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Abuse of psychotropic medicine, particularly benzodiazepines, goes back to many years. Valium (diazepam) and Ativan (lorazepam) were long abused by those who knew about them. The Pharma companies always maintained that these drugs were not addictive, rather only habit-forming. However, the habit was almost as strong as addiction, and many people got hooked on to them. Then came Lexotanil (bromazepam) and it replaced earlier products quickly. Two patterns were easily discernible: normal people got a prescription for anxiety and/or sleeping difficulty, they found relief and stuck to it; other regular people got to know about it, started using as an innocent thing and got habituated. These drugs were easily available over the counter, were cheap and socially acceptable. In fact, taking Lexotanil, like the golden pill – Prozac (fluoxetine) in the US, a part of modern life. After several years, Xanax (alprazolam) came on to market and took major share.

It is true that benzodiazepines do not disrupt life like hard drugs, but they create a dependence where the person feels incapacitated in their absence. The other important thing is that benzodiazepine abusers start at a young age and therefore are likely to continue for many decades. The third important thing is that benzodiazepines affect short-term memory and the person taking it mostly forgets what he said or did while he/she was under the influence.

Back to Poppy, Opium and Heroin, most of the poppy crop in Afghanistan was grown in five provinces along the border of Pakistan. Apparently, three major routes were used for drug trafficking: Western route via Iran; Southern route through Pakistan; and Northern route through Central Asian States. Through Afghanistan-Balochistan border, some shipments go to Iranian province of Sistan for onward transport to Turkey and Western Europe. Some quantities are smuggled through seacoast area of Pakistan, main ports, smaller fishing ports, and open areas of Makran coast to Gulf States and beyond. Another route went through Central Asian countries to China, which partly affected a decline in the supply of Heroin from Myanmar to China.

Substance abuse has a significant presence among medical students. Students admit to two stresses: one, the stress of study and clinical performance; and the stress of learning about dreaded diseases with common symptoms. Medical students jokingly say that as they study various diseases, they feel they have the same disease which they learn about.

Study titled, ‘Use of Psychoactive Drugs Among Medical Undergraduates in Ayub Medical College Abbottabad (KPK)’ is quite revealing.

780 participants were asked to fill a questionnaire about the use of 10 substances of abuse: cigarettes, naswar, benzodiazepines, cannabis, alcohol, amphetamine, opium, cocaine, heroin, and organic solvents (glues). 22% admitted to the use of a psychoactive substance in past or at present. Substance abuse was more common among males and senior students. Substance abuse by students in the order of prevalence was; cigarettes (76%), benzodiazepines (32%), naswar (28%), cannabis (27%), alcohol (16%), amphetamine (15%), opium (10%), cocaine (9%), heroin (7%), and organic solvents (3%). Use of more than one substance was seen in 47% respondents.

Another survey in Karachi collected data from students of 4 medical universities and 4 non-medical universities students about substance abuse. Of the 572 respondents, male:female ratio was 1.23:1.0. More males reported substance abuse than females. Substance abuse was higher in non-medical students as compared to medical students.

Addiction as an occupational hazard has been reported among doctors, particularly anesthetists, who may inadvertently keep inhaling the vapors of brain-affecting anesthesia drugs.

Substance abuse has risen sharply among younger population. If we go back 50 years, cigarette smoking was considered a fashion. The heroes in Hollywood and local movies smoked to show they were macho-men. It stirred a lot of inspiration among young people. Tobacco companies were major sponsors of all major events, sports, showbiz, and entertainment on ground and in media. Most youngsters started smoking in teenage, some continued for life, others quit on the way. It is considered that cigarette smoking opens the way to other, harder substances such as Heroin. After a long spell of smoking and tobacco companies reign, the world started turning against them. Public show of smoking was prohibited, tobacco companies’ advertisements and sponsorships were stopped, and an integrated campaign against cigarette smoking was launched. It did have an impact and smoking went out of fashion. Young people caught up to body-shaping and gyms. However, during the last 20 years, smoking has again become popular. Cigarettes are now supplemented or replaced with sheesha and vapes. These are equally dangerous in all respects.

To be Continued……

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Microsoft Word – PAK IDTR_Published April 08.rev1.doc (

Use Of Psychoactive Drugs Among Medical Undergraduates In Abbottabad – PubMed (

Are medical undergraduates more likely to indulge in substance abuse than non-medical undergraduates? A survey from Karachi – PubMed (

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