News

Rehabistan

Queuing for Recovery at Heroin's Ground Zero

By Jeremy Kelly

TEXT BY JEREMY KELLY, PHOTOS BY TRAVIS BEARD

s we’ve been telling you in our last few issues, it’s really easy to get opium and heroin in Afghanistan, where over 90 percent of the world’s supply is produced. The United Nations Office of Drugs and Crime estimates that there are 1 million drug users in the country—about 4 percent of the population. Of these, about 150,000 are estimated to be using opium or heroin. Some smoke it with dried scorpions and snake heads, while many parents use it in place of medicine. That’s correct: Heroin. As Medicine. For kids.

Naturally, wherever there are people using, there are people needing rehab. Our friend Jeremy Kelly went to see how Afghanistan is working to arrest its rapidly swelling drug problem.

This poster is real. It means, “Hey, please don’t blow heroin smoke in your baby’s face anymore.”

n the pockmarked southern suburbs of Kabul is the Nejat Center, which was set up in 2002 and is the oldest drug-treatment facility in Afghanistan. Funded by a group of NGOs, it operates on a structure that has worked with some success in Pakistan since the mid-1990s. Demand on the center is so high that prospective patients, desperate to get in, are first required to complete up to three months of voluntary daily counseling to assess their commitment to kicking the habit. On the day I visited, I sat with a group of 25 men who were listening to a former user talk about how he weaned himself off heroin. The group ranged in age from late teenagers to long-bearded grandfathers. One had brought his young son while another was a policeman, in uniform but not on duty.

After the group session, the center’s director, Dr. Tariq Suliman, guided me through the clinic. Some users, he told me, beat their addiction during the three-month counseling, but for most it’s a daily struggle. Of the 1,700 on the waiting list, only five patients a week are selected for the residential program, which involves going two weeks cold turkey. Upon arrival, they are washed, have their heads shaved, and are given fresh, clean clothes. They are all taught personal hygiene during the initial counseling, and for the first few days, they will try to sleep as much as possible.

When we entered the detox room it was 11 AM and all five patients were still asleep. One of them woke up when he heard us speaking and cracked a smile and shook my hand. His name is Mohammad Salim and he was introduced to opium in Pakistan and for the past nine years has been battling to stop. It’s hard, he says, when there are few jobs and it’s so easy to score. He is determined not to go on being a junkie dad. “I was in a very dark place. Now I am trying to get my head in the light,” he says.

Another patient, Maqsoud, checked himself in after he missed his infant daughter’s funeral. He had used some of the 800 afghanis ($16) his father had given him for the ceremonial cloth and gone out and bought heroin instead. When he woke from his drug-induced slumber, he returned to his family’s home to find that his daughter had already been buried and he had missed the whole thing. Ironically it was the wake-up call he needed and the only reason he is now in the middle of a full recovery in the Nejat Center.

Dr. Suliman says war has introduced many Afghans to drugs—and still does.

“When you take drugs, you see the helicopter as a butterfly,” he says, recounting the description given to him by patients. The center dispenses about 100 syringes a week and as many condoms and has a success rate of between 30 and 35 percent.

utside of Kabul it’s tougher to prevent and treat drug abuse. The relatively peaceful north of the country produces many of the famous Afghan carpets, as well as a younger generation of drug users. A UNODC national project officer we met, Mohammad Aqa Stanikzai, told us that “when mothers are weaving carpets, they might not have the time to look after their children. So if the child starts crying, they make a solvent from opium to pacify them.” Others use it for relief from the aches produced by monotonous hours behind the loom.

One family we met in a village called Tokahi, near the Uzbek border, was so poor they had sold their loom to buy food and support their opium habit. The husband now works as a laborer and most of the $1 to $1.50 a day he earns is spent on opium for himself, his wife, and his children.

The mother, who didn’t give her name, admitted to getting her children hooked but said she knew no better and had no other choice. “Until one month ago we had no services to buy medicine. It’s 60 kilometers to the nearest pharmacy and most of the opium is given to us, free. We didn’t know it was bad for them.” In the western city of Herat a mother spoke openly about her and her daughter’s opium addiction. They have been using for about a year. The mother started to combat depression after the death of her husband, who had been a drug user for 25 years. She introduced the drug to her daughter to cure pain in her leg. The daughter’s habit keeps her revolving out of school and into rehab.

ogether with its NGO partners, the UNODC uses what it calls Demand Reduction Action Teams to help both those in remote regions and women, who in male-dominated Afghanistan cannot check in for treatment as easily.

In remote Badakhshan, the second-highest opium-producing province, the drug is used liberally in place of medicine, often with disastrous consequences. Recipients get a taste for it and before long they are hooked. Others seek to enhance their high by catching scorpions, killing and drying them, and then crushing them into a powder that is mixed with either heroin or opium. It’s said to produce hallucinogenic effects. Others use the heads of dead, dried snakes in place of scorpions.

In Herat province, close to the Iranian border, 4,000 patients are on the waiting list for one of 20 beds at the Shahamat clinic, funded by a German NGO called GTZ. The UNODC is seeking to find sustainable futures for many who have found drugs as a way to escape the seemingly endless chain of war and poverty. They provide classes for both women and men in tailoring, with some having successfully opened small businesses.

Afghan and Western efforts to curb production have been stymied by an insurgency (most ferocious in Helmand province, which on its own produces a quarter of the world’s heroin) and the government’s inability to stamp out corruption. Perhaps unsurprising when the president-appointed corruption-buster spent nearly four years in a Nevada prison for heroin trafficking and you can be offered hashish at a wedding from a Ministry of Counter Narcotics official you’ve just met. Meanwhile, the number of drug users continues to climb. “This is a battle in Afghanistan that will be won,” Public Health Minister Amin Fatimie says optimistically. But with a country almost wholly dependent on foreign aid, it will need help. Fatimie believes that the international community has realized the importance of the issue, but getting the message across to the people of Afghanistan, where illiteracy is as high as 90 percent in some districts, makes its prevention-before-cure policy somewhat tricky.

A recent initiative has been to print 20,000 antidrug booklets for mullahs to use during Friday prayers. On the streets, billboards portray the devil dancing around opium fields while government-produced matchboxes depict a smiling man among huge sunflowers with the reverse side showing the man cowering under giant poppy bulbs.

Fatimie’s immediate concern is intravenous drug use—a relatively new phenomenon in Afghanistan, arriving after the fall of the Taliban in late 2001.

Predictably, it has spawned a spike in HIV—69 registered cases, but the real figure could be as high as 2,500. The government-run Drug Demand Reduction Department now covers 17 of the country’s 34 provinces providing specialized help within hospitals, but the task of treating the problem is really the domain of the UN and non-governmental organizations. The public health minister says saving this new generation from the drug menace will not only help his people but also the world, since his country is the global wellspring of heroin. We’ll see if he succeeds in plugging it up.

By Jeremy Kelly 4 years ago More from this issue Like · Comment · Share Tags: Rehabistan, Jeremy Kelly, Queuing, For, Recovery, At, Heroin's, Ground, Zero