26 Aug. - 1 Sep. 1999
Issue No. 444
|Published in Cairo by AL-AHRAM established in 1875|
'Enslaved by a giant'Recent efforts to combat drug abuse in Egypt have not been entirely successful. Should better strategies be enforced? Gihan Shahine listens to addicts and experts
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A social phenomenon develops into a worldwide epidemic that stumps experts everywhere. In Egypt as elsewhere, efforts have been exerted on different levels, harsher penalties have been imposed, and many studies have been conducted to combat the problem of drug abuse. Despite this all-out war on drugs, many experts believe that the problem has developed into an epidemic. But why?
This question has been the subject of many seminars held over the past two months. Drug abuse has recently regained media attention after being out of focus for some time. The reason may be that drug abuse is on the rise. But many studies have also been concluded and released, the most recent of which is a six-month study in Egypt funded by the United Nations International Drug Control Programme (UNIDCP) and conducted by the Ministry of Health. Almost all these studies indicate drug abuse is an epidemic that needs to be properly and urgently addressed. The question is how.
Perhaps no one can explain the drug problem in Egypt better than the users themselves. At a private psychiatric hospital in Madinet Nasr, a whole department is dedicated to addiction therapy, where many patients are, unexpectedly, willing to tell their stories to whoever cares to listen. The majority of those interviewed are young male patients, between 16 and 26, from well-off, caring families -- the same families that put them in hospital. There is no female addict in the hospital to interview: one psychiatrist explains that female addicts are much rarer. He also adds that women are rarely admitted to hospital: the social stigma would be too great.
Most of the patients gave similar reasons for using drugs: peer pressure and availability. Few have problems with their families, or face psychological or social difficulties -- believed to be the most common causes of addiction.
Karim was only 22 when he became a regular drug abuser four years ago. Before that, he used to drink excessively. He says none of his family members drink or even smoke cigarettes, because these activities are "forbidden by religion". Well-dressed, clean-cut and articulate, he is from "a close and religious family". He started drinking after graduation, when he began to organise parties. "Drinking was the norm, and I used to spend most of the day out, away from my family," he recounts. Due to work obligations, Karim had to live on his own for long intervals of time, including a stint in France that lasted over a year.
"I really liked alcohol, but then I started to look for more," Karim explains. "I used hashish for a while, but then I wanted a better high. I ended up taking heroin. That was what ruined my life."
Karim started to have many physical problems. Lack of concentration, oversleeping and exhaustion were only a few of his symptoms. He was always absent from work, and his whole life revolved around getting the LE50 he needed every day for his fix.
"The pleasure of heroin usually disappears shortly after the body gets used to it and develops a physical dependence on the substance," Karim relates. "I felt like a disabled person who had to take the dose just to be normal. I was enslaved by this giant. The very idea suffocated me. I sometimes stole things from our house to get money for the drugs."
Karim, however, never thought about going to hospital. "My family forced me to come here, but now I thank them for it," he says with a smile. "I was afraid of being locked up in a hospital and of going through a painful withdrawal process. I tried to stop on my own, but I failed. Finally, this was the only solution."
Nader, 21, concurred. "I believe the problem is that drugs are readily available. Dealers are everywhere: shops, kiosks, cafés -- even on the streets. This, with the encouragement of bad friends and my lack of awareness, stirred my curiosity to try drugs, especially that there are cheap substances like bango [an especially powerful strain of marijuana] that can cost only LE10 a day." Although heroin was recently a bit more difficult to find than before, Nader insists more efforts should be exerted to reduce the drug supply. "Even when a dealer is locked up, one of his 'boys' takes over. Dealers always make sure their stock is accessible."
Many experts and officials, however, insist that reducing the supply side of the drug equation has always been the focus of Egypt's strategy to combat addiction. "Egypt is making headway in its battle against illegal drugs and crime amid a United Nations-sponsored regional initiative, which had reduced the level of drug addiction in the country and curbed illicit drug plantations in southern Sinai," notes Pino Arlacchi, UN under-secretary general and the executive director of the UN Organisation for Drug Control and Crime Prevention (ODCCP), at a press conference during his short visit to Cairo last July.
