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

DRUG ABUSE IN PAKISTAN
Treatment
Seventy-three specialist treatment services for drug <strong>abuse</strong>rs were located dur<strong>in</strong>g the update of the 1994
register. This was considered to represent the majority of current treatment capacity <strong>in</strong> the country. The
provision offered may have diversified slightly. In the 2000 audit, all services reported provid<strong>in</strong>g detoxification,
59% offered both <strong>in</strong> and out patient facilities and over half (51%) reported some form of outreach
provision.
In terms of the number of services identified there was a decl<strong>in</strong>e <strong>in</strong> all sectors (government, private and
NGO), from the number identified <strong>in</strong> the 1994/95 audit.
The mean number of admissions <strong>in</strong> the last year before the survey was 264 admissions per facility. The
total number of admissions <strong>in</strong> this period for all facilities audited was calculated as 17,425. Young people
and women are less commonly found <strong>in</strong> treatment facilities. Of the current treatment caseload only
30% of patients were aged 25 or less and only 3% of patients were women. All treatment agencies except
one reported they kept records on their patients that <strong>in</strong>cluded demographic and drug tak<strong>in</strong>g data.
Considerable potential therefore exists for the future development of a treatment-based report<strong>in</strong>g system
as a drug use <strong>in</strong>dicator for <strong>Pakistan</strong>. Such a system would provide a longitud<strong>in</strong>al data set to allow
consideration of changes <strong>in</strong> drug <strong>abuse</strong> patterns over time.
Prevalence estimation
The work to estimate the number of hero<strong>in</strong> <strong>abuse</strong>rs <strong>in</strong> <strong>Pakistan</strong> builds on previous national assessment
studies, (1982, 1986, 1993). These earlier surveys have been used to estimate a growth rate for the prevalence
of drug use <strong>in</strong> <strong>Pakistan</strong> by updat<strong>in</strong>g the prevalence rate obta<strong>in</strong>ed <strong>in</strong> the immediately previous survey
(us<strong>in</strong>g the 1982 data as a base). Over time the estimates formed <strong>in</strong> this way are likely to drift away
from the true position. In order to avoid this problem the present survey adopts an alternative method
for calculat<strong>in</strong>g hero<strong>in</strong> prevalence. In do<strong>in</strong>g so, the study benefits from some of the recent advances <strong>in</strong>
statistical methods for address<strong>in</strong>g the problem of estimat<strong>in</strong>g drug prevalence levels.
The prevalence estimation exercise relates only to the chronic and regular use of hero<strong>in</strong> or drugs by
<strong>in</strong>jection. In this respect the def<strong>in</strong>ition is more restricted than that used for other national estimates <strong>in</strong>
<strong>Pakistan</strong>, although it reflects common practice for this k<strong>in</strong>d of calculation. Therefore, the estimate could
be revised upwards if occasional or non-chronic users were <strong>in</strong>cluded.
The best estimates are likely to be for those areas where the most detailed <strong>in</strong>formation has been obta<strong>in</strong>ed,
that is, <strong>in</strong> the four cities of Karachi, Lahore, Peshawar and Quetta. Information on other urban areas and
the rural areas that was collected <strong>in</strong> the other sections of the study <strong>in</strong> conjunction with national census
data was then used to produce a national estimate.
The upper estimate of approach<strong>in</strong>g 500,000 was calculated as the number of chronic hero<strong>in</strong> <strong>abuse</strong>rs
(<strong>in</strong>clud<strong>in</strong>g drug <strong>in</strong>jectors) for <strong>Pakistan</strong>. Given impact of the exclusion criteria <strong>in</strong> the methods used tak<strong>in</strong>g
this upper estimate is appropriate for policy and plann<strong>in</strong>g purposes. This figure is lower than previous
estimates but still represents an extremely serious hero<strong>in</strong> <strong>abuse</strong> problem <strong>in</strong> the country. When an analysis
of population levels and the demographics of hero<strong>in</strong> use <strong>in</strong> <strong>Pakistan</strong> is conducted, it is extremely
difficult to see how higher levels than this would be credible. In particular, estimates that are many times
this number would appear extremely unlikely, given the overall population characteristics of the
country.
It should be noted that some less populous geographic areas have been excluded from the prevalence
estimates for a number of technical reasons. For example, Balochistan prov<strong>in</strong>ce outside the Quetta district
proved too difficult to estimate by the present methods. Prevalence rates quoted <strong>in</strong> the provisional
figures are for males aged <strong>in</strong> the target age-band of 15 to 45 years of age, which accord<strong>in</strong>g to this research
and to previous government figures covers the vast majority of the hero<strong>in</strong> users <strong>in</strong> the population.
Hero<strong>in</strong> use by women is not therefore <strong>in</strong>cluded <strong>in</strong> this figure. Future studies that provided <strong>in</strong>formation
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