Pakistan’s opioid crisis

Opioid addiction is an emerging crisis in Pakistan that is rarely, if ever, discussed. The country finds its place in the list of top 10 countries with the highest rate of opioid addiction.

Psychiatric facilities in urban settings across Pakistan are reportedly flooding with cases of opioid misuse. It is estimated that one in every 20 people between the ages of 15 and 64 is dependent on these lethal drugs; heroin being the most popular opioid in use. The issue has already been recognised in the first world as a health hazard which demands immediate attention and a course of action. In fact, the problem is considered as one of America’s deadliest epidemic.

For the uninitiated, opioids are drugs such as morphine which are primarily used to relieve pain. A number of morphine derivatives are available in the market to aid doctors in treating acute and chronic pain.

I remember receiving a phone call of an acquaintance around midnight one day. He insisted that I inject him with nalbuphine, sold under the trade name nalbin. It is an opioid pain reliever related to the likes of heroin and morphine. The pretext he gave was that of severe pain. It was later when I observed his arms that reality hit me. The bruises and obscured veins indicated previous attempts of self-injection. It was then that I realised that he was a potential case of opioid addiction.

Multiple factors have led to a rise in opioid addiction. In the late 1990s and early 2000s, the conventional but mistaken wisdom amongst healthcare providers in the US was that opioids are free of addictive properties. This, along with the heightened expectation of a physician’s ability to alleviate a patient’s pain at any cost and poor appreciation of risks associated with opioid medications, led many doctors to regularly include these drugs in their prescription notes, even when they were actually not necessary.

The euphoric effect of opioids, seeking refuge from life’s stresses, lack of knowledge about these drugs and influence of peers are among the causes of the opioid crisis in our country. Students in medical schools have easy access to these drugs from their respective hospitals, and they are often the ones maintaining the supply chain. Physical and emotional trauma endured in a battlefield can also lead to addiction as injured soldiers when treated with potent opioids experience the drugs’ euphoric effects.

Frequent usage of these drugs leads to the body developing tolerance and giving a diminished response to them when administered. The user then has to increase the dosage to achieve the desired satisfaction. Over time, the body becomes resistant to the drug and traps the individual in an unforgiving whirlpool of addiction to experience a state of high.

Most opioid addicts end up dying as the overdose impacts the part of the brain that controls breathing by suppressing it. This could lead to choking as the body’s vital organs stop receiving the required amount of oxygen. On an average, 115 Americans reportedly die every day due to opioid overdose.

Drug addiction is, by no means, about lacking willpower or morals. It is, in fact, a brain disease that merits treatment as it forces the victim to take the drug despite knowing its adverse outcome. The social stigma, prevalent particularly in our rural sector, haunts an abuser’s path from home to the hospital. The addicts who manage to reach rehabilitation centres then suffer at the hands of substandard facilities.

This is why the success rate of opioid management in our part of the world is incredibly low. Where other options like drug control, provision of optimal rehab facilities and research investments fail, the only solution left for us is in emphasising on prevention by clearly advertising the dangers of opioid abuse through public health campaigns.

With an increase in the variety of drugs, the challenge for regulatory authorities is to keep pace with the potential misuse of these drugs. Sadly, the issue has not been met with the right conviction. We need a comprehensive policy to not only manage the supply but also rein in the demand for these drugs in our country.

The writer is a doctor based in Islamabad.

Twitter: @rajakhalidshab