Where despair and addiction meet

The scorching sun of Lahore shone on Nasir* as he narrated the harrowing story of his friend, who lost his arm a few days ago when a train ran over him after falling on the tracks.

But the real horror, Nasir says, came not from the accident itself, but from the subsequent treatment – ​​or lack thereof.

“They wouldn’t touch him in the hospital,” Nasir complained, a bitter taste in his voice. Rushed to a nearby public hospital, Nasir’s friend was met not with sympathy, but with contempt. “They shouted insults and treated us worse than animals,” he added.

Both Nasir and his friend are part of a marginalized community that is often in the shadows: people who inject drugs.

Nasir, only 24, started using at the age of 15, introduced by his employer, a chef who owned a small barbecue restaurant in Lahore. He started smoking Charas and eventually turned to injecting heroin.

Years of heroin use culminated in an HIV diagnosis, which he recently discovered, leaving him bouncing between the streets and his mother’s house in Lahore’s Ferozepur Road area.

The underbelly of a city: where despair and addiction come together
A representative image of a blood sample for HIV test. —Canva

Nasir, the youngest of four siblings, avoids talking about his father but adds that his mother is still good to him. “I’m stuck. I really want to quit, but I’m stuck,” he complained. “When I visit a hospital, they look at me like I’m their enemy.”

Nasir’s story is not unique. According to a 2013 UNODC report, Pakistan faces a significant drug abuse problem. It is estimated that more than 4.25 million people are dependent. But despite the high prevalence of drug use, it was not until 2022 that the government of Pakistan, with the help of UNODC, launched a new national survey on drug use in the country, which has yet to be completed.

The underbelly of a city: where despair and addiction come together
A representative image of opiate placed next to an injection. —Canva

The 2013 report also highlighted a strong desire for treatment among users, adding that lack of access and affordability were major barriers, and that women were even less likely to receive treatment than men.

Furthermore, the data is heavily skewed towards the younger demographic, with the 15 to 39 age group being the most affected.

The underbelly of a city: where despair and addiction come together
The railway track in Lahore where Nasir found his friend unconscious and his arm cut by a train.

Lonely, abandoned and stateless

Most active drug users are left homeless, abandoned by their families and without any legal documentation to establish their identity, explains Sheheryar Ahmad, a site manager in Lahore who works for a non-profit organization.

Ahmad is associated with the Nai Zindagi Trust, an Islamabad-based NGO dedicated to preventing drug-related harm, such as the transmission of HIV/AIDS and Hepatitis C viruses.

“They (the users) do not even have basic documents such as a national identity card,” he says Geo news.

Ahmad adds that this is because the majority of users have been living on the streets from a young age, so their families have never obtained their ID cards for them, or their families have disowned them, and their fathers or brothers refuse to help them get acquiring identity cards. identity documents.

The lack of documentation, Ahmad says, makes it challenging for those seeking treatment to obtain medication, visit a public or private hospital or even enroll in a rehabilitation center.

The underbelly of a city: where despair and addiction come together
A representative image of a hospital ward. —Canva

Several people working in the healthcare sector in Punjab, who preferred to remain anonymous, made this known Geo news that possession of a national identity card is a prerequisite for persons seeking registration in the government’s AIDS Control program in the province.

Even the ‘model’ men’s drug rehabilitation center in the city of Multan, established by the Punjab Social Welfare Department, lists a national identity card as a mandatory requirement for registration on its website.

The underbelly of a city: where despair and addiction come together
A drug user prepares to inject heroin into another user by the roadside in Rawalpindi. — AFP/File

Malika Zafar, Executive Director of Nai Zindagi, agrees that the lack of ID cards poses a significant barrier to access to treatment for persons who inject drugs and are HIV positive.

“The right to life is a constitutional right,” Zafar emphasized Geo news during a telephone interview. “Denying access to healthcare to our clients, only 20% of whom have ID cards, violates this fundamental right.”

To ensure that their clients receive the necessary medical attention, Zafar and her team, spread across 58 rural districts, do not require an ID card. Individuals who voluntarily seek help from Nai Zindagi services are assigned a ‘unique identification number’. This number consists of the city code, the area code, and a system-generated string to ensure anonymity.

The underbelly of a city: where despair and addiction come together
An image of drug injections lying on the ground. – Splash

However, Zafar emphasizes that the state must also develop good policies to tackle this problem.

According to data from the government-run National AIDS Control Program’s Integrated Biological and Behavior surveillance report 2016-2017, HIV prevalence among individuals who inject drugs is nearly 38.4%. The government has not yet updated these figures.

