Drug abuse in Pakistan - United Nations Office on Drugs and Crime

EXECUTIVE SUMMARY
About half of those <strong>in</strong>terviewed <strong>in</strong> the streets (52%) and just over a third of those <strong>in</strong> prison (37%) had
at some stage received treatment for a drug problem. For almost all this was for a hero<strong>in</strong> problem. The
mean age of first treatment contact for the sample as a whole was 26 years—this did not vary significantly
between groups. Although, many of the sample had had contact with treatment agencies usually
this contact was brief, for nearly half of subjects 10 days or less. Similar f<strong>in</strong>d<strong>in</strong>gs emerged from the
<strong>in</strong>terviews with current treatment attendees. This suggest the need to review the provision of community
based services to supplement the <strong>in</strong>patient detoxification provision currently provided.
On average respondents had been us<strong>in</strong>g hero<strong>in</strong> for nearly five years (4.6) before enter<strong>in</strong>g treatment. Over
half (66%) of subjects reported that at some time they had not been able to access treatment when they
had needed help. The reason for this was usually f<strong>in</strong>ancial—with 80% of respondents report<strong>in</strong>g that
they had failed to receive help <strong>in</strong> the past because of f<strong>in</strong>ancial constra<strong>in</strong>ts. Most (80% of those <strong>in</strong>terviewed
on the streets and 72% of those <strong>in</strong>terviewed <strong>in</strong> prison), reported that they were <strong>in</strong> current need
of treatment for a drug problem. This study strongly supports the need for enhanced and affordable treatment
provision to be made available for those with drug problems <strong>in</strong> <strong>Pakistan</strong>.
Overall, patterns of drug tak<strong>in</strong>g were remarkable similar across the three groups. The drug users <strong>in</strong>terviewed
overwhelm<strong>in</strong>gly report daily and chronic patterns of hero<strong>in</strong> <strong>abuse</strong>. Dependence measures suggested
a highly dependent population who would be appropriate for entry <strong>in</strong>to a drug treatment programme.
Poly-drug <strong>abuse</strong> patterns were common across the samples although hero<strong>in</strong> was the drug
consumed most frequently, followed by hashish/charas and alcohol. The mean age of first hero<strong>in</strong> use was
22. This figure was lower for hashish/charas (18) and alcohol (19).
Fourteen per cent of respondents had used synthetic opiate drugs, 11% <strong>in</strong> the year prior to <strong>in</strong>terview.
The age of first use, 27 was also higher than that found for all other drug types. Although only a m<strong>in</strong>ority
of those <strong>in</strong>terviewed were us<strong>in</strong>g synthetic opiates, those that did, appeared to be do<strong>in</strong>g so on a regular
basis. Most (80%), were also <strong>in</strong>ject<strong>in</strong>g their drugs. This is a worry<strong>in</strong>g observation and supports anecdotal
reports that a synthetic opiate <strong>in</strong>ject<strong>in</strong>g subculture had developed among a small proportion of the
longer-term users—possibly as a reaction to poor quality street hero<strong>in</strong>.
Inject<strong>in</strong>g
Nearly three-quarters of respondents reported “smok<strong>in</strong>g” as their usual route of hero<strong>in</strong> adm<strong>in</strong>istration
(usually by “chas<strong>in</strong>g the dragon”). However, a worry<strong>in</strong>gly high 15% of respondents reported that they usually
<strong>in</strong>jected the drug. Those us<strong>in</strong>g synthetic opiates and morph<strong>in</strong>e commonly reported <strong>in</strong>jection as a
usual mode of adm<strong>in</strong>istration. This level of prevalence <strong>in</strong> <strong>in</strong>ject<strong>in</strong>g practice represents a marked <strong>in</strong>crease
from the results found <strong>in</strong> the 1993 study, where <strong>in</strong>jection was reported by less than 2% of the hero<strong>in</strong>us<strong>in</strong>g
sample.
On a lifetime measure of <strong>in</strong>ject<strong>in</strong>g 31% respondents reported “ever <strong>in</strong>ject<strong>in</strong>g” and 27% “<strong>in</strong>ject<strong>in</strong>g <strong>in</strong> the
last year”. Inject<strong>in</strong>g rates varied by city with over half (55%) of those <strong>in</strong>terviewed <strong>in</strong> Karachi report<strong>in</strong>g
lifetime <strong>in</strong>ject<strong>in</strong>g prevalence as opposed to only 12% <strong>in</strong> Peshawar.
On average respondents would <strong>in</strong>ject four times on a typical <strong>in</strong>ject<strong>in</strong>g day. Only 31% reported always
us<strong>in</strong>g a new syr<strong>in</strong>ge and needle for each <strong>in</strong>jection. Inject<strong>in</strong>g risk behaviour was high, and this was especially
true for the street recruited sample. Over half of all those who had ever <strong>in</strong>jected (51%) reported
us<strong>in</strong>g a syr<strong>in</strong>ge after others had already used it. For many this was a regular occurrence. More worry<strong>in</strong>gly
still, 42% of respondents reportedly regularly pass<strong>in</strong>g on a syr<strong>in</strong>ge to be used by others. These data
suggest that among the <strong>in</strong>creas<strong>in</strong>g numbers of drug <strong>in</strong>jectors <strong>in</strong> <strong>Pakistan</strong> the potential for a dramatic
<strong>in</strong>crease <strong>in</strong> the <strong>in</strong>fection rate for blood borne viruses, such as HIV, is considerable. Interventions
that target drug <strong>in</strong>jectors should therefore be considered a priority need for <strong>Pakistan</strong>. It is also highly
desirable to monitor the HIV status of drug <strong>in</strong>jectors and related behavioural <strong>in</strong>formation, to better
understand the dynamics of any future epidemic and monitor the impact of any <strong>in</strong>terventions with this
group.
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