Devastating U.S. Heroin Epidemic, a Consequence of Unimpeded Supply from Afghanistan

As Heroin Use Grows in U.S., Poppy Crops Thrive in Afghanistan “Afghanistan has roughly 500,000 acres, or about 780 square miles, devoted to growing opium poppy. That’s equivalent to more than 400,000 U.S. football fields — including the end zones,” John Sopko, Special Inspector General for Afghanistan Reconstruction (NBC, July 7, 2015)

President Obama Heroin Summit

President Obama Heroin Summit, March 2016

On March 29, 2016 the White House issued a press release regarding its new heroin initiative. The Washington Post described how much President Obama proposed to do.  The long list of fixes and new public-private partnerships relate almost exclusively to treatment.  The 1 billion dollars, the President said, will treat “tens of thousands” of addicts.

The same day, President Obama spoke at the National Prescription Drug Abuse and Heroin Summit in Atlanta, and called addiction a “heartbreaking” issue that’s costing lives and devastating communities across the country.” But, I’m very optimistic that we can solve it.”

Mr. President, one billion dollars won’t make a dent in the U.S. heroin epidemic!

The most recent estimates indicate that 4.5 million Americans were addicted to illicit drugs. (The Opioid Addiction 2016 Facts & Figures report by the American Society of Addiction Medicine). Public Safety Aspects of the Heroin Epidemic (2015) a  A Pew Charitable Trust report, acknowledges that “Heroin Use Estimates Vary Across National Databases.” In other words, there are no accurate data for the scope of heroin use and addiction.

An analysis by the Centers for Disease & Prevention (CDC) and the FDA of the data gathered by the National Survey on Drug Use report by U.S SAMHSA (2015), shows that since 2000, the rate of deaths from drug overdoses has increased 137%. The rate of overdose deaths involving opioids (pain relievers and heroin) increased a staggering 200%.

These findings indicate that the opioid overdose epidemic is worsening. The 2014 data demonstrate that the United States’ opioid overdose epidemic includes two distinct but interrelated trends: a 15-year increase in overdose deaths involving prescription opioid pain relievers and a recent surge in illicit opioid overdose deaths, driven largely by heroin.” (CDC. Increases in Drug and Opioid Overdose Deaths – US, 2000 – 2014, Jan. 1, 2016 )

See: National Institutes of Health graph: National Overdose Deaths — Heroin Deaths. 2016.

According to the CDC Morbidity and Mortality Report (2016)

“More persons died from drug overdoses in the United States in 2014 than during any previous year on record. From 2000 to 2014 nearly half a million persons in the United States have died from drug overdoses. In 2014, there were approximately one and a half times more drug overdose deaths in the United States than deaths from motor vehicle crashes.

Opioids, primarily prescription pain relievers and heroin, are the main drugs associated with overdose deaths. In 2014, opioids were involved in 28,647 deaths, or 61% of [a total of 47,055] drug overdose deaths; the rate of opioid overdoses has tripled since 2000.

The 2014 data demonstrate that the United States’ opioid overdose epidemic includes two distinct but interrelated trends: a 15-year increase in overdose deaths involving prescription opioid pain relievers and a recent surge in illicit opioid overdose deaths, driven largely by heroin.

The suicide rate increase from 13.8 per 100,000 persons in 2013 to 14.7 per 100,000 persons in 2014… These findings indicate that the opioid overdose epidemic is worsening. There is a need for continued action to prevent opioid abuse, dependence, and death, improve treatment capacity for opioid use disorders, and reduce the supply of illicit opioids, particularly heroin and illicit fentanyl. Heroin overdose death rates increased by 26% from 2013 to 2014 and have more than tripled since 2010.” (CDC.  Jan. 1, 2016)

The Drug Enforcement Agency (DEA) acknowledges in its National Heroin Threat Assessment (2015) that “Heroin deaths are often undercounted…

“Heroin deaths are often undercounted because of variations in state reporting procedures, and because heroin metabolizes into morphine very quickly in the body, making it difficult to determine the presence of heroin. Many medical examiners are reluctant to characterize a death as heroin-related without the presence of 6-monoaceytlmorphine (6-MAM), a metabolite unique to heroin, but which quickly metabolizes into morphine. Thus many heroin deaths are reported as morphine-related deaths. Further, there is no standardized system for reporting drug-related deaths in the United States. The manner of collecting and reporting death data varies with each medical examiner and coroner.”

