he use of a drug or medicine beyond the recommended safe limit, whether accidental or purposeful, constitutes a drug overdose. In Pakistan, an estimated seven million people take drugs regularly. Over half of the estimated users are addicted to cannabis. The rest use opiates. Opioid and recreational drug overdose is a growing concern in the country, with nearly 700 drug use and overdose-related deaths reported every day in the last decade.

Drugs are chemicals that can affect both the brain and the body. It is important to note that some drugs can have different effects on different people. Drug abuse and addiction have a devastating impact on the behaviour and mind of a person. They can also permanently affect the body, destroying vital organs and causing systemic changes.

The physiological impact of drugs varies depending on the quantity, frequency, purity and method of use, i.e., whether these are ingested, injected or inhaled. At the same time, the mental impact (including but not limited to psychological effect) depends on whether the drug in question is a stimulant, depressant or hallucinogen.

Dr Tariq Aziz, a psychiatrist with over 25 years of experience, says that many people begin taking drugs for recreational reasons or to deal with stress, anxiety, trauma and depression but end up developing addictions that can have life-long impacts.

“For some, prescription opioids can become a way to achieve a sense of euphoria. To feel that pleasurable sensation caused by the release of endorphins, users may start abusing prescription drugs,” adds Shawaiz Faiz, a pharmacist.

“Cannabinoids (cannabis, marijuana) are responsible for psycho-active effects on the body. These drugs can have hallucinogenic properties, impacting a person’s understanding of self and their surroundings,” says Dr Aziz.

“Many drug users, particularly those injecting intravenously, are at great risk for catching hepatitis and HIV,” says Dr Israr-ul Haque Toor, professor of medicine and gastroenterology at the King Edward Medical University, Lahore. Needle sharing is common amongst drug users, making them vulnerable to viral diseases and STDs.

The added burden of hepatitis and HIV/ AIDS amongst drug addicts is a leading cause of alarm for Pakistan’s overburdened healthcare system. The HIV epidemic has become well-established among intervenous drug users in the country. According to a WHO study conducted in the mid-2000s, around 95 per cent of IUDs are sexually active and likely to transmit the HIV infection to their spouses and regular sex partners.

Partner-to-partner transmission of life-threatening drug-use-related infections is not the only cause for alarm in Pakistan. One oft-ignored transmission route for HIV and prescription drug abuse is unregulated medical practices set up by unqualified people in low-income areas. Infection transmission can be mitigated by using auto-destructive sterile syringes.

However, not all syringes have single-use variants available in the market. Hence injections remain a source of disease transmission if shared by drug users or for multiple patients in unlicensed medical practitioners’ offices.

According to some reports, 70,000-80,000 unlicensed quacks are in practice in the Punjab alone. They often prescribe medicines in substandard doses, resulting in adverse drug reactions and overdoses. The public healthcare system remains inaccessible for millions of Pakistanis, who frequently become victims of unqualified practitioners.

Clinicians have observed that social determinants of health can tip the scales against people in their quest to recover from an addiction. A 2019 study conducted in the US found that “opioid overdoses were concentrated in more economically disadvantaged zip codes, indicated by higher rates of poverty and unemployment as well as lower education and median household income.”

There is a research lag in Pakistan, but it can be deduced from the easy availability of opioids in the country that the fate of users is determined by similar factors here, too.

Some of the most commonly abused medicines are painkillers, specifically opioids. These drugs dull pain and, in large quantities, can cause a euphoric high. Their availability makes them easy to abuse and overuse, especially by individuals engaged in highly demanding physical labour or patients dealing with post-surgery or other injury-related pain.

It’s not just prescription drugs that are a problem. Dextromethorphan (DXM) is a common ingredient in over-the-counter cold and cough medicines. If taken in large doses, the substance can cause hallucinations. Since cough syrups are easy to purchase and often less costly than other drugs, they are commonly misused to achieve a high or induce drowsiness, as some contain antihistamines.

It is important to understand that addiction is, in part, a brain disease. It is not necessarily a moral failing on the part of the individual. There are social and economic determinants of drug abuse. However, the stigma associated with it is an extra barrier to people asking for the help they need. Many healthcare providers and even family members are reluctant to help people struggling with addiction due to stigma.

The economic and social consequences of drug abuse are far-reaching. A person’s health is greatly affected by drug abuse. Economically, this manifests itself in prevention and treatment costs, healthcare and hospital costs and increased morbidity and mortality.

Beyond health costs, people under the influence of drugs pose major safety risks and costs to people around them and the environment. For example, drug-affected driving accidents have emerged as a major global threat in recent years, according to the International Narcotics Control Board UK Report 2013.

Another cost of drug abuse is the loss of productivity in individual users. This cost, often borne by employers, can run into millions.

Since drug abuse places such a costly burden upon society, it is imperative that the issue’s severity is not dismissed.

Rehabilitation of drug addicts requires effort and consistency depending on the damage caused by addiction to prescription or illegal/ recreational and severe dependency-inducing drugs. Interventions depend on the condition of individual patients. In case of bodily injuries such as liver, brain or cardiovascular damage, a person may require hospital admission and medical care. In other cases, a psychiatric intervention might be needed.

Drug addiction is treatable and preventable. The long-term impacts of drug abuse can be mitigated by timely intervention and proper psycho-physiological support by trained medical professionals. If not treated, drug addiction can be fatal.

The writer is a staff member