Abstract
Drug addiction is a societal problem that has affected every nation at some point in time as each develops. South Korea’s recent struggles to combat the rise in drug abuse, particularly amongst its youth, suggests that there are deep social and structural issues that have allowed this crisis to rapidly progress. Korea’s drug abuse problem is unique in how a relatively drug-free nation has rapidly seen an increase in drug use, particularly narcotics, in recent years. Korea’s response of using technology and enhanced vigilance has just recently been ramped up to combat the problem but deeper societal patterns and beliefs about drug addiction may need to be changed to successfully combat the expanding problem with drugs.
Keywords: Biomedical and Health Sciences, Drug Abuse, Social Pressure, Medical Industry, South Korea
Introduction
Since its formation after the Korean War, South Korea has rapidly developed from one of the poorest countries in the world to one of the most developed nations in the world. With a Human Development Index (HDI) of 0.929, which places it 19th out of 193 nations, a high life expectancy of 83.53 years, universal health care and one of the most advanced medical infrastructures in the world1. The drug abuse crisis in Korea is particularly concerning because Korea has historically had very low rates of illicit drug use2. The country has seen a huge increase in drug use in the past decade, with over 18,000 drug arrests in 20223. Korea’s neighbor Japan on the other hand, has had illicit use of stimulants decline from 19,722 in 1997 to currently less than 6,000 criminal cases4. Furthermore, Japan’s drug arrests are primarily cases of cannabis use, while South Korea faces more concerning cases of increased use of narcotics such as methamphetamine and ketamine5. These differences highlight there are unique problems systemic to Korea responsible for the sudden rise in illicit drug use.
A large portion of the problem has emanated from abuse of legal prescription drugs. Its geographic isolation because of its closed border with North Korea has limited the traditional physical flows of illicit narcotics but the advanced technological infrastructure in South Korea has created a nearly undetectable distribution system. Combined with a widespread acceptance of digital currencies and transactions, the drug market in Korea has altogether skipped the traditional street trade of illicit drugs and become a network of contact and faceless transactions. As the society has rapidly developed, traditional conservative views towards drugs have limited efforts to treat drugs as a social issue. Instead, efforts at enforcement have focused on prevention and punishment instead of rehabilitation. This literature review seeks to explore the social causes of the problem and how the infrastructure of Korea’s medical, transport, and technology industries have fostered this growing problem. This review also attempts to explore efforts to combat the problem and analyze their effectiveness going forward.
Scope of the Drug Problem in South Korea
In comparison to other developed countries, the drug problem in South Korea is proportionally much smaller and less pervasive than other nations of similar economic status. Many drugs like marijuana, Heroin, and cocaine are not produced in the country, difficult to obtain, and expensive. In a 2022 study of wastewater by the Ministry of Food and Drug Safety, the government found that levels of drugs in the sewage wastewater were prevalent in every city and province. The study concluded that based on water samples, approximately 52,000 people consumed methamphetamines on a regular basis. Other drugs like cocaine were detected but at extremely low levels6. South Korea’s cocaine levels in wastewater were .37 milligrams in 2020 but had drastically risen sixfold to 1.43 milligrams by 2023. In comparison, cocaine levels in Europe were 353.9 milligrams and in America they were 1,800 milligrams in 2022. While the levels in South Korea are drastically lower than in other countries, the concerning issue was the rapid rise in relative levels of use amongst the population.
This is concerning because until recently, Korea had the reputation of being a country that was drug free. As a small and isolated country, Korea has been able to maintain public safety by strictly controlling the flow of illicit substances into the country. The zero-tolerance approach to drugs has been applied to other dangerous threats such as guns. Regulations in Korea do not permit people to own firearms and in 2016 there were only 5 deaths related to firearms, which equates to a 0.00005-gun homicide death rate per 100,000 people7. In comparison, there were nearly 48,000 firearm deaths in the United States in 2022 (which equates to 4.31 deaths per 100,000 people)8’9. Thus, South Korea has attempted to apply the same approach to illicit drugs as it has for firearms but has not found the equivalent success.