Doctors may be blamed for over-prescribing painkillers, such as OxyContin and psychotropic drugs that trigger suicidal acts; but doctors are NOT wholly responsible for the U.S. heroin epidemic which has increased exponentially affecting most demographic groups. As heroin use has increased, so have heroin-related overdose deaths. Between 2002 and 2013, the rate of heroin-related overdose deaths nearly quadrupled, and more than 8,200 people died in 2013.  (CDC Today’s Heroin Epidemic, 2015)

Mr. President, with so many millions of addicts who need treatment, one billion dollars is a drop in the bucket. There aren’t enough inpatient beds or outpatient slots for even 1/8th of the surge in narcotic users. $25 billion is needed to construct 100,000 inpatient treatment beds and $10 billion is needed annually to provide another million people outpatient treatment.

The heroin epidemic is in large part, a consequence of U.S. policy in Afghanistan.
Under the Obama administration, efforts at eradicating Afghanistan’s opium crop ended in 2009.

“There were 7,600 hectares of Afghan opium poppies when the War in Afghanistan began in 2001. (1 hectare = 2.5 US acres.) By 2009, there were 123,000 hectares. In 2014, Afghan poppy fields spread to 224,000 hectares resulting in a bumper crop of 6,400 tons of opium, enough to make 640,000 kilograms of heroin thanks to Obama. Opium yields far greater profit than foods like wheat or corn, so opium production will continue to rise without serious eradication efforts.”  (Read more at: Global Research, 2016

Numerous economic/ financial analyses concur that Afghanistan currently produces between 80% to 90% of the world’s opium and accounts for the bulk of global heroin manufacturing. The World Bank assessed that narcotics constitute the largest source of externally generated income for Afghans by a wide margin.

Afghanistan Opium Cultivation 1994-2014

United Nations Office on Drugs and Crimes, Afghanistan Opium Cultivation 1994-2014

As shown in the UN graph above, in 1999, opium poppies occupied 91,000 hectares. In 2000, the Taliban regime outlawed opium and within one year it was essentially eliminated down to 7,600 hectares in 2001.

Since 2010, US heroin deaths shot up from 3,036 to 4,397 (2011) to 5,925 (2012) to 8,260 (2013) to 10,574 in 2014.

“The increasing number of deaths from opioid overdose is alarming,” said CDC Director Tom Frieden, M.D., M.P.H. “The opioid epidemic is devastating American families and communities. To curb these trends and save lives, we must help prevent addiction and provide support and treatment to those who suffer from opioid use disorders. This report also shows how important it is that law enforcement intensify efforts to reduce the availability of heroin, illegal fentanyl, and other illegal opioids.” (CDC, Dec. 2015)

The narcotics trade is closely linked with corruption wherever it occurs in the world.
In February 2015, Special Inspector General for Afghanistan Reconstruction (SIGAR) John F. Sopko submitted written testimony to a U.S. Senate Committee on Appropriations subcommittee highlighting the perils of the Afghan drug trade:

The expanding cultivation and trafficking of drugs puts the entire U.S. and international investment in the reconstruction of Afghanistan at risk. The narcotics trade, which not only supports the insurgency but also feeds organized crime and corruption, puts the gains the U.S. agencies and their international partners have achieved over the past 13 years in women’s issues, health, education, rule of law, and governance in jeopardy.”

Why then, is the Obama White House Silent about Stemming the Flow of Heroin from Afghanistan?

Meryl Nass, MD, Maine

Meryl Nass, MD, Maine

A reality check, posted by Meryl Nass, MD, internist and a biological warfare epidemiologist and expert in anthrax and AHRP board member, whose blog www.anthrax.blogstpot.com covers medical and public policy issues:

  • In 2014, the White House and RANDsaid that the US had 800,000 to 2.4 million heroin addicts. Drug addiction treatment requires many months, even years; and costs tens of thousands of dollars per person.
  • The new funds will support less than 10% of those needing treatment, hardly enough to make a dent. Mr. President, someone in the administration ought to do the math!
  • Overdose deaths and heroin users are at an all-time high in the United States. Between 2 and 9 of every thousand Americans (2-0.9% of the population) is currently using heroin.
  • study in The New England Journal of Medicine (NEJM) found opiate-addicted babies in neonatal ICUs quadrupled between 2006 and 2013.
  • Despite what you have heard, the cause of our current heroin epidemic is not as simple as doctors over-prescribing narcotics, or users switching to heroin when prescription drugs became more scarce and expensive.
  • What’s missing entirely from the discussions by the President and from the topics discussed at the National Prescription Drug Abuse and Heroin Summit is ANY mention of the increased flow of heroin into the U.S.
  • Afghanistan is where between 75% and 93% of the world’s illicit opium is grown each year, on 500,000 acres.
  • “In 2006, a brief, intensive, ill-fated S.-Afghan campaign to eliminate Afghan poppies destroying the fields while also offering farmers help with alternative crops such as almonds and wheat. But the backlash was instantaneous and violent. Bombings and assassinations targeted poppy eradication agents. Poppy-growing regions that had been unstable before grew even more volatile as farmers sought protection from the Taliban … or picked up arms themselves.”
  • The reason for the violent outrage is economic: all the people in Afghanistan rely on poppies for some or all of their income: the Taliban, as well as millions of everyday farmers and their families. Within Afghanistan it is the corrupt Afghan government at all levels, from the sub-districts up to Kabul who gain the most.

Dr. Nass makes the case that the root cause of the current heroin epidemic is a massive increase in availability—huge amounts of relatively cheap heroin have been flooding into the US in the last few years, exceeding what can be sold in our large cities, and now finding its way into even the tiniest hamlets throughout the country. Without this influx from Afghanistan, she believes, there would be no epidemic. Her view is backed up by statistical data and by several academic experts in the field.

The National Institute on Drug Abuse data demonstrates that the US heroin epidemic really took off after 2009 after the Obama administration shifted gear on the U.S. poppy eradication policy which now targets only 10% of Afghan’s heroin harvest. Yet, neither the National Summit (2016) nor The New York Times  (October 30, 2015) mention the influx of heroin from Afghanistan.

In his recent article (2016), Professor Alfred McCoy is recognized as one of the world’s leading historians of Southeast Asia, opium trafficking in the Golden Triangle, underworld crime syndicates, and international political surveillance, wrote:

Prof. Alfred McCoy

Prof. Alfred McCoy

“By attacking the guerrillas but ignoring the opium harvest that funded new insurgents every spring, Obama’s surge soon suffered that defeat foretold. As 2012 ended, the Taliban guerrillas had, according to the New York Times, “weathered the biggest push the American-led coalition is going to make against them… a U.S. Embassy official told me: “You can’t win this war without taking on drug production in Helmand Province.”

“In the almost 15 years of continuous combat since the U.S. invasion of 2001, pacification efforts have failed to curtail the Taliban insurgency largely because the U.S. could not control the swelling surplus from the county’s heroin trade. As opium production surged from a minimal 180 tons to a monumental 8,200 in the first five years of U.S. occupation, Afghanistan’s soil seemed to have been sown with the dragon’s teeth of ancient Greek myth. Every poppy harvest yielded a new crop of teenaged fighters for the Taliban’s growing guerrilla army.

At each stage in Afghanistan’s tragic, tumultuous history over the past 40 years — the covert war of the 1980s, the civil war of the 1990s, and the U.S. occupation since 2001 — opium played a surprisingly significant role in shaping the country’s destiny. In one of history’s bitter twists of fate, the way Afghanistan’s unique ecology converged with American military technology transformed this remote, landlocked nation into the world’s first true narco-state — a country where illicit drugs dominate the economy, define political choices, and determine the fate of foreign interventions.” (Alfred McCoy. How a Pink Flower Defeated the World’s Sole Superpower: America’s Opium War in Afghanistan, TomDispatch, 2016) 

Michel Chossudovsky, Canadian economist, author, and professor of economics at the University of Ottawa wrote:

“In 2014 the Afghan opium cultivation has once again hit a record high, according to the United Nations Office on Drugs and Crime’s 2014 Afghan Opium Survey. In the course of the last four years, there has been a surge in Afghan opium production. The profits are largely reaped at the level of the international wholesale and retail markets of heroin as well as in the process of money laundering in Western banking institutions. The revenues derived from the global trade in heroin constitute a multi-billion dollar bonanza for financial institutions and organized crime.” (Michel Chossudovsky, “The Spoils of War: Afghanistan’s Multi-billion Dollar Heroin Trade Washington’s Hidden Agenda: Restore the Drug Trade, Global Research, 2015)

William Edstrom, a scientist and author of articles published in scientific journals, including Nature, the Journal of Biological Chemistry. He co-authored Agents of Bioterrorism: Pathogens and Their Weaponization (2005) published by Columbia University Press.

