Students' drug use: Do we know what we're talking about?

And is the government capable of providing quality rehabilitation?
Published May 29, 2018

Two standing committee reports on bills to drug-testing students in the capital will be taken up today, just days before the National Assembly dissolves. While these bills are likely to lapse, the demand for such a policy may be heard again in the future.

The policy has been discussed by parliamentary committees over the past year and proposed in Sindh and Balochistan.

This report explores the underlying claims of increased drug use among students in the capital, the effectiveness of such a policy, and the capability of the government to see it through.

“I think it is unfair that everyone is tested and that all drugs are treated the same. Many of my friends and I do weed. It’s not addictive, it doesn’t incapacitate you, it’s not expensive, and it’s harmless. To me, it’s ridiculous that cigarettes are legal and weed is not. We like to smoke after a particularly difficult exam or just when we’re hanging out. What harm is it doing anyone,” says Zarak, a bachelors’ student in Islamabad.

This year, the National Assembly received two bills mandating drug tests for school and college students in the capital. Both these bills are likely to lapse when the assembly dissolves on May 31, but parliamentarians have increasingly demanded mandatory drug testing.

However, neither of the bills appear interested in the nuance that Zarak points out above. In fact, only one of the bills even defines what it means when it talks about ‘drugs’.

The definition of what substances would qualify as drugs is critical to any potential legislation, especially one that imposes sweeping tests on students.

While the claim that marijuana is not addictive or harmful is questionable, the argument that there must be an elaborate understanding of drugs — and distinction among them — is a strong one. After all, there is a marked difference in the health risks associated with drugs such as marijuana and other substances.

Titled the Compulsory Drug Test of Students Act 2018, the bill moved by PML-N MNA Asiya Naz Tanoli deals with the issue summarily, without getting into much detail. It states that annual tests should be conducted in all colleges and universities, but does not provide any further information. Ms Tanoli could not be reached for comment despite repeated attempts.

The Prevention of Drugs in Educational Institutions Act 2018 tabled by PPP MNA Shahida Rehmani is relatively more thorough, though still not comprehensive. The bill is meant to be enforced in both public and private universities, as well as in high schools — defined as “9th grade to second year, O and A levels” — in the Islamabad Capital Territory and areas under the administrative control of the federal government.

The bill holds educational institutions responsible for conducting — and paying for — unannounced tests at least once a year, and for providing “sufficient evidence” of the tests to the government upon request.

Penalties have been suggested for failing to abide by the law, which include penalising institutions that do not administer the tests and barring students, who fail to take them, from sitting for their exams.

‘We simply do not have the numbers to justify such a move’

Ms Tanoli’s bill states: “There are reports that students of Universities and Colleges are using drugs and this trend is increasing day by day therefore, we need to control this trend.”

Ms Rehmani’s “aims to discourage rampant drug usage among students and strenthens the universities in their drug prevention role”.

Almost all the experts that Dawn spoke to agreed that there has not been any research that could substantiate this claim.

The United Nations Office on Drugs and Crime (UNODC) conducted the last comprehensive survey of drug use in the country in 2013, which found that drug use was more common among those aged between 25 to 39 than 15 to 24 — the age bracket these legislations target.

A senior Anti-Narcotics Force (ANF) officer, when posed the same question, said that there were no formal studies that would suggest an increase in younger drug abusers, but based on the number of patients treated at the ANF rehabilitation centre, it does not seem likely that there has been a surge.

“We simply do not have the numbers to justify such a move,” he said.

Secretary, Punjab Education Department, Dr Allah Bakhsh Malik said that no formal research had been carried but a committee recently formed by the government which included officials from the education department, police, narcotics and intelligence had made alarming findings.

He claimed the problem of “drug addiction” was particularly acute in elite schools.

“There could be a case or two in schools, but I don’t think drug addiction in schools and colleges is the way the media is projecting it,” said Private Schools Association President Zofran Elahi.