The program’s website further highlights that despite government efforts, the number of HIV infections across the country has increased significantly in recent years.

The underbelly of a city: where despair and addiction come together

Respect, compassion and a home

Even in the sweltering summer heat of a May afternoon, at a time when Lahore is gripped by a dangerous heatwave, site manager Shehryar Ahmad remains committed to helping the most vulnerable.

He starts work at 6am and his team travels through the 25 hotspots that Nai Zindagi has set up in Lahore to provide medical care, assistance and advice to people who inject drugs.

During a recent visit with Geo news to one of the hotspots near Ferozepur Road, he stands amid the sweltering heat, the temperature rising to 45 degrees Celsius, in a dusty corner of an old neighborhood in the city, talking to a man in bandages, traces and scabs on his arms.

Around him are young men and some women, dressed in torn clothes with disheveled hair, with garbage bags in their hands, taking refuge from the sun under an old tree.

“You know what that man said to me,” Ahmad says, smiling as he approaches. “He said the way you talk to me, even my parents don’t talk to me like that. If you sympathize with them and show them some love and compassion, they will be willing to change. The government must realize that these also concern patients who need medical treatment.”

But the widespread stigma surrounding drug users is another obstacle. Government officials often use derogatory terms when referring to individuals with drug addiction, calling them “addicts,” “drug users,” “junkies,” or “zombies.”

These terms, noted in a 2018 report from the Global Commission on Drug Policy, have negative connotations and further stigmatize people who use drugs as if they are “physically inferior or morally defective.”

The report further recommends that political leaders and journalists should instead use phrases such as “person with drug addiction,” “person who uses drugs” or people with “addiction to drugs.”

The need for respect in society was a sentiment echoed by several people Geo news spoke to those who used to use substances or who actively do so now. One of them is Fauzia, whose story is an example of the harsh reality that women who use drugs face.

She is now 21 and was only nine years old when her mother died. Unable to care for his daughter, her father often dropped her off at a neighbor’s house, run by a woman who, according to Fauzia, was a “dancer.”

It was here that the young girl was first introduced to methamphetamine, the drug commonly known as ice or crystal meth.

“I used to secretly watch her (the women use ice),” Fauzia said Geo news“One day when she went to Islamabad for a show, I decided to try it myself.”

Over time, Fauzia said she too started using the drug and eventually ended up on the streets. Today she is HIV positive. During the day, she begs on street corners to earn enough money to finance her substance use.

Now her only “family” is a small-time drug dealer she met on the street and who adopted her as a sister.

‘He’s Christian. I am Muslim, but he treats me better than my real brother,” she said, smiling, sitting among the rubble and garbage in an old neighborhood in Lahore. “Nowadays he is collecting money to register me in a (rehabilitation) center. I want help. I want to get married someday; you know.”

Fauzia adds that it is not easy for a young woman to beg and sleep in the open. And society is also not kind to people like her who need help.

“People, men, make dirty jokes about us,” she said. ‘They don’t treat us well. They say to me, ‘Come with us, we will give you Rs500’.”

The only respect she gets is from the other users who are homeless like her. For her, the dark corners of the city are her home, and these ‘junkies’ are her only family.

“Here, these people, only they treat me well,” she adds, “for them I am.”didi‘ or ‘Kaka‘.”

Is the Punjab government paying attention?

Khawaja Salman Rafique, Punjab’s minister for specialized health and medical education, announced that all 50 public sector hospitals in the province have allocated 10 beds for persons with substance abuse disorders.

In addition, the Department of Social Welfare and Ace-ul-maal has established ten ‘model drug abuse centres’, and plans for more facilities are in the works.

Regarding the requirement of identity cards to access these services, the minister said that a family member or companion of a patient can also provide his or her identity card number or fingerprint for registration. He added: “The system is designed to retrieve data directly from the National Database and Registration Authority (Nadra) through the patient’s thumbprints.”

However, it remains unclear what facilities are available for patients who are not registered in the Nadra system at all or for those whose families refuse to help them.

Furthermore, the minister acknowledged the stigmatizing nature of terms such as ‘junkie’ and ‘drug addict’.

“At the end of the day, victims of substance abuse are people,” the minister said Geo news, “And every person has the right to a dignified life. No individual is born an addict.”

Geo news also sought comments from Sohail Shaukat Butt, the social security minister in Punjab, and Mohsin Raza Naqvi, the federal home minister, but did not receive a response at the time of reporting.

*Names changed to protect identity.

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