In recent years the trafficking of drugs through China has increased substantially, primarily along the 2000-kilometre border with Myanmar . The proximity of the Golden Triangle and the Golden Crescent regions — the world’s largest producers of opium, heroin and amphetamine-type substances — has been a major challenge for Chinese authorities in stemming the trafficking of narcotics across its national borders . It is reported that most heroin produced in Myanmar (70–80 tons per annum) is now trafficked though China, which has become an important tranship- ment route for the international market . This proliferation of drug trafficking in China largely emerged as a result of new routes from Afghanistan into western China, particularly Xinjiang Province, which complement the traditional routes from Myanmar . This and the economic reforms introduced by Deng Xiaoping in the 1980s have simply made the drug networks currently penetrating China less restricted (National Narcotics Control Com- mission, 2004b; Silk Road Studies Program, 2004; United Nations Office on Drugs and Crime, Regional Centre for East Asia and the Pacific, 2003a; United States Department of State, Bureau for International Narcotics and Law Enforcement Affairs, 2004a) .
Border crossing is easy, particularly along the long southern border, where high mountains and dense forest provide substantial cover . Yunnan Province, bordering on Myanmar, attracts a large number of drug traffickers and every means of transporting drugs is used, from trucks to human bodies . Another important trafficking route is the 200-kilometre border between Guangxi Province and Vietnam which is also mountainous and remote . In this area there is one official crossing and five ‘semi- official’ crossings where, for a fee of around US$0 .05, border crossing is permitted . In other parts of this area the border is essentially open — researchers for one recent report observed hundreds of people (no doubt includ- ing drug users and drug dealers) crossing with no intervention or supervision (Hammett et al ., 2003; Zhenglai, 2002) .
Drugs transit southern China to the provinces of Yunnan, Guangxi, Guandong and Fujian and onwards to south-eastern coastal areas by various overland methods . Once the heroin reaches Guandong, it is believed to be shipped to the cities of Xiaman and Fuzhou in Fujian Province before being transported to international markets . Heroin entering the north-eastern regions of China is not only from Afghanistan but also from Pakistan and Tajikistan . It is reported that up to 20 per cent of heroin entering Xinjiang Province has its origins from south-west Asia, particularly Afghanistan . Some parts of China are more noted than others for drug trafficking: 10 per cent of China’s narcotics enter the country in the Lancang Prefecture located in Yunnan . New transit routes emerge
all the time and one report suggested heroin was transported from Myanmar to India and Nepal and then onto China (Drug Enforce- ment Administration, Intelligence Division, 2004a; Drug Enforcement Agency, 2002; French, 2004; Xinzhen, 2004) .
Currently drug traffickers are reducing the size of their shipments to minimise loss during seizures . Increasingly, drug traffickers are found to be women, children and poor uneducated farmers, who carry the drugs on or inside their bodies from the Golden Triangle and then onto various districts of China . Women couriers swallow 400–500 grams of drugs encased in rubber, then fly from Kunming to other parts of China under the pretext of searching for employment . Most airports do not possess the inspection instruments for appropriate detection and thus most drug couriers are not discovered . In Yunnan Province, depending on the amount of drugs trafficked, a payback of 1 million Yuan (US$120,000) was not an uncommon fee to offer those willing to walk the 30 kilometres into Myanmar and then return to China, where the drugs would then be sold to various crime syndicates (Drug Enforcement Administration, Intelligence Division, 2004a; French, 2004; Zhenglai, 2002) . Cross-border drug trafficking among ethnic minority groups in south-western China has long been established, particularly because many of the ethnic groups in these various drug production areas share kinship connections, traditional friendships, common languages and customs (Zhenglai, 2002) .
