Global Spread of Injecting Drug Use

Injecting drug use has been spreading internationally in both developed and developing countries due to political, economic, and social conditions and changes, drug control strategies, law enforcement, and local culture and tradition (Stimson, 1993, 1996; Des Jarlais, 1992). In the 1970s and 1980s, injection of illicit drugs began to increase in countries in Asia and South America. As yet there is no definitive explanation for the increase in injecting drug use in these countries, but three hypotheses have been suggested as important components. (Des Jarlais, et al. 1992; Stimson 1993; Inciardi, 1992).
First, illicit drug use occurs along drug production and drug trafficking routes (Des Jarlais, et al. 1992; Stimson, 1993; Inciardi, 1992; Sarkar, et al 1993). Particularly relevant are the areas referred to as the "Golden Triangle" and the "Golden Crescent." The Golden Triangle is a major heroin producing region which comprises the area in Southeast Asia where the Lao People’s Democratic Republic, Myanmar, and Thailand meet. (Inciardi, 1992; McCoy and Inciardi, 1995). The Golden Crescent is the second major heroin producing region, and includes districts in the Northwest Frontier Province of Pakistan, the adjacent Badakhshan area of Afghanistan and the Baluchistan area of Iran. (Poshyachinda, 1993; Inciardi, 1992).
The increase of injecting drug use in some countries in Asia, including Thailand, Myanmar, the Lao People’s Democratic Republic, Yunnan Province in China, Viet Nam, and also the northeastern states of India (including Manipur, Mizoram and Nagaland) has been attributed to the availability of inexpensive heroin, grown (from poppies) and produced in the Golden Triangle and distributed along drug trafficking routes in these countries (Stimson 1993, 1994). For example, until the 1960s, opium was produced in the Golden Triangle region for export for refining in the Mediterranean basin. As heroin was refined elsewhere, it was not available for local consumption, and opium was the drug most commonly used in Southeast Asia. However, from the late 1960s onward, the Golden Triangle region experienced an expansion of the refining of opium into heroin. The development of heroin refining was influenced by successful law enforcement against production in the Mediterranean countries and later in Mexico, as well as lower production costs and the growth of the world market (Stimson 1996). Markets for heroin emerged due to the refining and distribution of heroin in the Golden Triangle region, and resulted in availability of the drug at low cost. In addition, enforcement and government activity against dissident groups in Myanmar and the development of new transport networks caused drug trade routes to shift from Myanmar to a route that went through Shan State to Yunnan Province, China and on to Hong Kong (Stimson 1996). Yunnan Province has experienced a corresponding increase in heroin abuse.