The Need for an Evidence-Based Approach to Controlling Opium Production in Afghanistan

Transcription

1 The Need for an Evidence-Based Approach to Controlling Opium Production in Afghanistan DANIEL WERB, THOMAS KERR, JULIO MONTANER, and EVAN WOOD BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada Correspondence: Evan Wood, British Columbia Centre for Excellence in HIV/AIDS, Burrard Street, Vancouver, BC, Canada V6Z 1Y6. Journal of Public Health Policy (2008) 29, doi: /jphp Through both scientific evaluation (1), and the wisdom of experience (2), Western nations have learned that illicit drug markets are notoriously difficult to control from the supply side. A recent World Customs Organization report found that even post-september 11 security measures have had a negligible impact on the influx of illicit drugs into the United States (3). In Canada, we recently observed that a 100-kg heroin seizure, Canada s largest in history, had no impact on the supply of heroin on the streets where the seizure occurred (3). The inability of law enforcement to control illicit drug markets has led to international calls for greater incorporation of scientific evidence of effectiveness into illicit drug policies (4,5). The heroin trade has serious international public health implications. In North America, injection drug use accounts for approximately one in four cases of human immunodeficiency virus (HIV), and in some areas where the virus is spreading rapidly, such as Russia, more than 80% of all HIV transmissions result from this behavior (6). In addition to HIV, hepatitis C virus is spread efficiently through the sharing of used needles, and the prevalence of hepatitis C is generally much higher than HIV among injection drug users (7). Illicit drug overdose deaths from injection drug use are also among the leading causes of mortality in many large North American cities (8). In this context, the United Nations Office on Drugs and Crime (UNODC) reported in 2006 that Afghanistan s opium poppy crops are the source of 92% of the world s supply of heroin and that this figure is projected to increase in the coming years (9). Within Afghanistan, the booming illicit drug industry makes up Journal of Public Health Policy 2008, 29, r 2008 Palgrave Macmillan /08

2 WERB ET AL. APPROACH TO CONTROL OPIUM PRODUCTION 441 approximately 60% of the country s gross domestic product (10), and a report for the World Bank notes that profits from the drug trade may be benefiting antigovernment forces such as the Taliban (11). The presence of such a large illicit drug economy also increases the potential for corruption within the Afghan central government, particularly in the security and justice sectors (12). The influence of the opium industry in this regard is troubling given the fragility of these sectors and their importance to the consolidation of peace and rule of law in Afghanistan. Finally, the opium industry contributes to a deepening public health crisis, particularly as the processing of opium into heroin increasingly shifts from outside of Afghanistan to clandestine labs within that country (12). Following this shift, rates of illicit injection drug use among Afghans have increased dramatically (13), and the prevalence of HIV/AIDS between drug users and the general population is rising at an alarming rate (14). In Kabul, Afghanistan s capital city, estimates from 2004 place the number of individuals addicted to illicit drugs at 60,000 (11). Opium poppy cultivation has been present in certain regions of Afghanistan for centuries (15), and some observers assert that the first Papaver somniferum specimens were brought from Europe by the armies of Alexander the Great in the fourth century BCE (16). However, it was only with the invasion of Afghanistan by Soviet forces in 1979 that Afghanistan became a significant exporter of opium (17). Most recently, the massive, post-taliban increase in opium poppy cultivation has heightened concern among the international community and a fierce debate is emerging regarding the optimal way to address it (18). A 2004 survey of Afghan farmers intentions demonstrated that the vast majority of farmers cultivate opium poppies as a response to poverty, because of the high price of opium compared with other crops, and because opium provides access to creditors (19). Given these data, the growth of opium poppy cultivation in Afghanistan clearly represents a failure on the part of the international community, and the Afghan Government, to provide viable alternatives to local opium farmers (20). As a result of the growth in opium production, support has been increasing to initiate eradication of opium poppy crops through aerial spraying of chemical defoliant and through ground-based manual eradication schemes. Specifically, US policy makers have increased pressure on the Afghan Government to engage in

