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

DRUG ABUSE IN PAKISTAN
<strong>Drug</strong> <strong>in</strong>jection
In the 1993 exercise, concern about drug <strong>in</strong>jection
and its l<strong>in</strong>k to HIV <strong>in</strong>fection were expressed, but
<strong>in</strong>ject<strong>in</strong>g appeared to be very rare <strong>in</strong> <strong>Pakistan</strong>.
Perhaps the most worry<strong>in</strong>g conclusions of the 2000
assessment exercise is that drug <strong>in</strong>jection has now
become widely established, that it is cont<strong>in</strong>u<strong>in</strong>g to
grow, and that many drug <strong>in</strong>jectors are engag<strong>in</strong>g <strong>in</strong>
high risk practices that make them vulnerable to
<strong>in</strong>fection by HIV and other blood borne diseases.
To date, what evidence that exists on HIV <strong>in</strong>fection
suggests that it has not become widespread
amongst <strong>Pakistan</strong>i drug <strong>in</strong>jectors. Aga<strong>in</strong>st this optimistic
note, though, two notes of caution must be
sounded. Firstly, <strong>in</strong>fection rates have been shown <strong>in</strong>
other countries to rise dramatically over short periods
of time, when the behaviour of drug <strong>in</strong>jectors is
favourable to its spread. Secondly, HIV surveillance
studies have not been conducted with any <strong>in</strong>tensity
among drug <strong>in</strong>jectors <strong>in</strong> <strong>Pakistan</strong> and therefore the
possibility must be considerable that unrecorded
<strong>in</strong>fections exist.
It is therefore important that any future drug
research and surveillance activities <strong>in</strong>clude HIV seroprevalence
monitor<strong>in</strong>g wherever possible. Some
work is be<strong>in</strong>g currently developed <strong>in</strong> this area, supported
by UNAIDS and UNDCP. More <strong>in</strong>tensive activities
are urgently required. The 2000 study has
demonstrated that the research capacity exists <strong>in</strong>
<strong>Pakistan</strong> to efficiently access drug <strong>in</strong>jectors <strong>in</strong> street
and <strong>in</strong>stitutional sett<strong>in</strong>gs at relatively low costs.
Further research is required with drug <strong>in</strong>jectors not
only to monitor <strong>in</strong>fection rates but also to understand
the dynamics of drug <strong>in</strong>jection practices <strong>in</strong>
order to <strong>in</strong>form prevention strategies and other
<strong>in</strong>terventions. There is also a priority need to develop
<strong>in</strong>terventions that provide support to drug <strong>in</strong>jectors
and that address the HIV risk behaviours of this
group. UNAIDS, UNDCP and the government of
<strong>Pakistan</strong> have been develop<strong>in</strong>g a strategy <strong>in</strong> this
respect. Given the relative size of the drug abus<strong>in</strong>g
population <strong>in</strong> the country, the high levels of risk
behaviour detected, and the correspond<strong>in</strong>g potential
for a future epidemic, urgent and effective <strong>in</strong>terventions
are required <strong>in</strong> <strong>Pakistan</strong>.
Develop<strong>in</strong>g a permanent drug
<strong>in</strong>formation system to <strong>in</strong>form
policy and action
The year 2000 national drug assessment study has
provided an overview of drug <strong>abuse</strong> problems for
<strong>Pakistan</strong>. The study's aims were ambitious and the
fact that they have been largely achieved owes much
to the hard work of the research team <strong>in</strong> <strong>Pakistan</strong>, to
the implementation organizers and to the good will
of all those <strong>in</strong>dividuals <strong>in</strong> the country whose support
was necessary for collect<strong>in</strong>g the required <strong>in</strong>formation.
That so many people concerned with drug problems
<strong>in</strong> <strong>Pakistan</strong> were prepared to give up their time to
help with the assessment exercise demonstrates that
the importance of hav<strong>in</strong>g sound <strong>in</strong>formation on the
drug <strong>abuse</strong> phenomenon is widely accepted. That this
project was implemented jo<strong>in</strong>tly with the Anti-
Narcotics Force, and that it would not have been possible
without their work and support, reflects the
importance the Government of <strong>Pakistan</strong> has <strong>in</strong>vested
<strong>in</strong> bas<strong>in</strong>g its policy and actions on sound evidence.
In <strong>Pakistan</strong>, national expenditure on drug problems
has to be considered <strong>in</strong> relation to other press<strong>in</strong>g
calls on the public purse, and it is therefore particularly
important that <strong>in</strong>vestments be guided by an
accurate assessment of the situation.
However, whilst the mass of data collected by this
study is impressive, it represents a only a snap-shot
of the drug <strong>abuse</strong> situation. Studies conducted many
years apart cannot provide the on-go<strong>in</strong>g relevant
<strong>in</strong>formation required for policy formation. The assessment
study should be viewed as an important first
step <strong>in</strong> a permanent ongo<strong>in</strong>g drug <strong>in</strong>formation
system for <strong>Pakistan</strong>. The data presented here can
provide a valuable basel<strong>in</strong>e for future cont<strong>in</strong>uous
monitor<strong>in</strong>g exercises. UNDCP through its Global
Assessment Programme has already begun discussions
with the Government of <strong>Pakistan</strong> on how such
provision can be established. <strong>Drug</strong> <strong>in</strong>formation systems
typically rely on the collection of a range of rout<strong>in</strong>e
<strong>in</strong>dicators and other data and then provide a
forum for experts to discuss regularly the implications
of the <strong>in</strong>formation.
The four city sites <strong>in</strong>cluded <strong>in</strong> this study would make
a good start<strong>in</strong>g po<strong>in</strong>t for further work: city-based
62