Drugs in the Global Village
Pakistan
EXTENT, PATTERNS AND TRENDS IN ILLICIT DRUG SUPPLY
Setting
Extent of Illicit Drug Supply
Cultivation
Manufacture
Patterns and Trends in Illicit Drug Supply
Trafficking
Seizures
Arrests, Convictions and Imprisonments
Trends
Not reported
EXTENT, PATTERNS AND TREND IN DRUG ABUSE
Extent of Drug Abuse
Of a population of 125.94 millions in 1993, there were an estimated 3,005,649 drug abusers, or 2.39 per cent. Among those aged 15 years or older, the percentage of drug abusers is 3.96 per cent. Among drug abusers, opiates are the most prevalent drugs of abuse: heroin 50.7 per cent and opium 5.7 per cent, followed by cannabis 31.8 per cent. Other drugs abuse appear to be secondary (see table 1) (p.21 and appendix A:p.12-13). Most drug abusers consume drugs daily (70 per cent twice or more per day) and more frequently among heroin abusers (81 per cent once a day or more) (p.41) (Pakistan 1994).
Table 1: Drug abuse by type and region in 1993 in Pakistan
Total Urban Rural
N % % %
Heroin 1,527,000 50.7 33.6 17.1
Opium 171,000 5.7 3.8 1.9
Other opiates 9,017 3.3 3.3 ---
cannabis 956,000 31.8 19.5 12.3
tranquillizers 33,063 1.1 0.6 0.5
mandrax 3,006 0.1 0.1 ---
alcohol 135,254 4.5 3.7 0.8
0thers 174,329 5.8 3.0 2.8
Total 3,005,649 1,043,691 1,961,958
S=1000, P=125,940,000 in 1993
Source: National surveys on drug abuse (Appendix A:p.12-13) (Pakistan 1994)
Concern relating to drug abuse led authorities to invest increasing efforts in producing research-based assessments since the 70's (p.5). National Surveys were conducted between 1982 and 1993 to assess the drug abuse situation on the basis of responses of drug abusers (p.9) and community informants (p.15) (Pakistan 1994). Findings relating to drug research have been sent to UNDCP on regular basis. Pakistan has no registry of drug abusers. The drug abuse situation is assessed on the basis of surveys among the general and students populations and statistics on people receiving treatment (p.1-2)(ARQ 1989, Part B). Pakistan responded to the ARQ once, in 1989. Overall, the item response rate to ARQ 1989 Part B and to the CMO, Parts 1-5 is fair.
Findings reported in this country drug profile should be interpreted with caution as they appear to be reliable to assess drug abuse among drug abusers but not to estimate prevalence of drug abuse in the general population due to methodological limitations (see note @ and Pakistan 1995:3).
Abuser Characteristics
Drug abuse among males (7.33 per cent) is significantly higher than in the population aged 15 years or older (3.96 per cent) (p.21). Data on female abuse is subject to high variability as the survey sample included only 28 cases out of 1000. Heroin is the preferred drug of abuse among these women (71.4 per cent), followed by cannabis (10.7 per cent) (p.36) (Pakistan 1994).
Drug abuse is most prevalent among those 26 to 30 years old. Most drug abusers are less than 40 years old 83.6 per cent and about 53.8 per cent are less than 30 years old (p.28). The mean age of starting drug abuse is 12.4 years for heroin. Cannabis is more widespread than heroin abuse among those 20 years of age or less (p.31) (Pakistan 1994).
Drug abuse is more prevalent among those who are literate (p.28). It ranges between 22 and 24 per cent among those who have 10 years schooling or less, and between 15 and 17 per cent among those who have 11 years of schooling or more (p.29). It is widespread among different occupational groups: skilled (26 per cent) and unskilled (25 per cent) workers, salespeople (17 per cent), clerical and agriculture workers (7 per cent each), beggars (6 per cent), students (5 per cent), professionals (3 per cent) and others (4 per cent) (p.29). About 80 per cent of the drug abusers earn less than the national average of 3,168 rupies per month (p.30) (Pakistan 1994).
Most drug abusers live with their own families (82 per cent). “Homelessness” is more prevalent among urban (10.5 per cent) than rural (4.2 per cent) drug abusers (p.32) (Pakistan 1994).
Drug abuse has been spreading beyond traditional groups to youth and students in universities: 12 per cent of all students in four higher education institutions in Karachi abused drugs in 1993, while 18.3 per cent abused opiates and 8.3 per cent heroin. Similar findings were reported in other institutions in Lahore and in Baluchistan (p.19-20)(Pakistan 1987).
Regional Variations
About 33 per cent of the population lives in urban areas, according to 1992 estimates (HDR 1995).