While the drug abuse statistics are significantly smaller than other equivalent nations, the scope of South Korea’s problem must be considered from the rate of its growth, particularly amongst the younger generation. According to data (Figure 2) from the Ministry of Food and Drug Safety, since 2012, drug offenders among individuals nineteen and younger has risen over 1000%, from 38 offenders in 2012 to 450 offenders in 202110. Additional government studies have shown that drug users are not only increasing in number but increasingly younger in age11. In 2021 nearly 60% of all drug offenders were in their 30s or younger whereas in 2018 most drug users were in their 40s12. Thus, drug abuse in Korea has been growing exponentially; but most concerning is the increasing concentration of youth offenders both on the consumption and distribution side of the issue.
Social Causes: High Education Expectations and Intense Levels of Competition
Why is the drug problem growing so rapidly in the youngest demographics of the country? A deeper analysis of the issues that affect youth disproportionately can shed light on the issue. South Korea’s population is one of the most highly educated in the world, with nearly 70% of adults possessing a college degree or higher14. This percentage is much higher for the younger generation15. According to the Korea National Statistical Portal (KOSIS), 14.36 million out of 28.4 million people employed had a college degree or higher16’17. Thus, education is highly competitive and professional success depends on high test scores and admissions to top colleges. This places an excessive burden on the youth who must spend extra time and money studying at private institutes to prepare for college exams, which are held only once annually. According to the Ministry of Education, students on average spent 9.4 hours a week at private institutes in addition to regular schooling, with the average household spending 658,000 won ($450) per month on private education. Because of the intense academic pressure, students and parents turn to prescription medication to boost academic performance. Studies from the government show that widespread abuse of attention deficit hyperactivity disorder (ADHD) medication that includes drugs like methylphenidate has drastically risen in recent years. In 2007 there were 33,000 teenage prescriptions for methylphenidate and that number rose to 44,000 in 2021. From 2017 to 2021 over 199,000 teenagers had been prescribed the medication in the country18. Because diagnoses of the disorder are often based on subjective assessments, many of these drugs have been abused and traded among students seeking to boost their competitive advantage in studying. Peer pressure may also play a major role in increased drug use amongst Korean youth. A study has also shown that Korean adolescents reported stronger direct influence of peers than of parents on substance use, which explains why the drug use problem is also rising amongst Korean youth19.
Another consequence of the competitive environment is the increased number of suicides and depression among the youth in Korea20. This often leads many youths to turn to drugs as an outlet because of the competitive education and employment environments. Studies show that Korea has the highest suicide rate in the world amongst developed nations at 25.2 deaths per 100,000 which is nearly double the OECD average. In addition, 42.3% of deaths among teenagers are due to suicide. Some of these suicides are most likely linked to drug use which has been shown to be correlated with depression and suicidal thoughts in Korean teens21. Drug use is now the third biggest risk factor for suicide in Korea, just behind suicidal ideation and depression.22. Thus, the mental health issues such as depression that stem from cultural pressures to succeed due the competitive nature of Korean society are contributing factors to the growing drug abuse problem in Korea among the youth.
Socioeconomic Causes: Income Inequality and Rural Flight
Wastewater studies have shown that drug use is particularly higher in less affluent regions with declining economic conditions and more rural areas23.As South Korea’s population ages and its birth rate plummets, the country faces long-term economic challenges. One major consequence of this demographic shift is a shrinking workforce, leading to reduced economic productivity, particularly in less urban regions24 As local economies have declined, so too has access to jobs, economic mobility, and social stability, creating conditions ripe for substance abuse.
This situation somewhat mirrors the opioid crisis in the United States, where many individuals in economically distressed regions—such as the Midwest—turned to drugs after many manufacturing jobs were outsourced to other regions25 In Korea, those facing joblessness or stagnant wages may be more likely to turn to drugs as a means of escape, further deepening the cycle of poverty and substance abuse. The Korean government has been slow to address the widening gap between the wealthy and the poor, and this economic disparity can create an environment vulnerable to drug misuse. A study in South Korea showed that unemployment can lead to increased alcohol and drug use26, perpetuating a negative feedback cycle in which individuals unable to find work become addicted to drugs, making it harder for them to rejoin the workforce and further deepening their drug dependency.