According to Egypt's Anti-Narcotics General Administration (ANGA), authorities seized 51,222kg of heroin in 1997, a slight increase over the 48,195kg taken in 1995. At a recent seminar, a documentary film showed ANGA's efforts to destroy the remote bango plantations of southern Sinai. That region became the largest source of marijuana and opium for the domestic market after Egypt regained the peninsula from Israel in the early 1980s. Sinai marijuana has largely replaced Lebanese hashish as the drug most commonly available on the Egyptian market.
Although hashish has been available for centuries, the real problem started in the 1980s, with the introduction of the Open Door policy. Drugs were coming into the country in greater quantities than before, and more people had the money to buy them. Sinai, Alexandria and the Gulf of Suez are still the main points of entry. Other sources are Bilbeis, Qantara and Sudan.
Despite government efforts, Arlacchi warns, "southern Sinai still has drug plantations. Drug-related crime could escalate in the future with the integration of the Middle East into the global economy." Many drug users also insist dealers are everywhere. Should drug-related laws be better enforced, or harsher penalties imposed?
"Egyptian law is one of the harshest in the world, including severe penalties for drug-related crimes, which range from fines to life imprisonment and death sentences," maintains Hassan El-Badrawi, a legal counselor at the legislation department of the Ministry of Justice and head of the Fighting and Treating Addiction Fund (FTAF). "But with any social phenomenon, people start criticising the law and demanding more severe punishment, which, in the case of drug abuse, is an oversimplification of the problem." Anti-narcotic laws have been modified several times, with stricter penalties added every time. Experts observed that whenever harsher penalties are imposed, a temporary decrease in the number of drug-related crimes is registered; but after a hiatus of a couple of years, it is back to business as usual.
"Imposing penalties, tracking down the culprits and seizing narcotics are only one side of the coin," El-Badrawi explains. All recent studies indicate that efforts to decrease the demand for narcotics should be conducted in tandem with reducing supplies. The drug trade will persist as long as there is a market. "Many European countries, like the Netherlands, for example, have recently resorted to new anti-narcotics strategies, legalising soft drugs to dissuade users from using stronger ones like heroin," El-Badrawi adds. "Of course, we wouldn't do the same, but at least we should focus on other means of reducing drug consumption. Otherwise, drug problems will continue to rise."
Studies conducted by Mustafa Soueif, professor of psychology at Cairo University and the retired head of the addiction programme at the National Centre for Social and Criminological Research (NCSCR), provide an integrated picture of the drug abuse situation in Egypt. Soueif spent more than 30 years studying the problem and came up with interesting results.
Reasons for drug abuse vary: peer pressure, family problems, academic failure, cigarette smoking and low religious affiliation are the factors most commonly cited by experts. There is also a weak, though significant, association between monthly income and drug use. The higher the monthly income, the higher the rate of drug abuse. The majority of users were found to have begun using drugs under pressure exerted by personal friends and other persons close to them, according to Soueif's studies.
"We are quite aware now that drug abuse is on the increase," maintains Dr Ahmed Okasha, professor of psychiatry at Ain Shams University, president of the Egyptian Psychiatric Association, secretary-general of the World Psychiatric Association, and director of the WHO collaborating centre in Cairo. Okasha was also a member of the scientific consultant committee, headed by Soueif, affiliated to the National Council for Fighting and Treating Addiction (NCFTA). "Rough estimates indicate that 1.5 million people use hashish. The number of heroin addicts ranges from 13,000 to 14,000 and up to 1.8 per cent of the population, mainly labourers and university students, use psychoactive pharmaceuticals such as anti-neurotic medication and sleeping pills. It is interesting, however, that 75 per cent of those who take drugs stop after experimenting. The remaining 25 are equally split into occasional users and addicts."
Recent surveys show that 30 per cent of male industrial workers and 20 per cent of male students have used drugs at one time in their lives. Girls account for four per cent of drug users, abusers and addicts. Bango and opium are the most used drugs, followed by psychoactive pharmaceuticals and heroin. The most vulnerable age group of drug users is that between 18 and 25, followed by that ranging from 25 to 35. People aged between 35 and 45 rank the third.
"Addicts may be classified into four types: the good, the bad, the sad and the mad," Okasha explains. A "good addict" is a person who, suffering from physical pain, takes medication to relieve it and gets hooked. The sad are depressed individuals who develop a physical dependence on anti-depressant medication. The mad are those who have a mental disorder, while the bad is a personality characterised since childhood by "deviant behaviour".
