An addict injecting heroin on the outskirts of Peshawar. Credit: Ashfaq Yusufzai/IPS.

By Ashfaq Yusufzai
PESHAWAR, Mar 22 2014 (IPS)

Pakistan may have low prevalence of HIV/AIDS, with only about 9,000 officially confirmed cases, but the country is at high risk, particularly due to a growing number of injecting drug users (IDUs), say experts.

Of the country’s 180 million people, 420,000 are IDUs according to the Drug Use in Pakistan survey conducted last year.“In 2007, Pakistan had an estimated 90,000 IDUs and the number has now risen to around 500,000."

“IDUs contract HIV by sharing infected syringes. We are afraid that HIV/AIDS can spread to the general population through them,” Syed Mohammad Javid, manager of the National AIDS Control Programme (NACP) told IPS.

He said the easy availability of heroin from nearby Afghanistan, where large swathes of land are under poppy cultivation, has become a pressing problem for Pakistani cities. Peshawar, capital of the northern Khyber Pakhtunkhwa province, is one such place.

“Twenty percent of IDUs have tested positive for HIV/AIDS in Peshawar, which is alarming,” he said, citing a study conducted by the Canadian International Development Agency (CIDA) in collaboration with the NACP in 2010.

A similar study in 2008 had put the figure at 13 percent, Javid said, pointing out that HIV/AIDS prevalence is increasing.

He said Pakistan has officially declared 9,000 confirmed cases of HIV/AIDS. But the World Health Organisation (WHO) estimates that the actual number could well be more than 100,000.

Javid said in 2010 the World Bank had stopped funding free services for HIV infected drug addicts as the money had to be diverted for use in flood-hit areas. This compounded the problem, he said.

Dr Abdul Hameed, a WHO medical officer, is deeply concerned over the sharp rise in HIV/AIDS cases among IDUs because there is no official detoxification and rehabilitation programme in the country.

Hameed said the health department and donor agencies used to believe earlier that HIV/AIDS had no local source in Pakistan, and blamed an HIV positive immigrant population deported from the United Arab Emirates and other countries.

“A WHO study has proved that the infection has potential local source, namely IDUs, which warrants administrative support to addicts at antiretroviral therapy (ART) centres,” Hameed said.

Pakistan has set up 13 ART centres in collaboration with the WHO where around 5,000 patients have received treatment so far.

Oussama Tawil, UNAIDS country coordinator for Pakistan and Afghanistan, told IPS that a high incidence of HIV/AIDS among IDUs in Peshawar had alarmed UN agencies.

“The number of IDUs who share syringes has increased from 500 to 1,800 in the city over the last three years,” he said. The situation is also dismal in other Pakistani cities such as Karachi, Faisalabad, Sukkur, Larkana, Lahore and Rawalpindi, he said.

“In 2007, Pakistan had an estimated 90,000 IDUs and the number has now risen to around 500,000,” Tawil said.

UNAIDS is in the process of establishing 20 wards for detoxification and rehabilitation of IDUs. NGOs will locate IDUs and bring them to the wards for detoxification. Those with HIV will be taken to ART centres for treatment, Tawil said.

NGOs have also been tasked with implementing the UN’s needle exchange programme under which IDUs will be given sterilised needles to end the use of contaminated ones and prevent the human immunodeficiency virus (HIV) from spreading, he said.

This is a pilot programme for Peshawar and will be launched in other cities later.

After detoxification, the IDUs will be counselled and tested at ART centres so that they don’t go back to narcotics, Tawil said.

The 2013 survey, Drug Use in Pakistan, jointly conducted by the Narcotics Control Division, Pakistan Bureau of Statistics and UN Office on Drug and Crime (UNODC), shows that around 4.25 million people in the country are drug dependent.

Mian Zulqernain Amir, joint secretary of the Narcotics Control Division, told IPS that in the last 12 months only 30,000 adult drug users had access to treatment, mostly at private centres run by NGOs.

“However, we now have baseline information on the prevalence and pattern of drug use among the population and we are taking steps, in collaboration with the UN and NGOs,” he said.

The survey on Drug Use in Pakistan showed that cannabis was the most commonly used drug in Pakistan, with four million people listed as users. Opium and heroin were used by about one percent of drugs users. The highest levels of heroin use was seen in provinces bordering poppy cultivating areas in Afghanistan.

“We are making history: Uruguay approves the regulation of marijuana” reads this poster by an advocacy group that lobbied for state regulation and control of marijuana. Credit: Courtesy Proderechos.

By Inés Acosta
MONTEVIDEO, Jan 12 2014 (IPS)

Uruguay, about to become the first country in the world where the state will fully regulate production, sale and distribution of marijuana, will spend the next few months selecting a good quality strain of the crop that can be sold at a price similar to current illegal prices.

Uruguayan President José Mujica signed law 19.172 on the regulation of marijuana on Dec. 23. But it won’t go into effect until April, 120 days after it was approved by Congress on Dec. 10, and once the government has established specific regulations for the new legislation.

