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Collective blow
Published in Al-Ahram Weekly on 10 - 01 - 2008

While guaranteeing anonymity, the hotline for addicts reveals the dim reality of the growing number of drug users, finds out Ahmed Morsy
Many are shocked by the increasing number of drug users worldwide and intrigued by the reasons that push lots of people to walk the dark road of drug abuse, but for a 23-year-old undergraduate interviewed by Al-Ahram Weekly, who prefers to remain anonymous, the question was rather why not? A hashish user himself, he explained that he tried it out of curiosity, to break away from routine and depression. "It's a way of killing time, it makes me oblivious to this boring life. It also gives me feelings of enjoyment and satisfaction, something I never find in normal life."
This young student is but one of a disturbingly rising number of drug abusers in Egypt. "In seven months, we got 26,688 calls from addicts or suspicious families inquiring about how to deal with the problem," Laila Abdul-Gawad, professor of psychology and supervisor of the Hotline at the National Centre for Social and Criminology Research (NCSRC), told the Weekly.
Abdul-Gawad explained that in the same period, the centre received 2,882 calls from drug addicts who were unable to get any treatment elsewhere. Ninety seven per cent were males and three per cent females. Fifty seven per cent were 20 to 30 years old. "Despite the diversity of callers, the majority of hotline users are university graduates," added Abdul-Gawad.
According to the 2007 annual world drug report issued by United Nations Office on Drugs and Crime (UNODC), there are about 200 million people who use drugs each year, with almost 25 million considered drug users. Also the report indicated that the main problematic drugs continue to be opiates (notably heroin) followed by cocaine. For most of Europe and Asia, opiates continue to be the number one drug, while in South America cocaine comes first, and in Africa the bulk of treatment demand is linked to cannabis.
In Egypt, opiates come first on the list of drug distribution, constituting 45 per cent of the value of illegal drugs in circulation, with cannabis at 22 per cent.
Experts say the common reasons for drug addiction are bad company, curiosity, the urge to experiment, spare time and family problems. An ex-heroin addict, who agreed to share his experience with the Weekly, confirmed this. The 30-year-old samkari (car mechanic specialised in fixing dents), remembered how he used to take painkillers like Tramadol (TM) on a recreational basis. Caving in to peer pressure one evening, he snorted a line or two of heroin. The next day, his friend arrived with a syringe. "I was scared of the idea but finally I gave in." For six years, he struggled with addiction.
The second of five siblings, the samkari says his lower middle-class family was the prime factor in his developing an addiction. His mother was illiterate; his father had been away working in Saudi Arabia since he was five. Following his father's death, he dropped out of school. Starting at the age of 16, he took drugs courtesy of the bad company he kept, to make up for frustration and the "ugly reality" of his life, as he put it -- the lack of a father figure, no future to look forward to, tension at home -- seeking refuge with his friends. Heroin was but the last leg of a journey begun many years before.
"It was my daily habit and I couldn't live without it. I did whatever it took to get it. I robbed both my family and strangers. I even abducted a drug dealer once to force his boss to give my friend and me the dosage we needed. I was sure that only death or prison could make me stop." And indeed the police eventually arrested him for possession, and in prison he was forced to stop. For six months prior to that he had been determined to stop, having lost his job once too often and reverting to steal, but had failed. Only prison did the trick: "I almost died of pain during the first 20 days."
Following his release he went through a period of being stunned. "I couldn't believe this had actually happened to me. If I could turn back time, I would never have touched those drugs or even considered them. I am miserable today because I will never forget what I did. It's only now that I consciously remember the evil I perpetrated, how I was at the brink of death. Sometimes I'd forget to get all the air out of the neck of the syringe before injecting, only noticing at the last second, which would have meant death. Every day I thank God I am alive. I lost my family, friends, community, all the good things in life, but I have finally been gaining them back."
Although the ex-addict's road to recovery was probably the longest and the hardest, public and private hospitals provide different treatment, which is generally divided into phases. As Ashraf Ali, a psychiatry professor at a private addiction treatment hospital recounts, "some addicts come here of their own free will to recover, while others are forced to come."
The treatment starts with a medical check-up to diagnose the kind of drug used, then a detoxification phase follows, taking a maximum of five days depending on the kind of drug. For instance, it takes only three days for the body to get rid of some drugs, while others require five days, such as heroin.
The next step allows addicts to get special treatment from a team of doctors, nurses, psychiatrists and social workers as well as from a religious figure, to help them deal with withdrawal symptoms and rehabilitation. Afterwards comes the re- integration phase which involves psychological treatment, where addicts are required to follow the 12-step recovery process. "Our role in this phase is to connect our patients with recovered addicts to share their experiences in the hope of achieving reintegration," said Ali.
The assessment phase is very important to the future of the addicts to decide whether they are able to face the outside world or not. If they have responded well to treatment, they will be allowed to visit their family and relatives twice a month, or go on trips with other ex-addicts, supervised by specialists. "Step by step, they will be helped to resume their life again, and if not, they go through the phases and the 12-step recovery programme again." However, due to hospital regulations, the Weekly was not permitted to interview patients.
While there are strong efforts to curb the supply of drugs, the latest NCSC statistics show that there are 136 Internet sites involved in drug trafficking and propagating new kinds of drugs.
However, there are efforts to limit the effect of these websites. "The Global Positioning System [GPS] and a Geographic Information System [GIS] are used nowadays in Egypt to follow and detect drug operations," Medhat Zaki, head of the Ministry of Foreign Affairs Anti-Narcotics General Administration, told the Weekly. "The cultivation of cannabis requires a lot of work and that makes it harder to conceal. We successfully destroyed all the cultivated areas of cannabis in southern Egypt but in Sinai many lands have no known owners, making the mission more difficult," Zaki added.
