History of hedonism and inclination towards forbidden is as old as humankind, starting from the forbidden garden. Recent surge in increase SUD worldwide is obvious and evident in International Classification of Diseases 11 version, according to which more addictive substances were added to the chapter with more types of induced disorders included.1
In Pakistan, situation is not different from rest of the world. Increase in use of addictive substances with lesser treatment facilities and greater stigma is just like adding insult to the injury. According to UNODC Drug Report 2017, there are 8 million opioid dependents, 4.5 million cannabis abusers in Pakistan.2
The genesis of Pakistan’s opioid epidemic is critical to understand as the country became victim to the proximity to, and politics of, Iran and Afghanistan. There is poor resource allocation for the treatment of substance use disorder, especially in comparison to what is spent on counter-terrorism. Addiction has had a devastating effect on children and the youth of Pakistan. It is vital to recognize addiction as a chronic disease comparable to diabetes, hypertension and asthma; and not a personal weakness. Medication-assisted treatment includes using buprenorphine-naloxone and naltrexone for opioid use disorder, injectable naltrexone for alcohol use disorder, and mirtazapine and bupropion for amphetamine use disorder. Coordination between the healthcare system, the Anti-Narcotics Force, the pharmaceutical industry and parliament is important. A university-affiliated addiction center should be developed so it can provide guidance with research and treatment. Buprenorphine-naloxone and injectable naltrexone are urgently needed at an institutional level for the treatment of opioid and alcohol use disorder.3
The efficacy of prescribing medication online or through telemedicine is well established.4
In Pakistan, we used this telemedicine specifically after COVID-19 effectively along with other non-pharmacological interventions like Motivational Interviewing, Family therapy, Interpersonal therapy, CBT, Dialectical Behavioral Therapy and specifically Mindfulness through telemedicine to treat substance use disorders.
REFERENCES
- International Classification od Diseases version 11.
- UNODC Drug Report 2017.
3.Islam M. State of the art treatment options for Pakistan’s opioid, alcohol and methamphetamine crisis. J Pak Med Assoc. 2020 Jun;70(6):1063-1068. doi: 10.5455/JPMA.29284.
- Weintraub E, Greenblatt AD, Chang J, et al. Outcomes for patients receiving telemedicine-delivered medication-based treatment for Opioid Use Disorder: A retrospective chart review. Heroin Addict Relat Clin Probl. 2021;23(2):5-12.