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

DRUG ABUSE IN PAKISTAN
National treatment registry
update 2000
As part of the current research exercise, the National
Treatment Registry was updated. Dur<strong>in</strong>g this exercise
the field workers visited 18 selected major urban
centres <strong>in</strong> the country and identified 73 centres that
were provid<strong>in</strong>g drug treatment and rehabilitation
services on a regular basis. Out of the 73 centres,
38 facilities had been enlisted <strong>in</strong> the 1994/95 survey
of drug treatment services, whereas 35 centres and
facilities enlisted <strong>in</strong> the current exercise are either
newly established facilities or that had not been
enlisted <strong>in</strong> the previous exercise. Twenty-eight of
these 73 facilities (38%) are government funded and
adm<strong>in</strong>istered hospitals, 25 (34%) are NGO run facilities
and 20 (27%) are private (for profit) run drug
treatment centres.
Forty-three (59%) of the 70 three facilities provide
both <strong>in</strong> and outpatient services, whereas 27 (37%)
provide only <strong>in</strong>patient services and three (4%) provide
only outpatient services. The mean capacity, i.e.,
number of clients treated at any given time, for <strong>in</strong>patient
clients <strong>in</strong> the centres is around 37 whereas
for outpatients it is 59. The range for clients treated
as <strong>in</strong>patient was 1-1,000 (one facility only) and for
outpatient 1-450 (one facility only) clients.
All services reported provid<strong>in</strong>g detoxification services.
It should be noted that even with<strong>in</strong> this narrow
category of response considerable differences may
exist <strong>in</strong> terms of therapeutic practices. N<strong>in</strong>ety per
cent (66) of agencies reported provid<strong>in</strong>g counsell<strong>in</strong>g,
and over half of all agencies (50/68%) also offered
religious counsell<strong>in</strong>g. Forty-one (56%) reported that
they had an outreach service. This k<strong>in</strong>d of provision
is regarded as an important component of an overall
treatment approach as it can provide a conduit
to more formal treatment or deliver services to drug
<strong>abuse</strong>s who are unable or unwill<strong>in</strong>g to access other
treatment options. Just over half (59 of the 73-80%)
<strong>in</strong>cluded a relapse prevention element <strong>in</strong> their after
care facilities. A range of other treatment options
were mentioned by 26 (35%) of facilities.
The mean number of admissions (at each centre)
for drug treatment, <strong>in</strong> the 12 months prior to <strong>in</strong>terview,
was 264. This ranged from between 7 and
3,000 clients be<strong>in</strong>g admitted dur<strong>in</strong>g the relevant
period and <strong>in</strong>dicates that some services had considerably
higher client contacts than others. The
total number of admissions <strong>in</strong> the 73 centres was
calculated as 17,425 <strong>in</strong> the 12 months prior to <strong>in</strong>terview.
This can be regarded as a proxy yearly total for
client admissions. It should be noted that this
figure excludes alcohol users, and <strong>in</strong>cludes repeat
attendees. It should also be noted that this data
does not allow one to comment on the level of
double-count<strong>in</strong>g between treatment facilities. If repeat
attendees (those with more than one episode
of treatment at the agency <strong>in</strong> the last 12 months)
are excluded, the total estimate falls to 11,454 with
the mean of 176 different patients per agency admitted
<strong>in</strong> the previous 12 months.
Young people and women were less commonly seen
<strong>in</strong> treatment. Only 30% of clients less were reported
as be<strong>in</strong>g under 25 years of age and only 3% of
clients were women. How far this reflects a disproportionate
higher proportion of male drug use
and how far it reflects reluctance or difficulties
women have <strong>in</strong> access<strong>in</strong>g services is unclear. However,
the social stigma on drug use among women <strong>in</strong>
<strong>Pakistan</strong> is considerable. It would therefore appear
highly likely that women with drug problems would
be reluctant to enter mixed-sex services. Assess<strong>in</strong>g
the prevalence and nature of drug problems among
women <strong>in</strong> <strong>Pakistan</strong>, and develop<strong>in</strong>g culturally appropriate
treatment responses, rema<strong>in</strong>s an important
challenge.
As treatment services have ongo<strong>in</strong>g contact with
drug <strong>abuse</strong>rs, they can be considered a useful source
of <strong>in</strong>formation on trends over time. Around 40% of
treatment centre staff <strong>in</strong>terviewed thought that the
proportion of well-off clients com<strong>in</strong>g for treatment
has lowered over the last five or six years although
20% considered that this proportion had <strong>in</strong>creased.
Some staff (26%) were also of the op<strong>in</strong>ion that “sniff<strong>in</strong>g
drugs” (the use of <strong>in</strong>halants) had <strong>in</strong>creased especially
among adolescents, that the use of other opiates
and cough syrups had <strong>in</strong>creased due to a
decl<strong>in</strong>e <strong>in</strong> quality of illicit hero<strong>in</strong> (25% of the respondents)
and that <strong>in</strong>ject<strong>in</strong>g drug use was <strong>in</strong>creas<strong>in</strong>g
among treatment attendees.
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