Drug abuse is widespread in both rural and urban areas but it is more pronounced in urban areas (table 1).
Trends
Recent trends
Drug abuse has been increasing between 1982 and 1993 in both urban and rural areas (table 2). Most noticeable is the rise of heroin on account of a decline in opium abuse for the same period; while cannabis abuse remained relatively stable, in spite of some indications of a decline (table 3).
Table 2: Trends in drug abuse by year and region in Pakistan
1982 1986 1988 1993
Total 1,301,014 2,066,862 2,244,000 3,005,649
Urban 482,219 768,411 690,728 1,043,691
Rural 818,795 1,298,451 1,553,272 1,961,958
Source: National surveys on drug abuse (p.23) (Pakistan 1994)
Table 3: Trends in drug abuse by type and year in Pakistan
1982 1986 1988 1993
Heroin 30,000 657,000 1,080,000 1,527,000
opium 314,000 262,000 261,000 171,000
cannabis 985,000 708,000 854,000 956,000
Source: National surveys on drug abuse (p.24) (Pakistan 1994)
Most community leaders expressed the opinion that drugs are “easy” or “very easy” to get:
cannabis (82.5 per cent), opium (72.4 per cent), other opiates (62.2 per cent) and heroin (59.1 per cent) (Appendix A:p.57) (Pakistan 1994).
Historical Trends
Opium poppy has been traced back 6000 years to Sumer in Mesopotamia. Greeks, Romans, Turks and Egyptians used it for medical and religious purposes. Alexander the Great is said to have introduced it to the Indian subcontinent in 327 B.C. Cultivation was introduced by Arabs and Persians between the 9th and the 11th centuries. By the time of the Mughal dynasties in the 14th century, opium has been established enough to require a state monopoly. In the 18th century, the British assumed opium state monopolies and diffused them in the region. Opium provided 19 per cent of revenues in British India. Opium consumption has been widespread for medicinal, ceremonial and social purposes for centuries. However, it has been also associated with mounting concerns, which eventually led to the birth of international controls in Shanghai in 1909 (p.1-9)(Pakistan 1987).
Licit and illicit drug production in contemporary Pakistan are considered relatively recent. Pakistan established its Opium and Alkaloid Factory in Lahore in 1955 (p.9-10) (Pakistan 1987), as most production remained in India following the partition in 1947. Before and after the partition, opium was available in licensed shops (p.1)(Pakistan 1995). Opium vendors rose from 328 in 1947 to 664 in 1964 (p.11) (Pakistan 1987).
During the 50's and early 60's, the main drugs of abuse were cannabis and opium. This pattern of abuse was contained by tradition and the overall drug situation was considered stable. In the mid 60's, drug abuse began to spread to non traditional groups. Cannabis abuse spread among university students “under the influence of pop culture.” In the 70's, drug abuse expanded to non-traditional drugs such as methaqualone and other psychotropic substances (p.11)(Pakistan 1987). Abuse of drugs such as morphine, pethidine and barbiturates began to be reported, along with stimulants. Methaqualone and non-barbiturate hypnotics became fashionable in urban areas. More than a dozen benzodiazepines brands are easily obtained without prescription (p.1-2) (Pakistan 1995).
Mode of Intake
The predominant mode of drug intake in Pakistan is smoking or inhaling (78.4 per cent), followed by eating or drinking (18 per cent), sniffing (4.2 per cent) and injecting (1.3 per cent). Most of those who inject, inject heroin and other opiates. (Data on injection is based on a very small number of respondents. It is likely to be subject to high variability) (Appendix A:p.44). Multiple drug abuse is common among 78.2 per cent of the drug abusers in Pakistan. In urban areas, it stands at 64.6 per cent (Appendix A:p.56) (Pakistan 1994).
COSTS AND CONSEQUENCES OF ABUSE
The association between criminality and drug abuse has been subject to inconclusive results in published research (p.48). In Pakistan, 32.8 per cent of the drug abusers or about one third of the sample, reported having been conviction or arrest, with a higher share in urban areas (64.1 per cent) (Appendix A:p.54) (Pakistan 1994).
The 200 HIV positive cases reported are considered the “tip of the iceberg.” Concern has been expressed by local experts that with the spread of drug injection practices, more HIV infections would be detected (Pakistan 1993:16,146; 1995:6).
The drug economy is estimated at $5 billion or 10 per cent of the country’s GDP. Drug barons appear to be using their wealth to gain political influence as elected representatives in national or provincial assemblies, to acquire economic influence in the bank and industry sectors and to play a role in shaping public opinion through newspapers ownership. Some of the blame for this development is attributed to Western countries who supported drug production for political, security or economic reasons (p.17-18;160-161, 185) (Pakistan 1993). In the tribal areas of the North West Frontier Province, drug production is unhampered and drug money has been used to finance insurgency activities. Significant military forces have been dispatched to the area to contain a rebellion and drug related activities (p.23,26) (Far Eastern Economic Review 1994).
