Focus on female opium addiction

Rahema's tale is a sobering one. Three months pregnant, the 35-year-old mother of six is Afghanistan's latest female victim of opium addiction. Brought from remote northeastern Badakshan province to the Afghan capital's only drug rehabilitation centre, she knows this is her last chance for help. "I made a crucial decision to quit this addiction. My future and that of my children depends on it," she told IRIN. But after so many years of opium addiction, doctors wonder how much they can help - not just Rahema, but other women like her. "We don't have the resources to deal with this," Dr Nagibullah Bigzad, an Afghan clinical psychiatrist at the poorly-equipped unit told IRIN in Kabul. Speaking from his office at the 15-bed facility, the 29-year-old doctor maintained women were an increasingly vulnerable group to opium - a problem set to worsen unless greater steps were taken soon. "Opium usage remains a big problem in the region," Bigzad said. While most women use it for remedial purposes given the lack of doctors or health services in Badakshan, many still use it as an escape from the horrors of war or poverty, he maintained. "Women simply go to the market and buy it there," he exclaimed. But for David Macdonald, drug demand reduction specialist for the United Nations Drug Control Programme (UNDCP)in the Pakistani capital Islamabad, the problem of female opium addiction extends far beyond Badakshan. "There are thousands of women suffering from opium addiction throughout Afghanistan, as well as amongst the large refugee population in Pakistan and Iran," Macdonald told IRIN. "All indicators suggest this problem is increasing," he warned. Although there is no accurate data on the severity of the problem, Macdonald said the numbers are serious enough to warrant an urgent demand for treatment and rehabilitation. In Badakshan alone, Bigzad estimated that up to 60,000 women were addicted, while another report said between 20 and 30 percent of the local population along the eastern border of Badakshan and Tajikistan were addicted. Still another conducted by two different health centres for women and children in the southern province of Kandahar suggested that over 20 percent of older women used opium, particularly for respiratory problems. The disparity alone demonstrates a stronger need for quantifiable data. According to a recent UNDCP report, opium usage enjoys a long history in Afghanistan. First introduced by Alexander the Great over 2,000 years ago, its traditional usage among minority groups as Tajik Ismailis and Turkmens included a wide range of social reasons, from sexual stamina to physical strength, as well as a medicine for over 50 diseases. Indeed, in many remote rural areas where there were no health clinics, pharmacies or medical facilities, it was still the only available drug when someone falls ill and was claimed to be particularly useful for pain relief, respiratory problems and the treatment of diarrhoea, the report explained. In Badakshan today, other opium products apart from the resin were still commonly used, for example poppy seed oil for cooking and the dried stalks of opium poppy plants as fuel for cooking fires or as animal fodder (konjara), it added. However, in 1994, the Wak Foundation for Afghanistan (WFA) published a report entitled 'National Drug Addicts Survey in Afghanistan: Opium in the Hindu Kush', stating that in northeastern Nuristan, small amounts of opium were being given to young children for cough relief. The report warned that children of opium addicted mothers could become addicted through breast milk, adding this could lead to further problems. For example, if an addicted mother was unable to find opium for her use when her child could not sleep or began to cry, such a mother could attempt to calm her child by either rubbing a small amount of opium on her lips and then putting her lips over the lips of her child - or by inserting a grain-size piece of opium into the child's anus, the report said. Although Rahema maintains none of her six children suffer from addiction, she recalled how if her children were ill, she would blow opium into their open mouths. "It was effective and helped the children sleep," she claimed. In an in-depth assessment of Afghan refugee women in Pakistan's North West Frontier Province (NWFP), who were primarily opium eaters, UNDCP reported that the vast majority of women used opium not 'for fun' or 'out of curiosity' as some had reported, but rather as a self-medication for pain, either physical or psychological. Such action was often prompted by 'peer advice' by friends, neighbours or relatives. While some cited purely physical ailments, such as respiratory problems, toothache and general body pains, as the reason for first starting opium use, the majority cited mental pain caused by depression, sadness, anxiety or loss. "Underlying many of these mental health problems is the central problems of loss," Macdonald said. "Some people will understandably turn to drugs to help cope with the pain, both physical and psychological, caused by the loss of family members, home, job, well-being, personal security, and in the case of refugees - their country," he added. But with social displacement, increased impoverishment, reduced cultural constraints and social sanctions, as well as endemic stress and depression, more customary usage of opium inevitably leads to abuse. "With extreme human deprivation and suffering, the increased availability of opium and heroin, along with a wide range of cheap and easily available pharmaceuticals, abuse has increased," Macdonald said. "War and social disruption has devastated traditional coping mechanisms and has left the population, both inside and outside the country, extremely vulnerable to a range of mental health problems, particularly chronic depression, anxiety, insomnia and post-traumatic stress disorder," he explained. Additionally, the use of opium, along with other illicit substances, has been seen by an increasing number of Afghan women as a short-term palliative for their suffering. However, in the long term it results in a wide range of social, economic, legal and health-related problems for the individuals, families and communities concerned, he warned. In short, such abuse poses a distinct barrier to human and socio-economic development. Over 80 percent of female refugee opium users interviewed by UNDCP reported that the cost of buying opium 'damaged the family's financial situation'. For example, 25 percent of this group of impoverished women, many of them widows, sold or bartered their family's wheat flour rations for money to buy drugs. Moreover, over 60 percent of the women reported that taking opium had damaged their social relationships. Quarreling and fighting with family members over drug use was common. One woman cited in the report remarked: "My son always argues with me and wants to stop giving me money, and my father is angry with me all the time because I'm addicted to opium." What compounds the problem of opium usage most, however, is the absence of awareness. "There is a genuine lack of reliable information on the harmful effects and the addictive properties of a drug like opium," Macdonald said. "People have been using it for remedial purposes for centuries, but with the demise of social constraints on its usage, the chance of abuse is greater," he explained. Asked what needs to be done, he maintained education was key. "Women need to be warned of the dangers involved before they start, especially with regard to conception, pregnancy and other health care issues," he explained. As for those who were already addicted, he emphasised a need for a user-friendly detoxification and treatment service with a comprehensive aftercare and rehabilitation programme (including vocational training and income generating activities). "Home-based is what works best in a cultural context where it is difficult for many women to leave home and enter an in-patient treatment programme," he noted. But for Dr Bigzad back in Kabul, the needs are even more rudimentary. "Look at this place. We don't have enough medicine or food for the patients or medical staff on duty. The place has no heating and we don't even have enough glass for the windows," he exclaimed. Like many of the staff members at Afghanistan's only drug rehabilitation centre, salaries are minimal and often months late. In short, the resources to challenge the problem of female opium addiction simply aren't there. Meanwhile, sitting on the soiled sheets of her bed, Rahema is joined by her oldest son who has come to support her. "My problem has become my family's problem. I can only hope to rid myself of this," she exclaimed. Her battle, however, has just begun.