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The drug menace

June 24, 2013

THE Supreme Court has taken the Anti-Narcotics Force (ANF) to task over its abysmal performance in curbing the smuggling of narcotics. “Why was the ANF not arresting the drug barons running big business and confining its activities to only nabbing carriers and peddlers?” the chief justice asked during an appeal case recently.

“The offence of narcotics is bringing bad name to the country and it needs to be curbed,” the court said.

This concern by the apex court is justified in view of the latest survey carried out by the government of Pakistan through the Bureau of Statistics and facilitated by the United Nations Office of Drugs and Crime. An estimated 5.8pc, or 6.45 million, of the population in Pakistan aged between 15 and 64 years used drugs in the last year.

Drug use is a problem in Pakistan. Interplay between the supply of opiates, cannabis, synthetic and prescription drugs available over the counter, plus social and economic factors, makes the population vulnerable to drug use and related problems.

Plant-based drugs are the most predominantly used drugs by those between the ages of 15 and 64 with 3.6pc or just over four million annual users of cannabis. High levels of opiate use have been found with 0.9pc or just more than one million users of which 0.7pc use heroin and 0.3pc opium annually. Levels of use for opiates are highest as a proportion of the population in provinces that border cultivation areas in Afghanistan.

Synthetic drugs in the form of amphetamine type stimulants or ATS have emerged as a concern with 0.1pc found to use amphetamines and 0.02pc using methamphetamine. While the levels of the annual use of ATS are low the findings are quite noteworthy because for the first time such data has been compiled in Pakistan. Moreover, the non-medical use of prescription drugs has been found in a sizable population of men and women although it is significant that more women use tranquillizers and sedatives than men.

Vulnerability to blood-borne diseases such as HIV through injecting drugs is also considerable, with 420,000 drug users estimated to be injecting drugs, a higher estimate than ever reported previously.

Although 4.1 million individuals are estimated to be dependent on drugs, treatment and specialist interventions are available to less than 30,000 drug users annually.

The Anti-Narcotics Policy (2010) defines the priorities and methods in implementing drug control, including the supply and demand reduction strategies. The policy was translated into practical measures in the Drug Control Master Plan 2010-14, which aims to “reduce the health, social and economic costs associated with drug trafficking and substance use in Pakistan”.

Supporting the policy and master plan objectives requires a consolidated and coordinated approach from the federal and provincial governments, civil society and the private sector; and is likely to require changes in approach and priority. The newly elected governments in the centre and the provinces need to display sustained and stable commitments against the drug menace. The following recommendations are put forth for the consideration of all the relevant stakeholders.

One, sustained efforts by the law-enforcement agencies, particularly the ANF, to reduce the supply of narcotics and related precursor chemicals should be made. Particular focus should be given to Balochistan and KP where drug barons and smugglers are active in cross-border trafficking and supply is the highest. There is a correlation between areas with high levels of opiate use and proximity to trafficking routes from Afghanistan.

Two, the emergence of synthetic drugs, including ATS, and related precursors, requires attention of law-enforcement and regulatory authorities.

Three, in the context of demand reduction, evidence-based interventions for the prevention of drug use, with a focus on families and skills education should be widely implemented.

Four, with regard to the non-medical use of prescription drugs, a medication management system is required to ensure medication is only available to those who need it. Awareness-raising among policymakers, clinicians, parents, young people and teachers is needed. Healthcare professionals need to be trained to prevent, recognise and manage non-medical prescription drug misuse.

Five, there is a strong need to increase education and prevention efforts in HIV and hepatitis awareness among the general population and high-risk groups. An increased engagement is required with people who inject drugs through the strengthening of community-based outreach services and mainstream health providers.

Six, the drug treatment and care services are the weakest link in Pakistan. The scope and coverage of treatment should be expanded nationally, including pharmacologically-assisted psychosocial treatment of opioid dependence and effective aftercare provision for recovering users. Drug treatment centres should be supported to consistently implement the national treatment protocols for drug use endorsed by the Ministry of Narcotics Control in 2012.

Seven, the health departments and civil society in the provinces should expand drug prevention and treatment capacity and coverage, both to the general public and to specific sub-groups, including offenders.

Eight, regular monitoring of drug use in Pakistan would aid policy efforts to address needs and provide data for the evaluation of programmes and interventions. A national surveillance programme would be highly beneficial for understanding trends over time and measuring improvements.

Nine, implementation of the anti-narcotics policy requires very close coordination between the federation and the provinces. The narcotics control ministry will have to be proactive in engaging with national and international partners to combat the drug menace.

And finally, lack of political will and commitment, inadequate capacity of key stakeholders and ignoring civil society are surefire recipes for failure of the state. This will be yet another test of the resolve of the newly elected governments to overcome daunting problems being faced by the nation.

The writer is former secretary narcotics control.