Drug abuse in Pakistan is attributed to social or religious factors (acceptance by others 33.2 per cent, to be social 14.3 per cent, or religion 0.4 per cent), as well as to personal factors (relief from social stress 13.4 per cent, enhance sexual performance 8.3 per cent, curiosity 8.3 per cent, relief from physical stress 6.5 per cent, improve work performance 5.4 per cent, treatment of health problems 4.4 per cent), among other reasons (6.0 per cent (p.39-40) (Pakistan 1994).
NATIONAL RESPONSES TO DRUG ABUSE
National Strategy
The Pakistan Narcotics Control Board (PNCB) has been established in 1974. The drug control programme appears to focus on supply reduction, i.e., alternative development and law enforcement activities against illicit drug producers and traffickers. Recently, more efforts have been dedicated to demand reduction programmes, with a special focus on heroin abusers. In light of the continuing rise in drug abuse, programme effectiveness issues have been raised (p.130)(Pakistan 1993; see also Pakistan 1987:62, 128).
Structure of National Drug Control Organs
LEGAL, ADMINISTRATIVE AND OTHER ACTION
TAKEN TO IMPLEMENT THE INTERNATIONAL
DRUG CONTROL TREATIES**
Treaty Adherence
Measures Taken with respect to Drug Control
Recently enacted laws and regulations
Licensing system for manufacture, trade and distribution
Control system
Prescription requirement:
Warnings on packages:
Control of non-treaty substances, if any: None reported.
Other administrative measures: None reported.
Social Measures
Penal Sanctions related to social measures
Other social measures
SUPPLY REDUCTION ACTIVITIES
Crop Eradication
Alternative Development
Enforcement
Money-Laundering
Not reported
.
DEMAND REDUCTION STRATEGIES
Primary Prevention
Public expenditure on education has been estimated at 3.4 per cent of GNP in 1990 (p.179), the Adult literacy rate 35.7 per cent in 1992. The gross enrolment ratio for all levels, expressed as a percentage of those aged 6 to23 has been 25 per cent in 1992 (p.157). Two per cent of the population has televisions, based on 1992 estimates (p.159) (HDR 1995).
PNCB has been active in promoting drug prevention awareness through its “Drug Abuse Prevention Resource Centre,” conferences, publications and guides to practitioners such as health care workers, teachers, journalists and social scientists. These efforts have been supported by the media and NGO’s. UNDCP, among other parties, provide financial and technical assistance but more is needed (p.15; 130) (Pakistan 1993; Pakistan 8/1993; see also publications cited below for illustration).
Drug prevention education has been introduced in school programmes (p.5) (Pakistan 8/1993; ARQ 1989:1).
As part of drug prevention in education, a teachers guide to drug abuse prevention has been developed and distributed widely (Pakistan 1988) and teachers training was part of a UNDCP sponsored project as of 1991 (p.4) (Pakistan 2/1993; ARQ 1989:1).
Drug prevention training has been provided to health officials and family physicians (p.130) (Pakistan 1993; ARQ 1989:1) and to key NGO’s (p.3) (Pakistan 8/1993). Guidelines for family doctors and primary health care workers relating to heroin detoxification have been issued by the PNCB (PNCB 1991; PNCB 198?).
The “Drug Abuse Prevention Resource Centre,” established in 1989 with the help of US AID, has been active in setting up a network of NGO’s and providing them with drug abuse related information and training (p.3) (Pakistan 8/1993). About 50 NGO’s have been reported in 1989 (p.8)(ARQ 1989)
Treatment and Rehabilitation
Population with access to health services has been estimated at 55 per cent for the years 1985-93 (p.159). Public expenditure on health has been 1.8 per cent of GDP in 1990 (p.171). Population per doctor has been estimated at 2,000 and 3,448 per nurse for the years 1988-91 (HDR 1995).
The higher availability of doctors in comparison to nurses suggests to a lack of balance in the health care system and a weakness in developing a primary health care system (p.130). However, limited access to health services, has not led to widespread “abuse” of drugs for medical purposes as pointed out earlier. Efforts to improve health care services in general are noted. A small, but increasing, fraction of these resources have been allocated for drug related treatment, as priority has been given to the fight to contain malaria and tuberculosis among other diseases. UNDCP, among other parties, has been providing financial and technical assistance but more is needed (p.15; 130) (Pakistan 1993; Pakistan 1987:125-129).