3 442 JOURNAL OF PUBLIC HEALTH POLICY. VOL. 29, NO.4 aggressive opium poppy eradication (21). And, despite concerns of the leaders from the federal opposition parties to Canada s military involvement in Afghanistan (22), the Canadian federal government officially announced its support of increased counter-narcotics operations in Afghanistan (23). This support may lead to increased Canadian military involvement in combating the drug trade at a time when the future military commitment of a number of the North Atlantic Treaty Organization (NATO) countries in Afghanistan is under intense scrutiny (24). Indeed, the recent far-reaching recommendations of a high-level panel investigating Canada s role in Afghanistan suggest that the debate concerning the future of Canadian, NATO, NATO s International Security Assistance Force, and US involvement in Afghanistan has really just begun (25). Absent from this debate, however, is a discussion of scientific evidence regarding the likely success of conventional counter-narcotic strategies. This is of concern given that past scientific research has demonstrated that the proposed counter-narcotics efforts have consistently yielded negligible effects on the availability, price, or purity of the targeted substance (5,26,27). For instance, evaluations of Plan Colombia, a multiyear American-funded crop eradication and interdiction program aimed at curtailing cocaine production in Colombia, demonstrated no beneficial effect on the availability, price, or purity of the drug in the United States (27). A further concern is that, in addition to not achieving their desired results, the proposed counter-narcotics activities may produce harmful effects. Aerial spraying may damage non-illicit crops, thereby exacerbating conditions of poverty, lead to the movement or expansion of illicit farms into new areas, and create real and perceived health concerns among local residents (28). In Afghanistan, while the ban on opium poppy cultivation carried out by the Taliban in 2000 essentially ended opium poppy cultivation in areas that the movement controlled, it also precipitated an economic crisis among the millions of Afghans who depended on the opium trade for survival. The ban trapped poor farmers in a cycle of opium poppy cultivation for credit that remains embedded in Afghanistan s illicit economy today (29). It also caused relocation of opium poppy cultivation into areas outside of Taliban control in Afghanistan s northeastern provinces (29,30). Crop eradication schemes may undermine local support for the central government and international forces, thus raising concern

4 WERB ET AL. APPROACH TO CONTROL OPIUM PRODUCTION 443 about Afghanistan s stability. Communities that rely on opium poppy cultivation have already increased their criticism of the limited efforts of the central government and the international community in providing developmental assistance (20). Indeed, many Afghan communities in areas susceptible to Taliban influence rely on opium poppy cultivation for survival (31). Thus, crop eradication may enable the Taliban to capitalize on community disaffection in order to undermine the central government and increase their own influence. This danger is acute in the south of Afghanistan where opium poppy farming is most highly concentrated (31). From a practical perspective, then, economic analyses that suggest crop eradication efforts are unlikely to dissuade the majority of Afghan opium poppy farmers from cultivating poppies deserve special attention (32). Given the evidence of the limited positive effects and potentially negative ones of conventional counter-narcotics schemes such as crop eradication, it is useful to identify strategies that have successfully curtailed illicit crop production in other illicit drug producing countries. One approach suggested for Afghanistan that has been successful in Turkey is regulation of opium poppy crops to produce licit, opium-derived analgesics such as morphine for medical use (33). This strategy deserves greater consideration by the Afghan Government and the international community, especially given the failure of existing eradication efforts in Afghanistan and effects of these efforts in countries such as Columbia. The European Parliament s support of such a proposal in Afghanistan suggests that an opium poppy regulation pilot project should be implemented in order to determine this novel strategy s effectiveness (34). Another approach officially integrated into the current counternarcotics strategy in Afghanistan is development of alternative livelihoods to encourage affected populations to cease illicit drug cultivation. Under this plan, officials provide opium farmers with licit substitute crops such as wheat. Unfortunately, reports from the field suggest that these programs, while ostensibly a main pillar of Afghan counternarcotics, have not been adequately implemented and remain for the most part ineffective (20,35). Indeed, the UNODC reported that some farmers specifically noted the lack of developmental assistance as a reason for cultivating opium poppy (19,36). Exacerbating this perceived lack of assistance is a view held