Since the 1970s, consumption and possession of small amounts of marijuana for personal use have not been penalised in this South American country of 3.3 million people sandwiched between Argentina and Brazil. But cultivation, sale and distribution of the drug have been illegal up to now.

When the 44-article law enters into force, the entire sector will be under the regulation and oversight of the Institute for the Regulation and Control of Cannabis, a new government institution created by the law.

But there is much to do before April. Among the most important steps are to decide the type of marijuana to be planted, who will grow it and at what cost, and what price it will fetch in the pharmacies.

The registries of users and others involved in the different marijuana-related activities also have to be created, as well as the so-called cannabis clubs, to ensure the traceability of the legal strain of marijuana.

Social organisations and activists are studying the best way to produce competitively-priced high-quality marijuana while involving small and medium Uruguayan producers and preventing foreign companies from taking over the activity.

The aim of the law is to “put the availability of marijuana for users in the hands of, or under the control of, the state,” Senator Roberto Conde of the left-wing governing Broad Front told IPS.

“A free market of marijuana or other drugs is not being created here,” Conde explained. “People will have access to marijuana by planting it themselves, in cannabis clubs, or from pharmacies, by presenting their ID card.”

Legal marijuana – up to 40 grams a month (around 40 joints) – will only be available to residents of Uruguay who have signed up for a federal registry.

Individuals will be allowed to grow up to six plants or 480 grams a year.

“That is what is technically estimated as reasonable, to keep someone from falling into problematic use of the drug,” the senator said.

Martín Collazo, with the Proderechos human rights group, said public health will be the area that most benefits from the law. “Eighty-five percent of users of illegal drugs in Uruguay only consume marijuana,” which means the illegal market could shrink by a similar percentage, he argued.

“Contact with the clandestine market facilitates access to other substances, like cocaine or ‘pasta base’ [a cheap cocaine derivative], which are sold in the same places,” said Collazo, who also belongs to the Responsible Regulation coalition, made up of organisations and personalities in favour of the regulation of marijuana.

The price of marijuana to be sold in authorised pharmacies has not yet been set. Collazo estimates that the price per gram should be between 1.00 and 1.50 dollars – the current cost of illegal cannabis.

“There is a big comparative advantage in terms of quality, because illegal marijuana is very bad,” the activist said. But he warned that it can’t be more expensive than on the illegal market, “because there would be a segment of the population that would continue to buy it on the black market.”

Proderechos has been working with agronomists and economists since November, and has formulated production models that confirm that marijuana could be produced in Uruguay at that price.

The Drug Policy Research Centre based in Santa Monica, California says illegal production and sale of drugs is more expensive because of the high costs of security, transport and protection of merchandise.

Collazo believes practice will show to what extent that is true. If marijuana has to be cheap, he said, the quality is likely to be inferior to what is sold in the Netherlands, where the drug is legally sold in special coffee shops.

“But we don’t have to reach that level of quality in the first year,” he said. “This has to be seen as a gradual process of developing the chain of production.”

He explained that the production of one ton of good-quality marijuana could cost around 250,000 dollars – between 0.25 and 0.30 cents per gram – “in a low-tech setting, with one or two harvests a year.”

The expert said that in the current clandestine market, the marijuana comes from Paraguay, and includes “leaves, stems, really bad quality flowers, and additives like ammonia, which are put on the compact bricks to keep them from drying out in transportation.

“Now we’re talking about selling buds,” without leaves or stems, which, “even if they are not big and beautiful are an excellent quality flower,” he said.

“We are generating our own information, with the support of different professionals, and we are coming up with proposals that we will formally present later,” Collazo said.

The aim, he said, “is to generate production schemes that can easily be followed by small and medium producers at a reasonable cost, and that will put marijuana on the market at a price similar to those on the black market.”

There are already people planting marijuana in Uruguay, producing supposedly standardised varieties.

Regarding the possibility of guaranteeing traceability of the drugs circulating in the new regulated market, Collazo suggested “trying to get growers who produce for the pharmacies to always plant the same strains.

“If the growers take the authorised strains and use cuttings from the mother plant, they’ll always have the same crop, genetically,” he said.

That traceability would only be lost when producers introduce new varieties, he added.

Collazo said it would be easy to maintain traceability in sales through pharmacies in the tightly regulated and controlled new market.

But “other solutions would have to be studied for people who grow their own pot, and for the cannabis clubs, because those are much more difficult to control,” he added.

Senator Conde, on the other hand, said it would be easy “because from a scientific point of view, the advances made today are so huge that molecular traceability of the substance is possible, and in Uruguay we have sufficiently developed technology, and whatever we don’t have, we can ask for.

“Instead of setting a price, a fee will be set for users to pay for the public service of making a product that is chemically controlled from every point of view available to users,” he said.

Conde added that whether or not the state will subsidise marijuana in any form “is being debated” in the government.

“This will be decided within the 120 days we have for creating the regulations for the law. I don’t know if a subsidy will be necessary to implement it. If it is, it wouldn’t be an isolated subsidy, but just one more cost in our overall health policy,” he said.

There are between 18,000 and 20,000 habitual consumers of marijuana in Uruguay, and between 79,000 and 100,000 people who use it a few times a month.

