Drug abuse in Afghanistan

Sections

Introduction
Nature and size of the problem
Drugs commonly abused
Patterns of abuse
Relation to age
Relation to sex
Class distribution
Underlying causes for abuse
Production and sale
Management
Danger awaiting in the future
Some useful suggestions
Summary

Details

Author: Asad Hassan GOBAR,
Pages: 1 to 11
Creation Date: 1976/01/01

Drug abuse in Afghanistan

M.D., D.P.M., Asad Hassan GOBAR,
Associate Professor of Neuropsychiatry Dept., University of Kabul, Afghanistan

Introduction

The aim of this communication is to present a short review of the status of drug abuse in Afghanistan. Drug abuse is not a new feature of Afghan behaviour. The history of hashish as well as that of opium use goes back many centuries. Yet for certain reasons the consequences are not so badly felt as is the case in western societies.

Before considering the size of the problem, it should be remembered that in Afghanistan the cultivation of drug-producing plants as well as the sale and merchandise of any type of mind-altering substance is prohibited by law and prosecuted by the police. Moreover, private laboratories and factories concerned with drug synthesis are practically non-existent in the country. Afghanistan is a Party to the Single Convention on Narcotic Drugs, 1961.

Nature and size of the problem

As is the case almost everywhere, precise statistical data regarding drug abuse in Afghanistan are not available. However, recent observations of some areas and a review of hospital records during the last decade supply us with basic information about the incidence and types of drug abuse in the country. Much information has also been obtained from the addicts, their relatives and friends, farmers, private drug dealers and the local authorities.

Sanayee Hospital of Kabul University has so far been the only hospital in the country dealing with neuropsychiatric disorders. All mental patients including drug addicts are either referred to the hospital's outpatient department or taken directly into the hospital.

The hospital's records show an admission of 5 779 cases during the years 1960 to 1969. Excluding readmissions as well as patients who were basically schizophrenics or maniacs there remain seven hundred and fifty one cases of pure hashish intoxication which constitute thirteen per cent of all psychiatric patients admitted during the ten-year period (see table, page 4). On the other hand, the number of opium addicts and alcoholics referred for treatment was considerably smaller. For example, during the ten-year period 1965 to 1974 only twenty-four opium addicts were admitted into this hospital for treatment.

The number of alcoholics was even smaller. Apparently most cases of acute alcoholic intoxication are referred to the emergency services and treated by interns like other cases of poisoning.

Full size image: 44 kB

During the above-mentioned period, the author has visited only seven cases, including one lady, who abused a combination of narcotics and alcohol. Of these only five accepted admission to hospital, to undergo a short course of treatment.

The author's first impression about opium was that it had a very limited number of abusers who became involved through self-medication. Further enquiry from drug addicts and their associates, particularly information based on studies in drug-producing areas, showed that the small number of patients who came to hospital for treatment was a false indication and greatly under-estimated the incidence of opium abuse in the country. It has been roughly estimated that there are approximately 100,000 opium addicts in the Badakhshan province alone. This constitutes approximately 80 per cent of the whole opiate-dependent population throughout the country.

The province of Badakhshan with a population of 354,600, occupying an area of 42,600 km 2, lies in the north-eastern corner of Afghanistan bordering on China, Iran, Pakistan and the Soviet Union. Faizabad with a population of 64,700 is the capital of the province. It is 588 km from Kabul.

However, the incidence of opium abuse is not the same in all parts of the province: while it is rather high in Sheghnan, Zebak, Darwaz, Wakhan and Ishkashem, it is much lower in areas like Barak or Jurm.

The population of hashish abusers cannot be estimated as they are scattered diffusely throughout the country.

Alcohol abuse is presently limited to members of the upper middle class who reside mostly in Kabul and big cities like Herat or Kandahar. Lack of resources, high price and above all religious inhibition are factors which have so far prevented its spread in rural communities and among the population at large.

Drugs commonly abused

There are two main drugs which are commonly abused in Afghanistan. They are:

Hashish, which is known locally as "charas";

Opium, known as " taryak" or " kaif".

Both are produced within the country in large amounts. Of course, cultivation and sale are secret as it is otherwise illegal and punishable by law.

A third new drug recently becoming popular among the upper and middle classes is alcohol which is an influence on other cultures. Presently the use of alcohol is very limited and there are only a small number of alcoholics in the whole country.

Pills and injections, even if available, are respected enough not to be abused.