Ease of Access to Drugs: Pharmacy Loopholes and Lax Oversight in the Pharmaceutical Industry
Ironically, one of the biggest weaknesses in the drug abuse problem in Korea comes from its robust medical industry. With an advanced medical and pharmaceutical industry, South Korea boasts one of the best medical infrastructures in the world. Advanced companies research and manufacture medicines that are exported globally and access to health care is cheap and efficient. Most of the problems with opiates come from the abuse of the prescription drug system in Korea which until recently, allowed people unfettered access to these types of drugs27. In a recent case, a doctor was caught prescribing nearly 5,000 fentanyl patches to a single a patient on 304 separate occasions over the course of 2 years28. This same patient was able to purchase 7,655 fentanyl patches from 16 different hospitals after complaining about a lumbar disc herniation. In another investigation, it was discovered that 42 hospitals had prescribed an average of 150 patches of fentanyl per patient over a three-year period29. For perspective, a single patch is used once every 3 days, so hospitals were caught prescribing over a year of medicine from a single prescription30. Nearly 73% of the prescriptions were for patients in their 20s and 30s, and the prescriptions were given without any medical diagnosis. Patients were able to complain about back pain or request fentanyl because they had previously requested it at other hospitals. In South Korea, because medical care is so cheap and clinics are often located close to each other, it is common to doctor shop, so patients often go from clinic to clinic and go fentanyl medical shopping. Up until June of 2024, hospitals were not required to check a patient’s prescription history. In addition, prior privacy laws made it impossible for hospitals to check a patient’s medical history at other medical facilities. According to the Ministry of Food and Drug Safety, fentanyl patches were prescribed over 1.4 million times in the last three years31. Abuse of the medical system was not only restricted to fentanyl; in another case, a single patient who was prescribed 2,430 fentanyl patches over 26 months was also able to obtain 6,824 tablets of oxycodone from nineteen different clinics over a 15-month period. These cases are not isolated incidents and indicative of flaws in the medical system that led to the abuse of these drugs. Lastly, even teenagers were caught abusing this loophole in the system. In a case from 2022, 42 people including 9 teenagers were caught shopping hospitals for fentanyl patches32. Many of these teens distributed the patches in schools where they charged other students 150,000 won ($120) per patch. Many of the students used other people’s identities at the clinic because there were no safeguards to check the identity of patients. In summary, Korea’s medical network is made up of many independent distributors and pharmacists who do not face direct oversight from the government33. Driven by profit and unregulated, this allowed widespread abuse of the drugs.
Ease of Distribution: Technology and Contactless Payments
South Korea has a highly developed internet and transport network that has bolstered its economy. However, this has also enabled the flow of drugs to pass undetected throughout the country. With 95% of teenagers possessing a smartphone and nearly everyone having access to digital bank accounts, the development of cryptocurrencies and encrypted chat rooms have enabled contactless distribution of drugs throughout the country34. Online chat rooms and apps like Telegram make it nearly impossible for authorities to track drug dealers because there is never direct contact between individuals to exchange drugs or money35. This is also why the drug crisis has disproportionately affected the youth, who are first adopters to encrypted chat rooms and digital currencies. A common method in Korea is called “throwing” in which drug dealers throw drug packages in certain locations and buyers pick them up without ever meeting36. Transactions are conducted online and with little chance of being caught.
In addition to domestic distribution, Korea’s robust transport and shipping industries have enabled an increased flow of drugs into the country. According to statistics from the Korean government (Figure 3), the number of drugs captured in raids has increased 1000% from 15kg of drugs in 1996 to 1,272 kg of drugs captured in 202137.
The development of the drop shipping industry in which foreign goods are directly distributed to customer’s homes instead of going through traditional warehouse style import channels has enabled the distribution of illicit drugs directly through the transport industry. In an interview with a customs official, he admitted that there were only seventy agents assigned to custom surveillance for all airports and ports across the nation. In July of 2021, an Australian man was arrested for smuggling 1,134 kg of methamphetamines from Mexico to Korea by hiding the drugs in the airplane gearbox39. Combined with the social causes that have boosted demand for drugs, the development of technology and smartphones has also accelerated the proliferation of drugs in South Korea. While the drug problem may not be new, it has increased at a rate that authorities have been ill-prepared to manage.
