When is a drug not a drug?

Published: April 12, 2012
The writer is a doctor based in the US and board-certified by the American Board of Addiction Medicine

The writer is a doctor based in the US and board-certified by the American Board of Addiction Medicine

Thirty years ago, the Russian invasion of Afghanistan caused not only an influx of refugees to Pakistan, but also opium as Kabul became the opium capital of the world.

Marijuana is classified as a gateway drug and the stage was well set in Pakistan. Morphine is obtained from opium and the cheaply available acetic anhydride is used to convert morphine into heroin. Almost overnight, intravenous heroin and cocaine users mushroomed all over Pakistan. The 2006 National Report on Drug Use in Pakistan estimates that there are 628,000 opiate users in Pakistan, of which 77 per cent are heroin users. According to the report, the prevalence of opiate use is 0.4 per cent in Punjab and Sindh, 0.7 per cent in Khyber-Pakhtunkhwa and 1.1 per cent in Balochistan; the higher prevalence in the last two is due to a common border with Afghanistan.

Serious health issues are common among opiate users: HIV infection, hepatitis C and tuberculosis. Most opiate users use other substances on a daily basis. As naturally derived drugs such as marijuana and opiates became entrenched in Pakistan, synthetic or designer drugs made their entrance.

Amphetamine-like substances such as ecstasy or MDMA, crystal-meth or methamphetamine and MDA are synthesised from ephedrine in meth-labs. Ecstasy and crystal-meth increase alertness, reduce fatigue, lead to feelings of increased physical and mental powers and induce euphoria. MDA is also known as the ‘love drug’ because of the feelings of intense euphoria and desire to be with others that it produces.

Besides their addictive nature, these amphetamine-like designer drugs can cause severe agitation, life-threatening increases in heart rate and blood pressure, as well as bleeding in the brain, heart attacks, tearing of the aorta, irregular heart rhythms, seizures and death.

Chronic use of ecstasy in typical recreational doses can lead to a paranoid psychosis that is clinically indistinguishable from schizophrenia. A recent important study reveals that MDMA use (possibly in conjunction with marijuana) can lead to cognitive decline in otherwise healthy young people.

According to the 2006 National Report on Drug Use in Pakistan, amphetamine-like synthetic drug use was low; ecstasy was most common and it was imported into Pakistan from various countries.

The Anti-Narcotics Force (ANF) seized 13 tablets of ecstasy in 2005 and, get this, 8,326 tablets in 2006! It’s difficult to wrap one’s mind around these statistics; was it truly a dramatic increase in the abuse of ecstasy or did the ANF get a shot in the arm or both?

Ecstasy is more expensive than other drugs of abuse in Pakistan and is used largely in parties by young people, aged 16 to 25 belonging to upper-class families. These young people, high on ecstasy, also indulge in risk-taking behaviour such as car and motor-bike racing, among a host of other activities.

Drug addiction knows no boundaries of class, wealth, race, age, profession or education. Like the chronic relapsing disease that it is, it eats at the fiber of society at every level.

All that an addict worries about is his next fix and all means to that end seem justified –– be it cheating, lying, robbery, prostitution or murder. With widespread unemployment and economic decline, the last thing that Pakistan could have afforded was its large addicted population. That the powerful and privileged of Pakistan would become wealthy through such actions is bad enough; to think that those billions have the stench of deaths and destruction is a travesty.

Published in The Express Tribune, April 13th, 2012.

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Reader Comments (15)

  • faraz
    Apr 12, 2012 - 11:45PM

    Zia and mullahs banned alcohol and introduced heroine; interestingly, you won’t see any mullah issuing fatwas against heroin and its evils


  • Euler_89
    Apr 12, 2012 - 11:48PM

    I don’t know why marijuana is so reviled by people. There is little or no evidence about marijuana being a gateway drug according to Noam Chomsky (actually tobacco is more closely linked with hard drug usage). It has absolutely no harmful medical effects and it’s recreational use has been advocated by people like Dr. Carl Sagan (as Mr X). Legalizing marijuana might actually reduce the number of young people moving towards hard drugs like heroin, cocaine and methamphetamine.