Patterns of abuse

Hashish ( charas) is usually smoked either through a water pipe (chillum), normally used for tobacco smoking, or is put inside a cigarette which is then called a " cigarette". Very exceptionally some may try bhang, or alternatively a sweet mixture called " mofarrah" erroneously reputed to cause uncontrollable laughter.

Classification of mental diseases based on annual admission to Sanayee Hospital during ten years (1960-69)

Diagnosis

1960

1961

1962

1963

1964

1965

1966

1967

1968

1969

Total

Per cent

Acute organic brain damage
42 56 46 41 111 100 57 97 89 72 711 12.4
Schizophrenia
80 67 78 57 79 104 109 103 219 198 1094 19.3
Manic-depressive psychosis
93 87 82 86 118 173 220 149 172 97 1277 22.0
Reactive depression
12 23 18 16 28 31 20 35 44 49 276 4.5
Hysteria
24 36 25 30 15 35 90 32 40 71 398 7.0
Mental retardation
3 11 9 15 20 9 73 30 36 18 224 3.8
Drug abuse (hashish)
39 25 67 105 130 69 126 120 46 751 13.0  
Psychopathy
25 32 41 38 47 24 52 49 28 40 376 6.5
Dementia and chronic brain syndrome
6 14 9 11 4 17 10 7 19 15 112 1.8
Hypochondria
7 11 8 13 10 16 12 15 11 120 2.1  
Obsessive compulsive neurosis
-
2 5 3 6 8 4 7 11 9 55 0.9
Phobic neurosis
1 3
-
4 2
-
3 2 4 4 23 0.4
Psychosomatic disorder
20 29 22 45 38 47 44 27 40 38 350 6.1
Psychomotor epilepsy
1
-
-
3 2 2 1
-
2 1 12 0.2
Total number
338 410 368 433 588 690 768 676 839 669 5779  

Reprinted from GOBAR, A. H., International Mental Health Research Newsletter, Vol. XVI, No. 4, Winter 1974.

Afghan hashish is probably six to eight times stronger than marijuana due to its higher THC content. Opium on the other hand is either ingested as food or smoked in special pipes. This kind of smoking opium is called " ghamza". A ghamza session is primarily expected to be a pleasure-seeking occasion. Some addicts may use both techniques alternately. Hashish is usually smoked in a group or in association with a friend. Opium is more often used solitarily although in some localities group abuse can also be found. Groups usually prefer to perform their ghamza sessions in some hidden location called " takau". This can be their ghamza sessions in some hidden location called " takau". This can be considered as a safeguard against discovery. In certain parts of the province of Badakhshan abuse is often found to be shared by the entire family.

Opiate addicts usually avoid eating as their appetite is decreased. The hashish smoker on the contrary experiences hunger and an appetite for a big fatty meal.

The hashish users believe that smoking without the ingestion of lipids is harmful as only fat can absorb the drug's toxins and prevent mental and physical complications.

Relation to age

Both cannabis and opium are usually abused by the adult population as is the case with alcohol in other societies although the motives are quite different. Use among teenagers is rare. Only in the case of opium, as previously mentioned, parents blow smoke into the nostrils of their infants or feed some small quantities to their children to calm them down or to induce a good night's sleep. Just as with adults when these children suffer from diarrhoea, indigestion or a cough due to some pulmonary infection, opium is offered as treatment. In some such families a new-born child may show an abstinence syndrome. Also the dependent mother has much difficulty in weaning her children off the habit acquired through drinking her milk.

Relation to sex

So far as hashish is concerned, almost 99.9 per cent are male abusers. It would be a rare case or occasion to find a woman smoker. During twenty years of medical practice, the author has come across only one case of female hashish abuse.

On the other hand, women comprise about ten per cent of opiate addicts, and in some limited regions where family practice is prevalent, the relationship is one to one.

Class distribution

HASHISH

Cannabis is most prevalent among people of a low socio-economic standard. For example, most cases have been noted among hermits, taxi-drivers, truck drivers, tea-house dwellers, prisoners and in cheap restaurants. The hermits and less orthodox clergymen use hashish to reach a state of mind most suitable for metaphysical experiences. Hashish is both very inexpensive and easy to obtain. However, most people avoid it as they believe it to be the cause of insanity.

OPIUM

Major distribution of opium addiction is found among the northern provinces of Afghanistan, mainly Badakhshan, the most remote area in the north-east part of the country. People are very poor and live under rather primitive conditions. Here numerous families dependent on opium can be found, while only sporadic cases of opium addiction are encountered in a good number of other provinces of the country, particularly in Herat, Farah and Nimruz (Chakhansoor). The majority of these addicts belong to the lower socio-economic classes as is the case with cannabis abuse.

