“Selling poppies is easier than selling diamonds and gold in Afghanistan, and just as valuable,” an official in the Afghan Ministry of Public Health told me in 2011. “The [police] is corrupt, the farmer is poor, and the addict always buys.”

He was right. The failure of international forces in Afghanistan to curb the narcotics trade presents one of the gravest threats to the country’s long-term stability and security. Even though the U.S.-led coalition has spent more than $6 billion on stopping drug shipments, creating incentives for farmers to exchange poppies for other crops, and disrupting illicit financial networks over the past decade, Afghanistan remains the world’s largest supplier of heroin and other illegal opiates.

In NATO countries alone, Afghan narcotics cause more than 10,000 heroin-overdose deaths per year -- making them far deadlier than the munitions that have claimed the lives of approximately 3,200 coalition personnel since the start of the war. Meanwhile, needle-sharing among intravenous drug users has led to an explosion of HIV infections from the Russian heartland to communities in the Baltics and Eastern Europe. The Afghan drug trade presents a unique threat to international security, since it has created unlikely bedfellows out of ideologically divergent terrorist organizations, such as Hezbollah, which has its hands in narcotics transport and financing from Lebanon to South America, and the Taliban, which controls production.

Within Afghanistan, the drug trade provides the funding for the ongoing insurgency and perpetuates a culture of impunity and corruption -- major impediments to the establishment of good governance and a healthy civil society. Furthermore, from a public health standpoint, the skyrocketing rate of drug addiction there has created a potentially insurmountable challenge for the central government. A 2010 study by the United Nations Office on Drugs and Crime reported that roughly one million Afghans between the ages of 15 and 64 are addicted to narcotics, up from 860,000 in 2005. Afghanistan’s eight percent addiction rate among adults is twice as high as the global average.

Most troubling, Afghans are turning to intravenous drug use in large numbers -- heroin use increased by 140 percent between 2005 and 2010 alone. This raises the risk of lethal blood-borne diseases, including HIV/AIDS and hepatitis, which can be transmitted through shared needles. Left unchecked, Afghanistan’s growing HIV outbreak has the potential to upend the gains made since the Taliban era in limiting the death caused by infectious diseases.

Since the U.S.-led antinarcotics efforts have made scant progress, it is time for Afghanistan to look to other models. As it turns out, neighboring Iran’s failures and successes in reducing both the demand for drugs and the harm they cause offer a good example.


For much of the twentieth century, Iran’s strategy for curbing drug addiction looked a lot like Afghanistan’s current one: stopping the flow of narcotics and destroying crops. When, in the early 1970s, it became clear that this method wasn’t working, Iranian authorities adopted policies that focused more on prevention and treatment, with promising results.

But the 1979 revolution changed all that, and the Islamic government it brought to power implemented strict zero-tolerance narcotics laws. The regime, which saw drug use not as a medical or public health issue but as a moral shortcoming, believed that addiction and abuse could be beaten out of the public through punitive measures. Penalties for addicts included fining, imprisonment, and physical punishment; drug dealers and smugglers were often considered to be “at war with God” and executed. By the late 1980s, the government was sending thousands of addicts to prison camps, where they were supposed to detoxify and atone for their sins through forced labor.

These draconian social measures against drug users and dealers were matched with similarly aggressive operations to prevent the flow of opiates across the border from Afghanistan. By the late 1980s, an estimated 50 percent of Afghan opiate production was passing through Iranian territory, and the Iranian markets were flooded with Afghan opium, heroin, and morphine. Starting in the early 1990s, Tehran constructed more than 260 kilometers of static defenses -- including concrete dams that blocked mountain passes, anti-vehicle berms, trenches, minefields, forts, and mountain towers -- at a cost of over $80 million. By the late 1990s, more than 100,000 police officers, army troops, and Revolutionary Guardsmen were committed to antinarcotic operations.

