A Heroin Epidemic Essay, Research Paper

Adding to Pakistan’s Misery, a Heroin EpidemicRaees Khan sleeps most nights on a pillow of dust. His home is a median strip along the busy Liaquadabad Road, across from a mosque. A little before dawn a loudspeaker announces the first call to prayer, a reminder to the holy that before Allah all men are naught. This noisy summons fails to awaken Mr. Khan. Though a Muslim, he does not pray five times a day. Other rituals command him: emptying a tiny bag of heroin into a plastic bottle cap, adding water and heating it on a small flame, drawing the hypnotic broth into a syringe, hunting for a plump vein and feeding into it the fluid warmth. After a decade of addiction, locating the vein is the hardest part. Most of those conduits have long ago collapsed. One recent morning, Mr. Khan, 30, and a helpmate searched his arms, hands, feet and groin before settling on a faint line in his right biceps. The shot was transporting. His head lowered sideways as if he were laying it on a platter. But a few moments later he was up again and grumbling dissatisfaction. He scavenged in his pocket for another bag of the brown powder, and this time he inhaled it. “I am flying now,” he said, though this was merely the view from within. Actually, he was staggering toward the street, just another Karachi dope fiend on open display. Pakistan, which does not lead the world in much, is most likely No. 1 when it comes to heroin addicts. Reliable country-by-country numbers have not been compiled, with social science a low priority in the third world and addicts hard to poll anyway. But the United Nations estimates that 1.5 million heroin addicts live in this nation of 150 million, the unfortunate result of geography, geopolitics, corruption and poverty. “I think we can be quite definite that Pakistan has the largest heroin population,” said Bernard Frahi, who heads the United Nations drug program office for South and West Asia. “And whatever the total is, it seems to be getting quite a bit worse.” Karachi itself, a city notorious for lawlessness, political killings and gargantuan slums, has 600,000 heroin addicts, according to the nation’s anti-narcotics officials. And while that total seems exaggerated — for it would mean that about 1 in 15 adult males is hooked — the city is replete with the dope-addled in each section of its troubled sprawl. Addicts are everywhere and nowhere, easy to overlook from a car but impossible to miss on foot. They are huddled together on the sidewalk, under the bridge, behind the truck, against the fence, along the prime begging space beside the shrine. “Heroin is written in my fate,” said Mohammad Aslam, 40, who had a needle in his arm and a prayer cap on his head. “No one can change the decree of fate.” Their days fill with the customary gamut of degradation: the craving, the begging, the scheming. Mr. Aslam has been shunned by his wife — or perhaps it is the other way around. He sleeps near the city’s main drainage ditch, just a few feet from raw sewage. With the veins in their extremities withered, addicts often tug down their pants, injecting near the groin. Jan Sher, 29, does this. He is a theatrical man who lives beneath the girders of a walkway. Dirt is on him like plaster and there are crescents of sweat under his arms, but he handles a syringe so deftly that it may as well be an extra finger. “This is Karachi,” he said, letting the needle linger, drawing blood in, letting it out. “You can drop your pants in a police station and shoot up, and no one would care.” A dose of heroin, known as a token, costs about $1 — about a tenth of what it would cost in Brooklyn. The quality is bad, with barbiturates often mixed in. But with the price so cheap, a three-bag habit is affordable to anyone whose hands can beg small change or steal an item off a shelf. A syringe, heroin’s most efficient conveyance, sells for 10 cents. Addicts reuse them until the point becomes painfully blunt. They know the sermons about hepatitis and H.I.V., but many still share needles, playing the odds in a kind of microbiological roulette. The more favored practice, though, is referred to as panni, or what in America is called chasing the dragon. The heroin is spread on a strip of tin foil and heated from below. The addicts, who are overwhelmingly male, inhale the fumes through a straw, sniffing at the curl of smoke like an excited hound following a scent. An entire colony of panni sniffers has settled into the concrete hollows beneath the Sohrab Bridge, along the main highway. Dogs roam all over, and while the attraction for them may be in the ample rubbish, addicts insist that the animals themselves are hooked. At the steps around Aurangzeb Park, in the oldest part of the city, a hundred or so addicts gather each evening. From a distance they appear to be in prayer, kneeling over candles or matchsticks, entering a trance in the delicate sadness of nightfall. Mixed among the bedraggled are a few addicts who have clean clothes and barbered hair. They work at jobs and go home to families. And while their normal lives have yet to be entirely forfeited, they seem without illusions about the eventual surrender. “There are more of us every day,” Faeez Hussain said a little boastfully, “and people from good families, too. You’ll find university graduates among us.” Merchants with stores near the park are exasperated. “We have had some of these people beaten, to the point of almost killing,” said Abid Ahmed. “But they get up as if nothing had happened. Beating them is of no use. They will have to die on their own.” The police do not arrest the addicts, though the constables of Karachi are very much feared by them. They extort cash. Two with machine guns walked toward an older addict with