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The Narco-Pharma Nexus – still time to make amends?

August 13, 2012

Politics aside, the Supreme Court seems to have missed a golden opportunity in the ephedrine quota trial to dig deeper into the sordid narco-pharma nexus in the country and pry it open with the force at their disposal. Information available on this case in the press has been rather hyped and politically slanted making it impossible to get facts on scope and extent of the case and one cannot see how far and wide this case is going. But perhaps there still is time to make amends.

Having had the opportunity in the past to assist the Supreme Court as a pharmaceutical expert (amicus curiae) in a case involving counterfeit medicines, I have noticed that the Honorable Judges appreciate the public health issues involved and are very keen to resolve issues facing pharmaceutical sector. Perhaps this is the best the time in the country’s history to bring to light how health and narcotics control authorities at the federal and provincial level in successive governments have provided legal cover under which the narcotics and pharma industry have been working together since ages. Perhaps it is time the Supreme Court investigated why in the last twenty years has there been such a massive increase in issuing licenses of pharma manufacturing in the country when many of them would never set up a factory, never went into production or could not operate for more than one 8-hour shift in a day and still make so much profit that their business enterprises kept expanding.

Here is an explanation of how the system works. Let me underline that with the exception of cannabis, every illicit narcotic requires chemicals to be refined to its final, consumable form (e.g., the coca plant to cocaine, the poppy plant to heroin, etc.), or is purely the result of chemical synthesis (e.g., methamphetamine, ecstasy, etc).  Keeping these vital chemicals away from drug traffickers is the key to prevent or reduce narcotics production and lies at the heart of the problem that I am going to explain here briefly.

Complications in an otherwise simple situation start to arise when we consider that narcotics have been used as medicines and as raw materials for making both medicines as well as narcotics since time immemorial. Pharma companies, hakims, ayurveds and apothecaries have since long been creating concoctions of narcotics to relieve coughs, colds and pain as well as for aphrodisiac and recreational purposes. It is only in the more recent times that there has been colossal amount of production and trade of narcotics across the world, with links to terrorist outfits and mafias, that the need for induction of national and global regimes of regulation and control became necessary. However, it is exploitation of the grey area between legal and illegal drugs due to which the flow of huge sums of money continues to reach illicit traders and manufacturers.

Exhibit 2: List of narcotic medicines Though the law stipulates use and availability of the following narcotics to be highly restrictive for medicinal use, many of them are available freely at the leading whole sale pharma markets in Pakistan. A visit to the two of the biggest ones in Lohari Gate, Lahore and Katchi Galli, Karachi would be most instructive. A few years ago when I was visiting these markets for research I saw customers, young and old, shopping some of them freely from the small, dingy and dirty shops in the narrow convoluted alleys which Lohari and Katchi Galli markets are known for. I also bought a bag full of different brands for confirmatory purpose. There was clearly no regulation of sales and the products also looked shoddy even on cursory physical examination.

Now the “quotas” business is about issuing permits for import of raw materials used for both pharmaceutical as well as narcotics industry, which in our case have been going on unabated in by the authorities in excess by many thousand times to the domestic medicinal needs. Most of the chemical raw materials for narcotics would end up with narcotics manufacturers in Afghanistan and tribal belt bringing home huge funds for the Pakistani pseudo pharma manufacturers without ever having to do any manufacturing themselves.  The profits from trading of narcotics manufacturing in Afghanistan and FATA are instrumental in supporting the Taliban as between 40 and 60 per cent of its income comes from this trade.
  1. Fentanyl
  2. Sufentanil
  3. Remifentanil
  4. Buprenorphine
  5. Meperidine
Addiction Detox and Substitution
  1. Methadone
  2. LAAM
  3. Buprenorphine
  4. Dihydrocodeine
  5. Dihydroetorphine
  6. Heroin
  1. Morphine
  2. Codeine
  3. Loperamide
  4. Diphenoxylate
Cough Relief
  1. Morphine
  2. Codeine
  3. Dihydrocodeine
  4. Hydrocodone
  5. Hydromorphone
  6. Heroin
  7. Methadone
Pain Relief
  1. Morphine
  2. Methadone
  3. Oxycodone & Hydrocodone
  4. Oxymorphone & Hydromorphone
  5. Buprenorphine
  1. Etorphine
  2. Tramadol
  3. Fentanyl
  4. Carfentanil
  5. Diethylthiamutene
  6. Dimethylthiambutene
Although efforts have been made around the world to control the chemicals used for cocaine and heroin production, efforts to control the chemicals used in ‘methamphetamine’ production are on the up. This is because of the tremendous risks associated with methamphetamine consumption and production and because, unlike cocaine and heroin, there is no drug crop to eradicate since methamphetamine is a completely synthetic drug. The chemicals used in methamphetamine production are pseudo-ephedrine, ephedrine, and pharmaceutical preparations containing these substances (commonly known as “combination products”).  Additionally, producers have developed chemicals similar to these products– called analogues – in an effort to evade chemical control laws.

Though my Pakistani compatriots don’t like comparisons with India, especially in cases where India would look better, a comparison in this case would be most relevant and illuminating. Unlike the Pakistani pharmas Indian companies accrue large profits by exporting legally produced narcotics; these profits are then ploughed back into the country’s economy rather than being used to arm warlords. One good example of such a company is CIPLA (The Chemical, Industrial and Pharmaceutical Laboratories); established in 1935, CIPLA is now one of India’s largest narcotics manufactures competing with the finest pharmas from the West.


Ayyaz Kiani is a public health specialist. He heads Devnet – a network of development consultants. Based in Islamabad, he has travelled around the world and continues to do so to meet fellow travelers. He can be contacted at


The views expressed by this blogger and in the following reader comments do not necessarily reflect the views and policies of the Dawn Media Group.