# Pattern of Drugs Misuse among Patients attending Iftikhar Psychiatric Hospital, Peshawar

Ghaazaan Khan, Mian Mukhtiar Ul Haq, Aimal Khan, S M Naeem, Iftikhar Hussain, Mian Shafiullah

<figure><img src="image_1.png" /></figure>

## To cite this version:

Ghaazaan Khan, Mian Mukhtiar Ul Haq, Aimal Khan, S M Naeem, Iftikhar Hussain, et al. Pattern of Drugs Misuse among Patients attending Iftikhar Psychiatric Hospital, Peshawar. Journal of Saidu Medical College, 2021, 10 (1), pp.88-92. hal-04852779

HAL Id: hal-04852779

https://hal.science/hal-04852779v1

Submitted on 30 Dec 2024

HAL is a multi-disciplinary open access
archive for the deposit and dissemination of sci-
entific research documents, whether they are pub-
lished or not. The documents may come from
teaching and research institutions in France or
abroad, or from public or private research centers.

L'archive ouverte pluridisciplinaire HAL, est
destinée au dépôt et à la diffusion de documents
scientifiques de niveau recherche, publiés ou non,
émanant des établissements d'enseignement et de
recherche français ou étrangers, des laboratoires
publics ou privés.

<figure><img src="image_2.png" /></figure>

Distributed under a Creative Commons Attribution 4.0 International License
# Pattern of Drugs Misuse among Patients attending Iftikhar Psychiatric Hospital, Peshawar

Ghaazaan Khan<fnref n="1" />, Mian Mukhtiar ul Haq<fnref n="2" />, Aimal khan<fnref n="3" />, S. M. Naeem<fnref n="4" />, Mian Iftikhar Hussain<fnref n="1" />, Shafiullah<fnref n="3" />

## ABSTRACT

**Background:** Drug addiction is a very common issue in Khyber Pakhtunkhwa due to easy availability of drugs on account of sharing border with Afghanistan, illiteracy and lack of implementation of laws to deal with drug trafficking. There is need to study the pattern of misuse of illicit drugs in this region.

**Objectives:** To determine the pattern of drugs misuse among patients attending Iftikhar Psychiatric Hospital, Peshawar

**Material and Methods:** It was a descriptive study, carried out on 135 persons, with history of drugs misuse, who were presented to Iftikhar Psychiatric Hospital, Peshawar, from January 2019 to December 2019. Urine samples of every subject were screened for various drugs using immune chromatography technique.

**Results:** The most frequently misused drug in the study was Opiate (84%) followed by Marijuana(76%), Benzodiazepines(43%), Methamphetamines(8%), Tricyclic antidepressants(4%) and cocaine(0.74%). Out of the total 135 patients, 133(98.5%) were males while 2(1.5%) were females. Poly substance misuse was more predominant in the study.

**Conclusion:** Drug addiction is a very serious public health issue globally including Pakistan. Male addiction predominance and opiates overuse is observed high in the present study. There is need to take all necessary steps to curb the curse of drug abuse.

**Key Words:** Pattern, Drugs misuse, Immune chromatography

This article may be cited as: Khan G, Haq MM, Khan A, Naeem SM, Hussain IM, Shafiullah. Pattern of drugs misuse among Patients attending Iftikhar Psychiatric Hospital, Peshawar. 2020;10(1):88-92

## INTRODUCTION

Humans have been using drug in some form since prehistoric era. Wine was under use from the time of early Egyptians; narcotics had been used as drugs since 4000B.C; and marijuana was used for medicinal purpose in ancient China<fnref n="1" />.

Drug misuse is the continuous consumption of a substance despite evidence of damage to the user's physical or mental health<fnref n="2" />. Addiction is the compulsive use of psychoactive drugs at the cost of ignoring socially important activities<fnref n="3" />. According to the United Nations Office on Drugs and Crime June 2018 world drug report, the non-medical use of drugs has been a serious hazard to community health<fnref n="4" />. Drugs misuse is a social disorder producing many physical and psychosocial problems with enormous health care costs⁵.

