Drug Abuse in the Global Village
Drug Abuse in Asia
Afghanistan
Extent of Drug Abuse
Abuse of opiates and cannabis (“charaz”) has been common in spite of Islamic prohibition and community marginalization of the abusers as outcasts. Some of the use of opium is anchored in tradition and medicinal use. In general, drug abuse has not been significant, although a drug subculture is developing. It is estimated that drug abuse mong refugees in camps ranges between 10 and 15 per cent. There are reports that cannabis is used by fighters to overcome war related stress. However, there are also reports that some of the waring factions, i.e., the Taliban, have taken drastic control measures to reduce both supply and demand, at least in areas under their control . Heroin abuse is rising in urban centres. Abuse of heroin, morphine, codeine, mandrax, as well as, alcohol and tobacco is reported. An increase in the use of psychotropic subtances, such as “Sosegone”, has been attributed to reduced availability of opium and cannabis in some areas (Kohler 1995; E/INCB/1991/CRP.2; Afghanistan 1993). Estimates of the number of habitual drug abusers in the country range from 150,000 to 1,000,000 or 1 to 6 per cent of the population. There are no studies to confirm existing estimates (UNDCP 6/1995).
Abuser Characteristics
Abuse of opium is common among males and females, while cannabis is more prevalent among males. Abuse is more prevalent among the 15 to 35 age group (E/INCB/1991/CRP.2). Drug dependence is estimated to be pronounced among refugees in camps, both males and females. Males tend to abuse cannabis, opium and heroin while females abuse tranquillizers (UNDCP 6/1995).
Abuse of cannabis, opium,heroin and tranquilizers is common among male and female Afghan refugees in camps in Iran and Pakistan. Cannabis is most prevalent. Opium is also widely abused by males and females, as well as children. Opium is traditionally used for medicinal purposes to deal with cough, chest pain, intestinal disorder, toothache and other types of pain. It is commonly held that the abuse of heroin is more recent, especially among refugees in camps. Most heroin users tend to be young males, but female abusers have also been reported (UNDCP 6/1995; Kohler 1995).
Regional Variations
Drug abuse is estimated to be high in five provinces: Badakshan, Helmand, Kunar, Nangarhar and Qandahar. Drug abuse is estimated to be significant in all refugee camps situated near urban centers in Northern Afghanistan. A 1994 poppy survey suggests that opium is used in 6 per cent and cannabis in 3 per cent of the villages in Badakshan; cannabis in 23 per cent of the villages of Helmand; opium in 6 per cent and cannabis in 32 per cent of the villages in Kunar; cannabis in 14 per cent, opium in 1 per cent and heroin in 1 per cent of the villages in Nangarhar; and, opium in 8 per cent and cannabis in 32 per cent of the villages in Qandahar (UNDCP 6/1995).
Opium use is common in the Ismaili area, in Jawzjan, Balk, Kondoz, Badakhshan in the North and North East, Herat in the West, Nimruz and Nangarhar in the South and Kabul in the centre. Use does not appear to be associated with problems, since it is contained by tradition. Most use appears to be for medical purposes to overcome harsh living conditions . It is also common to use opium to pacify babies. In general, drug consumption is not concentrated in cultivation areas. This is illustrated in Badakhshan, where use of opium is rare, even for medicinal purposes. In Southern Afghanistan, there is a belief that drugs cultivated in the country are not consumed by Afghans, but by the “enemies”. However, use of opiates, especially heroin, is increasing in urban areas, with a heavier concentration in Kabul. Heroin use in refugee camps is of growing concern (Kohler 1995).
In the north and North East, in Badakhshan, it is estimated that there are about 7 to 9000 daily opium abusers who consume an average daily dose of four grams each. There are about 14 to 18,000 casual users, including medicinal use by adults and babies. Among casual users of opium, an estimated 35 per cent are women. In Aqcha, in the Jawzjan province, local authorities estimate that 1 in 15 (or 6.7 per cent of a population of 15,000) is a regular opium user and that about 24 smoking dens operate in the town. In the village Mengajek, 14 per cent of 90 to 100 familes use opium regularly (Kohler 1995).