ALCOHOL

The use of this drug is actually limited to members of the higher and middle income groups and the western educated class. The addicts encountered usually show neurotic or sociopathic tendencies.

Underlying causes for abuse

MEDICAL PURPOSE

Use of drugs, particularly opium, for the treatment of various aliments, is quite common especially in the remote parts and districts where modern medical facilities are non-existent. Opium is prescribed by local "hakeems" for all kinds of painful conditions as well as for pulmonary disease, dysentery, malaria, insomnia, colds and other minor complaints. Even cannabis is prescribed by some to heal indigestion and gastric discomfort. Most drug abusers are either ignorant of drug toxicity or live where no medical facilities are available.

Physical dependence is a natural consequence of repeated administration of opium and the subject may then continue the abuse simply to ward off the abstinence syndrome.

Stress and psychodynamic factors: frustration, illness, lack of occupation, boredom and poverty are the state of life of most of the thinly populated valleys in the opium-abusing areas. For these people opium serves a triple function:

  1. It calms pain;

  2. It reduces motivation to satisfy primary needs including food and sex;

  3. It makes them indifferent and passive towards an aimless and non-productive life.

These people have very few resources to live on, and they spend most of their time with practically nothing to do. A person who possesses a few cattle or an orchard of fruit trees is considered a wealthy man. In such circumstances opium, which is available as a local product, is a nice comforter, soothes idleness and regression and produces a state of passive dependence.

RELIGIOUS PREOCCUPATION

Cannabis sativa is mostly called " bothae faquir", i.e. the "hermits' plant". The reason for this is that cannabis has often been used by hermits and faquirs (who are mostly illiterate and ignore formal religious teachings) with the intention of obtaining religious insight, contact with eternity. They even consider the plant as a gift from heaven. The abuser, either alone or, more often, within a group in a so-called religious session, tends to alienate himself from the material world in order to reach the sacred world beyond and to discover metaphysical truth. The smoker tries to fit his religious or other phantasies to the dreamy state created by hashish.

AVAILABILITY AND PRICE

Being products of the country itself, both cannabis and opium used to be easily available and inexpensive. For example one "tola" (approx. 9 g) of opium used to cost about 20 afghanis which is one or two days' requirement for most addicts. Thus the average expenses per abuser were around $ 6-12 per month. However, the government ban has during the past two years been effective in reducing the opium gum production in Badakhshan. Growing probably continues in some dry areas in the mountains which are away from the main roads and is therefore not likely to be observed, but the ban and the establishment of a narcotic section of the Criminal Investigation Division of the Afghan police have been effective in curtailing traffic in opium throughout the country. These two factors have lead to a rather significant reduction of supply and a subsequent increase in the price of opium. Thus the retail price for a tola has since risen to Af 150 which brings the monthly expense for the average abuser now up to $ 45 to $ 90.

Cannabis is far cheaper than opium. One can buy a double smoking dose called a " paltha" for up to ten afghanis (20 cents). While in the United States one marihuana cigarette costs $ 5 the dose is five to ten times weaker than what can be obtained in Afghanistan for 20 cents. Exceptionally a heavy smoker may use up to six palthas per day. Before the ban it was far cheaper than this as one paltha of hashish in the market did not cost more than 2 afghanis (4 cents).

Production and sale

Opium was chiefly a product of the provinces of Nangrahar and Badakhshan although large quantities have also until recently been grown in Helmand and surrounding areas. Both in the provinces of Badakhshan and Nangrahar, there is some scarcity of arable land. Most people depend on small pieces of land, the majority of which lacks irrigation and lies at the foot of mountains. In such conditions timely rainfall is of crucial importance to the farmer. Considering the limitation of arable land, it is obvious that cultivating narcotic plants, particularly the poppy, used to be extremely profitable to any farmer. Ironically, in most cases all members of one whole family are dependent on what they can obtain from a dry piece of land. As a rule, one "jireeb" of land (about 2000 m 2) yields about 2 " seers" (i.e. 14 kg) of opium. Even if a farmer produced less and was able to secure only one seer (7 kg), he was quite well off. Opium produced in Badakhshan was said to be of better quality than that from Nangrahar and other areas and was sold at a higher price. However, since the Government's law enforcement programme began, one seer (7 kg) would fetch only 16,000 afghanis ($ US 3 200) from a wholesale smuggler because of the risks involved. Any smuggler retailing opium within Afghanistan would probably charge nearly double this price, that is about Af 30,000 ($ US 600) per seer.

