Fighting addiction

Published April 18, 2024
The writer is a secretary, Pakistan Psychiatric Society, Punjab chapter.
The writer is a secretary, Pakistan Psychiatric Society, Punjab chapter.

THE illicit global drug market, which is valued over $400 billion, is second only to the counterfeit products market in terms of the world’s main crime rackets. Cocaine, heroin, cannabis, and amphetamines are top sellers. Afghanistan leads in opium and heroin production, while Bolivia and Brazil are at the forefront of cocaine production. Mexico is a key player in cannabis and heroin circulation. The US is a leading market, which mainly receives drugs through Mexico. Canada is another market, to a smaller degree though.

The Golden Crescent, which includes Afghanistan, Iran, and Pakistan, serves as a significant centre for opium and heroin trade, fuelled as it is by regional politics and a legacy of conflict. In Afghanistan, the grip of the Afghan Taliban over key drug-producing regions further complicates the issue. Meanwhile, the international pressure is on Pakistan to escalate its anti-drug campaigns.

According to one estimate, just a decade ago, illicit drugs valued at $30bn flowed through Pakistan from Afghanistan, underscoring serious security threats at both the local and international level. There remains a degree of uncertainty about the effectiveness of current methods to combat drug trafficking, underscoring the urgency for worldwide collaboration and a concentrated effort to address the fundamental reasons and consequences of this deadly activity.

A 2013 report by the United Nations Office on Drugs and Crime and Pakistan’s narcotics control authorities revealed that 6.7 million adults had used illicit drugs in the previous year, with cannabis use seen to be most common. Additionally, the recent World Drug Report of 2022 points to a worldwide uptick in the use of substances such as cannabis and amphetamines, which coincides with a rise in health emergencies, including hepatitis C and HIV, particularly among individuals who use drugs via syringes. This situation underscores the critical need for widespread public health strategies to address the alarming level of substance abuse in the country.

Not enough is being done to contain drug abuse.

Founded in 1957, the Pakistan Narcotics Control Board has been pivotal in the crackdown against illegal drugs. It joined the interior ministry in 1973 and went through several transformations before emerging as the Anti-Narcotics Force in 1995. The ANF aims to stop poppy farming and drug trafficking. Besides prevention and global partnerships, the ANF runs Model Addicts Treatment and Rehabilitation Centres, which have been treating over 14,000 people since 2005 by combining enforcement with rehabilitation.

A recent study has focused on Pakistan’s escalating drug overdose emergency, revealing that 700 people die each day due to drug overdose complications. Faced with around 7m regular drug users, 4m of whom favour cannabis and another 2.7m struggling with opioid addiction, Pakistan is grappling with a significant problem. Tackling this issue calls for a unified strategy that includes strict regulation, improved medical training, and a thorough revision of public health initiatives.

Centres for the treatment of drug addiction in Pakistan face substantial challenges. Both public and private facilities struggle with inadequate infrastructure, a lack of skilled professionals, and weak enforcement of sound management practices. Although we live in the 21st century, Pakistan still has not recognised drug addiction and rehabilitation as an official sub-specialty in psychiatry, while the absence of qualified drug addiction psychiatrists, especial­­ly when compared to branches like forensic psychiatry, is deeply worrying. Although mental health laws are in place, the lack of specific legislation for overseeing drug addiction treatm­ent and its regulation means the field is not officially recognised.

This situation impedes the development of specialist training and programmes in the country.

Hospitals and pathology labs in Pakistan seldom conduct important tests such as breathalysers, drug screenings, immunoassays, let alone employ advanced techniques such as GC-MS. The country is also severely lacking in facilities for opioid substitution therapy, which incorporates medication.

Despite the availability of medications that can prevent drug relapse, their usage is uncommon, indicating a hesitation in adopting contemporary and evidence-based approaches to diagnosis and treatment.

Pakistan urgently needs a coordinated policy, better healthcare education, strong regulation, and uniform addiction treatment to halt the increasing number of deaths caused by overdose and substance abuse.

The writer is a secretary, Pakistan Psychiatric Society, Punjab chapter.

X: @AliBurhanMustfa

Published in Dawn, April 18th, 2024

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