Recommendations and Solutions: End the Social Stigma against Drug Addiction
Recently, Lee Sun-Kyun, a famous actor who had starred in the Best Picture winning film, “Parasite,” committed suicide after testing positive for illicit drugs and being involved in an extortion scandal. Due to an invasive police investigation and intense media pressure, he lost all his endorsements and film roles while the investigation was ongoing40. In Korean society, celebrities and athletes are expected to live perfect lives, free of scandal or controversy; the country looks down on drug addicts, accepting disproportionate levels of punishment for drug abuse. Several other celebrities have faced scrutiny and scorn for drug scandals, which indicates a social aversion to drug abuse.
A national survey conducted in 2020 of 1,000 adults found that in comparison to other countries, Koreans supported significant levels of discrimination against drug users (Figure 4). Koreans were significantly more likely to discriminate against someone in terms of denial of housing and employment if they knew a person abused drugs. This suggests that the country has a high consent rate for punishing drug abusers41.
As a result, the government’s efforts against the drug crisis have centered on preventing the spread of drugs and punishing individuals caught using them instead of allowing for rehabilitation and treatment. Drug abuse is considered a personal failing and not a social issue, so there is not as much willingness to provide treatment. Limited options for rehabilitation or funding for treatment have hindered efforts to fight drug abuse. Table 1 shows an overview of the number of drug arrests over the decade 2011 to 202243.
Year | 2011 | 2016 | 2021 |
Number of Drug Offenders | 9174 | 14214 | 16153 |
Despite this alarming rise in drug arrests, the Korean government’s Ministry of Health and Wellness only provided financial support for treatment for 350 individuals in 2021. Although this number was raised to 1000 in 2023 in response to rising drug use, it still dwarfs in comparison to the growing number of people affected by addiction44.
There are different approaches the Korean government can take to help reduce the social stigma of drug use that has been practiced in other countries. One approach is to decriminalize the personal use of illicit drugs, while making the production and sale of said drugs illegal. This has previously been proven to be successful in Portugal which decriminalized drugs to combat its drug crisis. It resulted in fewer drug related crimes and deaths by allowing drug addicts to seek help and get treatment45. The British Columbia district of Canada has also begun a 3 year trial of drug decriminalization last year as well to tackle their opioid crisis46. Decriminalizing drug use and treating drug addicts as patients and victims as opposed to criminals may help destigmatize drug addiction and allow South Koreans addicted to drugs to seek the help they need.
Furthermore, the government needs to expand the number of rehabilitation centers. As of now, there are only 6 rehabilitation centers in South Korea, while neighboring Japan has about 9047. The government shies away from rehabilitation efforts and instead is more focused on educating youth to not do drugs, while ignoring the plight of those already suffering from addiction.
Addressing the Socioeconomic Needs of Poorer Regions
Since there is a clear correlation between economic well-being and drug use, addressing these socioeconomic needs is essential to curbing South Korea’s rising drug use. Economic revitalization efforts, particularly in areas that have experienced economic decline can be paired with comprehensive social services that address mental health and addiction. Job creation programs and affordable mental health support from the government could help mitigate the root causes of drug abuse, offering people economic stability and alternative avenues for coping with hardship. Expanding government outreach to at-risk populations, particularly young people and those in economically depressed areas, will be key in reducing the demand for drugs and addressing the socioeconomic factors driving this growing problem.
Crackdown Major Areas of Drug Distribution
Data from studies show that most drug distribution in urban areas such as Seoul occur in night clubs and entertainment venues48. Having stricter policing and law enforcement in these areas can help reduce drug trafficking and make it more difficult for people to have easy access to illicit drugs.
