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

DRUG ABUSE IN PAKISTAN
procedures for drug withdrawal which was viewed as
a key first response to the <strong>in</strong>creas<strong>in</strong>g number of
hero<strong>in</strong> addicts seek<strong>in</strong>g help.
With regard to <strong>in</strong>stitutional and capacity build<strong>in</strong>g for
delivery of drug treatment and rehabilitation services,
one can see two dist<strong>in</strong>ct phases <strong>in</strong> <strong>Pakistan</strong>.
These were,
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Sett<strong>in</strong>g up of drug treatment facilities at
selected locations with the support of
UNFDAC (1982-1988)
UNDCP funded Integrated <strong>Drug</strong> Demand
Reduction Project (IDDRP) efforts at improv<strong>in</strong>g
the service delivery of treatment
programmes (1991-1996)
treatment at the supported centres. Every month the
drug treatment centres be<strong>in</strong>g f<strong>in</strong>anced <strong>in</strong> the project
sent <strong>in</strong> forms filled <strong>in</strong> provid<strong>in</strong>g <strong>in</strong>formation on
the social and demographic profile and drug use history
of every patient that came for treatment. These
were then complied, analysed at <strong>in</strong>tervals and f<strong>in</strong>ally
pr<strong>in</strong>ted as a PNCB publication with the same title.
At the end of the project, the responsibility of runn<strong>in</strong>g
the treatment facilities was handed over to the
Prov<strong>in</strong>cial Health Departments under whose adm<strong>in</strong>istrative
control fell the government run facilities.
Over the years due to f<strong>in</strong>ancial constra<strong>in</strong>ts and other
factors, most of the treatment facilities had become
dysfunctional and capacity appeared to decl<strong>in</strong>e, as
did the availability of specialized and tra<strong>in</strong>ed staff.
UNFDAC funded treatment
facilities
The erstwhile UNFDAC provided the first f<strong>in</strong>ancial
and technical support <strong>in</strong> the 1980s (1982-1988) <strong>in</strong>
sett<strong>in</strong>g up 32 model drug treatment centres <strong>in</strong> the
country, most of them situated <strong>in</strong> government teach<strong>in</strong>g
hospitals (departments of psychiatry) and some
with<strong>in</strong> NGO run facilities. The f<strong>in</strong>ancial support provided
to these facilities by UNFDAC <strong>in</strong>cluded provision
for part salaries of the staff <strong>in</strong>volved <strong>in</strong> the
treatment, cost of medic<strong>in</strong>es, and other operational
costs related to runn<strong>in</strong>g the treatment centres. The
material support <strong>in</strong>cluded provision of vehicles for
br<strong>in</strong>g<strong>in</strong>g <strong>in</strong> clients for treatment or for their follow
up, TLC (Th<strong>in</strong> Layer Chromatography) equipment for
drug test<strong>in</strong>g, beds, etc. Technical support was provided
<strong>in</strong> tra<strong>in</strong><strong>in</strong>g medical doctors not only from the
supported treatment facilities, but also from other
<strong>in</strong>stitutions as well as <strong>in</strong> treatment procedures, primarily
symptomatic treatment of withdrawal symptoms.
The <strong>Pakistan</strong> Narcotics Control Board (PNCB) also
published a booklet as a result of technical support
<strong>in</strong> the project titled “Guidel<strong>in</strong>es for Hero<strong>in</strong>
Detoxification <strong>in</strong> <strong>Pakistan</strong>”. As the name suggests,
this publication provided broad guidel<strong>in</strong>es for primary
health care physicians for detoxification of
people with hero<strong>in</strong> dependence. The project also
<strong>in</strong>troduced a “National Case Monitor<strong>in</strong>g System”
which looked at the profile of patients com<strong>in</strong>g <strong>in</strong> for
Integrated drug demand
reduction project
The second dist<strong>in</strong>ct phase <strong>in</strong> improv<strong>in</strong>g the service
delivery of treatment programmes was of the Integrated
<strong>Drug</strong> Demand Reduction Project (IDDRP)
supported by UNDCP. In its over five years of implementation
the project developed materials and provided
tra<strong>in</strong><strong>in</strong>g to service providers with the objective
of improv<strong>in</strong>g service delivery of treatment programmes
beyond the short-term medical <strong>in</strong>terventions.
The concepts <strong>in</strong>troduced focused on social
rehabilitation and <strong>in</strong>tegration of drug dependent
persons and <strong>in</strong>cluded assessment of drug related
problems, counsell<strong>in</strong>g, relapse prevention, and aftercare.
In all, through 23 workshops, over 600 health
workers, psychologists, social workers, paramedics,
and NGO workers were tra<strong>in</strong>ed <strong>in</strong> the application of
these approaches. The impact of this activity was
most apparent <strong>in</strong> the non-governmental sector where
some agencies were motivated and able to develop
modern and comprehensive treatment regimes.
However, such agencies are by no means common
<strong>in</strong> <strong>Pakistan</strong> and rely on extremely limited resources.
Impact on the Government run treatment sector has
largely not been apparent and this sector appears to
have decl<strong>in</strong>ed <strong>in</strong> importance as a primary provider of
care for those with drug problems. Where services
exist they are usually limited <strong>in</strong> approach and it is
unclear how successful they are <strong>in</strong> attract<strong>in</strong>g and
reta<strong>in</strong><strong>in</strong>g patients.
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