one eye, Sharif Uzzaman. He prudently scurried away. “Most days they rough us up and take our money,” he said. “They tell us: if you can afford to pay 50 rupees for heroin, you can afford to pay 20 more as a bribe.” Such accusations are not to be doubted. Shabbir, an addict in a pressed shirt, stepped forward to vouch for their truth. He pulled his police identification card from his wallet, showing his constable number. He was due at the station in a few hours. “A policeman is paid only 4,200 rupees [$84] a month, and a man with a family cannot subsist on this,” he said. “We have no options but to take bribes where we can.” Drug enforcement is usually left to Pakistan’s Anti-Narcotics Force, which is largely a military operation. Its focus is on major busts, and its chief, Maj. Gen. Zafar Abbas, cites record seizures: “Our force is small, but 1999 was a very good year.” Addicts scoff at those efforts, for heroin is as available as air. Even the bigger amounts are easily obtained in well-known spots like the Ilyas Goth shantytown, a tight cluster of wood and concrete shacks. An extraordinary percentage of the residents — men, women and sometimes children — are hooked, entire families pulled under. A melancholy addict named Lassi watched her daughter Fatima snort dope through a ballpoint pen with its ink cartridge removed. “I did not force her into addiction,” Lassi said defensively, pulling at her shawl. “It was her own decision.” Hashish and opium claim another two million addicts in Pakistan, the government says, and for many users heroin is but the next step. From there the rungs to come seem to be ones of methodology, from sniffing to panni to the needle. However far along, addicts are often unsure how to assess their sins. There is a metaphysical dispute about what qualifies as “haram,” forbidden by the laws of Islam. Abdul Qadir, an addict and a locally infamous car thief, was wearing a clean white prayer cap. He argued, as many do, “The Holy Prophet, peace be upon him, did not prohibit drugs. He prohibited intoxicants, and by that he meant only liquor.” Indeed, a ban on alcohol is commonly cited as a reason for Pakistan’s heroin problem. In 1979, as part of his so-called Islamization program, the military dictator Mohammad Zia ul-Haq declared drinking to be a “heinous crime,” punishable by public flogging. For many, drugs became the substitute for drinks. That same year, geopolitics turned this part of the world upside down. A strict Shiite Muslim government took power in Iran, and many of that country’s drug kingpins found Pakistan a welcome refuge. Then, in December, the Soviet Union invaded Afghanistan, and the region became a hot spot for the cold war. The Americans and Saudis financed the Afghan resistance through Pakistani intermediaries who sometimes found synergy between the heroin and weapons trades. Throughout the 1980’s and much of the 1990’s Pakistan was a world leader in the production of opium, from which heroin is derived. That distinction has since passed to Afghanistan, which last year grew 75 percent of the global yield. To reach the world market, the drugs are smuggled out along well-trod roads and donkey trails into neighboring Pakistan and Iran. Their populations have become convenient local customers. General Abbas said the opium trade across Pakistan’s porous border was impossible to stop. Besides, he lamented, “the main problem is a shortage of drug rehabilitation.” By any measure that would be an understatement. Karachi has the capacity to treat only 500 addicts, said Dr. Saleem Azam, a highly respected physician who gave up a prosperous medical practice to treat drug patients with his own waning funds. “The people in the government are indifferent to drug rehabilitation,” he said. “They say there is no money, but they always have plenty to spend on the military.” Mr. Frahi of the United Nations has found much of the same lack of interest among international donors. “Other countries are willing to fund law enforcement projects, but we can’t raise a penny for prevention or treatment,” he said. Most heroin addicts here, like those around the world, profess a desire to enter a drug program, anything to escape the sheer everydayness of the despotic routine, the relentless foraging for money, the guilty uncoupling from their families. But even if such programs were available, failure rates are high against so formidable a sickness. The urge to be helped usually proves subordinate to more immediate cravings. Raees Khan, the man who lives by the mosque, has tried drug treatment three times, but it involved nothing more than weeklong stays in a hospital and sedatives to moderate the agony of withdrawal. On release he was quickly back to a fatalistic apathy. “Now I believe this is the way my entire life will be lived,” he said decisively. In a moment of reflection, Mr. Khan felt a need to visit his mother, whose modest home is off an alleyway north of the airport. She was reluctant to let her son through the door. She loves him, she said, but his addiction is a family disgrace. “I have a young daughter, and soon we will need to find her a proper husband,” she explained. “We will make a much poorer match because of our shame.” But finally she softened and allowed him inside. He once had such potential, she said wistfully, stroking his shoulder. He knew how to weld. He could do electrical work. She brought her son a glass of water sweetened with red syrup, and they began to speak warmly to each other. As he left, he was able to wheedle the equivalent of $4. Not long after, he used his nose to empty another bag of heroin, forgetting his family again and retreating into his medicated self. He was soon nodding out, his eyeballs rising in his head like two balloons set adrift.