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Heroin Track Marks Are the Scars of War in Afghanistan

Decades of war have driven many Afghans to heroin, but addicts face stigma and trauma.

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The Need for Peace

Back under the burned bridge in Kabul, Azim, his glassy pupils constricted to pinpoints, tells me he started using opium to cope with myriad losses when he was a 13-year-old. Now he injects heroin. A thick rubber band is wrapped tightly around Azim’s thigh and as I watch, he tries in vain to find a vein in his groin. The sharp needle hovers above his skin, but then he slowly places the syringe on the dusty ground and nods off. He does this over and over again. 

Another regular at Pul-i-Sokhta bridge is a young man named Shams. He’s been using heroin for many years and says it helps him concentrate at work. He’s a translator for the U.S. military at Bagram prison, and his English is excellent. Other drug users explain that they moved illegally to Iran to find work to support their families. They found poorly paid employment and a lot of cheap heroin. Afghans are scapegoated for many social problems in Iran, and drug use was how they coped with both discrimination and the depression of being separated from loved ones. 

Afghan man suffers from stigma and isolation.

Afghan women use opiates too. It is estimated that between 18,000 to 23,000 women are smoking opium or injecting heroin. Women are never seen getting high in public; they have drugs delivered to the privacy of their homes. Mothers, particularly in remote, rural areas, give opium to sick children (they blow the smoke into their mouths) because they lack access to healthcare and other non-opioid medications. Some of the children become addicted.      

Many opiate users want drug treatment, so Nazir, another peer educator, scribbles their names on a waiting list to get into a methadone program. The problem is there are over 7,000 opiate addicts in Kabul and one methadone clinic in the city that serves only 77 people. Drug warriors in the Afghan government, like their counterparts in Russia, don’t like opiate substitution therapy (OST) and on two occasions blocked shipments of methadone from coming into the country. They prefer to fund abstinence-based treatment despite its high failure rate. Government drug prevention and education materials use the discredited slogan, “Just say no.”

It was left to the French doctors' organization, Médicins du Monde (MDM), to open the first methadone clinic in Afghanistan in partnership with OHRA. In 2012, the Afghan Ministry of Public Health accepted the necessity of OST and took over from MDM but capacity hasn’t increased to meet the need, and methadone maintenance is considered a “pilot” program, as if its efficacy needed to be studied.  

A man asks for methadone.

The Afghan government refuses to adequately fund validated harm reduction interventions to treat opiate addiction, reduce the spread of HIV, lower the rate of overdose deaths and decrease the sharing of syringes. Treating drug addiction and stopping the spread of infectious diseases isn’t difficult. A report by the Global Commission on Drug Policy outlines  how to do it: Mobile methadone vans, heroin or buprenorphine prescriptions, safe injection sites, condoms and naloxone distribution, and syringe exchange. These science-based, inexpensive, life-saving interventions are available right now. 

It is the criminalization and demonization of drug users, funded and fueled by the U.S. war on drugs in Afghanistan that makes implementing these common sense and humane measures difficult. The Drug Enforcement Administration, the U.S. military and the U.S. Agency for International Development (USAID) have wasted billions of dollars on poppy eradication, alternative crop development and hunting down, prosecuting and incarcerating thousands of Afghans involved in the drug trade. The enforcement-led, punishment approach  hasn’t made a dent in opium cultivation, the availability of heroin or the rate of addiction. That money needs to be channeled into a massive expansion of drug treatment that is available to anyone on demand. 

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