"At least a decade after Xylazine became a fixture in Puerto Rico, it entered the street opioid supply in Philadelphia as a more prevalent additive in the mid-2010s. The shift was noted by PWID, as well as harm reductionists and city public health officials (Johnson et al., 2021). PWID began to describe xylazine – often referred to as tranq – as a known element of specific ‘stamps’ or brands of opioid products in the illicit retail market.

"Prior to the widespread availability of xylazine in the Philadelphia drug supply, it was often mentioned in passing by residents of the majority Puerto Rican neighborhood where our fieldwork was based as a powerfully psychoactive additive ‘“back on the Island”.’ Xylazine was occasionally detected in fatal overdoses in Philadelphia as early as 2006 (Wong et al., 2008), but it was not common knowledge among PWID.

"Importantly, our results show that evidence of injection was more prevalent among decedents with xylazine and heroin and/or fentanyl detections.

"Harms of xylazine use in humans are not well documented, but evidence suggests that combined use of xylazine and an opioid such as fentanyl may increase the risk of overdose fatality.¹ Although naloxone, the opioid overdose reversal drug, is not effective against xylazine alone, unintentional fatal overdoses with xylazine detections also had heroin and/or fentanyl detections in Philadelphia, indicating timely administration of naloxone is critical for preventing deaths.

"Although some clandestine flights have been observed along the Pacific coast of Central America, including some affecting the Mexican airspace close to the border with Guatemala,⁹⁷ and some departing from Ecuador to various destinations,⁹⁸ this mode of conveyance appears to be more pronounced along the eastern (Caribbean) coast, where flights are extensively used alongside maritime shipments to facilitate the northward flow of cocaine from South America towards Mexico.⁹⁹ Venezuela (Bolivarian Republic of) is a major point of departure for such flights.

"North America, with its large consumer base,⁶⁸ continues to be one of the main destinations for cocaine trafficked from South America. Mexico is an important transit country functioning as a gateway for cocaine reaching the United States,⁶⁹ which accounts for the majority of cocaine users in North America,⁷⁰ as well as Canada (primarily via the United States, but also directly from Mexico⁷¹).

"Cocaine use is on the rise at the global level. The number of people who use cocaine has been increasing at a faster rate than population growth. The main markets for cocaine worldwide are North America, Western and Central Europe, followed by South and Central America and the Caribbean.

"The global supply of cocaine is at record levels. Cultivation doubled between 2013 and 2017, peaked in 2018 and rose sharply again in 2021. The process from coca bush cultivation to cocaine hydrochloride has also become more efficient, contributing even further to the global supply of cocaine.

"In parallel, law enforcement agencies are seizing greater amounts of cocaine. Preliminary figures for 2021 suggest a very sharp rise in seizures. In recent years, seizures showed an underlying upward trend across most regions, punctuatedf by a "bump" brought about by COVID.

"• At yearend 2021, about 5,444,900 persons were under the supervision of a correctional authority in the United States, including 3,745,000 persons under community supervision and 1,775,300 incarcerated in state or federal prisons or local jails (table 1).

"• The total correctional population in 2021 showed a 1% decline from yearend 2020 (5,506,000) and a 22% decline from 2011 (6,994,500).

"• The total correctional population declined by 0.6% to 2% each year from 2011 to 2019, but it decreased 13% from 2019 to 2020 due to responses to the COVID-19 pandemic.

"The Global Overview 2021 revealed that 2021 had ended as a year of mixed progress. On one side, the number of countries executing people for drug crimes had reached a decade-low, owing mostly to a halt in drug-related executions in Saudi Arabia and, to some extent, the COVID-19 pandemic. On the other side, a significant increase in confirmed executions had been recorded, largely attributable to a surge in Iran.6 In the course of 2022, the situation sharply deteriorated.