Dependence is repeated intake of a drug owing to development of a strong desire to do so, ignoring alternative sources of satisfaction due to involvement in substance taking activities, developing tolerance to the specific drug and getting withdrawal symptoms while suddenly

stopping it. Tolerance is the condition in which a drug dependent patient tends to use higher doses of drug to get the same effects which it used previously to get with smaller doses of the same substance⁶. Substances commonly misused are alcohol, psycho stimulants, tobacco, cannabis, opioids, inhalants, hallucinogens and physician prescribed sedatives⁷.

The peak age of onset of substance misuse is adolescence. Risk factors include easy availability of illicit drugs, male gender, poor social status, family history of drug misuse, peer pressure, parental conflicts/separation, poor parenting styles, history of childhood abuse/neglect, positive cultural norms about illicit substances, illiteracy etc⁸. In Pakistan, almost 5.8% of adult population is misusing drugs, mostly cannabis followed by opiates. About 0.4% of our population injecting drugs<fnref n="1" />,⁹.

Being a part of the Golden Crescent and subject of the 21st millennium Great Game, Pakistan is not only involved in the curse of illicit substance trafficking, specially cannabis and diacetyl morphine (heroin), but also a victim of the same menace¹⁰,¹¹

In Khyber Pakhtunkhwa, we see diverse responses related to medical treatment of drug abuse. Many people don't bother about substances like tobacco, some may conceal it for its illegality or social disapproval¹², while a few are

<footnote n="1">1. Iftikhar Psychiatric Hospital, Peshawar</footnote>

<footnote n="2">2. Lady Reading Hospital, Peshawar</footnote>

<footnote n="3">3. Nowshera Medical college, Nowshera</footnote>

<footnote n="4">4. Saidu Medical College, Swat</footnote>

<footnote>Correspondence: Dr. Ghaazaan Khan, Iftikhar Psychiatric Hospital, Peshawar
Email: dr.ghzankhan@gmail.com</footnote>
subjected to treatment on their own or by their families. The pattern of drug abuse observed in patients seeking treatment is somewhat different from the pattern of drug abuse found in general population and needs consideration.

The drugs of abuse can be detected in samples of urine, blood, saliva etc by various simple, rapid and economical screening methods like thin layer immune chromatography. High performance chromatography and mass spectrometry may be used to confirm the results. Urine is the sample of choice for its easy collectivity and higher content of drugs¹³.

The present study was carried out to explore the pattern of drug misuse in patients attending psychiatric facilities for treatment purposes.

## MATERIALAND METHODS

It is a descriptive cross sectional study which was conducted on 135 persons at Iftikhar Psychiatric Hospital, Peshawar, a private institution with in- and out-patient facilities, well equipped laboratory as well as detoxification center. The study duration was from 1st January 2019 to 31st December 2019. Patients who attended the out-patient department with history of drug abuse for the purpose of treatment to get rid of the drug taking habit or its co-morbidity, were included in the study. They and their nearest relatives/attendants were briefed about the study to take their consent.

The urine samples of the subject patients were analyzed in the hospital laboratory by immune-chromatography for nine drugs, namely marijuana (THC), cocaine, methamphetamine, benzodiazepines, tricyclic antidepressants, barbiturates, phencyclidine, morphine and methadone. After collecting urine in a dry, clean container, 03 drops of urine were added to the test device. Result was observed in the form of colored lines, after five minutes. A colored line in the

control line region(C) and a colored line in the test line region (T) for a particular drug exhibited negative result. A colored line in the control line region (C) but no line in the test line region (T) for a certain drug indicated positive result.

Test principle is based on competitive binding. Drug present in the test sample compete against the drug conjugate for binding site on the antibody. The test sample migrates through capillary action on the test device. Sample with sufficient concentration of the analyte saturates antidrug antibodies and produce no colour line in the test region, while drug negative specimen or containing lower concentration of analyte than the cut-off, generates no colour line in the test region. Amazon EZ 12 panel multi drug test kit was used for drug testing.

