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

IMPLICATIONS OF THE NATIONAL ASSESSMENT STUDY
to the difficulties of access<strong>in</strong>g and <strong>in</strong>terview<strong>in</strong>g
women on the topic of their drug consumption. It
may well be that qualitative <strong>in</strong>quiries us<strong>in</strong>g female
<strong>in</strong>terviewers will be the way forward here.
Second, attention should be given to develop<strong>in</strong>g
treatment facilities that would prove more attractive
to women with drug problems. The Guid<strong>in</strong>g
Pr<strong>in</strong>ciples on <strong>Drug</strong> Demand Reduction identify the
need for gender sensitive treatment services. This
issue is an <strong>in</strong>ternational one, which poses a challenge
for both developed and develop<strong>in</strong>g countries.
In <strong>Pakistan</strong>, cultural factors may make achiev<strong>in</strong>g this
goal particularly demand<strong>in</strong>g. Nonetheless this
rema<strong>in</strong>s an important issue for the future development
of drug treatment services.
Access to and delivery of
drug treatment
A f<strong>in</strong>d<strong>in</strong>g of both the key <strong>in</strong>formant exercise and the
addict <strong>in</strong>terviews is that <strong>in</strong>creased access to drug
treatment is urgently required <strong>in</strong> <strong>Pakistan</strong>. Nearly all
key <strong>in</strong>formants agreed that many drug users <strong>in</strong> their
area were too poor to get treatment. All the addicts
<strong>in</strong> the <strong>in</strong>terview samples were suitable for treatment
and furthermore three-quarters expressed a self
identified need for help, yet many respondents (66%)
reported previous failed attempts to access treatment,
overwhelm<strong>in</strong>gly because of f<strong>in</strong>ancial reasons.
Street recruited addicts appeared least able to
access help; <strong>in</strong> general those addicts <strong>in</strong>terviewed <strong>in</strong>
treatment sett<strong>in</strong>gs were better educated and more
likely to be <strong>in</strong> employment, support<strong>in</strong>g the suggestion
that <strong>in</strong>come levels <strong>in</strong>fluence treatment access.
Some evidence was found that current treatment
capacity was not be<strong>in</strong>g fully utilized despite the
identified need of many drug <strong>abuse</strong>rs for therapeutic
<strong>in</strong>terventions. A successful expansion of treatment
provision is therefore likely to be dependent
at least <strong>in</strong> part, on delivery mechanisms that allow
uptake of services by a wider section of the addict
population.
<strong>Drug</strong> treatment has been repeatedly shown to be a
cost-effective response at a national level to drug
problems. However, clearly the benefits of treatment
provision are reliant on the delivery of a high quality
service. Staff tra<strong>in</strong><strong>in</strong>g and the development and
implementation of appropriate therapeutic procedures
are all important here. The term “treatment”
is used to describe a wide range of activities that
address a diverse set of needs and patient characteristics.
Some positive evidence of the development
of comprehensive, high quality treatment services is
identified <strong>in</strong> this study. However, other evidence also
suggests that <strong>in</strong> some areas treatment services are
less well regarded. For example, overwhelm<strong>in</strong>gly key
<strong>in</strong>formants agreed—or strongly agreed—that treatment
services <strong>in</strong> their area did not offer a good service
to those with drug-problems.
The UNDCP is currently work<strong>in</strong>g with the Government
of <strong>Pakistan</strong> on measures to improve the quality of
services <strong>in</strong> the country. A more detailed <strong>in</strong>vestigation
of current practices and procedures would facilitate
this work. The long-term goal must be to broaden the
range of treatment options and to ensure that all
services provide the high quality care that is currently
found <strong>in</strong> some of the best facilities <strong>in</strong> the country.
Many of those on drug charges <strong>in</strong>terviewed <strong>in</strong> prison
were severely dependent and would benefit from the
provision of therapeutic services that address longstand<strong>in</strong>g
drug problems. This need is emphasized by
reflection on the fact that some of those <strong>in</strong>carcerated
have arrived <strong>in</strong> prison through the <strong>in</strong>tervention
of their families, who are no longer able to cope with
the behaviour of their family member. <strong>Drug</strong> <strong>abuse</strong>rs
are housed <strong>in</strong> separate barracks <strong>in</strong> <strong>Pakistan</strong>i prisons,
which could facilitate the development of services
with<strong>in</strong> the prison sett<strong>in</strong>g.
Many of those <strong>in</strong>terviewed <strong>in</strong> the street or treatment
sett<strong>in</strong>g had previously passed through the prison
system. The importance of develop<strong>in</strong>g post-release
rehabilitation services for drug <strong>abuse</strong>rs has been noted
elsewhere. In both <strong>in</strong>stances—for drug <strong>abuse</strong>rs <strong>in</strong>
prison and for those leav<strong>in</strong>g prison with a history of
drug <strong>abuse</strong>—the potential exists to further develop
demand reduction programmes. Deliver<strong>in</strong>g effective
drug treatment and prevention programmes with<strong>in</strong> the
prison sett<strong>in</strong>g is not an easy undertak<strong>in</strong>g. Work<strong>in</strong>g <strong>in</strong>
this sett<strong>in</strong>g presents a number of challenges but this
rema<strong>in</strong>s an area <strong>in</strong> which considerable potential exists
for the development of drug services.
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