Further protocols between institutions and concerned governments are necessary. Yet it appears there will always be a supply for these drugs despite all efforts. "Lebanon was the major source of hashish for Egypt but after the turmoil in Lebanon, now it's Morocco," noted Professor Nadia Gamaleddin, head of the Drug Research Department at NCSRC.
In addition to seizing drugs and arresting producers and suppliers, it is necessary to help growers of illegal crops to find viable legal alternatives. The fact remains that the greatest challenge in global drug control is reducing demand. With less demand, there would be less motivation for criminals to traffic drugs.
While addiction to illegal substances remains the most common form of drug abuse and the most talked about, addiction to pills is also another threat to the lives of many people.
As Kamal Zaki, a doctor and pharmacist, says, "addiction also means that you are unable to stop using a medication, even when you want to. For example, one of the biggest misconceptions of sleeping pills is that since you are able to fall asleep quickly, you will be sharper and more alert the next day," Kamal told the Weekly, " in fact, the opposite is true. Although you may sleep for more hours during the night, those extra hours do not help you feel fresh the next day."
As he explained, probably the most noticeable side effect of sleeping pills is that often the next day you are groggy and left with a hangover-type feeling. This is due to the fact that sleeping pills reduce brain cell activity during the day, one of the most dangerous side effects. He also added that a very common side effect of sleeping pills is hallucination. "Many people who have taken sleeping pills for the first time reported having nightmarish type hallucinations where they become very nervous."
Although there are side effects for almost any drug on the market today, the side effects of sleeping pills, like dizziness, dry mouth and throat, drowsiness, forgetfulness, and lack of coordination are significant and can become very dangerous. To minimise these side effects, Kamal suggested taking a very small dose of the sleeping pills the first time. "Also, do not take the sleeping pills if you need to be very alert first thing in the morning. More importantly, always consult your doctor before taking sleeping pills."
Withdrawal symptoms, which vary from person to person, can emerge, making it very difficult to stop taking the drug. They may include increased anxiety, depression, insomnia, muscle tension, tight chest, sweating, shaking, dizziness, headaches, nausea, blurred vision and increased sensitivity to light, noise, touch and smell. "Sleeping pill side effects should be taken seriously and monitored to see if the positive effects of the sleeping pills outweigh the side effects," added Kamal.
Addiction to prescription painkillers is increasing. Although drugs such as morphine and codeine carry a heightened risk of addiction, research has shown that concerns patients will become addicted to these pain medications are largely unfounded. The National Institute on Drug Abuse (NIDA) Director Nora Volkow has stated that at most seven per cent of patients who are prescribed narcotic or opiate analgesics to treat chronic pain will become addicted.
"Taken as directed by the doctor, even long-term use of painkillers is unlikely to cause addiction," said Kamal, "the body may become tolerant of a drug and one may need a higher dose to get the same relief. This is normal though, and not the same as addiction."
To ensure safe recovery from illness without addiction to painkiller, Kamal advised not to just stop taking painkillers when one feels better, because the body is used to the drug and one may get unpleasant withdrawal symptoms. "Your doctor can help you get off the medication slowly and safely," he clarified. He believes that you should pay attention to family or friends when they express concern that you are becoming dependent on a drug. "If you think you might have a problem, talk to your doctor at once. Addiction is much easier to treat at an early stage." NCSCR drug research director Gamaleddin also stresses the need for better social conditions to reduce the general demand for illegal drugs. "Sound guidance, good employment opportunities and recreational outlets for young people are the surest beams of light at the end of the dark tunnel of addiction."
The toll-free number of the NCSCR is 0800 220 0022. It provides free confidential services for callers.
Historical notes
" Hashish user" has been a derogatory term in Islamic countries, related to poverty, since the 13th century. In Cairo in 1253, Egyptian Muslims ordered cannabis plants to be burned, but farmers simply moved outside the city to grow the crop. In 1324, the Egyptian army was used to destroy the crop in the countryside, but hashish production survived. In 1378, farmers fought troops to protect their crop and revenues; marshal law was instituted and traffickers were killed, but by 1393 the business was again thriving there. Hashish was eaten and leaves were rolled into a ball and swallowed like a pill.
Arab traders were also responsible for spreading marijuana to other parts of Africa, where the plant was used by women during childbirth (an ancient custom) and to help wean babies. Laws forbidding the use of cannabis were issued in South Africa in 1870. Hashish was introduced in France by Napoleon's army when it came back from Egypt in 1800 and was first used for treating the mentally ill before becoming popular with Parisians. Frenchmen, including the psychiatrist Moreau de Tours and artists Gautier and Boissard, experimented with hashish and started Le Club des Haschischins, which lured others, such as Dumas, Delacroix, and Hugo, to try "pot". Many felt that the drug improved artistic creativity, but Moreau concluded finally that it was injurious to mental health.
Egypt was the first country in the world to establish a police department for combating drugs in 1929.
According to the UN annual world drug report for 2007:
- 15.6 million opium addicts, half of them in Asia, with Africa in second place.
- 70 per cent of global opium abuse in the form of heroin.
- 14 million cocaine addicts.
- 160 million cannabis users.
- 172 countries cultivate cannabis.
- Morocco is the number one country in producing cannabis from which hashish/bhang is derived.
- All African countries cultivate cannabis.
- Methamphetamines and amphetamines (chemically derived pills) are still the cheapest drugs.
- The United States is the largest producer of methamphetamines.
- There are nine million ecstasy users.

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