Focus on drug rehabilitation

Since 1990 he has smoked, injected and peddled drugs everywhere including Britain. His life was extreme highs and extreme lows - a sudden rush of heroin-induced exhilaration followed by depression, disappointment and regrets. But now Saleem Khan has been clean of drugs for three months and he looks forward to the day when his rehabilitation programme is over and he can return to his wife and daughter - and maybe a normal life. "I have no specific plan, but once out from here I will go to our ancestral land and start farming," Khan told IRIN in an interview. Khan is one of several thousand Pakistanis trying to kick away their addiction to drugs - mainly heroin and synthetic opiates including Bupronorphine, Anti-Histamine, tranquilisers, antiematic and morphine. Helping them in their quest are a few drug rehabilitation centres, mostly run by NGOs and private doctors. An official of the United Nations International Drug Control Programme (UNDCP) told IRIN that there were at least 73 specialised treatment centres in the country excluding such clinics where drug treatment and rehabilitation was just one of the services. Official and private estimates of the number of drug addicts, particularly those dependent on heroin, vary greatly. Official studies carried out with the help of the United Nations suggest that up to 3.2 million Pakistanis were addicted to heroin. Later that figure was brought down to 1.5 million out of a total population of 140 million. The UNDCP official said a recent Drug Abuse Assessment Study - whose findings are yet to be published - estimates that there were a maximum of half a million hardcore heroin addicts in the country, a much lower figure, but still a huge number given the small numberof treatment centres across Pakistan. "Keeping in mind the size of the country and the population, half a million is one of the highest chronic addict rates in the world," the official said, explaining that he defined chronic heroin addicts as those people whose mental and physical health has been disturbed by the abuse of the drug and were only found either on the streets, inside prisons or in treatment centres. A typical addict spends up to a dollar a day for his fix, showing how cheaply available heroin is in the country. Despite a major drive to eradicate opium poppy in Pakistan since 2000 there appears to be no corresponding reduction in the number of drug addicts in the country. Observers say this is manily due to the ready supply of heroin from its western neighbour, Afghanistan. Although the new government in Kabul has said it wants poppy cultivation banned, it is powerless to prevent thousands of farmers from cultivating and selling the high-yield high-return crop. A recent UN survey of poppy growing in Afghanistan suggests popy growing is increasing again following the end of the conflict. However health officials and NGO's believe that there would be fewer Pakistani drug addicts if more treatment and rehabilitation centres were opened up. The UNDCP is planning to set up four new model treatment and rehabilitation centres in the country soon, the official added. "I am very glad," Khan said about being away from drugs for more than three months in a 50-bed centre, Sunny Trust, being run privately on donations, outside the capital Islamabad. "I have a daughter you know and I want to be with her," he said with a smile. His doctor said it would take another three months before he was ready to face the world. But not all the addicts going through rehabilitation are looking forward to go back to their homes. Most are not welcome, have no jobs to return to and almost everyone else who knows their past, wants to stay away. "The society does not accept him [an ex-addict]," Akthar Ali, a psychologist and administrator of Sunny Trust, told IRIN, explaining why the relapse rate was high and people returned to their past habits even after undergoing rehabilitation programmes. The high relapse rate, which experts said ranged between 50 and 70 percent, is related to extreme poverty, lack of jobs, returning to old addict friends and the cheap supply of heroin. "Most of the drug addicts we treat in our centres are from very poor families," Tariq Zafar, head of Nai Zindagi [New Life] NGO, said. "Our patients are mostly from the streets," said Zafar who has been running rehabilitation centres for more than a decade now. Rehabilitation centres follow different methods of treating their patients. Munawar Fayyaz Sunny, chairman of the Sunny Trust, told IRIN that considering the challenges and available resources, their method of treatment focused on spiritualism and religion. Blue-uniformed residents of his facility, 20-minutes away from the capital, are supposed to offer Islamic prayers five times a day, attend classes of the Islamic holy book the Koran, and listen to clerics lecture on spiritualism and religion. "Of course if our patient is not a Muslim, he does not have to attend the Islamic teachings, but he is asked to follow his own religion or faith," Fayyaz said, adding that several non-Muslims have been treated at the facility without any problem. "We completely change their lifestyles. The aim is to restore his self-respect and self-confidence and enhance his self-esteem," he added. Not far from Sunny Trust in the same rural district, amidst green farms and hills, is the Nai Zindagi centre, whose approach to helping drug addicts is very different. Here the project focuses on giving those involved marketable skills so that they have a chance of earning a living on the outside. The centre trains people in woodwork, carpentry, furniture making, construction, leather products and rebuilding surplus army jeeps, a popular line given the huge taxes on new vehicles in Pakistan. Funded partly by the European Commission (EC) and Britain's Department For International Development (DFID) the centre generates the rest of its income from sales. "We went into commercial enterprise realising that donor support is very unreliable," said Zafar, an ex-addict himself. He has turned the NGO into some sort of a commercial enterprise offering jobs to some of his patients once they have fully recovered. "I came here in January 1995 after smoking heroin for eight years," said a former policeman Sardar Nabi, who is now manager of one of the workshops of Nai Zindagi. Sardar Nabi is now married and his wife and children live in a nearby farm house on the outskirts of the capital. "I am very happy," he said, adding, that he had not smoked any drug since the first day he entered the rehabilitation programme. Psychiatrist Amir Sindhu told IRIN that the method used to assist addicts back to normal life was less important than the outcome. "As long as half the people on the rehabilitation programme can find their way back to normal productive life, it is a good methodology," said Sindhu, who has worked with addicts outside Pakistan as well. He said the drug problem in Pakistan was not as acute as the media portrayed it to be, though it did not mean that the government and society should be complacent about it. "There is a strong need for government's active involvement in treating addicts," he added. Sunny said he was not sure the government was actually doing anything for the rehabilitation of drug addicts. "If they are I am not aware of it," he added, explaining that the government run hospitals admitted addicts for long-term treatment though it was not effective because patients usually got their 'fix' right there inside the hospitals. The same point was stressed by Zafar who said it was more fashionable to raise the issue of law enforcement because there was more international funding for that instead for rehabilitation. "Even if heroin supply is reduced addicts will find alternative synthetic drugs for their need," he explained. A Ministry of health official told IRIN in Islamabad that the government was not running specialised treatment centres for the addicts. "We have special sections attached with the psychiatry department in our hospitals where patients are provided detox facilities and a 10-day treatment," the official added. But doctors generally say it was not effective because the government had no follow-up procedure in the hospitals. The UNDCP official said follow-up was crucial in ensuring that addicts do not return to their past situation. The official said a new study had just been concluded in Lahore, capital of the populous Punjab province, to determine various aspects of drug abuse, which showed that heroin addicts were a minority compared to those using tranquilisers freely available in medical stores without a doctors prescription. "Based on the findings of the study it is clear that focusing just on heroin is not enough to resolve the addiction problem," Zafar said. The study was carried out to find out the effectiveness of a Harm Reduction Programme for addicts on the streets of Lahore in collaboration with UNAIDS. The programme aims to register drug users on the streets of Lahore, provides them with basic health care, diagnoses and treats sexually transmitted diseases, educates drug users on harms of sharing needles, provides free condoms, runs needle exchange, and refers people for detoxification and rehabilitation. Nevertheless, Zafar said, it was important that more drug rehabilitation programmes and awareness campaigns were launched. "It is a problem that can be contained," he concluded.