Addicts in general are anti-social persons who like to experiment to satisfy their curiosity and are sensation-seekers, Okasha says. They are social misfits, who have probably faced with academic failure and sought immediate gratification in drugs. Egyptian students tend to begin drug use with alcohol and then continue with the use of psychotropic substances before going on to natural narcotics such as cannabis and opiates, according to Okasha.
Egypt shifted its focus to reducing the demand for drugs after it joined the Vienna anti-narcotic accord in 1986. The NCFTA and the FTAF were established the same year to accomplish this objective. Since then, however, the council has accomplished only one per cent of its goals.
"Until 1997, we were busy preparing a reliable database for the problem of addiction in Egypt," concedes Soheir Lutfi, secretary-general of the NCFTA and head of the NCSCS. Lutfi explains that previous research work was inadequate. "All the studies were conducted from a psychological angle, ignoring all other aspects, and were usually carried out by students who were working for a university degree. But we have also started public awareness programmes, studied the possibility of creating alternative jobs for those who live off drug crops, and started a hotline to provide people with information about addiction," she adds.
The NCFTA is now launching a four-year survey of addiction in Egypt, two years of which have been completed. It has put aside a comprehensive strategy that took the council's scientific board, headed by Soueif, six years to produce. "We were about to put the strategy into practice when a new board took over the council and started its own studies from scratch," Okasha explains.
"But how can we combat the drug problem if we spend long years studying the phenomenon without immediately taking action?" exclaims Faisal Hegazi, UNIDCP national programme officer at the Regional Office for the Middle East and North Africa. "It is true that research is essential, but it should assume a faster pace. The drug problem is very dynamic, and today's research may be outdated tomorrow. Application should thus be immediately carried out. The drug mafia knows Egypt is a promising market due to a recent economic boom, and that's why we should move fast."
Many NGOs have already taken the initiative. Today, most of the addiction treatment hospitals are run by NGOs and private organisations. Only two departments in state-run mental hospitals are available to addicted patients.
"The problem of addiction has virtually proved that the government cannot combat it alone," asserts Dr Ahmed Gamal Madi Abul-Azayem, a psychiatrist specialised in treating addiction, and a member of the American Association for Psychiatry. Abul-Azayem is also a member of Pride Egypt, a Parents' Resource Institute for Drug Education. Pride's objectives revolve around prevention through education.
"Pride has made headway in reducing heroin use since its establishment in 1990," asserts Abul-Azayem. "It has contributed to raising public awareness by organising conferences, training school social workers, holding seminars in schools and training students, who can communicate with their colleagues, to participate in seminars on the dangers of addiction."
The organising has also been networking with the WHO in setting up drug prevention programmes, helping to improve conditions in hospitals treating addicts, and communicating with charitable organisations to include the treatment of addiction in clinics affiliated to mosques and churches, Abul-Azayem adds.
Many experts, however, believe the educational role of the mass media has recently dwindled and more efforts should be directed toward increasing public awareness. "Parents should be educated on how to diagnose addiction," cries Karim's mother. "I didn't realise my son was using heroin until his condition was already serious. Many of my friends had similar problems with their children, and none of them knew addiction could be treated, or that any specialised medical facilities exist. Kids also have to be well informed about the dangers of narcotics, and that can only be done through the media. Addiction is contagious, and I have to admit, it has spread to an unbelievable extent among boys and girls. My son is one example of how contagious it is, for he has always been intelligent. It is just unbelievable that he would slip into such a damaging habit. I think more hospitals should be established to treat the growing number of addicts."
For Okasha, however, rehabilitation is a priority. "We should not only think of building more hospitals: the medical part constitutes only 25 per cent of an addict's treatment," he says. Rather, he believes, psychiatrists, clinical psychologists, social workers, nurses, teachers, police officers, the media and recovered addicts should cooperate in following up on the rehabilitation of patients after treatment. "Without a rehabilitation programme, the probability of relapse is very high," Okasha warns. "The addict feels dislocated from society and he has to be integrated into it after treatment."
Five to 15 per cent of addicts die within three years of their first experience as a result of lung edema. Twenty per cent end up in prison, seven to eight per cent become mentally ill and 30 to 40 per cent suffer relapses after treatment. In Egypt, Okasha warns, the death toll is higher among addicts because most drugs are contaminated. Parents of young users concur. "A national initiative should be organised now. Our children are dying," pleads the mother of a 22-year-old heroin addict.