Like cocaine, heroin is produced outside the United States and is smuggled into the country illegally. Trafficking in both drugs has spawned several criminal industries, including money laundering, organized crime syndicates, and associated smuggling operations. Opium poppies, from which heroin is derived, are grown primarily in three regions of the world—Southeast Asia, Southwest Asia, and Latin America. Heroin is produced in a variety of geographic regions and trafficking routes are more geographically dispersed than cocaine. Unlike most South American cocaine organizations, heroin trafficking organizations are not vertically integrated and heroin shipments rarely remain under the control of a single individual or organization as they move from the overseas refinery to the streets of the United States. The principal source of heroin consumed in the United States is Southeast Asia, most of which originates in one country—Burma. According to the Office of National Drug Control Policy (ONDCP), in fiscal year 1993, the United States spent an estimated $52.3 million, or about 10 percent of the international narcotics control budget, on international heroin control activities. In fiscal year 1994, ONDCP estimated the United States spent $47.6 million on international heroin control activities or about 14 percent of the international narcotics control budget. U.S. heroin control programs have the following general objectives: (1) assisting source countries in attacking opium production and heroin refining, trafficking, and use; (2) gaining greater access to opium-producing regions through bilateral and multilateral initiatives; (3) pooling U.S. intelligence resources to assist U.S. and foreign law enforcement agencies in targeting and arresting key leaders of major heroin trafficking organizations; and (4) reducing the flow of heroin into the United States. Current efforts focus on Southeast Asia because it is the primary source of heroin smuggled into the United States. ONDCP views heroin as a serious danger to the United States, a threat second only to cocaine. ONDCP reports that Americans consume an estimated 10 to 15 metric tons of heroin annually, an increase from the estimated 5 tons consumed each year in the mid-1980s. Heroin abuse has increased due to the wider availability of high-quality heroin at low retail or street prices. From 1987 to 1994, the estimated worldwide production of opium grew from 2,242 metric tons to 3,409 metric tons. The two leading source countries, Burma and Afghanistan, are responsible for much of this increase. For example, in 1994, Burma produced about 2,030 metric tons of opium, or about 60 percent of worldwide production. The Department of State estimates that this amount of opium could be refined into approximately 169 metric tons of heroin, enough to meet U.S. demand many times over. Although Burma’s 1994 production was limited by adverse weather conditions, a recent survey in Burma indicates a resurgence in production during the 1995 growing season that will approach record levels. Figure 1 shows recent worldwide trends in opium production in the primary source countries; figure 2 shows the primary opium poppy cultivation areas in Southeast Asia. In recent years, the purity of heroin available on U.S. streets has risen significantly, while prices have fallen. This combination is a key indicator of the increasing availability of heroin in the United States. In its August 1995 annual report, the National Narcotics Intelligence Consumers Committee stated that the nationwide average purity for retail heroin was 40 percent in 1994, a dramatic increase from the single-digit purity levels of the mid-1980s and much higher than the 26.6-percent purity level reported in 1991. In New York City, the largest importation and distribution center in the United States for Southeast Asian heroin, average purity levels have risen from 34 percent in 1988 to 63 percent in mid-1994. This rise in overall purity levels has been attributed to the increased availability of high-quality Southeast Asian and South American heroin. While purity levels have risen, heroin prices have fallen to their lowest levels ever, according to ONDCP. For example, DEA reports that heroin prices in New York City dropped from $1.81 per milligram in 1988 to $0.37 by mid-1994. U.S. counternarcotics officials believe heroin’s greater availability is allowing increased experimentation with a highly addictive drug. Moreover, the higher purity levels permit users to ingest heroin through nasal inhalation versus injection with hypodermic syringes. Users find inhalation attractive because it is easier than injection, and they can avoid contracting the diseases associated with using needles. The U.S. heroin user population may be increasing in response to the increased availability of heroin. ONDCP estimates there are up to 600,000 hardcore heroin addicts in the United States. While there is no evidence suggesting there is an epidemic of new users, reports indicate that the heroin user population may be gradually increasing. Much of this increase is among drug users whose prime drug of abuse is not heroin. ONDCP reports that this link is especially strong for long-term users of “crack” cocaine, who