Drug Abuse in Pakistan 3 – Pharma Veterans’ Blog Post #588 by Asrar Qureshi

Drug Abuse in Pakistan 3 – Pharma Veterans’ Blog Post #588 by Asrar Qureshi

Dear Colleagues!  This is Pharma Veterans’ Blog Post #588. Pharma Veterans welcome sharing of knowledge and wisdom by Veterans for the benefit of Community at large. Pharma Veterans Blog is published by Asrar Qureshi on WordPress, the top blog site. Please email to asrar@asrarqureshi.com for publishing your contributions here.

Most addicts use Heroin through smoking, either in a cigarette, or directly. However, 15-20% addicts usually inject drugs. Particularly, those who use opiates and morphine inject these drugs. The survey shows that there had been a marked increase in injecting practice since previous survey. On a lifetime measure of injecting, 31% respondents reported ‘ever-injecting’.

On average, they would inject four times on a typical injecting day. 70% or more injected with a syringe already used by another addict. Similarly, they passed on the same syringe to next addicts. It can be inferred that the prevalence of blood-borne viruses such as Hepatitis C, and HIV would be quite high among addicts.

The upper estimate of almost 500,000 was calculated as the possible number of Heroin abusers. This number has several limitations. It is not based on the entire geography; it represents selected areas. Women are not counted in this. The inclusion criteria were tough, but if it is relaxed slightly, the numbers would jump up. The number of Cannabis abusers is much higher and the two should be considered together to estimate the burden of addiction in Pakistan. The last estimate was over 4 million, and it is expected that this number has grown much above it.

The son of someone I know closely became Heroin addict several years ago while he was a teenager. The conservative parents tried to curb it but failed. Finally, they decided to enroll him in a rehab. The father asked me to accompany him for visiting and getting information. We went to a prominent rehab clinic in Lahore and met the owner who was a doctor. His speech highlighted the following ‘key points’.

• Addiction is based on genetic profile. The addicts have a psychology which makes them prone to become addicts. Given favorable circumstances, these people will certainly become addicts.

• Addiction cannot be treated. The addicts shall always be addicts. 

• The rehabs only ‘detoxify’ the addicts and keep them clean as long as they are there. 

• When they go out, it is the responsibility of their parents/guardians to protect them.

• On the first available opportunity, the ‘clean addicts’ shall again fall back into addiction.

This is the version of rehabs who are charging millions of rupees from hapless addicts and their parents.

It is true that drug addiction is a chronic, relapsing brain disorder. Multiple neural networks in the brain including the ‘reward system’, the ‘anti-reward/stress system’, and the central immune system are involved in the development of drug addiction and relapse after withdrawal from drugs of abuse. This finding has a bearing on the development of therapies for management of addiction.

The above quoted survey was conducted in 2000. Now we look at a UN report from 2013.

The report says that 14% of the global total of opiates has been seized in Pakistan. Amounting at 71,784 kgs, this makes Pakistan the third largest country in amounts of opiates seized. Afghanistan is second with 26% and Iran at the top with 39%. Amounting for 82% of global illicit opium production, Afghanistan is the international market’s main supplier. Pakistan being one of the routes through which these drugs are smuggled is being adversely affected. It should be understood that some part of it will surely land in Pakistan which will keep fueling the addiction problem. 

Pakistan cultivation of opium poppy greatly declined during 1990s to near zero level by 2000. It was the result of commendable government efforts. The commitment of federal government may be seen from the serious decrease in poppy cultivation, from 9,441 hectares to just 213 hectares. There was a re-emergence after Taliban prohibited poppy cultivation in Afghanistan. In 2003, poppy cultivation was reported at 6,703 hectares, including the first-time cultivation in the Balochistan province. While the area cultivated in Pakistan was equivalent to only about 1.2% of the area cultivated in Afghanistan, the risk of increase is always there. The total area again declined to 2.306 hectares by 2007 as a result of joint, integrated eradication efforts. 

Opium production in Afghanistan increased dramatically during the period 2001 – 2006; from 185 metric tons in 2001 to 6,100 metric tons in 2006. In 2007, Afghanistan produced 8,200 metric tons of opium, accounting for 93% of illicit global opiates production.

No official statistics on Cannabis cultivation, production, and eradication, if any, are available. However, considerable amounts are believed to be cultivated in the country, and though illegal, it is widely used due to low price and easy availability.

Production and trafficking of synthetic drugs – Amphetamine Type Stimulants (ATS) and benzodiazepines are relatively low in Pakistan but growing steadily. Ecstasy, the most common form of ATS, is smuggled into Pakistan from various countries. Benzodiazepines are manufactured legally in Pakistan. While drug abuse of plant-based drugs is the major part, there has been an increase in the abuse of synthetic drugs. Their prices are high, and the availability is restricted, therefore, their abuse remains limited to affluent young people. The use of Ecstasy in parties organized mainly by young men and women, aged 16 to 25 years, usually belonging to upper or upper middle class families, is on the increase in major urban centres. Additionally, young people involved in racing cars and motorbikes use Ecstasy to enhance their risk taking behaviour. 

To be Continued……

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Microsoft Word - PAK IDTR_Published April 08.rev1.doc (anf.gov.pk)

Drug Abuse in Pakistan – HOW (houseofwellness.pk)

Rising trend of substance abuse in Pakistan: a study of sociodemographic profiles of patients admitted to rehabilitation centres - PubMed (nih.gov)

Drug addiction: a curable mental disorder? - PubMed (nih.gov)