Afghanistan is by far the number one producer of opium and heroin. Total worldwide opium production was 7,554 tons in 2014, of which 85% came from Afghanistan. The remaining 1,154 tons are primarily from Myanmar, Laos, Mexico, Thailand and Vietnam. Mexico produced 162 tons of opium in 2014…Heroin from Mexico cannot supply even 10% of US heroin demand. Yet the DEA claims most heroin in the US is from Mexico.

Most heroin in the US is coming from US-occupied Afghanistan….We’re getting hit with the largest ever illicit drug epidemic in American history and the DEA is asleep at the wheel.” (Edstrom. “Obama Gives a “Green Light” to the “Heroin EpidemicGlobal Research, 2016)

Prof. Peter Dale Scott

Prof. Peter Dale Scott

Peter Dale Scott, Professor at the University of California, Berkeley is a former Canadian diplomat. His books include, American War Machine: Deep Politics, the CIA’s Global Drug Connection, and the Road to Afghanistan, 2010. His most recent book is The American Deep State Wall Street, Big Oil, and the Attack on U.S. Democracy, 2014)

In his highly informative, and very relevant article Afghanistan: Opium, the CIA and the Karzai Administration, posted on Voltaire Network (2010), he described an innovative proposal by the International Council on Security and Development (ICOS), formerly The Senlis Council that aimed at stemming the heroin supply from the illegal drug trade. Few Americans had ever heard of: “Poppy for Medicine” because the government adamantly opposed it.

The New York Times reported about it once, in 2007, noting that the idea has attracted little attention. The [ICOS) council attributes this partially to the lobbying power of the religious right and law enforcement groups, both of which react with horror to any talk of legalization. “It’s almost theological, their opposition to our idea,” said Norine MacDonald, the council’s founder.

Poppy Field Afghanistan

Poppy Field Afghanistan

In 2008, the World Medical Association General Assembly adopted “Poppies for Medicine”. The proposal would establish a trial licensing program that would allow Afghan farmers to sell their opium legally for the production of much needed essential medicines such as morphine and codeine. These medicines are especially needed and unavailable in more than 150 poor countries. While this proposal would provide farmers with a profitable income, it would remove the enormous profitability from the chain of intermediaries that constitute the criminal drug trade.

The World Medical Association:

Supports the investigation of possibilities for the controlled production of opium for medical purposes in Afghanistan through a scientific pilot project in Afghanistan; and

Urges governments to support a scientific pilot project to investigate whether certain areas of Afghanistan could provide the right conditions for the strictly controlled production of morphine and diamorphine for medical purposes.

“Poppies for Medicine” would provide farmers with a profitable income, it would remove the enormous profitability from the chain of intermediaries that constitute the criminal drug trade.  The proposal received the support of the European Parliament and Canada. But the proposal was unacceptable to the United States where it came under heavy attack, chiefly on the grounds that it might well lead to an increase in opium production.

“An unspoken consequence of the “poppy for medicine” initiative would be to shrink the illicit drug proceeds that are helping to support the Karzai government. Whether for this reason, or simply because anything that smacks of legalizing drugs is a tabooed subject in Washington, the “poppy for medicine” initiative is unlikely to be endorsed by the Obama administration.” (Peter Dale Scott. Afghanistan: Opium, the CIA and the Karzai Administration, Voltaire Network, Dec. 2010)

Read also, Poppy for Medicine: An Essential Part of a Balanced Economic Development Solution for Afghanistan’s Illegal Opium Economy in Berkeley Electronic Press, 2010. The article was written by by Romesh Bhattacharji, a specialist in narcotics and trans-border trafficking who was Narcotics Commissioner of India between 1996 and 2001, then Chief Commissioner of Customs, 2001 – 2003; and Jorrit Kamminga, Director of Policy Research at the ICOS.