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Cannabis is grown mainly in Xinjiang and Yunnan, primarily for domestic use . The ephedrine plant grows wild in many parts of north-east China and the chemical extracted from the plant is processed for pharma- ceutical purposes . China, together with India, is the world’s largest producer of the chemicals extracted from the ephedra plant . The production of methamphetamines, of which China is now a major producer, is based on the precursor chemicals pseudo- ephedrine and ephedrine . Methamphetamine laboratories are located in various provinces along the eastern and south-eastern coastal areas; most trafficking groups are involved with crime groups in Hong Kong, Taiwan and Japan . China in recent years has become a major source of methamphetamine for many Southeast Asian and Pacific rim nations . Chinese law authorities also note a surge in the production of MDMA (‘ecstasy’), mostly for the domestic market in Beijing, Shanghai, Nanjing, Guangzhou and Shenzhen . China also produces the chemical potassium perman- ganate, known to be sold to Latin America to refine cocaine . The National Narcotics Control Commission reports that up 3490 tons of precursor chemicals have been prevented from being shipped to foreign markets in 2003 . The growing of illicit opium is as yet minor, and manufacturing of heroin within China’s national borders has not yet been identified (Drug Enforcement Administration, Intelligence Division, 2004a; International Narcotics Control Board, 2004; Kulsudjarit, 2004; National Narcotics Control Commis- sion, 2004b; United States Department of State, Bureau for International Narcotics and Law Enforcement Affairs, 2004b) .
As of January 2003 the wholesale price of heroin varied depending on location . On the Burmese border, 700 grams of heroin retailed for around US$5,000 while in Guangzhou and Fuzhou the equivalent cost was US$18,000 . A typical retail price per gram for heroin in 2002 was US$50, with a purity in the range of 22–57 per cent . The price of crystal methamphetamine per kilogram in 2003 in Guangzhou was US$3,700, while a typical retail price per gram in 2002 was US$48 . To produce MDMA (ecstasy) tablets in China reportedly costs as little as US$0 .06 per tablet, but in the cities of Beijing and Shanghai a single tablet in 2003 could retail for as much a US$27–36 (Drug Enforcement Administration, Intelligence Division, 2004a; United Nations Office on Drugs and Crime, 2004d) .
Arrest and seizure data
Drug enforcement agencies at all levels have been launching increasingly concentrated campaigns against drug use and various drug-related crimes . In 2003, the National Narcotics Control Commission reported that 94,000 drug-related crimes were solved and that there were 63,700 drug-related suspects arrested: in 2002, there were 42,854 recorded offences related to drugs . Figures from the early 1990s show an increasing trend in the number of drug-related arrests in China . As with increasing drug arrests there was often an overall rise over the past decade in drug seizures . Seizures of heroin have been fluc- tuating in size, with 9 .29 tonnes in 2002 dropping to 4 .07 tonnes in 2003 . In 2002, Chinese authorities were reported to have seized around 20 per cent of the world’s heroin supplies .
Opium seizures have remained fairly stable over the decade, amounting to 1–2 tonnes per annum . Methamphetamine seizures have risen substantially since the late 1990s: in 2003, 4 .53 tonnes were seized, but this was minor compared to the record figures of 20 .9 tonnes in 2000 . Cannabis seizures appear to be on the decline — from 4 .493 tonnes in 2000 to 1 .3 tonnes in 2002 . Seizures of ecstasy pills are rising — 409,000 in 2003 compared to 225,000 in 2002 . In 2003, 72,800 kilograms of precursor chemicals were seized (Berniker, 2003; Drug Enforce- ment Administration, Intelligence Division, 2004a; National Narcotics Control Commis- sion, 2004b; United Nations Office on Drugs and Crime, 2004a; 2004d) .
Between August and December 2004, Chinese police cracked down on over 1000 drug gangs (including 66 cross-border drug trafficking gangs), arrested over 10,000 drug suspects and seized over 6 tonnes of illegal drugs . These drug seizures include 2 .03 tonnes of cannabis (33 times higher than 2003), 73 .74 kilograms of ecstasy (16 times higher than 2003), 3 .15 tonnes of heroin, 218 .87 kilograms of opium, 436 .24 kilograms of methamphetamines, 11 .95 tonnes of opium poppies and 96 .42 tonnes of chemicals for drug manufacture . During the campaign to dismantle the drug gangs and drug seizures, 12 police died . The number of deaths is not surprising as more drug gangs increasingly armed themselves with automatic weapons and grenades to protect their drug shipments from being seized by officials and/or other criminal gangs . The recent seizures led to a 126 per cent rise in the price of heroin in the south-western borders of Yunnan, while in south and central China the price jumped 50 per cent (China Daily, 2004; Xinzhen, 2004) .
From August 2003 to January 2004, 13 south-eastern provinces and cities in Fujian and Guangdong provinces saw the launch of a special operation to crack down on the manufacturing, trafficking and transnational smuggling of methamphetamine and MDMA . During the operation 139 trafficking groups were exposed, 14 drug manufacturing and processing factories were destroyed, with over 450 kilograms of methamphetamine and 123,000 MDMA tablets seized (National Narcotics Control Commission, 2004b) .
