Pakistan’s Opioid Squeeze: Impacts of Taliban Edicts, Indian Synthetics and Chinese Regulations

Abstract

This study examines how the Taliban’s opium poppy eradication edict and the westward shift in illicit fentanyl production from China to India potentiates an opioid squeeze on Pakistan from its east-west flanks, influencing Pakistan’s opioid production, distribution and use. As opioid output sputters in Afghanistan, while Indian chemists increasingly normalise illicit fentanyl production in South Asia, opportunistic Pakistani chemists will be incentivised to supply synthetic opioids to high-demand international markets, just as Pakistani farmers supply opium and heroin to international clients. This convergence has ramifications for Pakistani law, drug enforcement and public health, as domestic production increases domestic access to synthetic opioids. The article conducts an empirical examination of current trends in South Asian opioid production, distribution and use, along with an exegesis of the legal and regulatory systems in Pakistan, Afghanistan and China. This study also details how the Pakistani government should respond to this challenge legislatively, foremost through blanket ban of fentanyl and its precursors. Pakistan can reduce domestic use through evidence-based treatment programmes, including discrete and confidential treatment administered by females to female users, opioid substitution therapy, safe needle exchange programmes, culturally sensitive drug awareness campaigns, and increased data collection to detect geographic hotspot locations of opioid use and overdoses.