Around 1974, five treatment centres were established, growing to 30 in 1993 (p.130) (Pakistan 1993). In 1982, about 100,000 heroin abusers were treated in 27 treatment centres (p.126) (Pakistan 1987). Based on this information, the 30 existing treatment centres may be servicing more than 100,000 drug abusers in 1995.
Detoxification through “cold turkey” and symptomatic medicinal therapies are the main treatment modalities reported. Other programmes include treatment by acupuncture, “hakims” and “sinyasis” and heroin substitution with opium and morphine. Maintenance programmes were discontinued (p.134-138). Selected evaluation studies suggest that successful detoxification ranges between 48 and 68.3 per cent depending on treatment modality but the rate of relapse is as high as 84 per cent (p.128-129;132) (Pakistan 1987). Efforts are underway to improve the effectiveness of drug treatment practitioners (p.5) (Pakistan 2/1993).
About two thirds of the drug abusers who responded to a 1993 sample survey are aware that treatment facilities are available (67.2 per cent) (Appendix A:p.62). A significant proportion of the drug abusers report having “attempted to abstain from drugs” (58.7 per cent or 587)(Appendix A:p.58), but a fraction (19.7 per cent or 197) have opted for treatment, most due to opiates dependence (85.78 per cent). Most receive treatment in hospitals (57.4 per cent), by a doctor (27.9 per cent), in a treatment centre (10.7 per cent) or in and NGO (4.1 per cent) (Appendix A:p.59). The duration of abstention from drug abuse (n=576) is less than six months for most (71.5 per cent), followed by 7 to 12 months (11.6 per cent), one to two years (8.3 per cent), or two years or more (8.5 per cent) (Appendix A:p.61) (Pakistan 1994).
Rehabilitation programmes were established in the 70's and early 80's with the help of ILO, to provide occupational training. Some 700 non drug abusers were trained in those centres. Drug abusers did not use these centres (p.132) (Pakistan 1993). According to other reports, rehabilitation is nonexistent (Newsline 1992).
References and Notes
Supply Reduction
Demand Reduction
ARQ 1989 “Replies to Annual Report Questionnaire” for the year 1989
Far Eastern Economic Review 1994 “Drug Overdose - Bumper Opium Harvest Threatens Social Order” by Rashid A. in Far Eastern Economic Review December 1994
HDR 1995 The Human Development Report 1995, UNDP, New York, Oxford University Press.
Newsline 1992 “No Way Out” Newsline July 1992
Pakistan 1995 Anti Narcotics Force Yearly Digest January 1991-December 1994, edited by Bhatti S.A.J. and Rana I.A., Government of Pakistan
Pakistan 1994 Pakistan National Survey on Drug Abuse 1993 prepared by Ahmed A.M., Ali.S.M., Rafiq M. And Toor S.S., Pakistan Institute of Development Economics (PIDE), for the Government of Pakistan and UNDCP, August 1994, Islamabad, Pakistan
Pakistan 1993 National Policy and Public Conference on Drug Abuse Government of Pakistan, Report on the conference held in May 1993 in Islamabad, Pakistan
Pakistan 8/1993 “Country Paper - Pakistan” Workshop of national focal points on drug abuse demand reduction, Golden Crescent countries, Bangkok, August 16-20, 1993
Pakistan 2/1993 “Country Report - Pakistan” Senior officials meeting on strengthening the regional network of national focal points on drug abuse demand reduction, February 1-4, 1993
Pakistan 1989 “Narcotics Control Programmes- The new Strategy and Achievements” Government of Pakistan, Islamabad.
Pakistan 1988 “Teachers’Guide to Drug Abuse Prevention” PNCB, Government of Pakistan, Islamabad.
Pakistan 1987 Menace of Opiates Abuse in Pakistan, prepared by Ashraf M.M. for PNCB, Government of Pakistan, Islamabad.
PNCB 1991 “Recognition, Consultation and Referral of People with Heroin Problems: A guide for the Professional Support of People with Heroin Problems,” Government of Pakistan
PNCB 198? “Heroin Detoxification: Guidelines for Family Doctors and Primary Health Care Workers” PNCB, Government of Pakistan, Islamabad.
Notes:
* The general background information is taken from HDR 1995, unless indicated otherwise.
** The Legal, Administrative and Other Action Taken to Implement the International Drug Control Treaties section is primarily based on Pakistan 1987 above as response to ARQ Part I has not been received.
@ Some of the estimates provided in miscellaneous official reports appear to be inconsistent, raising doubts about their reliability. For example, a 1989 report estimates “one time abusers” of tranquillizers to be 5,830,224 and “continued abuse without prescription” 3,033,501 (Pakistan 1989:7), compared to 33,063 in 1993 (Pakistan 1994: appendix A:p.12-13). Such a large difference could not be explained by tightening control measures, and there is evidence that drug abuse has been increasing steadily.