The deteriorating state of rehabilitation centres and Pakistan's reluctance to own the drug problem

Fourteen-year-old, Obaid Rehmat* is currently undergoing rehabilitation for drug addiction at a private clinic in Islamabad. In addition to hashish, the teenager was addicted to hard drugs such as heroin and crystal meth.

Obaid started using drugs when he was in the sixth grade. Drug abuse is common where he lives, in Khyber District in the Peshawar division. “There is no taboo against using hashish in our area, particularly on happy occasions such as weddings,” the teenager tells Eos. His first exposure to hashish was at his elder sister’s wedding.

“I was living a normal life until I started using hashish and then I also got on heroin. But since I started using meth, my life turned into hell,” says Obaid, now in the ninth grade. His father, Rehmat Khan*, says bringing his son to Islamabad for treatment was hardly affordable, but there was no other option if he were to save his son’s life.

Rehmat Khan was concerned about Obaid’s failing health and his waning interest in studies amidst other activities. The day he came to know about Obaid’s meth addiction was nothing less than a nightmare.

The shortcomings of treatment facilities

Khan made efforts to admit his child for treatment to the Anti Narcotics Force (ANF)-run Model Addiction Treatment & Rehabilitation Centre (MATRC) located in Islamabad, under the Tribal Areas quota, but could not get space for him there.

“There are some private clinics providing treatment in Peshawar, but their treatment charges are very high and a poor man, like me, cannot afford them,” he says. Some private centres in Islamabad are more affordable than those in Khyber Pakhtunkhwa. Here he found a suitable one for Obaid.

The UN Office of Drugs and Crime (UNODC) in its Technical Summary Report on Drug Use in Pakistan 2013 revealed that addiction to hard drugs is on the rise among Pakistanis, with 6.7 million past-year users, including 4.25 million thought to be “drug dependent”. Yet, “treatment and specialist interventions are in short supply, available to less than 30,000 drug users a year. Moreover, not all structured treatment is free of charge,” the reports highlights.

A staggering 99.7 percent of those who seek treatment for drug addiction in Pakistan simply cannot afford it, the survey further reveals.

Khyber Pakhtunkhwa (KP) and Balochistan are the most affected provinces in terms of opiate users, with tens of thousands of drug users, especially the youth. KP had the highest prevalence overall of any form of drug use — 10.9 percent of the population had used an illicit substance in the past year. Meanwhile, Balochistan had the highest prevalence of opiate users — 1.6 percent of its population uses either heroin, opium or both.

A senior officer at the ANF headquarters in Rawalpindi, requesting not to be named, tells Eos that although limited-capacity treatment centres are operational in different parts of the country, they are not adequate to accommodate the large numbers of patients.

The ANF official discloses that a 45-bed MATRC, working on self-help basis, was established in Quetta, but has remained closed since January 2016 due to the non-availability of staff. There is no treatment facility operational under the ANF in Peshawar, Azad Jammu and Kashmir (AJK), Gilgit-Baltistan (GB) and the erstwhile Federally Administered Tribal Areas (Fata), adds the ANF official.

The MATRC Islamabad is a 36-bed facility with approximately 2,650 patients on its waiting list, according to ANF documents. “Besides Islamabad and Rawalpindi, the centre has to accommodate patients from Gilgit-Baltistan, AJK and the Tribal Areas,” says the MATRC project director Jibran Yousafzai.

The centre tries to accommodate the maximum number of patients, but people doubt their credibility when they are turned away, he says. And a significant number of people approach the centre, like Rehmat Khan and Obaid. “MATRC has the capacity to treat around 400 patients annually. It provided treatment to 5,747 drug patients from 2005 to 2019,” says Yousafzai.

What are the authorities doing to help?

The KP provincial government, in coordination with the ANF, had constructed a 100-bed facility in Peshawar but, upon its completion, the government handed it over to the social welfare department of KP, because the department needed a building for Prime Minister Imran Khan’s inauguration of a shelter home last year, according to an ANF officer in Peshawar.

The KP Social Welfare Department Secretary Idrees Khan claims that the building location was not suitable for drug patients, and the department will soon establish a facility in a rented building in Peshawar.

Talking to Eos, Idrees Khan says the government has planned to establish rehabilitation facilities in every district of KP and, in this regard, they are planning to coordinate with the health department. However, according to the ANF Peshawar officer, a proposal to start another joint venture for a hospital with the provincial government was denied by the secretary.

