Menace of addiction in Pakistan: Time to Act


Menace of addiction in Pakistan:
Time to Act
Lt. Gen. Mahmud Ahmad Akhtar

Opioid addiction is spreading like a wildfire all over the Pakistan. It is affecting the campuses acutely- the target of illegal traders. The spread of an opioid addiction is one of the after-math of the Afghan war. According to the United Nations report there are 7.6 million drug addicts in Pakistan, 78% male, 22% female. There number is increasing at a rate of 40000 per year. In October 2016 an NGO reported that about 53% of the students in leading private schools in Islamabad are addicted to various kinds of drugs. Similarly a recent study which includes two universities from Lahore revealed that 75% of students reported the use of at least one drug. Almost free of from the use of fatal habit-forming synthetic drugs till late 1979 Pakistan ,now figures- among the top 10 drug abusing countries in the world.

There are practically no treatment/ rehabilitation centers in the country and no effective organization is involved in its prevention. There are some so called private “Rehabilitation Centers” run on commercial lines- charging heavily using violent methods- not using scientific based protocols.

Opium is smuggled from Afghanistan with impunity. The trafficking of opium needs strict control. There is no control on using opioid prescription drugs. These are freely available in the market. There should be strict control on its sale use/ misuse and abuse.

Lt. Gen. (R) Mahmud Ahmad Akhtar

Whenever there is a genuine need of painkiller opium drugs for the palliative treatment of cancer, these are not available while at street corners, heroine and other addictive drugs are sold openly. For the treatment of over dosage/poisoning the lifesaving anti-dote is not available although it is included in the WHO ‘Essential Drug list’ devised by its “Drug Expert Committee” for the low/ middle income countries. Sadly Pakistan is the only country in the World not implementing the system though the lists were made and commitments given. The system has worked extremely well all over the world, provides affordable, cost effective, relatively safe lifesaving medicines, and eliminates harmful irrational medicines. The reason is Pakistan’s serious ailment corruption to make money out of the irrational, non-cost effective medicines.

The virus of corruption has destroyed the socio-economic fabric of the country. The result is that Pakistan is at the bottom of the World Health indicators with the highest mortality rate from the still-births to adulthood, highest incidence and prevalence of communicable and non-communicable diseases in the World even now lagging behind the newly- emerged Bangladesh and sub Saharan African countries like Rwanda and Namber. The “Essential Medicine System” should be implemented immediately. It provides lifesaving anti-dotes. Portugal met enormous success in tackling the problem of opioid addiction in contrast to the USA’s poor performance. Nicholas Kristofer reports in the New York Times that Portugal has decriminalized the use of drugs including heroin and cocaine. Drug addiction has been taken as a medical challenge than a criminal justice issue under the decriminalization policy the addicts do not fear arrest, fully cooperate with the authorities. The addicts were treated as patients not criminals. The patients involved with injections were provided clean syringes, taught aseptic techniques to prevent infections like HIV/AIDS, Hepatitis B, and C etc. The anti-dote Naloxone was made available at all health facilities, lowering fatalities considerably. The patients were also counseled by the “DISSUADING COMMISSION”. The USA cracked upon the addicts, incarcerated them, spent millions of dollars. More than 6400 addicts died due to poisoning and lack of treatment- more than soldiers killed in Vietnam, Iraq, Afghanistan combined.

In Portugal about 2500 Portuguese use heroine down from 100000, when its policy began. The number of Portuguese dying from overdoses plunged to more than 85%. Its drug mortality rate is the lowest in Western Europe, one tenth of the rate in Britain or Denmark and 1/50th of the USA. Delegations from all over the World are flying to Lisbon what is now referred as “Portuguese model”. The government sends mobile vans to cruise Lisbon’s streets every day of the year and supply users with free methadone -an opioid substitute to stabilize their lives and enable them to hold jobs.

Portugal switched to the health focus under a socialist Prime Minister Antonio-Gutierrez -now Secretary General of the U.N.O -did not change focus on drug trafficking. Dealers still go to prison and it did not quit legalize drug use, but rather the purchase or possession of small quantity (up to 10gm per day supply) not a crime but an administrative offense like traffic ticket. Approach is close to a medical doctor than a court of law. The public health approach arises from an increasingly, common view worldwide that addiction is a chronic disease, comparable to other chronic disorders, thus requires medical care.

Platonic health effort leads to overall decrease in addiction. The Health Ministry sent workers to the drug infected neighborhoods to provide the needles and urged users to try methadone. The Portuguese Health Minister applied strict prescription opioid control- prevented routine use. The World Health Organization and American health Association have both praised decriminalization and Public Health focus on drug policy.

The authorities in Pakistan should study closely the successful Portuguese model and adopt active measures to tackle the problem which is spreading like a wildfire. It should adopt measures to prevent smuggling of opioids, its spread to the people particularly in young people and the campuses. Adopt all legal measures to deal with criminals involved in the nefarious trade, and it should handle addicts as medical problem actively by adopting health policies like Portugal. Portugal has met huge successes. Its economy has improved enormously. Pakistani youth are getting addicted in large numbers, particularly at the campus and this is disastrous to the country’s future and security. Atomic bombs and missiles would be meaningless if our youth indulges in suffering from diseases like addiction. Families across Pakistan are demanding more to be done to end this despair and devastation of addiction.

Active users need to be kept alive long enough and emergency rooms need supplies of naloxone, the medication use on someone who has overdoses of opioids. Like the Government of Portugal Pakistan needs to spend on needle exchange and clean syringe programs to combat the infectious diseases that are associated with it including HIV/AIDS assisted support medication treatment programs.

Treatment of addiction

One of the most effective methods of treating addiction is through continuation medication therapies like methadone, naltrexone, and buprenorphine. This is not done in Pakistan. Half to 70% of people with substance abuse suffer from depression, post-traumatic stress and other mental disorders. These disorders should be treated effectively: Physical and mental health should be taught and practiced as one entity not separately and treatments should be amalgamated. Medical students should receive training in the management of prescription opioids and prevention of their misuses.

Considering it as an issue of immense public importance the authorities need to educate the youth about the adverse effects of drug abuse ,adopting the right policy of rehabilitating addicts with the policy of awarding deterrent punishment to the producers, smugglers and pushers of these drugs -which is not being done. Sadly the conviction rate of people involved in the nefarious trade in very low. The staff of enforcement agencies must be made to perform their duties properly. All the stake holders should be involved in the campaign to contain it. The problem of addiction should be taken seriously-tackled as a grave emergency. All-out efforts involving all concerned; departments should be involved in solving this serious problem.