Opioid Crisis' Roots: Examining The Afghanistan War Connection

The opioid crisis in the United States has been driven by the overprescription of legal pain medications, and intensified by the influx of cheap heroin, fentanyl, and other synthetic opioids supplied by foreign drug cartels. While Afghan heroin is not a significant contributor to U.S. opioid consumption, the country's illicit opiate trade has become one of the world's greatest transnational drug and crime threats, impacting health, governance, and security. Afghanistan produces three-quarters of the global opium supply, and the number of Afghans suffering from drug addiction is twice the global average. The country's decades-long war and political instability have contributed to the availability of cheap narcotics and limited access to treatment, exacerbating the addiction problem. The complex dynamics of the Afghan opiate trade involve various criminal gangs, insurgent groups, and power brokers, making it challenging to address the issue effectively.

Opium addiction in Afghanistan

Opium has been used in Afghan communities as medication for pain and respiratory issues, and it also has a traditional role in the societies of some groups. However, the drug is highly addictive, and opium addiction is now a major problem in Afghanistan, with many Afghans self-medicating with opium to deal with the hardships of life. The problem is particularly acute among women and children, with many children becoming dependent on drugs at a very young age while in the care of drug-dependent parents or family members.

The number of addicts in Afghanistan has been increasing aggressively, rising from an estimated 200,000 opium and heroin addicts in 2005 to nearly a million in 2009 and reaching between 1.9 and 2.4 million in 2015. The growing number of addicts reflects the increased availability of drugs, with Afghanistan being the world's largest opium producer. The peak poppy cultivation period was in 2017, when 328,0000 hectares were cultivated, and the second-largest harvest was in 2018, with 263,000 hectares despite a devastating drought.

The increase in opium production and addiction in Afghanistan has had severe consequences for health, governance, and security at national, regional, and international levels. The Afghan opiate trade has become one of the world's greatest transnational drug and crime threats, with Afghan opiates being trafficked to almost every continent in the world.

Within Afghanistan, the consequences of opium addiction include behavioural, social, and health problems, crime, accidents, and loss of productivity in the workplace. Injecting drug use and sex traded for drugs or money have also led to the spread of HIV and other blood-borne diseases. The problem of opium addiction in Afghanistan is further exacerbated by the limited access to treatment, with only 10% of drug users surveyed having received any form of drug treatment.

The role of the Taliban in the opium trade

Afghanistan has been cultivating opium since 1100 AD, but production has steadily increased since 1979. The country currently produces three-quarters of the global opium supply.

The Taliban's role in the opium trade has been significant. In the 1990s, the Taliban did not initially exploit the drug economy for financial gain, but rather relied on other sources of funding, such as external sponsors and the exploitation of the illicit traffic of legal goods. However, as the Taliban expanded its control, it began to embrace the drug economy as a source of revenue.

The Taliban has taxed opium farmers, charged smugglers, and provided security for traffickers. It has also been involved in processing opium into heroin within Afghanistan. The Taliban's income from the drug trade is estimated to be in the tens to hundreds of millions of dollars per year.

In 2000, the Taliban banned opium cultivation, which resulted in a significant reduction in opium production. However, this ban was short-lived, and the Taliban rescinded it in 2001. Since then, the Taliban has generally allowed poppy cultivation, with some exceptions in certain areas.

The Taliban's involvement in the opium trade has been a source of funding for its insurgency and has contributed to its ability to consolidate power in Afghanistan. Efforts by the US and its allies to suppress the opium trade in Afghanistan have largely been ineffective and, in some cases, have even strengthened the Taliban by alienating local populations and driving them towards the Taliban.

The impact of the US-Mexico fentanyl meltdown

The US-Mexico fentanyl meltdown has had a profound impact on the relationship between the two countries, with the Biden administration urging Mexico to clamp down on the drug trade. Fentanyl has become the most lethal category of opioid in the US, with the Centres for Disease Control and Prevention (CDC) estimating that more than 47,000 people died from an opioid overdose in 2017, 28,000 of which were due to synthetic opioids. The US government has seized more than 410 million deadly doses of fentanyl so far this year.