Yet both the social policies and the border fortifications were fruitless. Although the Iranian authorities seized nearly eight times the amount of narcotics in 1999 than they had in 1990, they could not keep up with the expansion of Afghan opium production, which rose in those years from approximately 1,500 metric tons to roughly 4,500. Iran also found that the number of intravenous drug users was growing. Ironically, the prisons and camps where addicts were expected to kick their habits became epicenters of drug use, in which people learned how to inject heroin and shared primitive infection-prone needles.

The rise in malignant drug use brought with it more deaths, more cases of addiction, and, most embarrassingly for Iran’s leaders, a full-blown HIV/AIDS epidemic. After years of blaming the West’s moral turpitude and decadence for the virus, Iran’s leadership had to face an outbreak at home, fueled by its own failed antinarcotic policy. By the late 1990s, in some provinces, double-digit percentages of heroin users were falling prey to the disease. In 2005, biological surveillance data from the Kermanshah province showed a 13.5 percent HIV prevalence rate among the adult prison population.

These setbacks prompted a complete turnaround in Iran’s approach to fighting narcotics. Instead of focusing on punishing addicts and trying to stop the drug supply, Iran decided to try to reduce the harm of narcotics and the demand for them. By 2002, over 50 percent of the country’s drug-control budget was dedicated to preventive public health campaigns, such as advertisement and education. Iran’s conservative and previously intransigent leadership opened narcotics outpatient treatment centers and abstinence-based residential centers in Tehran and the provinces.

The Islamic Republic also began to allow nongovernmental organizations to launch their own prevention and treatment efforts. The government began to implicitly support needle-exchange programs, going so far as to encourage the distribution of clean needles in the Iranian prison system. Gradually, the road was paved for methadone maintenance treatment centers and clinics that dispensed locally produced opium pills, in a bid to turn injection drug users into medicated patients.

In making this shift, Iran sought not only to halt the growing HIV/AIDS epidemic but also to reduce the demand for illicit narcotics and to reintegrate drug users back into the economy. These new measures began to show results: the number of new HIV cases among intravenous drug users dropped from a high of 3,111 in 2004 to 1,585 in 2010. This trend was particularly notable among Iran’s prison population, which witnessed a drop in HIV prevalence from a high of 7.92 percent in 1998 to a low of 1.51 percent in 2007. Additionally, in areas where the country set up harm-reduction programs, improvements were observed in addicts’ life expectancies and psychological well-being, coupled with an overall reduction in the illicit consumption of opiates.


Iran’s experience is particularly instructive for Afghanistan; both are Islamic republics that are inclined to see drug addiction through a religious prism. Yet the Iranians demonstrated that it is possible to overcome this inclination and to view drug use primarily as a public health issue. Going forward, the United States and other donor countries need to encourage Kabul to take a page out of the Iranian playbook and adopt a broader, medically oriented approach to its drug problem.

In the past several years, several European organizations have begun to train Afghans in harm reduction strategies. Médecins du Monde, a French nongovernmental organization, has established a handful of methadone treatment centers to treat HIV-positive patients with antiretrovirals in addition to caring for intravenous drug users. These efforts, however, have run up against inadequate funding and significant ideological barriers within Afghanistan’s strictly conservative government. Moreover, powerful members of President Hamid Karzai’s ruling clique still have financial stakes in the poppy trade, and are therefore unenthusiastic about such efforts.

But as Iran’s experience shows, the only way to actually drive down drug use and contain its negative effects is to focus on prevention and treatment. To make this shift, Afghanistan should start by creating a drug-oriented policymaking body that could operate outside the corrupting confines of the Afghan government. For this measure to succeed, the international forces in the country would need to move beyond their counterproductive focus on crop exchanges and interdiction. Western investments in Afghan counternarcotic efforts should emphasize education, treatment, and reducing the overall demand for the drugs. If these efforts fail, much of the international efforts to stabilize Afghanistan will have been for naught: the country will remain a dangerous narco-state, home to a devastating public health epidemic, and an exporter of addiction and death to the rest of the world.

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  • AMIR A. AFKHAMI is Assistant Professor of Psychiatry and Behavioral Sciences, and of Global Health, at George Washington University. Follow him on Twitter @Psych_Doc.
  • More By Amir A. Afkhami