use heroin to counter the depressive effects of withdrawal from cocaine use. Furthermore, data on heroin-related emergency room visits show that the problems associated with long-term heroin use are also on the rise. For example, the annual number of emergency room episodes involving heroin increased from 42,000 in 1989 to almost 63,000 in 1993, a 50-percent increase. According to the Substance Abuse and Mental Health Services Administration, emergency room admissions for heroin abuse in Baltimore alone increased 364 percent from 1989 to 1993. The U.S. international heroin strategy, signed by the President on November 21, 1995, calls for a regional approach focused on Southeast Asia and the need to reduce opium production in Burma to stop the flow of heroin into the United States. The objectives of the new strategy remain similar to the earlier objectives. The implementation of the Burma portion of the strategy relies on the development of counternarcotics dialogue with Burmese authorities, exchange of counternarcotics information, in-country counternarcotics training, and continued support for UNDCP efforts. Implementation guidelines for the new strategy are currently under review and it is not clear at this point to what extent resources will be dedicated to support the strategy. As noted in the strategy, Burma remains the key to successful regional heroin control efforts, due to its status as the world’s leading heroin producer. However, the United States does not provide significant counternarcotics assistance to Burma because of its record of human rights abuses and the Burmese military dictatorship is not equipped to address ethnic disputes that impact on development of an effective regional program. Moreover, difficulties in tracking and interdicting heroin-trafficking organizations have limited the effectiveness of international law enforcement efforts against the criminal organizations responsible for moving the drug from Southeast Asia into the United States. In addition, poor law enforcement cooperation between the United States and China demonstrates the difficulties in interdicting key heroin-trafficking routes. Despite these obstacles, U.S. efforts have achieved some positive results in countries or territories with sufficient will to implement counternarcotics activities, such as Thailand and Hong Kong. The key to effective U.S. heroin control efforts in Southeast Asia is stopping the flow of Burmese heroin into the United States. In 1994, Burma accounted for about 87 percent of the opium cultivated in Southeast Asia and approximately 94 percent of the opium production in the region. Most of the heroin smuggled into the United States originates in Burma’s eastern Shan State. Unless the United States addresses opium poppy cultivation and production in Burma, U.S. regional heroin control efforts will have only a marginal impact. However, several factors create substantial difficulties in establishing effective programs in Burma. U.S. policy toward Burma prohibits providing significant levels of counternarcotics assistance until the Burmese government improves its human rights stance and recognizes the democratic process. In addition, the Burmese government does not control the majority of opium cultivation areas within its borders and has not seriously pursued opium reduction efforts on its own. Moreover, ethnic insurgent armies that control most of the opium cultivation and heroin-trafficking areas are reliant on proceeds from the drug trade and are unlikely to relinquish this source of income under the current Burmese government. In response to Burmese government human rights abuses and unwillingness to restore democratic government, the United States has terminated almost all counternarcotics assistance. In 1988, the Burmese military violently suppressed antigovernment demonstrations for economic and political reform and began establishing a record of human rights abuses, including politically motivated arrests, torture, and forced labor and relocations. In 1990, the Burmese people voted to replace the government in national elections, but the military regime refused to recognize the results and remained in power. Further, for decades, the Burmese government has engaged in fighting with insurgent armies representing ethnic minority groups who want autonomous control of territory they occupy within Burma’s borders. Some of these groups, particularly the Wa people of Burma’s eastern Shan State, control major opium production and heroin trafficking areas and have fought successfully to maintain their independence from the central government. Over the past 8 years, the military regime has consolidated its control and virtually eliminated any threat to its power in Rangoon. In 1988, the United States discontinued foreign aid to Burma in response to concerns over human rights abuses by the Burmese government. U.S. assistance had supported the Burmese government’s opium poppy eradication program during fiscal years 1974 through 1988. In response to the Burmese government’s insufficient efforts to address increasing opium production and heroin-trafficking within its borders, the President has denied certification for counternarcotics cooperation since 1989.