It is worth mentioning that in Nangrahar, which is a big producer of opium, addiction and abuse are negligible. Even in Badakhshan where there are the largest number of drug addicts, people of those areas which produce the poppy are abusing it less than the neighbouring districts in which, due to lower temperature and other adverse conditions, cultivation is not really possible. This indicates that availability of drugs and their comparatively low price are not the only deciding factors for abuse and dependence.

In spite of restrictions instituted by law, it appears that most of the opium and cannabis leaks out of the country through co-operation between Afghan and foreign smugglers. It is only a part of the produce which is sold within the country where private stock-keepers take delivery and sell it to the local consumers. The smugglers although (or perhaps because) their lives and property are in serious danger often derive great profits overnight. One can estimate their profit by considering the fact that one mesqual (4.5 g) of opium which here costs twenty afghanis (40 cents) or less, is sold for not less than 200 afghanis ($ 4) in Teheran. However, due to strict control on the part of the Afghan Republic during the last two years, illegal drug traffic is hampered to a considerable degree. According to an official announcement, during the fifteen-month period from July 1973 to November 1974, the following quantities of drugs were seized from smugglers who had arranged ,for transport abroad:

Opium: 16,478 kg.

Cannabis: 3,738 kg.

Liquid hashish: 76 kg.

Similarly a smaller quantity of patent drugs (narcotics and hallucinogens) imported illegally, was seized by the police, as well as ordinary medicine not meant for abuse.

Narcotic drugs legally imported annually under licence are stocked and distributed to various hospitals and pharmacies according to a schedule and under the strict supervision of the health authorities.

Management

OPIUM ADDICTION

The results of medical treatment in cases of opiate dependence were indeed very successful in contrast to what is usually known and reported. This is equally true of both the hospitalized patients and those who for personal reasons wished to be treated privately at home.

Treatment consisted of administration of a combination of drugs at full dose at the beginning and gradual reduction after passing the critical period. Since for the majority of patients the quantity abused was about one mesqual (4.5 g) the following dosage combination was found to be very satisfactory:

Tranquillizers: chlorpromazine 50 mg b. d. by intramuscular route;

Neuroleptics: trimeprimine 50 mg b. d. by intramuscular route;

Antihistamines: promethazine 50 mg b. d. by intramuscular route;

Vitamins: pareneral application of vitamine B complex and vitamin C;

Perfusion: as necessary.

This cocktail method of treatment practised in our hospital is found to be very effective in suppressing the withdrawal syndrome and relieving patients of both psychic and physical discomfort.

Average duration of hospitalization has been two weeks, although some patients have been discharged after one week. Each patient on discharge received prescriptions to use a milder dosage of tranquillizers for another month or so. In the experience of the author none of the follow-up cases have ever returned to opium abuse. It was actually difficult to follow up each and every case after discharge as most patient lived in far-off localities and were neither motivated nor could afford to return as desired.

The follow-up cases include four subjects residing in Kabul and two cases from other provinces who kept their word to report back after a year's treatment.

However, there were five cases who were abusing a combination of drugs including opium, alcohol, hashish, barbiturates, etc. These multiple drug abusers did not respond to treatment as they were not really motivated to get rid of drugs. They all had resorted to hospital treatment either due to a financial handicap, not being able to purchase the drug, or due to physical illness associated with drug abuse.

HASHISH HABITUATION

Almost all cases brought to the hospital suffered from acute poisoning from the drug and manifested overt psychotic behaviour. Treatment consisted of the administration of major tranquillizers such as chlorpromazine alone or in combination with other phenothiazines. With the exception of those who later turned out to suffer basically from schizophrenia or some other mental disorder, almost all cases calmed down and improved in a short while.

Apparently long-term prognosis did not prove as effective for these hashish abusers as it did for the opiate addicts. Approximately 60 per cent of them had a history of readmission either once or twice. Most of them showed an underlying personality defect of one sort or another. They were often jobless or working part-time in a lowly capacity. Inadequacy, passivity, aggressivity or some other form of psychopathic behaviour were commonly observed. It must be remembered that there are a lot of chronic or part-time hashish abusers who never need any psychiatric treatment nor show any abnormal or antisocial behaviour. The author knows a number of these people who have been abusing hashish for more than ten or fifteen years with no ill effect on their jobs or social interaction. It is perhaps due to moderate use although lack of neuroticism and personality disorders appear to be more protective factors.