Crop studies and crop eradication statistics
Cannabis is grown illegally mainly in south- western China, in particular Xinjiang and Yunnan; in some parts of China hemp is grown for commercial rope manufacturing . Statistics on eradication of cannabis are not available . Illicit cultivation of opium occurs mainly in Yunnan, Ningxia, Inner Mongolia and remote parts of the north-west . The cultivation of licit opium poppy is controlled by government and in 2003 around 14 tonnes were grown for use in the domestic pharmaceutical industry . Statistics on eradi- cation of illicit opium are not available (Drug Enforcement Administration, Intelligence Division, 2004a; United States Department of State, Bureau for International Narcotics and Law Enforcement Affairs, 2004b) .
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A3 .4 Drug-taking practices,
risk factors and trends
Heroin is the main illicit drug of choice, con- sumed widely throughout China . The largest surveys conducted among drug users are most often confined to those receiving treatment in drug centres . Heroin injecting is common, with many studies showing 60 per cent and more of users choosing this method . While intravenous injecting is more popular, some heroin users prefer intramuscular injections . In Kunming, 77 per cent preferred intravenous injecting, while 11 per cent used intramuscular injections; in the Shanghai area, 77 per cent preferred intravenous injection with only 4 per cent choosing the intramuscular method (Garten et al ., 2004; Yunnan Institute for Drug Use, 2003) . In 2003, data from DASS showed 47 per cent of the respondents injected intravenously, while 5 per cent did so via intramuscular or subcutaneous routes (National Narcotics Control Commission China, 2004a) . In Guangxi, heroin comes in powder form, and drug users add mineral water, diazepam solution or pethidine to dissolve the heroin inside the syringe or other receptacle such as bottle cap, jar, cup or cigarette foil . Some drug users prefer to add diazepam as it produces a deeper sleep . In other circumstances the diazepam is used as water is not available or because the availability of heroin has de- creased . Many drug users discard their needles after initial use for fear of being caught by police, being searched and arrested, and then having to perform a urine test . Syringes are commonly discarded in toilets, dustbins or into fields (Yap et al ., 2002) .
While the smoking of heroin is still popular, the trend towards injecting is well estab- lished . One method of smoking is to mix heroin and tobacco in a cigarette but it is more common to ‘chase the dragon’, which involves placing the heroin onto a piece of foil, heating it underneath with either a lighter or candle and inhaling the rising smoke (Hao et al ., 2004; Yap et al ., 2002; Yunnan Institute for Drug Use, 2003) . Poly- drug use has become increasingly apparent, and while heroin may be the drug of choice there are 15 other kinds of opiates and 28 kinds of non-opiate substances such as ecstasy, methamphetamines and alcohol being used with a higher frequency . Users of opiates use different substances to seek different mental effects or to enhance the mental effects while using drugs (National Narcotics Control Commission, 2004a) . Ecstasy is generally taken orally or by smok- ing while ‘ice’ is usually inhaled or smoked: there are reports of injecting ice, sometimes mixing it with heroin, but the widespread nature of this practice is difficult to gauge (Liu & Hao, 2002; Reid & Costigan, 2002) . According to DASS data, the location of drug use varies, but the use of their own house or the house of friends or a rented house is the most common (89%) . Other popular places are public recreational spaces such as dance halls, tea houses, schools or public toilets, con- struction sites, illicit drug transaction places, cars and unfixed locations (National Narcotics Control Commission, 2004a) .
Reports show that unsafe injecting is wide- spread among drug users, the greatest risk factor being the sharing of syringes and the use of non-disinfected syringes (Bezziccheri & Bazant, 2004; Hong & Cheng, 2004; Li, Feng & Liu, 2004; Ma et al ., 2004; Ruan et al ., 2004; Yunnan Institute for Drug Use, 2003) . A survey in Kunming found more than 68 per cent of the respondents shared their syringes with and/or lent their syringes to others . In Yining City, Xinjiang, a study found the rate of sharing syringes among injectors to be 84 per cent (Ni et al ., 2004; Yunnan Institute for Drug Use, 2003) . A recent survey conducted with 668 IDUs in Kunming, Kaiyuan, Ruili and Yingjiang in Yunnan Province found more than one-third were involved in risky behaviours in the past month with 37 .4 per cent sharing needles, 39 .4 per cent sharing injecting equipment and 37 per cent drawing their drug from a common drug solution . While the respond- ents reported the availability of injecting equipment as high (91 .2%), only two-thirds indicated the consistent use of clean needles and syringes (Population Services Inter- national/China, 2004) .