5 444 JOURNAL OF PUBLIC HEALTH POLICY. VOL. 29, NO.4 among opium poppy farmers and communities that counternarcotics efforts such as eradication target those individuals who are too poor to build walls around their crops, or unable to finance bribes of local counter-narcotics officials (36). While development of infrastructure such as irrigation networks and roads, as well as a strengthening of the rule of law, are crucial in the eventual reconstruction of a stable Afghan state, these only benefit Afghan communities in the long term (37 39). In the short term, other incentives to reduce illicit crop cultivation must be investigated. Despite debates concerning the future of the international mission in Afghanistan, international forces look poised to play a prominent role in that country for at least the next 2 years. More countries, including Canada, may join in implementing the country s counternarcotics strategy (23,24). Considering the global public health and security implications of developmental failure, and the high-profile role of the many countries involved in this important work, the international community should use its presence in Afghanistan to ensure that counter-narcotics strategies take into consideration past scientific evaluations of conventional counter-narcotics programs and the likely effects of future interventions on targeted communities. Countries such as USA, UK, and Canada should reconsider lending military and political support to forced eradication programs, since research has suggested that these are likely to be counterproductive in Afghanistan. Reports from the field indicate that such programs are, at least in some cases, ineffective and may produce potentially highly negative consequences (35). Instead, these and other countries could help to ensure the effectiveness of the international mission in Afghanistan and the safety of international and Afghan troops by advocating for an evidence-based approach to counternarcotics. As calls for evidence-based domestic drug policies mount in Canada and other countries that are net importers of illicit drugs (40,41), the same level of evidence and research should inform policies focusing on source countries. It is encouraging in this regard that the UK Government of Gordon Brown and the World Bank are conducting joint research on a system of economic incentives for opium poppy farmers (42). Additionally, there are signs that the US Congress and defense department may limit support for aerial spraying of opium poppy crops in Afghanistan (43), although the US still strongly supports forced eradication by other means.

6 WERB ET AL. APPROACH TO CONTROL OPIUM PRODUCTION 445 Unfortunately, in Canada, the federal government has yet to show leadership in this area, preferring to support the US position on forced eradication over more pragmatic and evidence-based approaches (23,44). This pattern is consistent with Canada s recent changes in domestic illicit drug control, which now favor a US war on drugs approach over evidence-based, public health approaches (41). This is unfortunate given that evidence-based policy making may reduce the negative impacts of Afghanistan s opium industry. It could also profoundly improve the capacity for security and development in Afghanistan, and have significant and positive public health effects in those urban centers across the world facing injection-related infectious disease epidemics. ABOUT THE AUTHORS Dan Werb, B.A., is a researcher at the British Columbia Centre for Excellence in HIV/AIDS, and a writer and journalist on HIV/AIDS, drug policy, and housing. His background includes work on international drug policy with The Senlis Council, a European drug policy group. Thomas Kerr, Ph.D., is a research scientist at the British Columbia Centre for Excellence in HIV/AIDS and an assistant professor in the Department of Medicine at the University of British Columbia. His special expertise includes research on supervised injection facilities, using both quantitative and qualitative methods. Julio Montaner, M.D., Ph.D., FRCPC, is a UBC Professor of Medicine and the Chair of AIDS research at the University of British Columbia, and Director of the British Columbia Centre for Excellence in HIV and AIDS. He is a member of the Antiretroviral Therapy Guidelines Committee of the International AIDS Society- USA and president elect of the International AIDS Society (IAS). Evan Wood, M.D., Ph.D., is a research scientist at the British Columbia Centre for Excellence in HIV/AIDS and an assistant professor in the Department of Medicine at the University of British Columbia. His expertise in clinical epidemiology, especially in evaluating the treatment of HIV/AIDS, addiction, and epidemiologic

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