It should also be stressed that the Afghans generally have a negative attitude towards hashish as they consider it a probable cause of insanity. Moreover they tell by experience that "charas" makes people cowardly. These factors explain why cannabis is not as commonly abused as expected in spite of availability and low price.

Danger awaiting in the future

It is agreed that at present we do not have many problems with drugs. In Afghan society drug abuse has not been associated with criminal behaviour. Our drug abusers appear to be of a more peaceful nature and have a general public reputation for passivity or cowardice. It appears certain that there is no basic relationship between crime and drug abuse. Major criminal behaviour is apparently mostly related to the psychopathic character of the individual and his antisocial outlook. However, petty crimes such as stealing or lying can be initiated in a drug abuser who is financially handicapped or unable to compensate for his drug expenses. This may likewise be true of other societies where drugs are smuggled in, hard to get, and very expensive to buy.

There is no guarantee that in future Afghanistan will not encounter the same situation that now prevails elsewhere. The major influence of course would be a change in the attitude of the people towards drugs. This may occur gradually during transition as part of accepting foreign cultures and life-styles by the coming generations.

Future risks can be summarized as follows: l. Experimenting with more dangerous drugs not yet known or introduced into the community.

  1. Experimenting with more dangerous drugs not yet known or introduced into the community.

  2. Wider publicity for alcohol in the cities and its introduction into rural areas.

  3. Attraction of the teenage and younger generation towards drug abuse which is right now a crucial problem in Europe and America.

  4. Associated moral decline and financial distress leading to crime and legal complications.

This would then become a major problem and of course difficult to handle. Hence, preventive measures are most important and should be considered seriously if we are to protect our society from the misery of drug abuse in the future.

Some useful suggestions

  1. First of all the public should be warned against the dangers involved in self-treatment and non-medical use of any drug. This calls for an educational programme directly communicated through the masse media.

  2. Health centres should be provided and extended where they are needed most, so that there should be no necessity for self-treatment.

  3. A special medical centre should be organized in Badakhshan to treat all patient previously addicted to opium. These people have neither the knowledge that treatment is possible, nor can they afford to seek treatment on their own. The implementation of such a project of course needs firm support from the international organizations concerned.

  4. To encourage production of drugs for medical purposes and legal export obviously does not offer any comparable profit to either side. It is also impossible for the Government to buy drugs at prices comparable to those in the illicit traffic only to sell them at a fraction of the purchase price.

  5. The population in drug-abusing areas should be supplied with jobs and motivated to earn their own living and live a happy life. For the achievement of this objective, a socio-economic development project should be planned with the joint co-operation of the Afghan Government and international organizations concerned with drug abuse control.

** *

A plan of operation based on realistic aims would certainly result in reducing the illicit production of natural narcotic drugs, permit the treatment and rehabilitation of the present drug-dependent population and prevent wider abuse and its harmful consequences in the future. Presently a large number of povertyridden addicts who live mostly in the north lead a totally unproductive life. Treatment, rehabilitation and reactivation of these addicts as well as of those scattered in other parts of the country is practically possible. Considering the etiopathology of the Afghan addicts as well as the attitude of the people towards drugs and our own observations, it is anticipated that in the majority of cases there would be no relapse after treatment. This is particularly true of the opiumdependent population whose recuperation would mean manpower plus socioeconomic prosperity.

Within the country the project should be supported by a joint effort of the Kabul University, Ministry of Public Health and the local authorities.

Punitive measures directed at the producer with the intent to reduce the availability of drugs do not appear, if applied in isolation, to be the complete solution to the problem,

Summary

  1. The two major drugs abused in Afghanistan are hashish and opium. Opium is either smoked or eaten. Hashish is only smoked.

  2. Solitary abuse of one single drug, either hashish or opium, is the common feature of drug abuse in Afghanistan.

  3. Abuse of other patent drugs as well as multiple drug abuse by the same individual, increasingly common elsewhere, is quite rare.

  4. Self-treatment is a major cause of drug abuse in Afghanistan while escape from boredom and lack of work and motivation is another.

  5. Hashish as well as opium is commonly abused by people of a low socio-economical standard.

  6. Alcohol, a more recent introduction by the upper class, is becoming popular among city dwellers with major risks involved for the future.

  7. Drug abuse in Afghanistan has so far not created problems comparable to those in the West, although there is no guarantee that in future it will not do so. Coercive measures aimed at depriving an individual of his drug of choice may involve the greater risk of drug substitution which will then be an even more difficult problem to manage.

  8. Factors involved in prevention as well as cure of the drug-dependent population in Afghanistan have been discussed.