Pubdate: Sun, 28 Aug 2011
Source: New York Times (NY)
Copyright: 2011 The New York Times Company
Contact: http://www.nytimes.com/ref/membercenter/help/lettertoeditor.html
Website: http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: Mauricio Lima
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

TRAPPED IN A NARCOTIC HAZE

Few Treatment Options for Afghans As Drug Use Rises

KABUL, Afghanistan -- Once a river flowed under the low Pul-i-Sokhta 
bridge here, but now the thin stream is clotted with garbage, the 
banks are piled with refuse and crowds of heroin and opium addicts 
huddle in the shadows, some hanging like moths near the bridge's 
supports, then slumping in the haze of narcotic smoke.

When outsiders venture in, dozens of the addicts -- there are 200 or 
300 here on any given day -- drift over to see the newcomers. Most of 
the visitors are health care workers trying to persuade the addicts 
to visit their clinic for a shower and a medical screening.

"Are you taking names for treatment?" one man asks, his soiled salwar 
kameez hanging loosely around his thin body. "Put me down, my name is 
Zainullah."

This is another of Afghanistan's afflictions: a growing drug 
addiction problem and all the ills that come with that, not least 
H.I.V., the virus that causes AIDS, which can be transmitted when 
addicts share needles. There were about 900,000 drug users in 
Afghanistan in 2010, according to the United Nations Office on Drugs 
and Crime, a marked increase from previous years. That means about 7 
percent of the adult population of 14 million is using narcotics.

A vast majority take opium-based drugs, which are extraordinarily 
pure here and very cheap -- about $3.50 for enough to get high, 
addicts say. Afghanistan is the world's leading producer of opium 
poppy, and the opium produced and sold here and its derivatives, 
including heroin, are among the most potent on earth. About 150,000 
of those using opium-based drugs are injecting heroin, according to 
the World Health Organization.

A measure of the problem is that surveys show that 12 to 41 percent 
of police recruits test positive for some form of narcotic -- most 
are hashish smokers -- according to a recent report by the Government 
Accountability Office. Another indicator of the problem is a recent 
report by the Ministry of Public Health in partnership with Johns 
Hopkins University that found H.I.V. present in about 7 percent of 
drug users, double the figure just three years ago, said Dr. Fahim 
Paigham, who until recently directed the Ministry of Public Health's 
AIDS control program.

Unlike the situation in many countries, where H.I.V. is transmitted 
primarily through sexual contact, in Afghanistan the primary 
transmission is through shared needles.

The Pul-i-Sokhta bridge -- the name means "burned bridge" -- and 
another bridge nearby are the most recent refuges for many of Kabul's 
heroin and opium addicts who used to gather in the ruins of the 
Russian cultural center on the east side of the city. They were 
forced out in late 2010; although some remained in the neighborhood, 
many came to the bridges.

Some come here every day to buy and use narcotics, crouching in the 
dark corners to shoot up or gathering in small groups to heat the 
opium powder until it melts into a black liquid and gives off smoke to inhale.

The ground under the bridge is thick with discarded syringes. Six 
mornings a week a team of former addicts, nurses and a couple of 
social workers from the French group Medecins du Monde (Doctors of 
the World), a nonprofit health care organization, forge ahead into 
this particular circle of hell, with large plastic disposal jugs in 
one hand and long-handled pincers in the other to pluck needles from 
the garbage. It is not uncommon to pick up 160 or 170 needles in a 
morning. They hand out fresh needles and alcohol swabs, and the 
nurses treats the addicts' seeping wounds where they have injected 
themselves too many times.

Not all the addicts are sure they can tolerate treatment, and some 
are so high they often make little sense. "I am the Bobby Devil of 
this town," said a tall, bony young man in aviator glasses, cargo 
pants and a plaid cotton shirt, who was sprawled next to a small 
group smoking heroin, but had propped himself up on his elbows to 
talk. Bobby Devil is the stage name of an Indian actor well known 
here for his action movies.

"I've been using for four years," he added. "Last night I went home 
with money and fresh fruit, and my wife and children told me to go 
away. They said, 'You are a drug addict, you are a dog.' "

Could he quit? "Well, I can't decide; both my wife and the drug are 
strong," he said and lay back down.

Many of the addicts say they want to stop using, but treatment 
options are woefully few. The government, through some Afghan 
nonprofit groups, runs several detoxification centers and is building 
seven more, but the facilities offer almost no post-detoxification 
support and have a 92 percent relapse rate, according to the Ministry 
of Counternarcotics, which is involved in running them. The most 
efficacious treatment -- opiate substitution therapy -- has been all 
but blocked by the ministry despite pleas from the Ministry of Public 
Health, whose doctors are worried about the rising incidence of H.I.V.

"The results from opiate substitutes like methadone are very 
positive," Dr. Paigham said.

"If you stop using heroin, you stop using the needles, and if you 
stop using the needles there is much less risk of spreading H.I.V."

Methadone is typically given in syrup form here. However, officials 
at the Ministry of Counternarcotics are leery of it, perhaps because 
they have the most experience with detoxification, but also, they 
say, because the opiate substitutes do not cure addiction.

"It is the view in Afghanistan it is just substituting one addiction 
for another," said Mohammed Ibrahim, the deputy minister of counternarcotics.

The ministry undermined the country's sole opiate substitution 
effort, a pilot program run by Medecins du Monde that administers 
methadone to 70 addicts. The program has been strongly endorsed by 
the World Health Organization as well as by participants, and it has 
a waiting list. However, the ministry twice blocked the import of the 
methadone, making it all but impossible for the heavily addicted 
participants to stick with the program.

For now the pilot program is running, but it has not been permitted to expand.

This year the number of drug addicts is expected to rise. Many 
Afghans start using narcotics when they seek work in Iran, which has 
one of the worst drug problems in the region. Increasingly, Iran is 
expelling addicted Afghans, shipping them back across the border. A 
few Afghan addicts say they were trying to quit while in Iran, which 
has a comprehensive system of methadone clinics that provide the 
drug, but most cannot imagine a way out.

"I started using in Iran from depression and sadness," said 
Zainullah, 19, a Hazara man from Ghazni Province. "I was alone. There 
was no one in Iran from my family. I went there to find work, and I 
started smoking heroin."

He returned to his farming village and his nine siblings six months 
ago, but a month later came to Kabul.

"Nobody likes a drug addict, so my family sent me here to quit," he 
said, speaking softly. "Instead, here I am under the bridge, and I 
have increased my dose since I came.

"If you could help me, please," he said, raising his thin arms as if 
beseeching the aid workers. "I don't know how to stop."

Sangar Rahimi contributed reporting.
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MAP posted-by: Jay Bergstrom