Addiction: Drug abuse in Kabul city and beyond

Afghanistan is trying to pick up the pieces after more than two decades of violent and socially destabilising civil war. Already one of the poorest countries in the world, the years of war have compounded the challenges facing modernisation of a primarily agrarian society with feudalistic and traditionalist social relations. The civil war caused extreme hardship for millions of Afghans who also suffered the highest population displacement of a country in recent years. With traditional coping mechanisms damaged and many families losing the male breadwinner, levels of destitution have risen, compounded by the return of millions of refugees from Iran and Pakistan. The post-conflict reconstruction period has yet to offer tangible opportunities for most Afghans who struggle to survive. However, outside the towns, amidst the struggling reconstruction and recovery efforts, the opium economy is booming. Afghanistan is by far the world's leading supplier of opiates, with more than 1.7 million farmers estimated to be involved in opium production. According to the UN Office on Drugs and Crime (UNODC), the years of war and social disintegration have left the population "extremely vulnerable to a range of mental health problems, particularly chronic depression, anxiety, insomnia and post-traumatic stress disorder. In such a context the availability of cheap opium, heroin and other pharmaceuticals is causing a rapid rise in drug dependency in Afghanistan as well as neighboring countries". In its Community Drug Profile report of July 2003, the UNODC goes on to say: "Kabul has a serious drug problem with tens of thousands of drug users requiring assistance with the social, financial and health-related problems resulting from their drug use that effects not only themselves, but their families and the community they live in". Kabul city had 1, 781,000 inhabitants, according to the 1999-2000 census, although this has increased significantly since the fall of the Taliban and as Kabul has become a relative hub of fast economic growth in a chronically poor country. The influx of refugees from Iran and Pakistan has also added to this recent increase. In early 2003 the UNODC estimated, using a methodology of key informants, that the lowest estimate of drug users in the city was approximately 63,000. The same study showed that hashish was the top drug used, with opium, heroin, pharmaceuticals and alcohol following. The head of the Counter-Narcotics Directorate in Kabul, Mirwais Yasini, told IRIN that the number of opium addicts in Kabul alone was more than 30,000. A senior representative of Nejat, the non-governmental organisation running rehabilitation centres and community outreach facilities in the city, suggested there were between 30-60,000 addicts, but cautioned against trying to define the problem with data that was not reliable in a society where few will admit to using drugs, which are considered unclean and are forbidden by Islam. In Kabul, where the medical services are primitive, massively overstretched and entirely unprepared for dealing with addicts, the Nejat centre offers a unique, residential treatment programme. Despite being funded by various international donors, the centre told IRIN it has only 10 beds for residential addicts on its rehabilitation programmes. The provision for rehabilitation of opium addicts is almost negligible in Kabul as well as in other cities. In Herat city, a local drug-related prison houses those addicted and convicted of trafficking crimes as well as addicts seeking assistance. Conditions are austere and there is no separation between those who voluntarily seek help and those serving part of their drug-related prison sentence in detoxification.

Two addicts 'chasing the dragon' in Kabul Credit: IRIN/Chris Horwood

The problem of addiction exists in all layers of society. Both men and women are affected. Local residents and returning refugees from Iran and Pakistan use opium mainly to alleviate medical conditions such as tuberculosis, colds and asthma. It is also reported that young children receive opium as a painkiller. Some addicts recognise they are addicted and seek assistance; many others are thrown out by their families or communities, who regard drug addicts as morally degenerate. A range of patterns of opium use is discussed in the UNODC survey. It says users often carry on using opium because they have developed an addiction, and the withdrawal pains are too challenging to endure. These withdrawal pains include insomnia, tuberculosis and heavy coughs. The opium user is often forced to bring an end to its use when resources are not enough to cover an addiction. With opium being more expensive in comparison to hashish and pharmaceutical drugs, it is not uncommon for the opium user to replace opium with more available and less expensive alternatives. There are various ways to consume opium. In Kabul, the most common technique is to smoke it though a cigarette, a water pipe, or though a 'shekhi shang'. The latter method involves using a heated metal blade covered with opium. The resulting fumes are then inhaled through a tube. However, many users consume opium orally, or use it to make tea. According to the report, it is difficult to estimate the quantity of the opium intake, as the users themselves measure it in terms of beans and peas. With a predicted average of two to three doses per day, at a cost of between Afg 20-50 (US $0.40-$0.60), opium users regularly have financial difficulties. Many resort to stealing and begging from family members and at bazaars. Withdrawal pains often prevent addicts from working, and thus unable to earn money. Often, drug addicts cause tensions, disagreements and fights within their family and the community they live in. In the family, a subject of crucial concern is often the household economy - money spent on drugs can drain already small purses. One addict recounts in the report: "I spend my son's salary on opium so it affects our economy, and always my daughter-in-law fights with my son because of my opium use". Shunned by their neighborhoods, the opium users sense they are unwanted and have low levels of confidence. As the use of intoxicants is forbidden ('haram') under statutory law, there is a risk of arrest and conviction. "Sufficient treatment and rehabilitation instead of custody is necessary in order to find a way out of the cruel cycle of drug addiction," advises the UNODC study. With rising production, trafficking and spillovers into local markets, neighbouring countries to Afghanistan are exposed to the spread of drug abuse. Iran is the country most at risk, with between 800,000 - 1.2 million abusers, followed by Pakistan with at least 700,000 addicts and Central Asian countries with more than 300,000 opium users. Central Asia now stands out as the region with the highest global rise in opiate use in recent years. Large harvests of poppy in Afghanistan, which are expected in 2004, are most likely to lead to a drop in opium prices and an increase in opium abuse in these countries. Hand in hand with the proliferation of the use of opiates goes the threat of HIV/AIDS. The rapid rise of HIV/AIDS cases has been accelerated by the tendency of the users to inject their drug via shared needles. Forty of every 100,000 inhabitants in countries neighbouring Afghanistan have HIV/AIDS, with Iran and Pakistan the most affected. The recent explosion of cases in Central Asian countries has been reported by the UNODC to be in direct proportion to the rise in opiates taken through intravenous methods. According to one UNODC report: "The drug-related problems experienced by many drug users are compounded by the general lack of accurate, practical and realistic information about drugs". The lack of awareness, openness and information concerning drugs in Afghanistan add to the severe predicament of drug users, as they often underestimate the character and the consequences of the drugs they use. With opium production rising, and without the restrictions implemented by the Taliban on individual use, the number of addicts in Afghanistan is bound to rise. In neighbouring countries through which opium travels en route to world markets, the rise in addiction, with the accompanying rise in cases of HIV/AIDS, is reaching alarming levels. While donors and government departments wrestle with the issues of eradicating the opium economy, people working with addicts hope that provision for those affected is not overlooked and can be significantly increased.