Opiates and opioids top the list of problem drugs that cause the most burden of disease and drug-related deaths worldwide. For the third consecutive year, Afghanistan, which has the world's largest opium poppy cultivation, saw an increase in the area under cultivation (from 154,000 hectares in 2012 to 209,000 hectares in 2013). In addition, Myanmar witnessed expansion in the area of opium poppy cultivation, although less pronounced. In 2013, the estimated global production of heroin rebounded to the levels seen in 2008 and 2011.
The global area of illicit opium cultivation in 2013 stood at 296,720 hectares - the largest area since 1998, when estimates became available.
There is evidence that Afghan heroin is increasingly reaching new markets, such as Oceania and South-East Asia, that had been traditionally supplied from South-East Asia. The long-established Balkan route seems to remain a corridor for the transit of Afghan heroin to the lucrative markets in Western and Central Europe, but its importance has declined due to various factors such as more effective law enforcement and a shrinking market in Western and Central Europe, as seen by the decline in opiate use and seizures in the subregion and the reduced level of supply compared with the peak levels of 2007.
The so-called "southern route" is expanding, with heroin being smuggled through the area south of Afghanistan reaching Europe, via the Near and Middle East and Africa, as well as directly from Pakistan.
An emerging phenomenon among opioid-dependent drug users in the United States of America is that synthetic opioids are being replaced with heroin, driven by the increased availability of heroin in parts of the United States, and lesser costs to regular users to maintain their dependency. Further, the reformulation of one of the main prescription pharmaceuticals abused, OxyContin, now makes it more difficult to snort or inject it.
Following a sharp increase in 2011, global seizures of heroin and illicit morphine declined in 2012, while remaining higher than the levels of 2010 and prior years. The fluctuations were mainly driven by seizures in South-West Asia and Western and Central Europe. However, in 2012, there was an increase in heroin seizures in many other regions, mainly Eastern and South-Eastern Europe, South Asia and Oceania. Significantly, heroin seizures, and therefore presumably the flow of heroin, in key countries located along the "northern route" from Afghanistan to the Russian Federation, have gone down. At the same time, there is evidence of a significant number of small seizures of home made desomorphine, which is likely serving as a substitute for heroin.
The emergence of potentially more harmful behaviour, including the abuse of opioids such as fentanyl, has been noted among opioid-dependent persons in Estonia, Finland and the United States. It has been observed that opioid users may alternate between pharmaceutical and/or prescription opioids and heroin, depending on which substance is more available, accessible and cheaper in the market.