Tobacco, cannabis, and meth are among common addictions. Psychiatrists at Meri Sehat recommend rehabilitation centers to save young adults from substance abuse.

A Short Guide to Local Addictions

Drug addiction is a major issue Pakistani society is facing but the lack of acknowledgment, action and, most importantly, sheer denial makes it worse.

A Short Guide To Local Addictions

Overview

Drug addiction is defined as &lsquo;a neuropsychological disorder leading to intense and persistent urge to use a substance.&rsquo; It overrides a person&rsquo;s self-control and his or her awareness of harmful effects by altering their brain function.&nbsp; 
Addiction is thus identified as a brain disorder and not a personal failure on the part of the individual. Much of the conversation around drug addictions needs to be remodeled based on these principles.&nbsp; 
When we talk about substance abuse in Pakistan our mind immediately conjures up a very particular image of cachectic men huddled in street corners trying to have their most recent hit. This, however, is not the whole picture.&nbsp; 
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Guide to Local Addictions

In recent years, drugs have become not only much more readily available but also cheaper. The youth of Pakistan from all classes and social strata has found themselves using one thing or another at some point. Those who manage to stay away from it have still been impacted by it in some way. Road accidents, broken <a href="https://merisehat.pk/article/love-in-a-long-term-relationship">relationships</a>, lagging behind in school and sports, overall health suffering as a result of these addictions, are just a few examples. Factors such as gender, age, class etc influence this and so does peer pressure and accessibility.&nbsp; 
 
Some of the most common local addictions we have are as follows, this list however is in no way comprehensive:&nbsp; 
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The most popular, most easily available, and a favorite amongst those who indulge. The psychoactive substance here is THC (tetrahydrocannabinol). Two forms of cannabis are available; hashish (hash) and charas (weed). The difference between both is the form they come in and the concentration of THC.&nbsp;

Hash has a more concentrated form of THC. It&rsquo;s either smoked by rolling in a cigarette or inhaled as a vapor by heating it up in a bong. Bhang is a mixture of cannabis and milk and is also widely consumed. Then there are cannabis teas, capsules, vapes and edibles.

It has been labeled as a gateway drug which means that the individuals indulging in this are open to experimenting with harder drugs in the future.&nbsp;

Locally, several cases have been reported where people (both children and adults) started out with smoking cannabis and ended up with addictions to harder drugs such as heroin and crystal meth.&nbsp;

In some areas the country, it&rsquo;s a part of the local culture, and happy occasions like weddings even call for it.&nbsp;

The main effects of cannabis are a feeling of euphoria and relaxation. Then there might sense of time slowing down, increased appetite, heightened senses and even paranoia and anxiety. All of these vary dramatically depending on the form, method and the person using it.&nbsp; 
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Pakistan has the largest cigarette-smoking populations in the world. In the era of harder drugs being accessible, cigarettes aren&rsquo;t even considered a taboo. People of all ages, genders and social strata partake in this and nicotine addiction is a major issue our population suffers from.&nbsp;

Nicotine is considered to be the culprit when it comes to forming a habit of smoking. However, it has been postulated that it is the unique combination of other chemicals added to cigarettes that may actually be facilitating the process.&nbsp;

Cigarettes contain over 7,000 chemicals and most of them are carcinogenic, what we fail to focus on is the fact that they also contain monoamine oxidase inhibitors (MAOIs). This compound is used in antidepressants and this is what leads to the characteristic &lsquo;smoker&rsquo;s high&rsquo;. A smoker&rsquo;s high is when you have increased serotonin in your brain making you feel happier.

Nicotine has other detrimental effects on the body, such as an increased heart rate and blood pressure, your blood vessels shrinking and of course the very obvious toxins introduced into the lungs. All this works together to wreak havoc on the body of the smoker while making sure that they never stop. Then there is the problem of second-hand smoke (which is very harmful for those inhaling it) which is a whole different beast of its own.&nbsp; 
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This is a sweet or savory mixture of crushed areca nut, tobacco, catcechu, paraffin wax, slaked lime and spices such as turmeric, cardamom, cloves, saffron. This is pretty much casually consumed by people usually belonging to the lower socio-economic classes.&nbsp;

They believe that it helps with digestion and killing germs. It also leads to a sense of euphoria, sweating, salivation, palpitation, feelings of warmth, alertness, tolerance to hunger, and a higher stamina for work.&nbsp;

