With respect to international surveillance systems, the UNODC administers two separate surveillance systems that collect data from all participating UN member states: the Annual Reports Questionnaire surveillance system that collects price and purity/ potency data, and the Drug Seizures Database that collects seizure data. Finally, the European Monitoring Centre for Drugs and Drug Addiction administers the Reitox drug surveillance system network, which aggregates data from several country-level surveillance systems in Europe, as described below. Table 1 presents surveillance systems that matched search criteria. First, purity and/or potency of illegal drugs generally remained stable or increased overall during the study period. Second, the price of illegal drugs, with few exceptions, generally decreased. Third, seizures of cannabis, cocaine and opiates generally increased in major drug production regions and major domestic markets. Figure 1 presents data from the US Drug Enforcement Administration’s System To Retrieve Information from Drug Evidence . As can be seen, between 1990 and 2007 , the purity of heroin and cocaine, and the potency of cannabis herb in the US increased, while the inflation-adjusted and purity-adjusted retail street prices of these three drugs declined. Specifically, heroin purity increased by 60% , cocaine purity increased by 11% and cannabis herb potency increased by 161% during this time. During the same period, the prices of heroin,rolling flood tables cocaine and cannabis decreased 81% , 80% and 86% , respectively. Figure 2 presents data collected by the UNODC on the street price of cocaine and opiates in participating European countries .
In these countries, between 1990 and 2009, the aggregate average retail street price of cocaine decreased by 51%, from US$198/g to US $98/g . Similarly, the aggregate average price of opiates in Europe decreased 74%, from a high of US $295/g in 1990 to US$77/g in 2009 .With respect to opiate seizures, the Golden Triangle includes parts of Thailand, Laos, Vietnam and Myanmar, and according to the UNODC, this region is the second largest supplier of heroin globally, although production has declined throughout the last decade, with opium production decreasing by approximately 60% and 90%in Myanmar and Laos, respectively. In this region, trends in seizures of opium have fluctuated; 3198 kg of opium were seized in 1990, with a high of 12 462 kg seized in 2007 before a steep decline to 1225 kg in 2010 . Similarly, seizures of heroin fluctuated, with a decrease of more than half, from 1337 kg in 1990, to 627 kg in 2010 , and a peak of 1565 kg seized in 2009. In Afghanistan, which is believed to supply more than 90% of the world’s opium,30 seizures of raw and prepared opium increased by more than 12 000%, from 453 kg in 1990 to 57 023 kg in 2010, and seizures of heroin increased by more than 600%, from 1256 kg in 1990 to 9036 kg in 2010 . With respect to cocaine seizures, according to the UNODC, Latin America’s Andean region, which includes Peru, Bolivia and Colombia, is the primary global supplier of this drug, as coca leaf is grown exclusively in this region. While seizures of cocaine in the Andean region decreased 81%, from 97 437 kg in 1990 to 17 835 kg in 2007 , seizures of coca leaf increased 188% from 601 038 kg in 1990 to 1.73 million kilograms in 2007 . During the same period, the area of cocacultivation in this region declined slightly, from approximately 210 000 to 180 000 ha . Finally, according to the UNODC, major areas of cannabis cultivation exist in North Africa, Afghanistan and North America.
These areas are net exporters of cannabis, although most cannabis-producing countries also produce the drug for internal consumption. In North Africa , seizures of cannabis herb increased by 208% from 67 930 kg in 1990 to 209 445 kg in 2007 . In North America , seizures of cannabis herb increased by 288% from 782 607 kg in 1990 to 3.05 million kilograms in 2007 . In Afghanistan, while data on cannabis herb seizures are not available, seizures of cannabis resin increased 630% from 5068 kg in 1990 to 36 972 kg in 2006 .Longitudinal data from government surveillance systems demonstrate that during the past two decades there has been a general pattern of increased illegal drug supply as defined through lower price and higher purity of heroin, cocaine and cannabis. During the same period, patterns of drug seizures either increased or remained stable, although the trends detected in some of these indicators did not reach statistical significance. As such, we conclude, consistent with previous studies,19 that the global supply of illicit drugs has likely not been reduced in the previous two decades. In particular, the data presented in this study suggest that the supply of opiates and cannabis, in particular, have increased, given the increasing potency and decreasing prices of these illegal commodities. These results have implications for the development of evidence based drug policies, particularly given the interest in novel drug policy approaches in a number of settings in Latin America, North America and Europe. As noted elsewhere, there are limitations of ecological analyses based on international surveillance systems. First, some states collect little or no data on indicators of illegal drug supply, whereas other states spend significant energy on monitoring drug availability. Second, even in states that closely track indicators of supply, the degree to which seized samples of illegal drugs reflect purity of retail drugs sold on the street is subject to variation, though where possible we presented purity-adjusted prices to address this limitation.