Trends
The war provided favorable conditions to the growth of the illicit drug trade. Drug revenues were used to finance the uprising against the Soviet Forces. However, after the withdrawal of these forces, the continued hostilities and difficulties in implementing peace agreements have been attributed also to Illicit drug production and trafficking. It seems that the warring parties vie for control of drug cultivation areas for revenues to consolidate their positions. The increased availability of drugs in Afghanistan have been associated with much corruption and a significant rise in drug consumption in Afghanistan, Pakistan, Iran, India, and, the Central Asian Republics. A rise in the consumption of drugs in other parts of the world has also been attributed to increases in supply from Afghanistan (UNDCP 6/1995; Rashid 1994; Afghanistan 4/1990; Afghanistan 10/1990; Kohler 1995). Drug abuse is estimated to be high among refugees, especially. An estimated 5.7 million Afghans, about one third of the total population, became refugees in Pakistan (3.2 million), Iran (2.4) and elsewhere (0.1). Another two million are displaced internally. Inside Afghanistan, mines present a major threat to personal safety. Agriculture, the backbone of the Afghan economy (85%) suffered a great deal. Consequently, much food aid has been required. Health and health care services deteriorated significantly. Access to education has been severely affected, harming the young generation, especially. Significant increases in drug abuse have been attributed to war related disruption in everyday life, as described above. Heroin emerged as the leading drug of abuse, followed by opium and cannabis ( Far East Economic Review 1994; Afghanistan 1993; E/INCB/1991/CRP.2; UNHEAPA 1988; Kohler 1995).
Mode of Intake
According to some reports, the demand for opium was created by introducing opium laced cigarettes in refugee camps, followed by opium sales and then heroin. The dominant mode to intake is smoking (or “chasing the dragon”) (Kohler 1995).
Drug abuse by injection appears to be rare and HIV drug related cases have not been reported yet (Afghanistan 1993; Ministry of Public Health, undated; Kohler 1995). Opium is smoked but also ingested for medicinal purposes (UNDCP 6/1995). Opium tea is consumed by all family members during day time (Kohler 1995).
COSTS AND CONSEQUENCES OF ABUSE
Traditional use of cannabis and opium is believed to serve positive medicinal functions. Opium and canabis seeds are used to produce cooking oil, opium stalks serve as fuel, cannabis fibre is used to make cloth and rope (Kohler 1995).
NATIONAL RESPONSES TO DRUG ABUSE
National Strategy
Drug control in Afghanistan consisted mainly of supply reduction programmes, which are considered of little effectiveness (Afghanistan 1993). In 1990, A State High Commission for the Campaign against Narcotic Drugs was established (referred to below as the Commission). Led by the Vice President of the Republic, it is composed of the Ministers of Interior, Finance, Justice, Agriculture and Land Reform, Education, Public Health, Information and Culture, the Deputy Minister for the Interior and the Chief Justice of the Supreme Court (E/INCB/1991/crp.2).
The Commission gave more attention to demand reduction in its overall programme, which includes:
1. formulation, coordination and monitoring of the implementation of a National Anti Drug Programme;
2. solicit international assistance and improve its cooperation with the sub region and UNDCP;
3. encouraging community participation, prevention and treatment programmes as well as enforcement , crop substitution and intelligence gathering; and,
4. introducing a comprehensive drug control legislation and becoming party to the 1972 protocol and the 1988 convention (E/INCB/1991/CRP.2).
Data collection, in general, is considered to have suffered due to the war situation. UNDCP received no responses to the Annual Report Questionnaires and INCB did not receive data on seizures, nor estimates of medical needs, although some of these are known to be available (E/INCB/1991/CRP.2).
Treaty Adherence
As governments in Afghanistan have been alert to abuse of opium and cannabis in the country, they joined international drug control treaties in 1912, 1925, 1931 as well as to the 1961, 1971 and 1988 conventions. The effectiveness of relevant legislation adopted, is considered limited. Cultivation of illicit narcotic crops remains widespread and controlled and non-controlled drugs are available in street markets (E/INCB/1991/CRP.2).
Authorities in poppy cultivation areas have voiced the opinion that alternative development is needed to encourage illicit cultivation. Further, drug related problems are not a priority for local authorities, given other hardships. However, the central authorities in Kabul expressed the wish to fulfill international treaties obligations, regardeless of aid received (Kohler 1995).
DEMAND REDUCTION ACTIVITIES
Demand reduction activities are limited. Social and cultural characteristics of the country suggest that the demand reduction efforts be community based and comprehensive, including primary prevention, treatment and rehabilitation, relapse prevention and social reintegration. Primary prevention should be integrated into appropriate human development and education programmes of the UN organizations and non-governmental organizations. A special effort is needed to collect drug abuse related information (UNDCP 6/1995). There are indications that in areas controlled by the Talibans the population is responding positively to a ban in cultivation and use. In the same areas, drug related intervention programmes which involve women are also curtailed (Kohler 1995).
