The Golden Crescent and HIV/AIDS in Central Asia: deadly interactions.

Afghanistan has become the world's largest producer of illicit opiates. Opium and its derivative heroin are widespread substances of use, abuse and dependency in Central Asia. The region is currently undergoing expanding HIV epidemics driven largely by needle sharing among people who use drugs, in contexts where public health interventions to reduce the harms associated with substance use are limited by policy, law and legalistic and repressive approaches to drug users. Evidence-based approaches to drug treatment are lacking or limited in multiple states. Urgent reform is needed. The massive volumes of Afghan's illicit opiate exports are having serious impacts on the health of the region.

The global diversion of pharmaceutical drugs. India: the third largest illicit opium producer?

AIMS: This paper explores India's role in the world illicit opiate market, particularly its role as a producer. India, a major illicit opiate consumer, is also the sole licensed exporter of raw opium: this unique status may be enabling substantial diversion to the illicit market. METHODS: Participant observation and interviews were carried out at eight different sites. Information was also drawn from all standard secondary sources and the analysis of about 180 drug-related criminal proceedings reviewed by Indian High Courts and the Supreme Court from 1985 to 2001. FINDINGS: Diversion from licit opium production takes place on such a large scale that India may be the third largest illicit opium producer after Afghanistan and Burma. With the possible exceptions of 2005 and 2006, 200-300 tons of India's opium may be diverted yearly. After estimating India's opiate consumption on the basis of UN-reported prevalence estimates, we find that diversion from licit production might have satisfied a quarter to more than a third of India's illicit opiate demand to 2004. CONCLUSIONS: India is not only among the world's largest consumer of illicit opiates but also one of the largest illicit opium producers. In contrast to all other illicit producers, India owes the latter distinction not to blatantly illicit cultivation but to diversion from licit cultivation. India's experience suggests the difficulty of preventing substantial leakage, even in a relatively well-governed nation.

Documentation of a heroin manufacturing process in Afghanistan.

The present article documents an authentic process of heroin manufacturing in Afghanistan: white heroin hydrochloride produced using simple equipment and a small quantity of chemicals. The quantities of chemicals actually used corresponded to the minimum needed for manufacturing heroin. The only organic solvent used was acetone, and only a very small quantity of it was used. Because the chemicals used in the demonstration were from actual seizures in Afghanistan, some of the chemicals had been disguised or repackaged by smugglers. Others had been put into labelled containers that proved to be counterfeit, and some glass containers used were not the original containers of the manufacturer displayed on the label. The brown heroin base prepared as an intermediate step in the process shares some of the characteristics of the South-West Asia type of heroin preparations often seized in Germany. The final product of the documented heroin manufacturing process was white heroin hydrochloride, which shares the key characteristics of the white heroin occasionally seized in Germany and other countries in Western Europe since 2000. The present article demonstrates that this kind of heroin can be produced in Afghanistan.

Opium in 20th-century Britain: pharmacists, regulation and the people.

AIMS: To indicate how the system of pharmaceutical regulation of the sale and use of opium in Great Britain continued throughout the first half of the 20th century. DESIGN: An oral history investigation of community pharmacy in Great Britain (n = 50), together with an analysis of standard pharmaceutical texts. SETTING: Community pharmacies in Great Britain during the 20th century. PARTICIPANTS: Retired community pharmacists with experience of the sale and use of opium during the period. MEASUREMENTS: Oral testimony of retired community pharmacists about the use and sale of opium, and quantitative analysis of numbers of official preparations of opium available during the period. FINDINGS: The popular use of opium continued well after the First World War, and its use as an ingredient of prescribed medicines continued well beyond the introduction of the National Health Service in 1948. CONCLUSIONS: Although the role of pharmacy in the regulation of opiates and other drugs was displaced by medicine following the passage of dangerous drugs legislation in the 1920s, pharmacists continued to play an important part in this regulation, exercising considerable discretion in the process.

Dilemmas of Iran's opium maintenance program: an action research for evaluating goal conflicts and policy changes.

Much of evaluative research in the drug abuse field to date has centered on the outcome comparison of different treatment and rehabilitation modalities. Consequently, despite avowed interest in policy research by the students of drug abuse to a great extent and, in part, due to lack of research opportunities, there have not been many action-oriented evaluative policy researches even in the industrially advanced countries. On the other hand, the piecemeal accumulation of information through numerous ad hoc drug-related research activities has signaled the need for more integrated research activities on a comprehensive scale, embracing both the demand and supply dimensions of drug abuse. In the absence of substantive inputs from drug policy research, there is a real danger than the call for comprehensive approaches may once again, by default, neglect the crucial dimension of macro policy. This paper presents the findings of an action research design for evaluation of Iran's opium maintenance program. As such, the paper's primary focus is on the impact of unintended and unanticipated consequences of Iran's opium maintenance program upon treatment and rehabilitation efforts for the drug addicts. The findings here are based on a two-wave study. The first wave was carried out in the early summer of 1976. The major conclusions of the first wave suggested the need for fundamental revisions in both the eligibility requirements for and the the distribution system of opium coupons to those who legally received opium, the registered addicts. The findings of this study convinced the government to initiate a number of changes in the eligibility requirements. In addition, the authors were given the responsibility to design a new system of opium distribution for registered addicts. The second wave of the study was conducted in the spring of 1977, some 6 months after the policy revisions, in order to monitor their effects.

Influence of opium availability on addiction rates in Laos.

Crude rates of opium addiction were determined in 1972-1974 in ten communities of Laos, representing eight different ethnic groups and three provinces. In six rural communities, data were obtained by a house-to-house survey, and in four urban communities by opium den registration. Communities raising opium poppy as a cash crop had highest crude rates of addiction (7.0-9.8 addicts per 100 people). Thos involved in opium commerce had intermediate rates (4.1-5.5). Where neither opium production nor commerce was present, the communities had the lowest rates of addiction (1.8-2.3).