“It’s possible at the university level, but up to FSc college — if it happens — it must not be common.”

Asked if he felt there had been an increase in drug use amongst his peers, Ahmed, 21 — who said he began using drugs when he was 17 or 18 — said: “Yes, it has increased. It’s bad. It’s really easy to get now; there’s a dealer on every corner, three or four in every sector.”

“I don’t know if it’s the move from school to university or if it’s becoming more common. I think it’s the latter because I have younger siblings who understand the idea better than I did [at that age]. For me, I might not have had access to drugs when I was in my A Levels, but now I know where to get something if I wanted it,” said Alia*, a university student.

According to Dr Asma Humayun, a consultant psychiatrist, it does seem that ‘unofficially’ the problem is growing.

“I have done some work with a few leading educational institutions, and the [results] are alarming,” she said.

However, most of the discussion around an increase in drug use among younger people in Pakistan is anecdotal, said Dr Kamran Niaz, an epidemiologist with the UNODC Research Branch in Vienna.

He added: “Moreover in Pakistan, there have not been any time series, a repeated survey on drug use that is based on the established scientific methodology of conducting school surveys on drug use. Due to this, we can neither establish a baseline nor any trends in use.”

‘Students are our future’

“We have no other option. Students are getting side-tracked, and police, teachers and the government tried to curb the problem but could not,” Ms Rehmani said.

“Students are our future, and the whole nation is responsible for them.”

When asked about drug use amongst her peers Sana, an A-Levels student, said: “Many students do drugs at our campus. It’s not new; it’s something we have grown up with.

“But it doesn’t mean you will start misusing drugs when you associate with those who do. I think most of us have a clear idea of who we are and I don’t think peer pressure or wanting to blend in is such a big factor.”

Another high school student, Rabia*, added: “Teachers say don’t do drugs, but that’s where it stops. They put up posters, but they don’t understand why we do drugs. I think a lot of us — while being privileged Islamabadi teenagers — are depressed.

“Why? It’s because of school, because of the expectations and the pressure. Then they tell us, ‘don’t do drugs’; they organise a seminar. I’m sorry, it doesn’t work that way.”

‘A deterrent’

An important question that arises from the proposed legislation is whether a policy to test students for drugs would be an effective preventive measure.

In an emailed response to questions posed by Dawn, Dr Humayun and Dr Niaz said most of the literature on substance abuse prevention does not include drug testing as a useful measure in preventing drug use.

Drug testing is considered an invasive exercise that requires investment to ensure that there are enough laboratory resources to confirm and reconfirm a range of substances, as well as rule out false positives.

The United Nations Educational, Scientific and Cultural Organisation’s (Unesco) 2017 booklet How the Education Sector should respond to the Substance Use Issue states: “Evidence in support of drug testing students in school is very limited, with most studies showing no preventative effect. Weighed against the many concerns (e.g. expense, alcohol and tobacco is not tested, significant ethical considerations concerning student privacy, and the possibility of harm due to punitive actions that reduce school engagement), this measure is not recommended.”

Dr Humayun and Dr Niaz added that effective prevention requires younger people to have a caring and nurturing environment. Punitive measures and mandatory drug testing mostly have the opposite effect.

In the absence of science-based prevention programmes, an annual drug test, even if done randomly, would in no way yield any benefits, and would not serve any deterrence, they said.

Mandatory testing as a deterrent, however, has been brought up by proponents of the policy.

Senator Rehman Malik, who has also proposed drug testing students, when asked said: “When you are a student, you’re scared. If the test is there, the student will be afraid of their parents and teachers finding out about their drug use.”

Dr Allah Bakhsh Malik told Dawn these tests “will act as a deterrent”.

“I feel like if this happens, you’re getting checked, and a lot of kids might not get into it in the first place,” said Alia*.

“I wouldn’t be comfortable [having to give a drug test]; I would reduce my use, but I wouldn’t stop completely. Of course, I would be uncomfortable because I may test positive, and my parents will have to see it,” said Ahmed*.