Reasons for the widespread sharing of inject- ing equipment are varied and include: sharing with friends with whom it was believed they were safe from contracting any diseases; a state of desperation to relieve heroin crav- ings, consequently using any needle; lack of opportunity to buy equipment when clinics or pharmacies were closed; not having enough heroin to fill multiple syringes; lack of funds to purchase equipment; accepting second needles and syringes passed on by friends; and for some drug users the fear of contract- ing HIV/AIDS was a low priority when the heroin urge overwhelmed them . Most IDUs prefer plastic disposable syringes as they were widely available from pharmacies and cheaper than those made from glass (Yap et al ., 2002) .
It appears that many IDUs clean their inject- ing equipment for traces of blood, but it was not apparent that this activity was done to prevent blood-transmissible diseases . Many drug users cleaned the equipment with water but it was uncommon to use hot water and rare to use bleach, not always a common household product . Others have reported up to 39 per cent of a group of drug users cleaned their equipment with hot water and 34 per cent used an alcohol spirit to rub against the syringe . While one report described drug users using water or alcohol, drawing the liquid repeatedly in and out of the syringe to remove any visible traces of blood, generally cleaning techniques undertaken by drug users are inadequate (Yap et al ., 2002; Yunnan Insti- tute for Drug Use, 2003) .
Sexual risk behaviours among drug users are alarming, with multiple sexual partners common and the rate of condom use being low . A recent report at various sites of Yunnan found 88 per cent of IDUs had unprotected sex with a regular partner while 64 per cent had unprotected sex with a sex worker (Population Services International/China, 2004) . Studies in Kunming show that it is common for male drug users to have 2–5 sexual partners, but consistent use of condoms is rare (Yunnan Institute for Drug Use, 2003) . Female heroin users in China are found to be more likely to exchange sex for drugs (Monitoring the AIDS Pandemic, 2004), and in one study of 171 participants around one-third had not used condoms . Of those exchanging sex for drugs, half were IDUs and, of these, 45 per cent reported sharing needles . For many of these women, exchanging sex is the only practical way for them to raise the money to purchase drugs (Wang & Lin, 2003) . However, overall, female drug users in China are believed to be more likely to use condoms than males because of their involvement in sex work for drugs or money (Lin & Wang, 2003) .
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Major risks for IDUs are HIV/AIDS and other blood-borne viruses, in particular hepatitis C . The health status of drug users was often poor, as shown by a study in Shanghai in 2002 which showed that, of the over 23,000 participants, 77 per cent had bacterial and viral infections including hepatitis (70%) (Chengzheng et al ., 2004) .
By 2002 HIV was found among drug users in all 31 provinces, autonomous regions and municipalities . Reports from the 2003 national sentinel sites show the average HIV/ AIDS prevalence among IDUs is 5–8 per cent . Nationwide, the average prevalence of HIV among IDUs has been increasing since 1995 . In Yili, Xinjiang, average HIV prevalence has reached 89 per cent while in Guangxi it is over 20 per cent (State Council AIDS Working Committee Office and UN Theme Group on HIV/AIDS in China, 2004) .
In 2001, 70 per cent of all HIV cases were found among IDUs (Reid & Costigan, 2002), but as of 2003 the proportion of reported HIV among IDUs had dropped to 44 per cent . However, IDU remains the main HIV trans- mission route in China . Current surveillance suggests the HIV/AIDS epidemic is spreading into the general population and that the spread of HIV from IDUs to other groups in society will continue to increase . In 2003, Chinese authorities estimated there are between 840,000 and one million people infected with HIV; UNAIDS suggests this figure could rise to 10–15 million cases by 2010 if no effort is implemented to curb the rise: since 1999 there was a 30 per cent annual rise in reported HIV cases (Settle, 2003; State Council AIDS Working Committee Office and UN Theme Group on HIV/AIDS in China, 2004; UNAIDS/ WHO, 2004; Wu, Rou & Cui, 2004; Zhimin, 2004) . The prevalence of hepatitis C among IDUs was high, and mostly above 70 per cent (Ruan et al ., 2004; Yin et al ., 2003) .