You might want to treat those sky-high numbers with some skepticism; it's not clear how the authors could know this with such certainty or how so many North Koreans could get their hands on the drug when so many can't afford or find basic medicine and when undernourishment remains a serious issue. A 2010 Brookings Institution report found that meth addiction rates were significant and growing but far from this scale. Still, the report is drawing attention to North Korea's meth problem, which, whatever the scale, is well-documented and an apparently significant problem for the country.
So how do people in North Korea, a country where markets are so tightly regulated that even video CDs can be considered dangerous contraband and where social controls are often beyond Orwellian, manage to get hold of meth? It's an interesting story, regardless of the scale of drug use today, and one that offers some interesting lessons for how North Korea works.
The problem actually goes back to the 1990s, when North Korea experienced a famine so devastating that virtually the entire world believed the country would collapse at any moment. But it didn't, in part because Pyongyang finally decided to open up the world's most closed economy just a small crack, by allowing a degree of black market trade across North Korea's border with China. The idea was that the black market would bring in food, which it did, preventing North Korea's implosion.
The black market trade into China has remained that little bit open ever since, either because Pyongyang authorities can't close it now or because they see some trade as beneficial, probably both. Some provinces along the border have seen their economies liberalize a tiny, tiny bit -- most notably North Hamgyung, which is named in the North Korea Review report as particularly blighted by meth addiction.
In the years after the border with China opened that little crack, two other things have happened that led to the current meth crisis. First, medicine ran out and the once-not-terrible health system collapsed -- more on this later. Second, North Korea started manufacturing meth in big state-run labs. The country badly needs hard currency and has almost no legitimate international trade. But it was able to exploit the black market trade across the Chinese border by sending state-made meth into China and bringing back the money of Chinese addicts.
This is where things started to spin out of control for North Korea. The state-run meth factories and the cross-border black market trade started to mingle. And some of that meth ended up migrating back across the border and into North Korea, through the black market trade that brings in Chinese rice and DVDs and the like. It's possible that some North Korean civilians started making meth on their own domestically, although it's not clear where they would get the chemicals or the cooking space, and the scale would surely not match that of the state factories. But, either way, the influx of meth into northern North Korean cities was a product of the same barely tolerated black markets that the state allowed to open to fight the famine now almost 20 years ago.
This is where the collapse of the North Korean health system becomes relevant. As Isaac Stone Fish reported in a great 2011 Newsweek story, many regular North Koreans started using meth to treat health problems. Real medicine is extremely scarce in the country. But meth is much more common, which means that the prices of medical drugs are artificially inflated, while the price of meth is artificially low. In a culture without much health education and lots of emphasis on traditional remedies, people were ready to believe that meth would do the trick for their medical problems, and many got addicted.
The meth problem is hard for North Korea to deal with for three reasons: (1) because its health system is ill-equipped, (2) because the state doesn't want to shut down North Hamgyung's quasi-liberalized economy but also can't regulate the black market effectively, and (3) because the country believes it needs to keep making meth and shipping it across the border to bring in hard currency. Meanwhile, North Korean addicts, whatever their numbers, are on their own.