(*Names have been changed to protect identities)

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Published in Dawn, May 29th, 2018

‘Students will feel humiliated if you treat them as offenders’

While both bills – the Compulsory Drug Test of Students Bill and the Prevention of Drugs in Educational Institutions Bill - call for mandatory drug tests for students in the city, only one mentions the protection of students’ biological data.

MNA Shahida Rehmani’s Prevention of Drugs in Educational Institutions Bill directs the responsible institution to maintain the confidentiality of students who test positive for drugs, and says it shall not be used to defame or blackmail students.

“Any personnel divulging such information mala fide shall be penalised from Rs50,000 to Rs150,000,” the bill states.

Who will collect and secure the biological data of minor and adult students?

Ms Rehmani suggested that the heads of schools and universities should be made responsible for keeping the records, while Dr Malik from the education ministry said the data should be kept by the state and made available to parents and heads of schools upon request.

Inspector General of Islamabad Police Dr Sultan Azam Temuri, who is leading a separate police initiative to test students suspected of using drugs by their parents and teachers, said that if a database of students’ test results is maintained at all, it should be handed over to the responsible agency and no one should have access to it.

Another question is whether it violates students’ privacy to drug test them at all. The European Monitoring Centre for Drugs and Drug Addiction and Unesco have cited invasiveness and ethical considerations regarding student privacy when discussing the effectiveness of drug testing in schools.

According to Society for the Protection of the Rights of the Child founder and lawyer Anees Jillani, there is no right of privacy under the Constitution, although privacy is “well protected” under the United Nations Convention on the Rights of the Child - which Pakistan has ratified.

Saroop Ijaz, a lawyer with Human Rights Watch Pakistan, said: “The closest law we have that covers privacy is Article 14 of the Constitution, which [states]: ‘the dignity of man and subject to law, the privacy of home shall be inviolable’. With this, we can sort of go around the element of forced searches and the right to privacy.”

Asked if mandatory drug tests would violate students’ privacy, Ms Rehmani said: “Thalassemia testing and polio vaccinations are mandatory, whether someone likes it or not. This is also a public health issue, and the tests should be enforced regardless. We have to move on with the times.”

Women’s rights activist and Human Rights Commission of Pakistan member Nasreen Azhar agreed that the privacy of underage and adult students is important.

When asked about the mandatory drug testing bills, she said: “My opinion is that there is massive confusion in our law between moral and criminal offences.”

“These things, like drugs and so on, strictly speaking, are not crimes against the state. These are moral offences, and it is the responsibility of your parents, primarily, and secondly it is also the responsibility of educational institutions to control it through student counsellors. Not through the danda, you see,” Ms Azhar said.

The government’s primary duty is to control the drug trade, she said, adding: “I think if they go into schools and colleges like that it’s going to be rather nasty for the students.”

When asked whether such a policy would affect students’ right to be considered innocent until proven guilty, rather than treating them as suspected drug users who have to prove their innocence by submitting to drug tests, she said: “Yes, you’re right, that is also tied up with it. They will feel humiliated if you treat them all as offenders.”

Not all students see it the same way.

Alia, a university student, argued: “Because I’ve seen the damage these drugs have done so closely, I feel like the privacy concern is a bit smaller than this problem. I understand why people might have privacy concerns…but if drug awareness campaigns increased, I feel people would be a lot more comfortable with the idea of getting tested. I don’t think that should be a big problem if you’re actually educating them and making them aware.”

Another student, Sana, said: “I don’t know how to feel about these bills. It is unfair that those who have never done drugs are also to be tested, every year… I would suggest taking more time and, if necessary, [making a policy] that only implicate those who do drugs, and not those who don’t. It’s unnecessarily invasive.”

“I think it’s a breach of our privacy. Mandatory drug testing doesn’t reduce drug use,” said Rabia. “There are other preventive measures; why don’t you get schools to lower the pressure? Why don’t you get psychologists on spot? Why don’t you have better security in your country so we don’t have access to these drugs? It’s like ordering McDonalds.”

