Drug markets are evolving at unprecedented speed. The range of substances and combinations available to users has never been wider, and the amounts produced have never been greater. Cultivation and manufacturing of heroin and cocaine have reached record highs, synthetic drugs continue to expand, and the market for new psychoactive substances (NPS) remains widely diversified with a growing interplay with traditional drug markets. The non-medical use of regulated prescription drugs (either diverted from licit channels or illicitly manufactured) is becoming a major threat: in addition to the ongoing opioid epidemic in North America, there are signs of an opioid epidemic due to the non-medical use of tramadol in North and sub- Saharan Africa, as well as in the Middle East. Drug-related deaths are on the rise. At the same time, access to controlled drugs for medical purposes remains a dramatic problem in most low and middle-income countries.

Reasons for blooming drug markets are complex and diversified. A combination of poverty, limited social and economic opportunities of rural communities, political instability, lack of government control, and changed strategies of trafficking organizations has driven the high level of illicit crop cultivation. There remain multiple factors at individual, micro and macro level that affect the vulnerability to drug use and its path to harmful use. While progress has been made by some countries to increase the accessibility to human-rights and evidence based policy interventions, challenges remain with insufficient investment and implementation of schemes to prevent, treat and reduce the potential harms posed by drug use. In contrast to an increasing trend of donors’ commitment for overall international assistance, assistance in the sectors of alternative development and “narcotics control” has significantly declined since 2008. Punitive drug policies continue to be used in some communities, despite being ineffective in reducing drug trafficking or in addressing non-medical drug use and supply, and continue to undermine the human rights and well-being of persons who use drugs, as well as of their families and communities.

The SDG 2030 Agenda is putting the dignity, health and rights of people and planet at the centre of sustainable development.