Muhammad Afzal, 35, a resident of Chah Meeran, Lahore, is one of the thousands of those drug addicts who again fall into the trap of drug abuse. He had promised his treating doctor at Mayo Hospital during his first visit that he would not take drugs in future.

Afzal was brought to the hospital with a leg fracture after an accident. When he continued to cry with pain for many hours despite having being administered pain relief medicine he confessed that he was a habitual drug user, consuming hashish (cannabis) for many years. He had to suffer more as medication takes more time to be effective in a drug user as compared to non-users.

A driver by profession, Afzal left his home in sheer disappointment when after the death of his father he developed differences with his brothers and owing to financial problems and other issues, and started living with his grandfather in Gujranwala, where failing to get a job, he started taking hashish in friends’ company. Frustration and collapse of family system and unemployment are some of the major reasons to force many young men to abuse drugs.

When Afzal, re-visited the hospital after two months for a medical examination, Dr Salman, who had treated him earlier, learnt that he was again using drugs and this time he was taking heavy doses.

Health experts and government officials say that Pakistan’s geographical location next to Afghanistan, the world’s largest producer of opium, has placed the country in a vulnerable position in terms of drug trafficking as well as drug abuse. They are of the view that Pakistan became a major exporter of heroin in the 1980s, following the influx of Afghan refugees in 1979.

Kashif Dogar, a member of an NGO, says that until the late 1970s heroin was virtually unknown in the country.

Prof Dr Hussain Mubashar Malik, Chairman, University of Health Sciences, depicted a gruesome picture of drug addiction in the country, saying that the number of drug users has increased with the passage of time. He said that the problem had become more complicated with the increase in the number of injecting drug users (IDUs).

According to Dr Malik, opiate users fall in the age bracket of 15-60 years, while the average age of initiation of drug use is 18. The majority of drug users use cannabis as the first substance. Unfortunately, after 2006-07, no survey was carried out either by government agencies or private institutions and NGOs pertaining to the number of people consuming drugs or involved in this business.

United Nations Office on Drugs and Crime (UNODC) carried out the first comprehensive and detailed survey on drug abuse in Pakistan titled ‘National Drug Abuse Assessment 2006-07’, after a report compiled in 2000, in collaboration with the Ministry of Narcotics Control and Anti Narcotics Force. The UNODC-2000 survey estimated that there were 500,000 chronic heroin users in Pakistan.

According to the National Assessment Report (2006) on the Problem of Drug Use in Pakistan, there were 628,000 opiate users. Of these around 482,000 (77 per cent) were heroin users, while 125,000 were injecting drug users. It is important to note that in 2000 the number of injecting drug users in Pakistan was 60,000, which almost doubled in 2006, an alarming trend that needs to be addressed on a priority basis. In the 1990s the proportion of injecting drug users was reported between two and eight per cent of opiate users, which rose to 15 per cent in 2000.

The National Survey on Drug Abuse (NSDA) conducted in 1993 by the Pakistan Narcotic Control Board, said there were nearly three million drug dependents in Pakistan of which 51 per cent were heroin dependents. It represented nearly a three-fold increase in the total number of dependents and 30-fold increase in the number of heroin dependents as compared to the findings in the first National Survey on Drug Abuse conducted in 1982.

The NSDA 2006 report said many drug users faced serious health and social problems. Around eight per cent were reported to have HIV infection, 18 per cent tuberculosis and 11 per cent Hepatitis C infection.

The report estimated that the average age of drug users was 35 years. Country-wide, up to 33 per cent of the drug users were between 31 and 40 years old. While 38 per cent had no education, 25 per cent had up to primary and one-third up to high school education. It said around one-third of opium users were unemployed, while the remainder (39 per cent) were supporting themselves through casual work or were working part or full time.

A senior consultant of anti-narcotics campaign, Syed Zulfiqar Shah, who is dealing with the issue for the last 25 years, expressed his disappointment over the measures taken by successive governments to eradicate or stop drug production and abuse.

Dr Malik said there had recently been an increase in the abuse of synthetic drugs, though it is currently largely restricted to affluent, young people owing to high prices and limited availability. The upper-middle class youth, aged 16 to 25, are using Ecstasy in their parties. Similarly, those youngsters involved in racing cars and motorbikes also use Ecstasy to enhance their risk taking behaviour, while inhalant abuse is common among street children.

A large number of Sheesha bars offer Sheesha to youngsters in posh localities. Among women, Dr Malik says the use of Sheesha is increasing with the passage of time, particularly in major cities. Dr Rubina Zafar, a senior psychiatrist at Jinnah Hospital, Lahore, is of the opinion that teenaged girls usually abuse substances in order to lose weight, relieve stress or improve their mood, reduce inhibition, treat depression and increase confidence.

Talking about treatment and rehabilitation, Dr Malik says that though there are a number of centres in the private sector most are minting money as they charge around Rs150,000 to 200,000 for a 45-day treatment, and a rehabilitation package which is beyond the reach of a middle-class patient. Despite willingness, hundreds of drug addicts cannot kick the deadly habit because there are hardly any treatment centres in the public sector. Whatever centres there are they only provide detoxification services as no modern rehabilitation programmes are being run in the public sector.

Dr Rubina Zafar says that habitual drug users need psychiatric and other treatments in isolation for no less than 40 days. They should be kept under observation and not allowed to keep any money as they might try to run away or arrange drugs. She reveals that 70 per cent of the patients do not get complete treatment at homes and again start consuming drugs because of their family’s lack of interest or other reasons.