A DECADE ago, during one of the ‘Growing Up’ sessions I was holding in Karachi schools, I talked to seventh graders about drugs and addiction. Their interest and giggling prompted me to ask whether they knew where drugs could be obtained. They named several locations. Later, I realised that drug availability among the youth is far more common than we may believe. Perhaps the most alarming evidence is found in rehabilitation centres where children as young as eight years are being treated for substance abuse. News of teenagers dying of overdose in the country has become increasingly common. Seemingly healthy teenagers are succumbing to substance abuse — accidentally or intentionally — as they seek to escape from life’s difficulties and take refuge in the world of temporary pleasure that drugs provide.
Substance abuse refers to drug use, which causes significant problems at school, work or home — and continues despite the consequences. Dependence may develop, requiring larger amounts of the drug and causing withdrawal symptoms when use stops. Addiction begins with experimentation, especially during adolescence, with cigarettes, alcohol or drugs out of curiosity or peer influence. The adolescent brain is still developing, especially the areas responsible for judgement, decision-making and self-control. This may explain why teenagers often engage in risky behaviour. Adolescents are strongly influenced by their peers, and often resort to drugs to fit in. The maturing brain may not fully appreciate the long-term consequences.
According to an ANF report last year, almost nine million Pakistanis are struggling with substance abuse, with young people among the most affected. Universities and colleges are increasingly being targeted by drug dealers. Traditional drugs such as cannabis (marijuana, charas and hashish), heroin and cocaine have been overtaken in recent decades by methamphetamine derivatives such as ice, and designer drugs such as ecstasy. Hallucinogens (ketamine, LSD and phencyclidine) remain in circulation, and inhalants (aerosol spray cans and petrol) are often abused, particularly by street children. Numerous synthetic drugs are also available. Their effects are unpredictable; even a single dose may be fatal.
Alcohol use is common, while paan, gutka and naswar are often overlooked because of cultural acceptance, despite their addictive nature and health risks. Nicotine use has also changed. Traditional smoking and hookah are increasingly being replaced by vaping and shisha. Many teenagers, even parents, wrongly perceive vaping as harmless. Some vaping products contain high levels of nicotine or other psychoactive substances. Shisha smoke contains toxic substances linked to cancer and cardiovascular and lung disease.
Parents should know that drugs aren’t just sold on street corners.
The choice of substance often depends on affordability, availability, social acceptance and current trends. As a result, adolescents may have different reasons for experimenting with or regularly using particular substances.
Research shows that risk factors for substance use include poor parent-child relationships, parental substance abuse, inadequate supervision, inconsistent discipline, peer pressure and mental health conditions such as anxiety, depression, ADHD and conduct disorders. In contrast, strong parent-child relationships, positive role models, healthy friendships and supportive home environments act as protective factors.
Parents must remain vigilant. Warning signs include declining grades, loss of interest in activities, sleep disturbances, irritability, mood swings, aggression, secrecy, unexplained requests for money, frequent lying about whereabouts, unusual od-
our on clothing and evidence of smoking or vaping. Parents should know that drugs aren’t just sold on street corners but, in the age of social media, can be marketed and distributed through online platforms and messaging apps.
If you suspect substance abuse in your teenager, stay calm and start a conversation. Open and non-judgemental discussions are more effective than accusations or threats. Seek help early from your child’s pediatrician or a mental health professional. Remember that substance abuse is often a symptom of an underlying problem rather than the problem itself.
Pakistan is often implicated in regional drug trafficking because of local production and its geographic location along major trafficking routes. The government recognises the problem, but stronger efforts are needed to curb production, trafficking and distribution, while ensuring effective prevention and rehabilitation programmes for the young. Governments, schools, healthcare professionals, communities and families must all play a part in addressing the challenge. Failure to act will lead to harmful consequences for our youth — Pakistan’s future.
The writer is a paediatrician at AKUH.
X: @kishwarenam
Published in Dawn, June 12th, 2026