Nevertheless, the long-term trends in increasing purity and decreasing price presented here likely reflect the overall trends in many regions, though it should be noted that in some regions , indicators of price and purity may have been strongly influenced by a few countries such as the UK and Spain. In addition, some exceptions in the trends were observed. Australia for instance, while experiencing a significant decrease in the prices of heroin as well as cannabis, did not experience a significant decrease in the price of cocaine, which may reflect the geographic isolation of the region or other market factors. It is also of note that Australia’s ‘heroin drought’, which saw a sudden drop in measures of the supply and availability of heroin, appears to have had a limited long-term impact on supply, though some experts suggest that it may have resulted in higher levels of poly substance use among Australian heroininjectors. Third, limitations in longitudinal data collection precluded our ability to include amphetamine-type stimulants and other emerging synthetic substances, as this data is limited to certain countries and the focus of this study was on regional trends. It is noteworthy in this regard that the production of synthetic substances—as well as indoor cannabis cultivation—present particular challenges for supply reduction strategies, given that these drugs can be mass produced in clandestine locations regardless of climate or other factors that limit traditional drug production. Finally, while this review focused on patterns of price and purity of selected illegal drugs, these measures are only a marker of drug supply and do not measure other factors determining availability and concomitant rates of drug use. These limitations in assessing global drug supply using classic proxy measures such as price, purity and, to a lesser extent, seizures, flood and drain tray suggest that there may be a need to expand the range of measures systematically collected by governments and international bodies such as the UNODC and the European Monitoring Centre for Drugs and Drug Addiction. In particular, meaningfully incorporating measures derived from street-level questionnaires of people who use drugs may provide a more reliable metric of supply and availability. Indeed, some bodies, such as Australia’s IDRS, collect such data, and this methodological approach should be considered by those coordinating surveillance of illegal drugs. Other bodies have also prioritised emphasising measures of community health including reduced HIV infections, reduced drug-related violence and reductions in number of individuals incarcerated. In summary, longitudinal illegal drug surveillance systems demonstrate a general global pattern of falling drug prices and increasing drug purity and potency, alongside a relatively consistent pattern of increasing seizures of illegal drugs. Although source data have limitations and there are some exceptions to these trends, these findings should be useful given the current debates and drug policy experimentation under way in Latin America, North America and Europe. It is hoped that this study highlights the need to re-examine the effectiveness of national and international drug strategies that place a disproportionate emphasis on supply reduction at the expense of evidence-based prevention and treatment of problematic illegal drug use.Death by suicide among Native American peoples is an alarming, racialized health disparity .
According to the Office of Minority Health, Native Americans young people ages 15 to 24 years old die by suicide at a disproportionately higher rate compared to white youth of the same age . Within California, suicide-related behavioral health outcomes for Native American youth are also worse than white youth. From 2017-2019, on average 20.0% of Native American high school students reported experiencing suicidal ideation compared to 17.6% of white youth . Attempting to address this crisis, the US Department of Health and Human Services Substance Abuse and Mental Health Services Administration spent approximately $20,000,000.00 per year on tribal-specific suicide prevention efforts from 2018 to 2023 . Despite these efforts, suicide rates have continued to rise over the past decade perpetuating suicide as the leading cause of non-accidental death for Native American young people ages 15 to 24 years old . This shortcoming has urged some scholars to rethink Native American youth suicide by urging a examination of key theoretical constructs to better direct suicide prevention efforts in tribal communities . These critics of mainstream suicidology argue that the domination of a psycho-centric conceptualization of suicide-related behavior overemphasizes the risk factors related to psychopathologies, maladaptive cognitive schema, and other mentally disordered characteristics . As such, the invitation to rethink Native American youth suicide emphasizes aneed to examine suicide and suicide-related behavior beyond this narrow psycho-centric focus to be more engaged with social, structural, and cultural dimensions of tribal health. This paper uses an Indigenous-based theoretical approach to guide a examination of the multi-level, wholistic factors that may influence suicide-related behavior among Native American young people in California. Indigenous Wholistic Theory constructs health as multifaceted, amalgamating spiritual, emotional, mental, and physical domains . Aligned with tribal constructions of health and wellness, positive health outcomes occur when these domains align with responsive historical, social, political, and economic contexts . Subsequently, maladaptive health outcomes—like the exhibition of suicidal ideation— can arise from dysfunction influenced by determinants across any of these domains and related contexts. In this paper, Indigenous Wholistic Theory provides a framework to introduce and situate a broader array of factors that may influence suicide-related behavior in a manner culturally relevant to the lived experienced of Native American youth. A computational, algorithmic approach is employed to understand how a more wholistic array of factors from various levels can predict the individualized presence of suicidal ideation among Native American youth in California . This approach diverges from traditional regression methods that inquire about the statistical associations between risk factors and health outcomes at the population level. This paper incorporates prediction modeling techniques for three purposes relevant to Native American youth in California: 1) identify a model comprising a selection of factors that combine to best predict the individualized presence of suicidal ideation; 2) evaluate how the selected model can discriminate between the presence and absence of suicidal ideation; and 3) assess the agreement between the model’s predicted outcomes with the actual outcomes of the input dataset . Additionally, this paper leverages a substantiation of the Indigenous Computational Approach to guide its inquiry . As such, this paper asks the following research question: which combination of factors can predict suicidal ideation among Native American high schoolers in California? The Indigenous Computational Approach is a response to the inherent limitations of Western research methodologies that employ computational methods within the domain of social science research. By establishing a framework rooted in Indigenous ways of knowing and being, the Indigenous Computational Approach underscores the imperative of recognizing and valuing Indigenous knowledge systems that center tribal voices and perspectives.