June 26 marks the International Day against drug abuse and illicit trafficking. The theme for 2023 is “People first: stop stigma and discrimination, strengthen prevention”.
According to the United Nations Office on Drugs and Crime (UNODC), nearly 284 million people were using illicit drugs such as cocaine, cannabis, hallucinogens, opiates and sedative hypnotics worldwide in 2022.
In December 1987 the UN General Assembly decided to observe June 26 as the International Day against Drug Abuse and Illicit Trafficking
“In 2012 and 2013, UNODC in collaboration with the Ministry of Narcotics Control, the U.S. Department of State’s Bureau of International Narcotics and Law Enforcement Affairs (INL), and other national stakeholders conducted a national survey on drug use to estimate the extent and patterns of drug use in Pakistan.
The overall results of the survey revealed that approximately 6 percent of the population – 9 percent of the adult male population and 2.9 percent of the adult female population - equivalent to 6.7 million people - had used a substance other than alcohol and tobacco in the preceding year.
This year the World Drug Report 2022 revealed an estimated 284 million people worldwide had used drugs in 2020. Cannabis remains by far the world’s most used drug, and the report also notes an increase in use of amphetamines.
Globally, the report estimates that 11.2 million people worldwide injected drugs during the period of the study. Around half of this number were living with hepatitis C, 1.4 million were living with HIV, and 1.2 million were living with both”—Press release of October 26, 2022 by United Nations Office on Drugs and Crime titled ‘National Drug Use Survey of Pakistan 2022-24, Launched’
Eighty-five to ninety percent of drug users are not chemically dependent. They still have the ability to give up drug use if they understand the consequences.
They should be made to understand the risks involved by the society, which has the prime responsibility to treat them humanely. Those who are chemically dependent have lost the ability to stop on their own or even understand what is happening to them as a result of addiction.
Drugs have clouded their judgements so that they are unable to hear and respond to any message. Somebody else has to come in and do it for them. Fortunately the percentage of such dependents in Pakistan is still not more than ten to fifteen.
Effects on human body
Unfortunately, sufficient attention has not been given in creating public awareness for a successful campaign against narcotics abuse. None of our agencies engaged in the fight against drug use has tried to inform the people effectively about the devastating effects the prohibited substances have on human body.
The result is that the pharmacology of drugs that are abused in our society is largely misunderstood or totally ignored when any campaign against it is initiated. This approach is not only unscientific but also is bound to fail in tackling the major issues of why certain drugs have a high potential for abuse.
It must be recognised that drugs are simply chemicals, and that the effects a specific drug has on a person can vary from individual to individual and these variations are based on the interaction between the person and the drug.
Not only does a person’s physical make-up influence the effect a drug might have, but many psychological factors are involved as well. What was the mood (set) of the person at the time the drug was taken? In what location (setting) was the person at the time the drug was taken? What expectation did the person have regarding the drug’s action (placebo effect)? Basically, the effects of drugs can be divided into three types:
(1) expected
(2) toxic and
(3) idiosyncratic, or unexpected toxic.
In Pakistan not only illicit drugs are widely abused but many licit drugs like tranquillizers are also being abused. Therefore, it must be remembered that a licit drug may also be an illicit drug depending on how, when, where, or by whom it is used. The problem is that most studies on drug abuse are carried out with pure substances of known doses, but that is not the way most of the illicit drugs are frequently available in the streets. Most drug addicts in this country are totally unaware of the actual chemical substance, the dose being purchased, and the contents in the said drug.
In recent years as the demand for heroin and ice increased, the drug-dealers started mixing many other toxic ingredients. This also brings into question the validity of self-reporting in emergency rooms. A case in point occurred in a local hospital where a young man claiming to have taken amphetamines was brought in.
An analysis of blood and urine showed no amphetamine. It was discovered that he had taken salconal sodium (available in the drug market under the name of rocket). Due to adulterants in illicit drugs, the rate of death among the users has gone up to 200 percent during the last few years (this is confirmed from data collected from 25 treatment centres throughout the country).
A number of opium addicts in Karachi and Lahore started using more than one drug at a time not realizing that such intake of different drugs is more harmful. Many poly-drug abusers interviewed disclosed that multiple-substance abuse was unbelievably ‘‘high” experience. One example of this is heroin and naloxone.
Naloxone has no effect of its own unless it is given in conjunction with an opiate. When this occurs, it blocks the effect of the opiate and can even reverse an opiate overdose. Another example is that of abusing cough syrups, which contain codeine with mandrex. Multiple drug abuse can be life threatening though no empirical data is available to prove it.
Charas (cannabis) is the most widely abused substance. This is considered to be a ‘‘safe” or the least harmful drug. A yearlong research conducted by the US National Institute on Drug Abuse contradicts this claim. It is found that charas has two commonly seen adverse effects. The first is acute paranoia, which occurs most often in the naive user during the first or second use.
This paranoid reaction can last for several hours. The second adverse effect is one combination of hypertension and tachycardia sometimes seen to occur with very potent forms of charas. Cases of allergic reactions to cannabis products have also been reported.
Some of the better-known effects of charas include its mild sedative action, disruption of recent memory and enhancement of appetite. Charas has been reported to cause an amotivational syndrome leading an individual to drop out of normal activities. Bronchitis has been discovered in heavy users of charas, and there is some evidence that the organic by-product produced when it is burnt may be carcinogenic.
The sedative hypnotic drugs are the most widely prescribed and among the most widely abused in Pakistan after charas. The withdrawal syndrome seen with the sedative-hypnotic drugs is the most severe of any group of drugs and can be life threatening. Tremulousness, loss of sleep, nausea, and vomiting are frequently seen and can develop into seizures and status epileptics, which is life threatening if not treated.
The primary effect of these drugs is to depress the entire control nervous system. This depression begins with the higher cortical centres as the dose increases; more and more of the nervous system becomes depressed until, in high doses, the respiratory centres of the control nervous system are depressed leading to death.
Among the stimulants most commonly abused in our society are amphetamines and cocaine (although their use is much less as compared to heroin, ice and charas). The overdose of amphetamines or its regular abuse leads to seizures, elevation of blood pressure, tachycardia (rapid heart rate) and difficulty in urinating and dilated pupils.
When amphetamines are taken in high doses for longer periods of time, a toxic psychosis can develop. It is normally a paranoid type of psychosis, and the person suffering from this can become violent.
Closely related to amphetamine because of its stimulant properties is cocaine, an alkaloid extracted from the cocoa plant. It causes numbness in the mucous membrane of the nose if it is snorted. It also contracts blood vessels.
Opiates are among the oldest drugs known to humanity and have probably been abused since long before recorded history. Most of the opiates occurring naturally are extracted from the opium poppy, Papaver Somniferum.
Among its naturally occurring alkaloids are morphine and codeine. Making additions to the naturally occurring opiates can create the semi synthetic opiate, and heroin is an example of it. Opiates have sedative properties and produce a marked euphoria.
All the opiates have a high dependence liability and rapid development of tolerance. In high doses, opiates can cause seizures and, in overdoses, cessation of respiration and death.
Heroin (diacetylmorphine) is usually smoked in Pakistan (chasing the dragon) but intravenous use is common in the West. Its tolerance develops most rapidly initiated by repeated administration of small doses but ends in continuously increasing dosage. Death from overdose is easily possible.
Some of its adverse effects include constipation, loss of appetite and reduced libido. Withdrawal symptoms appear after a few hours of the last dose, including vomiting, diarrhoea, aches and sweating.
Copyright Business Recorder, 2023
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