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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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Under the bridge downtown
Is where I drew some blood
Under the bridge
I could not get enough
Under the bridge
Forgot about my love
Under the bridge
I gave my life away – Red Hot Chili Peppers

Drug users are drawn to bridges. They offer a modicum of privacy and camaraderie to go about the illegal business of staving off opiate withdrawal and tamping down painful feelings. On a recent trip to Kabul, Afghanistan, I stood among dozens of men injecting heroin and inhaling opium vapors huddled under scarves in small groups under the Pul-i-Sokhta bridge – the name means “burned bridge.”

Some corners were so dark I wondered how users found a vein to inject. The smog of combustible opium filled the air. The soggy mud under our feet was full of putrid human detritus. I saw caked blood on track-pocked arms, weeping sores, scars and necrotic tissue. All I could think of was this: It doesn’t have to be this way. The hell and human suffering under the Pul-i-Sokhta bridge is entirely man-made. Drug users in Kabul need a safe injection site ( like this one), but instead, many will die from bloodborne infections and preventable diseases like HIV/AIDS and Hepatitis C.  

Drug users at Pul-i-Sokhta bridge

I was at the bridge with a group of outreach workers from the Organization for Harm Reduction in Afghanistan (OHRA), who deliver “kites” filled with condoms, syringes and alcohol pads. Amidst feces, discarded syringes, cigarette butts and crushed plastic bottles, men surrounded me and Ziauddin, a former heroin user and a peer educator for OHRA. They shouted loudly and angrily about the police. Drug users are routinely assaulted and injured by officers driving them away from the bridge. Some are arrested. One man was beaten to death; Ziauddin showed me a picture of the dead man taken with his cell phone camera.

There is a mosque next to the bridge, and Ziauddin said the Mullah has given permission for Muslims to attack drug users with heavy wooden sticks. Hospitals openly refuse to treat the drug addicted. “We have no rights,” the men said over and over again. Then came a series of desperate pleas to the outreach staff, for basic items like food, clothing, housing and money. The men believe it’s the government’s responsibility to help them, although they’re cynical enough to understand that their criminal status makes any assistance unlikely.  

Ziauddin and Nazir, outreach workers from the Organization for Harm Reduction in Afghanistan, talk with a drug user.

Ziauddin explained many of the men have lost family support due to their opiate addiction. In Afghanistan, drug use brings tremendous shame to families. But to be without family is emotionally devastating in a country where there are few social support programs. Drug users depend on each other for survival, and meeting in public places to use drugs creates alternative families and community. 

Scars of War

Afghans use drugs for many reasons, but in a country that’s suffered 30 years of uninterrupted war and foreign occupation, it’s no suprise that many men, women and even children use opiates. Opiates are well known for their calming effect, as well as their ability to mediate unpleasant emotions and suppress traumatic memories. Heroin and opium are fast-acting, powerful pain relievers with effects that last a long time, from seven to eight hours depending on the purity, which in Afghanistan, outreach workers told me, is about 80 percent.  

The trauma of war creates the conditions for, and increases the risks of drug addiction. The prevalence of post-traumatic stress disorder (PTSD) in Afghanistan is among the highest in the world. Add that to the facts that more than 20 million Afghans live in poverty, the unemployment rate is 35 percent, and hundreds of thousands of internally displaced people live in squalid refugee camps. No one in Afghanistan talks about addiction as a brain disease; it seems obvious that addiction is a response to trauma and social and economic deprivation.  

 
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