXECUTIVE SUMMARY K O POLICY IMPLICATIONS O B T E L GLOBAL OVERVIEW OF DRUG DEMAND K O AND DRUG SUPPLY O B T E L DRUG MARKET TRENDS: K O CANNABIS, OPIOIDS O B T E L DRUG MARKET TRENDS: K O COCAINE, AMPHETAMINE-TYPE STIMULANTS O B T E L COVID-19 AND DRUGS: K O IMPACT AND OUTLOOK O B CONTENTS 2 PREFACE 3 ts n e EXPLANATORY NOTES 7 nt o C SCOPE OF THE BOOKLET 9 W | E DRUG DEMAND 11 VI R E Looking towards 2030: how will demographic changes impact drug use? 11 V O Impact of drug use on the health of the user and on public health 19 L A B Extent of drug use 19 O L Health consequences of drug use 32 G DRUG SUPPLY 51 Drug production and trafficking 51 Drug trafficking over the Internet 65 Drug trafficking over the clear web: the example of substances supplying synthetic drugs markets 66 Drug trafficking over the dark web 75 ANNEX 91 GLOSSARY 105 REGIONAL GROUPINGS 107 5 Acknowledgements 21 20 The World Drug Report 2021 was prepared by the Research and Trend Analysis Branch, Division for Policy Analysis RT and Public Affairs, United Nations Office on Drugs and Crime (UNODC), under the supervision of Jean-Luc Lemahieu, O Director of the Division, and Angela Me, Chief of the Research and Trend Analysis Branch, and the coordination of P E Chloé Carpentier, Chief of the Drug Research Section. R G U R Content overview Data management and Editing D D Chloé Carpentier estimate production Jonathan Gibbons L Angela Me Monika Barratt (RMIT University) R O Enrico Bisogno Graphic design and production W Analysis and drafting Diana Camerini Anja Korenblik Nicole Cook Conor Crean Suzanne Kunnen Philip Davis Hernan Epstein Kristina Kuttnig Michael Lohmuller Natalia Ivanova Maria Moser Kamran Niaz Sabrina Levissianos Lorenz Perszyk Thomas Pietschmann Virginia Macdonald (WHO) Barbara Remberg (INCB Secretariat) Bradley Mathers (WHO) Administrative support Andrada-Maria Filip Andrea Oterová Iulia Lazar Martin Raithelhuber Umidjon Rakhmonberdiev Francesca Rosa Ali Saadeddin Keith Sabin (UNAIDS) Tun Nay Soe Review and comments The World Drug Report 2021 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 Afarin Rahimi-Movaghar Paul Griffiths Peter Reuter Marya Hynes Alison Ritter Vicknasingam B. Kasinather Francisco Thoumi Charles Parry The analysis on the global situation on hepatitis C in Booklet 2 benefited from a contribution from the Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes of WHO. The analysis on purchases of drugs on the dark web in Booklet 2 is based on original data graciously shared by the 6 Global Drug Survey team. EXPLANATORY NOTES 2 The designations employed and the presentation of the The following abbreviations have been used in the s e material in the World Drug Report do not imply the present booklet: ot n expression of any opinion whatsoever on the part of the y Secretariat of the United Nations concerning the legal ASEAN Association of Southeast Asian Nations or t status of any country, territory, city or area, or of its na ATS amphetamine-type stimulants a authorities, or concerning the delimitation of its frontiers pl or boundaries. CBD cannabidiol Ex W | Countries and areas are referred to by the names that COVID-19 coronavirus disease E were in official use at the time the relevant data were VI DALYs disability-adjusted life years R collected. E V DMT dimethyltryptamine O Since there is some scientific and legal ambiguity about L the distinctions between “drug use”, “drug misuse” and Δ-9-THC delta-9-tetrahydrocannabinol BA O “drug abuse”, the neutral term “drug use” is used in the EMCDDA European Monitoring Centre for Drugs L G World Drug Report. The term “misuse” is used only to and Drug Addiction denote the non-medical use of prescription drugs. Europol European Union Agency for All uses of the word “drug” and the term “drug use” in Law Enforcement Cooperation the World Drug Report refer to substances controlled GBL gamma-butyrolactone under the international drug control conventions, and their non-medical use. GHB gamma-hydroxybutyric acid All analysis contained in the World Drug Report is based INCB International Narcotics Control Board on the official data submitted by Member States to the LSD lysergic acid diethylamide UNODC through the annual report questionnaire unless indicated otherwise. MDMA 3,4-methylenedioxymetamphetamine The data on population used in the World Drug Report MPDV 3,4-methylenedioxypyrovalerone are taken from: World Population Prospects: The 2019 NPS new psychoactive substances Revision (United Nations, Department of Economic and Social Affairs, Population Division). PWID people who inject drugs RMIT Royal Melbourne Institute of Technology References to dollars ($) are to United States dollars, unless otherwise stated. S-DDD defined daily doses for statistical purposes References to tons are to metric tons, unless otherwise UNAIDS Joint United Nations Programme stated. on HIV/AIDS UNDP United Nations Development Programme UNODC United Nations Office on Drugs and Crime WHO World Health Organization 7 SCOPE OF THE BOOKLET 2 Constituting the second part of the World Drug Report On drug supply, the booklet provides an overview of the et 2021, the present booklet contains an overview of the extent of illicit crop cultivation and trends in drug pro- kl o global demand for and supply of drugs. It provides the duction and trafficking, including of NPS, at the global bo latest estimates of and trends in drug use and looks at level. In addition, it reviews the latest evidence regarding e h several cross-cutting issues related to the world drug the supply of drugs and other substances through drug of t problem. Among the issues examined are the extent of markets on the Internet. It includes a chapter dedicated e drug use and its health impact, including trends seen to the sale on the clear web of a number of synthetic op c among people with drug use disorders, drug treatment substances destined for drug markets, and another on S demand, the harms resulting from NPS use, and HIV and trafficking in drugs and NPS on the dark web. W | hepatitis among people who inject drugs. The booklet E VI also features a projection of the impact of population R E growth on drug use by 2030. V O L A INCREASE IN POPULATION AT MOST RISK OF DRUG USE OB IS HIGHEST IN COUNTRIES WITH LOW LEVEL OF INCOME GL 2018 2030 +43% $ Low-income countries $ +10% Middle-income countries $ -1 % High-income countries 9