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This article was exclusively written for The European Sting by Mr. Muhammad Shahzeb, a third-year medical student from Allama Iqbal Medical College Lahore, Pakistan. He is affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

Drug addiction, or substance abuse disorder, can be accepted as a worldwide phenomenon. In Pakistan alone, a UN Drug Report in 2012 suggested that about 7.8 million people were injecting drugs and about 11 percent of these users were also HIV positive. This HIV-positive percentage has increased to about 40 percent in recent years. This increase in both numbers – the addicts and the HIV positives – raises several serious questions. Have the drug combating strategies failed at achieving their supposed results? And what is to be done about the increase in the number of AIDS patients?

The traditional methods of dealing with substance abuse would have suggested demand reduction and supply reduction as a solution to both these problems. But years of clinical studies have shown that these approaches failed at large. Here the need for a humane and pragmatic approach to substance abuse arose and harm reduction was introduced.

Harm reduction refers to a range of practical strategies and public health policies aimed at decreasing the negative social and/or physical consequences associated with drug use. This approach calls for the acceptance of addiction as the first step toward the treatment process. It accepts the fact that there is still a large population of people involved in drug use and other high-risk behaviors and that the idealistic visions of a society free of drugs are unlikely to become a reality.

The history behind the use of harm reduction for dealing with substance abuse and its associated disorders can give an idea about its efficacy. The English pioneered the ‘medicalization’ approach in which they prescribed the use of narcotics like Heroin and Cocaine to help the addicts in their recovery process, an approach in which they were soon joined by Australia, Amsterdam, and the Netherlands. These countries started making amendments to drug control laws and introduced Needle-Exchange Programs to combat the use of shared needles for drug injection. These approaches helped in treating the addiction problem as well as reducing the spread of contagious diseases.

Pakistan however, has still to adopt this approach on a large scale. Several harm reduction programs were initiated by the government from 2012 to 2014 in about 20 cities. These included the Needle and Syringe Program (NSP) among many other initiatives aimed at providing the citizens with safe needles for drug injection. Although they helped decrease needle sharing, there were no major changes in the number of AIDS patients, which significantly increased in some cities covered by the program. A low level of programmatic coverage of such services was found to be the major problem in this case.

Pakistan needs to revise its drug control programs and implement a controlled approach to harm reduction. This can only be achieved when there is an acceptance of the addicts without passing any moral judgments on them and providing them with safer options of drug injection. Only then can we hope to see control on the substance abuse problem and a Pakistan free of deadly epidemics like AIDS.

Muhammad Shahzeb is a third-year medical student from Allama Iqbal Medical College Lahore, Pakistan. He is a member of the IFMSA local cabinet at the college.

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