Meanwhile, Dr Said Ramzan, a Quetta-based philanthropist, holds the Balochistan government responsible for the lack of rehabilitation facilities in the province.

He, along with a few other philanthropists, had established a state-of-the-art rehab centre in Quetta, but the centre had to discontinue its services after two years. Many factors were at play that forced its closure. Ramzan and his team were not only threatened by the drug mafia but the province’s Social Welfare Department prosecuted a case against them over occupation of the building.

A minister or two had visited the centre while it was operational and had also pledged support, but they never returned to uphold their promises, says Ramzan.

“No one is ready to take responsibility,” says Javed Baloch, director of the Detoxification and Rehabilitation Complex (DRC) Quetta. According to him, from 2008 to 2019, the complex received only one million rupees for the purchase of medicines and a mere three million rupees for the diet of patients.

As far as facilities are concerned, it has a similar problem as the MATRC. “We have a 250-bedded complex,” says Baloch, “but it is not enough to accommodate all drug patients, as the number is much higher than the available space. We have to put them on the waiting list.”

Baloch warns that the drug abuse problem may get out of control if state institutions do not take the issue seriously.

He draws attention to the alarming rise of drug abuse in the areas bordering Afghanistan. According to another UNODC report, The Global Afghan Opium Trade 2011, of the estimated 350 to 400 tonnes of opium trafficked through Pakistan in 2009, an estimated 132 tons were consumed in Pakistan. Also in 2009, of the approximately 160 tonnes of heroin trafficked from Afghanistan into Pakistan, an estimated 20 tonnes were considered to have been consumed in Pakistan.

“Easy access to drugs and a lack of treatment facilities have worsened the situation in Balochistan,” Ramzan says. Who will take responsibility?

Reluctance to own the drug problem

In 2014, the UN recommended that addiction be treated as a medical issue, and that the member countries of the United Nations address it through their healthcare systems.

The UNODC Adviser on Drug Demand Reduction in Pakistan, Dr Manzoorul Haq, says, “State institutions’ approach towards this mental health issue lacks coordination. The UN has termed drug addiction as a health risk factor which needs serious efforts at the state level. The issue should be a health subject but, in Pakistan, it is handed over to the social welfare department, which should be responsible for the rehabilitation of recovered persons to prevent relapse.”

Farman Ali Turi, director PsychAid Islamabad, points out that “If the state can declare HIV/Aids a national health risk factor, why is the state ‘reluctant’ to own the drug problem? After all, injected drugs are a leading factor of HIV/Aids.”

The federal health secretary, Allah Bakhsh, says his ministry is facilitating the provinces with treatment and rehabilitation centres under the Global Financing Facility (GFF). He adds some public sector hospitals in Islamabad and the rest of Punjab have allocated separate psychiatry wards where treatment is also provided to patients with drug disorders.

Yet the attitude towards these patients is apathetic. A psychiatrist at the state-run PIMS hospital in Islamabad, requesting not to be named, says, “The hospital [PIMS] has a 20-bed psychiatry ward, but they prefer accommodating patients with other mental health issues rather than drug users.” In her view, accommodating drug users is “a waste of time and money” because “99 percent of drug patients are non-cooperative and, without patient cooperation, treatment is not possible.”

A senior bureaucrat in the Ministry of Narcotics argues that every stakeholder has developed its own mechanism of providing treatment to drug patients. The majority of such clinics do not follow international treatment standards approved by an anti-drug agency and they lack trained and skilled staff. The ministry has sent a draft bill for the establishment of a new regulatory authority but, according to the bureaucrat, Prime Minister Imran Khan passed it along to the health ministry for consent.

No development on the bill has been made so far.

DRC Quetta’s Javed Baloch insists that the way forward is to identify the responsibilities of the various stakeholders, adding that providing treatment facilities should be the health department’s prerogative while rehabilitation should be the responsibility of the social welfare department. “Well-coordinated efforts by the stakeholders can improve the situation but, under the existing circumstances, it seems impossible,” he says.

Despite drugs having harmed millions of people in the country, it seems we as a society and state are still in denial. “The undeniable drug issue is affecting our health, economic and political development directly or indirectly,” says Turi. “We don’t realise how much drug abuse has penetrated the roots of our society.”

Those struggling with drug abuse disorders, such as young Obaid, are in dire need of immediate care. They can no longer be turned away from a chance to regain their lives.

*Names have been changed to protect identities

This article was first published in Dawn, EOS, November 15th, 2020