Apart from the nicotine addiction this causes, gutka is a major cause of cancers of the lip, mouth, tongue, throat and esophagus. Supari is areca nut consumed on its own and is also linked with oral cancers some of which simply don&rsquo;t have a cure, such as oral submucous fibrosis. 
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This is derived from the poppy plant (papaver somniferum). Pakistan is a part of the golden crescent where, along with Afghanistan and Iran, 90 percent of the world&rsquo;s non-pharmaceutical grade opium is produced.&nbsp;

It is then transported through the region which makes it so readily available that can get it for as cheap as Rs10, which is cheaper than getting food here. Pakistan has therefore been called the most heroin-addicted country in the world. The active compound in the drug is morphine which has a soporific effect, hence the name. This is the main ingredient in many opioids, including heroin.&nbsp;

It can be smoked, eaten, taken as a pill or most commonly; injected. Sometimes in desperation and sometimes as a sign of brotherhood, needles are shared among the addicts. Around 92percent of PWID (people who inject drugs) were reported to practice &lsquo;booting&rsquo; or &lsquo;registering&rsquo; where blood is first jerked into the syringe and then this mixture is injected back into the system. These syringes are then shared.&nbsp; 
 
This leads to the rise of blood-borne infections and the main reason behind the HIV/AIDS crisis in the country. Hepatitis B and C are also on the rise and have the same etiology. Practices such as &lsquo;flashblood&rsquo; [khoon bozee] where another&rsquo;s opium laden-blood is injected into the body in times of scarcity, or to share the high, worsen this issue.&nbsp;

 
Harmful on its own, it is also added to marijuana joints and a mixture of marijuana, opium and heroin is also injected by some. People suffering from this particular affliction develop intense physical and psychological dependence on the drug. This has implications far and wide starting from health, work, family and ending with an added burden on the healthcare system.&nbsp; 
 
When brought to hospitals on account of either accidents or poor health requiring pain management, the bodies of these addicts fail to respond to the prescription drugs leading to severe physical and psychological distress. Helpless doctors try everything in their power to mitigate the condition but the only thing that works is what they have gotten used to. 
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Pakistan is one of the top 10 countries in the world where people are addicted to opioid analgesics or narcotics. These are strong prescription drugs used for pain management. Taking these in order to achieve feelings of general relaxation, happiness and a high which makes one feel as if they are weightlessly floating through life is what leads to addictions. 
 
Abusing these drugs can lead to severe adverse effects, however, the least of this is nausea, vomiting, reduced peristalsis hence constipation and the worst being respiratory depression leading to death.&nbsp; 
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This is an illegally brewed alcoholic drink made by fermenting sugar cane or wheat husk. Mostly consumed by teenagers, this is essentially a poison. The process happens in remote fields and has no check and balance. The hazardous effects of this are the usual alcohol-mediated liver damage but what&rsquo;s worse is that it leads to a loss of eye-sight as well.&nbsp; 
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Methamphetamine is a highly addictive nervous system stimulant and a recently growing addiction in a younger, more educated demographic. It can either be smoked, injected, snorted or taken by mouth. The feelings derived from this are your usual sense of euphoria but, most commonly, it leads to irritability and paranoia on the part of the user. 
 
People have reported increased focus and no loss of inhibition on this as well but most of this data is purely anecdotal. We know that this is a highly dangerous compound and can lead to strokes, convulsions and even death. It&rsquo;s also very difficult to treat meth addiction. 
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Bottom Line

Pakistan&rsquo;s Drug Abuse Control Master Plan 2010-14 had the lofty aspiration of making the country drug-free by 2020, this has clearly not been executed. A pragmatic approach is needed.&nbsp;

The Lancet (a weekly peer-reviewed general medical journal) reported a government official saying that the relapse rate in Pakistan is 90 percent. The UN Office of Drugs and Crime (UNODC) published a Technical Summary Report back in 2013 which reported that 6.45 million people (aged 15-64) in Pakistan were using drugs.&nbsp;

Things are much graver now and worsened by the fact that treatment and rehabilitation efforts are underfunded. Treatment centers that are cheap are overburdened, while others charge too much for an everyday man to afford. Tertiary care hospitals with psychiatry wards refuse to admit drug addicts and consider it a waste of time and resources. There is also a lack of training and staff. Much of the responsibility is relegated to the social welfare systems which fail to accommodate the sheer weight of the issue.&nbsp;

The best way to proceed would be a coordinated effort where treatment by the health department and rehabilitation by the social welfare system is provided. However, we are still lacking such efforts. Developing an effective response will require an in-depth understanding of the issue. We must raise awareness, fund efforts, stabilize the socio-economic condition of the region strict border control, conduct studies and surveys to assess the real magnitude of the issue (the last national survey dates back to 2013).&nbsp;

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