The Biden administration has made tackling the opioid crisis a priority, with President Biden declaring synthetic opioid trafficking a national emergency and signing executive orders to sanction individuals and entities associated with the production and dissemination of fentanyl. The US has also launched a global coalition to address synthetic drug threats and resumed bilateral cooperation with China on counternarcotics.

However, despite these efforts, the flow of fentanyl into the US from Mexico has continued, with Mexican cartels intensively hiring US citizens to smuggle the drug across the border. This has led to increasing frustration within the Biden administration and heated political rows between the administration and Capitol Hill. Some Republican lawmakers have even proposed bombing or invading Mexico to target drug cartels, while the Mexican government has sought to shift the blame for the fentanyl crisis to the US, citing a breakdown in family values and a "lack of hugs".

The US-Mexico fentanyl meltdown has also had repercussions for global public health and security. The establishment of pharmacies in Mexico that sell fentanyl-laced drugs and other dangerous substances has increased the dangers of fentanyl trafficking and posed a threat to global public health and security. In addition, the use of wildlife products to pay for drug precursors from China has raised concerns about the potential spread of dangerous zoonotic diseases.

To address the impact of the US-Mexico fentanyl meltdown, the US has prioritised improving border controls at legal ports of entry and demanded better cooperation from the Mexican government. The US has also sought to disrupt the economic activities of Mexican criminal groups, including countering poaching and wildlife trafficking and acting against illegal fishing. However, the effectiveness of these measures has been limited by the Mexican government's unwillingness to cooperate fully with US counternarcotics efforts.

The effect of the COVID-19 pandemic on opioid abuse

The COVID-19 pandemic has had a significant impact on opioid abuse and the opioid crisis in the United States. The pandemic has exacerbated the opioid crisis, with rising overdose rates and relapses. People with substance use disorders are more vulnerable to COVID-19 and are more likely to experience severe health outcomes if infected. The pandemic has also led to social isolation, stress, and economic downturns, which are triggers for substance use and relapse.

The pandemic disrupted access to treatment and recovery services for those with substance use disorders. Treatment centres faced challenges providing in-person services due to social distancing policies, and some facilities limited services or closed. However, the pandemic also created opportunities for healthcare providers and support systems to reach more people through remote services and telehealth.

The pandemic's impact on drug supply chains also contributed to the increase in overdoses. Disruptions led people to turn to unfamiliar drugs, and social distancing measures resulted in more people using drugs alone, increasing the risk of overdosing. The pandemic's effects on the opioid crisis highlight the need for comprehensive solutions that address the underlying social issues contributing to both crises.

The pandemic has also led to changes in drug use patterns. Limited data indicate significant increases in the use of various drugs, including fentanyl, cocaine, heroin, and methamphetamine, in the United States since the national emergency was declared in March 2020. Alcohol sales have also risen by more than 25%. However, according to the Monitoring the Future survey, adolescent substance use decreased significantly in 2021 and held steady in 2022.

The COVID-19 pandemic has intersected with the opioid crisis, creating a "perfect storm" for those struggling with substance use disorders. The social and economic impacts of the pandemic, including job losses and limited social interactions, have exacerbated the challenges faced by this vulnerable population. The pandemic has also diverted attention from the opioid crisis, slowing down progress towards policy solutions.

To address the impact of the pandemic on opioid abuse, there have been calls for policy changes to improve access to treatment and enhance mental health infrastructure. Temporary flexibilities implemented during the pandemic, such as remote prescribing of certain medications and take-home dosing, have been beneficial and should be considered for permanent adoption.

The economic impact of the opioid crisis

The opioid crisis has had a significant economic impact in the United States. The societal burden of the crisis was estimated to be $1 trillion in 2017, with the cost to the US economy between 2015 and 2018 being $631 billion. The cost in 2020 alone was $1.5 trillion, or 7% of the gross domestic product (GDP) for that year.

According to a study by the Council of Economic Advisors, over 85% of the total economic burden was attributed to the reduced quality of life from opioid use disorder and the value of life lost to opioid overdose. Lost productivity costs were estimated at $100 billion, while healthcare costs were $34.8 billion, and criminal justice costs were $14.8 billion.

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