  • alicia
    Apr 12, 2012 - 11:53PM

    “The 2006 National Report on Drug Use in Pakistan estimates that there are 628,000 opiate users in Pakistan, of which 77 per cent are heroin users.”
    I don’t know if I agree with this report only 600,000 drug users from a population of 180 million people?


  • Max
    Apr 12, 2012 - 11:56PM

    Dr. Sahiba,
    Glad that you are back after a leave from journalism. The topic that you touched is very important, and is also your specialty. You not only know the chemistry of these drugs but see the life cycle of edicts (your patients) every day. Given the way the drug culture has penetrated the Pakistani society, I would like to see more articles from you on this topic.
    Thanks again.


  • Ali Tanoli
    Apr 12, 2012 - 11:58PM

    The percrentage is not too much compare to pakistan population Doc.


  • omar
    Apr 12, 2012 - 11:59PM

    thank you for writing this article Dr. My cousin recently managed to get off of a heroin addiction and it was a very difficult time for him and all of us. Do you have any advice for how pakistan can deal with heavy drug use for the future? Also what is your opinion on cannabinoids like marijuana? Recently portugal decriminalized all drugs in their country and have increased governement subsidies on drug rehabiliation and medical care. as a result they saw a marked decrease in drug use there. do you feel a similar policy could work here?


  • Ata
    Apr 13, 2012 - 12:42AM

    Is it just me or the whole article sounds way too dramatic? Chemicals – I understand – have a tendency to screw things up. But herbs? Has anybody around here read the literature available on marijuana?


  • Ata
    Apr 13, 2012 - 12:43AM

    Not advocating the use marijuana btw. It’s just that it hasn’t really killed anybody so far then why put it in the same category as MDMA, Ecstasy and what not.


  • sidjeen
    Apr 13, 2012 - 10:39AM


    Ecstasy and crystal-meth increase alertness, reduce fatigue, lead to feelings of increased physical and mental powers and induce euphoria

    i already want to use these drugs and i have never even smoked a cigarrete in my life. lol.


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    Apr 13, 2012 - 11:49AM

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  • Ali
    Apr 13, 2012 - 12:36PM

    For God’s sake lift the alcohol ban! Ban on Liquor created more problems instead of providing the solution, before this ban the cases of Drug Addiction were almost negligible whereas after the ban Pakistan faced worst Drug addiction statistics mainly during General Zia’s Period (1977 – 1988), and if that wasn’t enough the drug related income found its way in national politics.


  • MarkH
    Apr 13, 2012 - 2:57PM

    All drugs are always a drug. If it is used to have an unnatural effect on the human body to manipulate its chemistry, it’s a drug. Addictive or not, helpful or not, noticeable or not, safe or not.
    The appropriate question is “When does the existence of a drug’s bad traits outweigh the positive ones and who should be the one to decide it?”


  • Mustafa Moiz
    Apr 13, 2012 - 9:05PM

    When did Zia introduce heroin?


  • Mustafa Moiz
    Apr 13, 2012 - 9:18PM

    The ban on alcohol isn’t what caused a rise in drug addiction in Pakistan, it was the Afghan war. As Afghan refugees flooded our country, they brought with them heroin. It is logical that the number of drug addicts in Pakistan rose because of this. It had nothing to do with Bhutto’s ban on liquor.


  • Sam
    Apr 16, 2012 - 6:01AM

    Very pertinent. There have to be more than 600,00 addicts in Pakistan. Can there be a significant impact on controlling this problem among the young and affluent Pakistanis if their parents’ generation have confused values? Just a hypothetical question. Materialism and lack of ethics combined with a soft approach on inebriants may not have the makings of a suitable environment for reform.


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