Quantitative variables like age were presented as mean and standard deviation (SD). Qualitative variables like gender, positive results for each drug and number of drugs of misuse were presented in the form of frequencies and percentages. All collected data was entered and analyzed using Software SPSS (Version 20).

## RESULTS

Out of total 135 patients, 133(98.5%) were males while 2(1.5%) were females. The two females in our study were addicted to an opioid drug, tramadol. Age ranged from 16-60 years and the mean age of the sample was 31.69(SD 11.48). Misused drug included opiate (84%), Marijuana (76%), Benzodiazepines (43%), Methamphetamines (8%), Tricyclic antidepressants (4%) and cocaine (1%); Barbiturates and Phencyclidine were not detected in any patient in our study. Out of total 135 patients, 121(89.62%) were using two or more drugs while 14(10.38%) were addicted to single drug.

<table><caption>Table 1. Age wise distribution of the subjects</caption><thead><tr><td>Age ranges(years)</td><td>No. of patients (frequency)</td><td>%ages</td></tr></thead><tbody><tr><td>16-24</td><td>42</td><td>31%</td></tr><tr><td>25-39</td><td>64</td><td>47%</td></tr><tr><td>40-60</td><td>29</td><td>22%</td></tr><tr><td>Total</td><td>135</td><td>100%</td></tr></tbody></table>
<table><caption>Table 2. Drug wise frequency distribution.</caption><thead><tr><td>Drugs of misuse</td><td>No. of patients(frequency)</td><td>%ages</td></tr></thead><tbody><tr><td>Opiates</td><td>114</td><td>84%</td></tr><tr><td>Marijuana</td><td>103</td><td>76%</td></tr><tr><td>Benzodiazepines</td><td>58</td><td>43%</td></tr><tr><td>Methamphetamines</td><td>11</td><td>8%</td></tr><tr><td>Tricyclic antidepressants</td><td>6</td><td>4%</td></tr><tr><td>Cocaine</td><td>1</td><td>0.74%</td></tr></tbody></table>

<table><caption>Table 3. Frequency of patients misusing single/multiple drugs</caption><thead><tr><td>Single/poly drug users</td><td>No. of patients (Frequency)</td><td>%ages</td></tr></thead><tbody><tr><td>Single Drug users</td><td>14</td><td>10.38%</td></tr><tr><td>Poly Drug users</td><td>121</td><td>89.62%</td></tr><tr><td>Total Drug users</td><td>135</td><td>100%</td></tr></tbody></table>

## DISCUSSION

Drug addiction is a global issue¹⁴. Illicit drug use accounts for heavy economic loss, disability and mortality globally¹⁵. Suicide is a major cause of death in youth, its risk being 3-9 times higher in drug addicts¹⁶. Substance abuse not only increases the risk of developing various mental disorders but also upturns their severity and chronicity, sometimes termed 'dual diagnosis'¹⁷. Drug overdose, especially prescription opioids, is one of the alarming and leading cause of deaths in US and has attained the form of an epidemic¹⁸. Illicit drug use is also associated with various crimes and unlawful behaviors like robbery, theft, rape, violence, kidnapping and even murder. Illicit drugs produce their addictive effects on CNS, firstly by excitation of mesolimbic area, also called reward pathway, producing pleasurable feelings and secondly by inhibition of brain regions responsible for perception of pain sensations¹⁹.

Out of the total 135 patients, 133(98.5%) were males while 2(1.5%) were females. These findings are comparable to the findings of another local study by Farhan et al wherein drug misuse is more common in males than females²⁰. Another study conducted by Oche Joseph Otorkpa in Nigeria, a developing country, also reported increased drug misuse in men as compared women²¹.

