Legal drugs help heroin hobos feed the habit

By Nick Jackson

LAHORE: The door to the shack in Shahi Mohalla Park is boarded up. A window with a rug hung across it provides the only entrance; two beds, the only furniture. This is Kismat Ullah’s home.

Mr Ullah, 44, has been a heroin addict for 25 years but now mostly injects the drug diazepam. He comes from a village near Dera Ismail Khan but made the move to Lahore after being thrown out by his father.

When asked if he is concerned about the potential health risks involved in sharing needles, Mr Ullah simply replies that Allah will protect him. “Blood is natural, like water, it comes from the earth. I do not like sharing needles, but I am not careful about it.”

He works as a pickpocket in order to finance his Rs 75 a day habit and is eager to demonstrate his expertise. He hams up his performance by over-dramatically checking for police over my shoulder. Yet when he goes to take a watch from my inside jacket pocket, I do not feel it, and in any other circumstances would probably not have noticed.

Since 1997, according to a spokesman for the Nai Zindagi Clinic, opposite the park, addicts who previously smoked heroin from cooking foil have now moved on to inject it and a variety of over-the-counter drugs, all readily available from pharmacies. In Lahore, 65 percent of street drug users now inject; 64 percent share needles and 73 percent share syringes. The clinic offers addicts clean needles in exchange for their dirty ones, and introduces them to detoxification and rehabilitation programmes. However, it has limited funds at its disposal and relies heavily on European investment.

Diazepam is the most popular of these legal drugs and sells for Rs 10 a hit, making it at least a quarter of the price of heroin. The clinic’s spokesman, Ahmad Bakhsh, says most of those injecting are taking legal pharmaceuticals. “They’re legal, they’re a quicker kick, and they’re cheaper. They’ve become standardised in our culture,” said Mr Bakhsh. “And the pharmacies, not criminals, are pushing these drugs.”

Due to increased injection, 89 percent of Lahore addicts have contracted Hepatitis C. And although the impact of HIV remains low, drug workers’ experience across Asia suggests that it is only a matter of time before this too spreads through the addict community. Moreover, since a significant number of addicts are also sex workers, the potential for the epidemic to spread to the general population cannot be underestimated.

In Lahore, life in the Shahi Mohalla Park bears tragic testimony to the miserable reality of drug injection and addiction. Clusters of addicts crowd the park injecting themselves or others, often in full view of the police and passers-by. Many inject into their groin. The vein there lies between a nerve, that if severed by a needle could cause paralysis, and an artery, that if punctured could cause massive blood loss and possible fatality, say doctors. Yet it is the only option for long-term addicts whose veins have become withered due to repeated injection.

Apart from offering syringe exchanges, Nai Zindagi, which also has centres in Rawalpindi and Quetta, offers basic hygiene and healthcare facilities, such as antiseptic swabs to clean abscesses brought on by drug injection. Its rehabilitation programmes provide addicts the opportunity to learn new skills or brush up on existing ones, so that they can eventually find gainful employment.

But there are limits to what an NGO in Pakistan can do. In many other countries, such as Britain and India, substitute drugs like methadone can be prescribed to wean the addict off heroin and diazepam. But in Pakistan such substitutes remain illegal, even though many of the drugs used by addicts, such as diazepam and pheniramine, are not.

Controlling addiction has been left in the hands of NGOs, while many of the drugs causing misery and disease continue to be sanctioned by the Pakistani government. Thus, addiction in Lahore will keep spreading, and with it diseases like HIV.

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