Female cannabis plant. Credit: Bokske/CC BY 3.0

By Emilio Godoy and Inés Acosta
MEXICO CITY/MONTEVIDEO, Sep 27 2013 (IPS)

In Latin America, where marijuana is the most widely consumed illegal drug, there is basically no home-grown research into its effects and properties. But possible legalisation in Uruguay and the Mexican capital could open the door to new studies.

“We can’t close our eyes to serious research in other parts of the world,” Rodolfo Rodríguez, a scientific researcher at the department of pharmacology in the National Autonomous University of Mexico (UNAM) medical school, told IPS.

Rodríguez, who has been studying different psychotropic substances for 45 years, is one of six experts making up the Marijuana and Health Group at the National Academy of Medicine who are completing a theoretical study on the medicinal and therapeutic effects of Cannabis sativa.

One of Rodríguez’s interests is to learn about the drug’s effects in patients with chronic or terminal diseases, such as fibromyalgia, multiple sclerosis, or certain kinds of cancer.

The results of their work, set to come out in October or November, will inform the debate that Mexico City authorities are holding with a view to legalising the medical use of marijuana.

The left-wing city government of Miguel Mancera and the Mexico City legislative assembly are assessing the health, economic and security aspects of legalisation.

“It’s a plant with more than 400 chemical substances and more than 70 cannabinoids,” Rodríguez said. “When it is consumed, the effects aren’t only due to the delta-9 [tetrahydrocannabinol or THC, the primary psychoactive ingredient in marijuana], but to the combination of all of the chemical compounds.”

Marijuana is mostly grown in the western and southern states of Mexico, largely to supply the lucrative U.S. market. Tens of thousands of small and large farmers and rural workers depend on the illegal crop for a living.

It is used by four million people in this country of 118 million, making it the most widely consumed drug, followed by cocaine, according to the health ministry’s National Addiction Survey 2011.

In Uruguay, far to the south, it is also by far the drug of choice, consumed by slightly over eight percent of the population. But almost all of the marijuana used in the South American country is smuggled in from outside, especially from Paraguay.

Consumption and possession of small amounts of marijuana for personal use are not penalised in Uruguay, a country of 3.3 million people sandwiched between Argentina and Brazil.

And the lower house of Congress has approved a draft law that would legalise and put the production, distribution, and sale of marijuana in the hands of the state. It is expected to make it through the Senate shortly and be passed into law, with the votes of the ruling left-wing Broad Front party.

More than 6,000 studies on the properties and effects of cannabis were published in scientific journals from 2010 to 2012, according to NORML, an organisation that advocates the legalisation of marijuana.

Uruguayan biologist Cecilia Scorza, assistant researcher at the Clemente Estable Institute for Biological Research, said “it’s not worth working on something that has been studied for so long, because it would not be original research.

“With marijuana, there can be differences in terms of the quantity of the active ingredient. But it’s always the same ingredient, and the effects are the same too,” she told IPS.

She pointed out that this is not at all the case for the cheap cocaine derivative known in South America as basuco, paco or pasta base, which poses a great potential risk to the user’s health.

The drug’s impact on the region and the lack of scientific research on it have made it a prime focus of studies. “In 2005, we began to research the chemical composition of the drug and its pharmacological effects on the central nervous system,” Scorza said.

But she said it would be original to study the chemical composition of the marijuana that has begun to be produced in Uruguay, “because it would give us a notion of what people will be consuming under the new law.”

Psychologist Gabriela Olivera, a technical adviser to Uruguay’s National Secretariat on Drugs, said research was indispensable to help users stay safe.

The draft law foresees the provision of “information and education that would make it possible, for example, for a person in certain health conditions who consumes marijuana to know that if they use such and such a quantity there is an active ingredient that could provide benefits, but would also have negative consequences,” Olivera told IPS.

To carry out experiments with psychoactive substances, a permit is currently needed from the National Secretariat on Drugs, which only exceptionally makes available a small quantity from drugs that have been confiscated.

“That makes systematised research impossible,” Olivera said.

Once it is passed, the law will create the Institute for the Regulation and Control of Cannabis (IRCCA), whose mission will include advising the government and providing scientific evidence.

The evidence would involve “all aspects, from the chemical composition of the marijuana that will be sold, to the effects on people, depending on its different uses – medicinal or recreational,” Olivera said.

In addition, the Technical Forensic Institute, the Technical Police laboratory, and the Chemistry Faculty of the University of the Republic are designing a research protocol on the potency of THC and other components of the marijuana that is trafficked illegally today, the director of the Uruguayan Observatory on Drugs, Héctor Suárez, told IPS.

Research on the varieties produced and sold legally would be regulated once IRCCA was up and running, he said.

In Mexico City, meanwhile, even if the medicinal use of marijuana is legalised, patients would not start receiving prescriptions overnight, Rodríguez said.

“We are not prepared for that,” the UNAM researcher said. “We have the knowledge and the infrastructure, but it would imply an educational process in health institutions.”

Treatment with marijuana “cannot be within reach of just any doctor, and learning about it can take months or even years,” he added.