Less number of females in our study reflects actual paucity of female drug abusers in our general population, probably related to our cultural values, subordinate socio-economic status of woman in our setup and their limited access to illicit drugs in general. However, a local study conducted in KP educational institutions

revealed that about every 4th substance abuser was a female. Most of the subject students were boarders²². This could be due to lack of family constraints and poor institutional controls in these environments, giving even females the chances of drug abuse. More comprehensive studies are needed to confirm or refute such a claim of high female drug abuse in KP educational institutions.

The mean age of subjects in our study was 31.69 ranging from 16 to 60 years with the highest frequency of drug addicts seen in the age range of 25-39 years which is comparable to the findings in UNODC report in Pakistan (2013)²³. These findings are also comparable to the studies of Farhan et al and Datta et al. in which the mean age of participants were 30 and 27 respectively²⁰, ²⁴.

Excluding tobacco, whether used in smoked (cigarette) or smokeless (Naswar) forms, cannabis is the most common substance of abuse even in developed countries like US²⁵. In Khyber Pakhtunkhwa, Pakistan also, cannabis is the most common substance of abuse followed by opiates, particularly heroin²⁶. The most common drug of abuse detected in our study belonged to opiate group (heroin/opium). Two female patients in our study were addicted to tramadol which also belongs to opiate group. Although tramadol has minor abuse potential, there have been similar reports in other international studies²⁷.

Even with high incidence of cannabis use in the population, our study reveals lesser number of such patients attending our psychiatric facility for treatment purposes as compared to opiate addicts. This is likely due to more severe adverse effects related to opiates in comparison to
cannabis with more social pressure on opiate users for treatment. Such perception is also evident at international level where opiate addiction is considered as epidemic while state policies are changing towards cannabis wherein the population of its users is not only rapidly increasing²⁸, its sale and use are becoming legalized even for recreational use in some US states and Canada²⁹. Such lenient attitude towards cannabis use is developing on the face of established association between cannabis use and psychosis³⁰ rather it is considered that such legalization may reduce opiate related harms³¹.

Afghanistan is the largest opium producing country and due to high degree of drug trafficking to Pakistan through Pak-afghan border there is high frequency of opiate misusers in Pakistan³². In 2014, Pakistan was declared as the largest heroine addicted country of the world³³.

The 3rd most frequently abused drug in our study was benzodiazepines (43%) which is comparable to the findings in another study conducted in Pakistan by Syed Ahmer et al in which the frequency of benzodiazepines in psychiatric outpatients was 45%³⁴. The findings in our study are different from another study conducted in Karachi by Saleem P.Iqbal et al which may be due to difference in the study populations³⁵. The relatively high frequency of benzodiazepines abuse may be due to their increased prescription by physicians and psychiatrists on long term basis for the treatment of anxiety and insomnia and due to their over the counter availability in Pakistan³⁶,³⁷.

The misuse of methamphetamine (commonly called ice), which is a synthetic psychostimulant, is rapidly increasing among youngsters and students throughout the world including Pakistan. It causes addiction by increasing dopamine production through its effects on limbic system leading to symptoms of euphoria, delusions, hallucinations and feeling energetic³⁸. The frequency of methamphetamine users in our study was 8% which is comparable to the findings of study conducted in Cape Town by Andreas Pluddemann et al in which the frequency of methamphetamine use was 9%³⁹. The number of patients misusing multiple drugs (two or more) is 89.62%(n=121) as compared to single drug users 10.38%(n=14). This is comparable to the findings in a local study by Aqsa Iqbal et al in which poly drug misuse was more common than single drug

use¹³. The findings are also comparable to a study in India by Sau manabndra et al in which multiple drug misuse was more predominant⁴⁰. The high number of poly drug abusers in our study may probably be due to over the counter availability of drugs in Pakistan, drug trafficking across Pak-Afghan border and improper implementation of laws to curb drug mafia involved in drug production, trafficking and sale.

**LIMITATIONS OF STUDY:** The potential for false positives/ negatives and adulteration or sample substitution are possible.

