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I would like to quote from a very recent article (published December 14, 2021) by a student at National Defense University, Islamabad, Ms. Palwasha Khan.
“With the recent withdrawal of US troops and NATO forces from Afghanistan and the takeover of the Taliban, the smuggling of narcotics into Pakistan has further increased. In Pakistan, the prevalence of drug abuse is increasing at an alarming rate. However, risk factors, which are increasing vulnerability toward addiction, remain largely elusive.”
The most used drugs are heroin and marijuana, with cannabinoids becoming more popular. Other drugs include opium, amphetamine, methamphetamine, cocaine, and misused prescription drugs. According to the United Nations Office on Drugs and Crime’s (UNODC) research, almost 800,000 Pakistanis between the ages of 15 and 64 use heroin daily.”
As mentioned earlier, Afghanistan remains the biggest supplier of Heroin to Pakistan and the world. In addition, there has been a significant growth in the use of synthetic drugs such as Crystal Meth, and Ice. These were initially used by urban youth, but now appear to have more widespread use.
Another published study highlights the prevalence of addiction in Rawalpindi/Islamabad areas.
It is clear that the menace of drug abuse is one the rise. It is likely to further increase due to economic pressures on both sides. The sellers want to sell more to generate more money, and the users are under enormous pressure and must find some way to relax. The widespread availability of various substances of abuse is also fueling the fire.
TREATMENT & REHABILITATION
This much needed area in quite grey. There are several reasons for this situation.
- Government facilities are so limited and completely insufficient to handle the load of addicts in Pakistan
- Many patients are treated as outpatients in government hospitals. The treatment is restricted to giving drugs to counter addiction, but there is no isolation or rehabilitation.
- In admitted patients, complaints about substances supply in connivance with the employees is reported.
- Therefore, the entire treatment and rehabilitation effort is dominated by private sector.
- Like regular private hospitals, rehabs are entirely unregulated. No license is needed to establish a rehab center, and there are no policy guidelines or control on what they do.
- The cost of addiction treatment must also be brought under some control. It is a national issue that needs government intervention. Price slabs should be fixed like the testing fee for dengue and COVID were fixed.
- Rehab facilities should be required to obtain a license by fulfilling certain requirements. The treating physicians’ qualification and capability should be certified. The support staff training, like nursing, should also be considered.
‘Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health’ recommends various measures which are equally applicable here. It highlights that the separation of substance misuse treatment from other mental health and general healthcare services has had a negative impact on the outcomes. Because substance misuse is generally considered criminal and socially unacceptable, their treatment is not considered to be the responsibility of the healthcare system.
- Integrated services for primary care, mental health, and substance use-related problems together produces the best outcomes and provides the most effective approach for supporting whole-person health and wellness. Efforts are needed to support integrating, screening, assessments, intervention, use of medications, and care coordination between general health systems and specialty substance use disorder treatment programs and services.
- Most people with substance use disorders do not seek treatment on their own, many because they do not believe they need it, or they are not ready for it, or they are not aware the treatment exists. However, they do access the healthcare system for other health problems like illness, injury, overdose, and chronic physical and mental health problems. It is therefore important to include screening for substance misuse in diverse healthcare settings.
- Early intervention to prevent escalation of misuse to substance abuse should be done.
- Patients of substance abuse should be engaged to seek and continue treatment.
- All levels of severity of substance abuse should be treated.
- Long-term monitoring and follow-up of these patients should be done.
The sum up of treatment scenario in Pakistan is currently marred by the following factors.
- Insufficient – the rehab centers are too few. These are established usually in small, rented homes with no proper facility for keeping patients.
- Inefficient – the time to ‘detoxify’ is neither determined nor communicated. Patients may stay for as long as they can afford it.
- Ineffective – the outcomes are dubious. No one knows how many people were successful in leaving their habit. Furthermore, the entire emphasis is on chemical treatment. There is a semblance of psychological counseling without monitoring results. There may be emphasis on religious practices like prayers, but the outcome is not known.
- Isolated – the rehab centers do not cater to general health issues though it is known that substance misuse leads to several health problems.
- Unregulated – it is a completely unregulated business where qualification, facilities, support systems, accommodations, are out of the ambit of any regulation.
- Exploitative – the cost is astronomical, and it is tough for most people to bear the costs. In some cases, the rehab may even be more expensive than a four-star hotel. Apart from accommodation, many other charges are applied.
- Criminally negligent – in severe cases of substance abuse, personality disintegration already sets in. Further abuse or negligence is prevalent because the poor patients may not realize or complain.
There is an urgent need to address proper policy making for handling treatment and management of substance abuse. The efforts for prevention and curbing of drug trafficking shall be discussed in the next post, which shall be the last part on this topic.
To be Continued……
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Use Of Psychoactive Drugs Among Medical Undergraduates In Abbottabad – PubMed (nih.gov)