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Published in Dawn, May 29th, 2018

Is the government capable of providing quality rehabilitation?

ANF's Model Addiction Treatment and Rehabilitation Centre has 45 beds and a waiting list of 800 people, but is not currently equipped to deal with minors.
ANF's Model Addiction Treatment and Rehabilitation Centre has 45 beds and a waiting list of 800 people, but is not currently equipped to deal with minors.

The Prevention of Drugs in Educational Institution Bill says that if a student tests positive for drug use more than once, they will be “referred to [a] drug rehabilitation centre”. The expenses for the facility will be borne by the student.

“If the student cannot afford such a facility, the cost shall be borne by the federal government and in case private facility (approved by the federal government) is availed, the expenses equivalent to those incurred in a public-sector rehabilitation [centre] shall be covered by the federal government,” it says.

Is the government capable of catering to potentially thousands of students and providing them with quality rehabilitation?

According to a senior Anti-Narcotics Force (ANF) official, there are only three rehabilitation centres at the government level, all run by the force – one each in Islamabad, Karachi and Quetta. The majority of people running the Islamabad facility are volunteers, including doctors and paramedical staff.

“The government does give us funding, but it is nowhere near enough,” he said.

The facility in Islamabad has 45 beds and a waiting list of 800 people at any given time, he said, which includes patients from Azad Kashmir, Khyber Pakhtunkhwa and other areas.

According to Talal Zubair, director of the private addiction treatment centre, Willing Ways, the condition of the ANF centres is “very pathetic”.

“The government simply does not have the infrastructure to deal with something like this. We do have psychiatry units in government hospitals, but they are not equipped. For instance, you need to have a quarantine environment for drug addicts. There are many psychological disorders behind drug abuse which need to be addressed.”

ANF’s Model Addiction Treatment and Rehabilitation Centre has 45 beds and a waiting list of 800 people, but is not currently equipped with dealing with minors.
ANF’s Model Addiction Treatment and Rehabilitation Centre has 45 beds and a waiting list of 800 people, but is not currently equipped with dealing with minors.

But the ANF official was sceptical of the private rehabilitation centres in Islamabad as well.

“Government-run centres will be the best option for students, if such a project is ever undertaken. That is because one, private rehabilitation centres are not regulated so we do not know what sort of treatments they are providing and two, because most of them are interested in making money they will extend treatment unnecessarily,” he said.

Mr Zubair said the government does not even have the infrastructure for regulating private rehabilitation centres.

UNODC’s adviser on drug demand reduction Dr Manzoorul Haq said the government should set up a body for regulating drug rehabilitation centres run by the private sector, civil society and the government. The body will ensure these facilities are following protocols in line with international standards.

He quoted a 2012-13 survey which said four million of 6.7m drug users across the country required drug treatment services. “And how many drug treatment services or centres are available in the country? 100? 150? We do not know as yet,” he said.

Research is also needed into the types of rehabilitation centres and treatment services available, he said.

“Rehabilitation and reintegration into society is a long journey for the person undergoing treatment as well as the family. You have to invest in the family and support system. That should be visible in our policies and strategies and in the practical implementation,” he said.

A bigger issue will be resistance from parents, the ANF official said.

“In our society, we like to keep everything under wraps. How do you think we will be able to convince parents to let us take their sons, and daughters, to a rehabilitation centre for drug use,” he asked. Security concerns will also need to be addressed, such as providing separate facilities for students and then a further division for male and female patients.

Society for Human Rights and Prisoners Aid Chairperson Liaquat Banori said he did not think any rehabilitation facilities will be established even if this bill passed.

“We have a record of not providing the infrastructure specified in other laws so what makes us think that these rehabilitation centres will ever be established,” he said and gave the example of shelters for victims of gender-based violence or human trafficking, which have yet to be established as specified in various laws.

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Published in Dawn, May 29th, 2018