Narcotics Management System
Recently the government has attempted to implement a greater system of oversight of the distribution of drugs in the medical industry. A Medical Information System is being trialed to prevent the misuse of drugs49. This system would check a patient’s medical history and alert medical providers to instances of abuse. This integrated system would require all narcotics handlers to identify patients that abuse the system while also granting greater oversight into a patient’s medical history and needs. Combined with changes in societal views of drug abuse, advances in technology such as this system show potential solutions to this problem in Korea50. However, with South Korea’s medical system being overburdened by a lack of physicians, rolling-out this system could prove to be challenging. In response, President Yoon has recently announced plans to increase enrollment in medical schools – having drug rehabilitation be an integral part of medical school curriculum or mandating a certain number of positions be filled for those who will work in drug rehabilitation could be a way to ensure this system will not be overburdened in the coming years51.
Limitations and Future Research Directions
While this study has explored several key socioeconomic, medical, and technological factors contributing to the rise of drug abuse in South Korea, it is important to acknowledge certain limitations. Firstly, the availability and accuracy of data pose challenges; some of the statistics on drug use, particularly from government sources, may not reflect the true extent of the crisis due to underreporting or limited access to comprehensive studies. Much of the drug abuse occurs in underground networks, making it difficult for researchers to track precise data on drug use. Secondly, statistics on drug use and arrests do not give a nuanced view about the context behind the arrests. More specific details such a detailed breakdown of all of the different types of drug used, the dosage and frequency, and whether the arrests are repeat offenders are more difficult to reliably get for our analysis. Additionally, while socioeconomic disparities between urban and rural areas have been noted, more detailed analysis is needed to compare drug use rates and causes across different regions in South Korea, as regional differences in law enforcement, healthcare access, and economic opportunities may contribute to localized trends that are not fully captured here. Finally, although societal stigma surrounding drug addiction has been highlighted, the complexity of cultural attitudes toward mental health, addiction, and rehabilitation remains underexplored, which could limit the effectiveness of proposed solutions, such as decriminalization, if they are not adapted to the specific social and cultural context of South Korea.
For future research, several directions should be considered. One key area is the evaluation of the potential impact of decriminalizing drug use in South Korea, drawing lessons from countries like Portugal and Canada. Comparative studies could examine the social, legal, and economic implications of decriminalization and whether it would reduce stigma and improve treatment options for drug addicts in South Korea. Furthermore, given the significant role of technology in facilitating drug transactions, future research should delve deeper into how young people engage in drug-related activities through digital platforms. Understanding how encryption, cryptocurrencies, and contactless methods are utilized could inform more effective policy responses, particularly targeting youth drug prevention and digital oversight. Additionally, there is a need for further investigation into the effectiveness of existing drug rehabilitation centers in South Korea, especially considering the shortage of such facilities. Studies could explore how to expand access to rehabilitation services, improve treatment quality, and evaluate different models of rehabilitation to identify the most effective approaches within the context of South Korea. Finally, exploring the intersection of economic decline, mental health, and drug addiction is crucial. Future research could analyze how mental health services and job creation programs can be integrated into drug prevention strategies, particularly in economically depressed areas. This research could provide deeper insights into solutions that address the root causes of drug addiction rather than just the symptoms.
Conclusion
South Korea’s experience with the drug crisis is concerning due to the pace with which the country has gone from a drug-free nation to a country with a concerning rise in rates of drug use. Key societal, socioeconomic, medical, and technological factors have contributed to this rise. The highly stressful competitive environment in Korea causing mental health issues, income inequality, and lax drug prescription regulations have created an environment where more people are susceptible to drug use. This problem has been further compounded with a lack of accessible rehabilitation services and social stigma against drug use that dissuades individuals from seeking help.
The Korean government has also been slow to react to these changes and have been too focused on prosecution rather than rehabilitation. Furthermore, the government appears to be tackling the symptoms rather than the causes of this issue. Trying to treat the underlying issues behind drug use by addressing the economic needs of those who are financially struggling and offer mental health support for those who are depressed would be a step in the right direction.
South Korea could also learn a valuable lesson from other nations on how to handle increasing rates of drug use and could invest more in treating current addicts by building more rehabilitation centers. Recommendations for future research include longitudinal studies that assess the long-term effects of decriminalization on drug addiction rates in other countries to see if decriminalization can be applied in South Korea. With a shift towards rehabilitation and decriminalization, South Korea could come up with new innovative ways to tackle this growing crisis.
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