Primary Prevention
The visibility of an Awareness Creation Campaign (ACC) has been significant. Posters are seen all through the Badakhshan province. It appears that the attitude towards opium cultivation among local authorities in Nangarhar, one of the major opium producing provinces, have been influenced by the ACC campaign. In Kandahar, the Taliban waring faction disempowered local warlords and imposed a ban on smoking dens and use of cannabis and opium. In refugee camps in Pakistan, ACC material is visible. In spite of the considerable visibilty of the ACC, it appears that its impact has been limited by the continuing power struggle, which feeds upon the drug trade. The ACC, however, has been effective in setting poppy cultivation on the political agenda and harnessing communities to address problems related to drug supply and demand (Kohler 1995).
The Ministries of Education and Higher Education and Vocational Training encouraged students to participate in awareness campaigns to sensitise the general public to drug related risks. A Monthly publication regularly features articles on the negative impact of drugs. The Ministry of Information is cooperating with the BBC on the development of drug related scripts (E/INCB/1991/CRP.2).
The Academy of Sciences held a seminar to study causes and effects relating to drug abuse. Teachers are trained in special seminars in selected areas and lectures are offered at students seminars (E/INCB/1991/CRP.2). UNDCP funded projects trained community workers, teachers, religious leaders, doctors, women resource persons, women health workers, social workers in drug abuse prevention, community based rehabilitation and after care following detoxification (UNDCP 6/1995; Kohler 1995). The Commission called upon religious and tribal leaders to use their influence to prevent drug abuse. Lectures are given in detention centres (E/INCB/1991/CRP.2).
There are many NGOs which are implementing relief programmes inside Afghanistan as well as among refugees in Pakistan. Among the many, listed by the UNHEAPA, some, such as medical services organizations, could play an important role in drug abuse prevention, treatment and rehabilitation. To increase effectiveness UNDCP interventions could be integrated in coordinated relief efforts (UNHEAPA 1988).
Treatment and Rehabilitation
In a letter dated April 24, 1990, the Council of Ministers reported to UNDCP that a mental health hospital has been established to treat drug dependent abusers. The letter states that, at least 5,000 abusers were in treatment in Kaihan Valley and 1200 in the Province of Badakhshan (Afghanistan 4/1990).
According to a 1991 INCB report, drug abusers are normally treated in the psychiatric ward of a small hospital, which can accommodate about 20 patients in poor conditions. The commission prepared plans to establish a detoxification centre and sought funds for this purpose (E/INCB/1991/CRP.2).
There are three treatment centres supported by UNDCP: one is located in Peshawar , in Pakistan (20 beds) and two in Badakshan, in Afghanistan, with about 50 beds, were closed in March 1995 due to lack of funds (UNDCP 6/1995; Kohler 1995). One treatment centre in the refugee camp Nejat/ORA has been operating by a community based NGO, with the support of the European Union since March 1995. (Kohler 1995).
References and Notes
Afghanistan 4/1990 Council of Ministers of the Republic of Afghanistan Resolution. Letter to UNDCP dated April 24, 1990.
Afghanistan 10/1990 “International Action to Combat Drug Abuse and Illicit Trafficking” Letter dated October 2, 1990, from the permanent representative of Afghanistan to the United Nations addressed to the Secretary General
Afghanistan 1993 Workshop of National Focal Points on Drug Abuse Demand Reduction Golden Crescent Countries. 1993. Country Paper. Bangkok 1993.
E/INCB/1991/CRP.2 “Action to Ensure the Execution of and to Improve Compliance with the International Drug Control Treaties. Report on the Mission to Afghanistan”, February 1991.
ESCAP 1991. Proceedings of the Meeting of Senior Officials on Drug Abuse Issues in Asia and the Pacific. United Nations.
Kohler, U. 1995 “UNDCP Assessment and Strategy Formulation Mission. Afghanistan” May 23 through July 20 1995 Report. Demand Reduction.
Ministry of Public Health (undated) “Prevention, Treatment and Social Re-integration of Alcohol and Drug Abuse in Afghanistan”.
Rashid, A. 1994 “Drug Overdose: Bumper Opium Harvest Threatens Social Order” Far Eastern Economic Review
December 15, 1994
UNHEAPA 1988 The First Consolidated Baseline Report, the Office of the Coordinator for United Nations Humanitarian and Economic Assistance Programmes relating to Afghanistan, Geneva.
UNDCP 6/1995 “Afghanistan: The Impact of Drugs on the Peace Process and Rehabilitation in the Country” Briefing Note prepared for the Stockholm Meeting, I-2 June 1995.
Notes:
** The Legal, Administrative and Other Action Taken to Implement the International Drug Control Treaties section was not available by July 26, 1995. The most recent relevant part of the annual reports questionnaire was submitted for 1984.