**CONCLUSION**

Drug addiction is an alarming and serious public health issue globally including Pakistan. The present study reflects higher percentage of drug abuse in males than female in our society, which may be because of exposure. Secondly Opiates are observed to be the predominantly addictive agents. There is need to take all necessary steps to curb the curse of drug abuse.

**Disclaimer:** None.

**Conflict of Interest:** None.

**Source of Funding:** None.

**REFERENCES**

1. Rasool SH, Arif M, Ahmed M. Sociodemographic Profile of Intravenous Drug Users in Lahore-A Retrospective Study. Pakistan Journal of Medical & Health Sciences. 2014 Apr 1;8(2):338-43.

2. Nasir MJ, Khan AS, Tabassum I. Socio-Economic Profile of Drug Abusers Attending a Treatment Center in Peshawar, Pakistan. The Journal of Humanities and Social Sciences. 2015 Dec 1;23(3):57

3. Ahmed SH. The science of making drug-addicted animals. Neuroscience. 2012 Jun 1;211:107-25.

4. World Drug Report 2018; United Nations Office On Drugs And Crime (UNODC)

5. Rajita Sinha. Chronic Stress, Drug Use, and Vulnerability to Addiction. Ann NY Acad Sci. 2008;1141:105-130.

6. Harrison P, Fazel M. Shorter Oxford Textbook of Psychiatry. Oxford university press; 2017 Oct 12.

7. Han B, Compton WM, Blanco C, Crane E, Lee J, Jones CM. Prescription opioid use, misuse, and use disorders in US adults: 2015 National Survey on Drug Use and Health. Annals of internal medicine. 2017 Sep 5;167(5):293-301

8. Degenhardt L, Stockings E, Patton G, Hall WD, Lynskey M. The increasing global health priority of substance use in young people. The Lancet Psychiatry. 2016 Mar 1;3(3):251-64.

9. Batool S, Manzoor I, Hassnain S, Bajwa A, Abbas M, Mahmood M, Sohail H. Pattern of addiction and its relapse among habitual drug abusers in Lahore, Pakistan. EMHJ. 2017 Mar 1;23(3).

10. Dube S, Chaudhary A, Mahajan R, Purohit R, Gaur DR, Saluja N, Kumari S, Dube S. Prevalence and pattern of cannabis abuse in a rural area of Punjab. Journal of Evolution of Medical and Dental Sciences-JEMDS.
11. Jain S. Balochistan: On The International Drugs Superhighway. Strategic Analysis. 2018 Sep 3;42(5):545-53.

12. Mansourian M, Abbas J, Qorbani M, Mehr BR, Ziapour A, Lebni JY, Safari O. Secrecy in Drug Abusers: A Qualitative Study in Iran. Journal of Postgraduate Medical Institute (Peshawar-Pakistan). 2019 Nov 6;33(3).

13. Iqbal A, Dar R, Sadiq F. To Study the Pattern of Drug of Abuse in Patients of Psychiatry Department Mayo Hospital, Lahore.

14. Singh J, Kaur M, Singh G. Evaluation of Drug Addiction Causes in Punjab using Machine Learning. International Journal of Advanced Research in Computer Science. 2018 Mar 1;9(2):730.

15. Peacock A, Leung J, Larney S, Colledge S, Hickman M, Rehm J, Giovino GA, West R, Hall W, Griffiths P, Ali R. Global statistics on alcohol, tobacco and illicit drug use: 2017 status report. Addiction. 2018 Oct;113(10):1905-26.

16. Dragisic T, Dickov A, Dickov V, Mijatovic V. Drug addiction as risk for suicide attempts. Materia socio-medica. 2015 Jun;27(3):188.

17. Reginsson GW, Ingason A, Euesden J, Bjornsdottir G, Olafsson S, Sigurdsson E, Oskarsson H, Tyrfringsson T, Runarsdottir V, Hansdottir I, Steinberg S. Polygenic risk scores for schizophrenia and bipolar disorder associate with addiction. Addiction biology. 2018 Jan;23(1):485-92.

18. Ho JY. The contemporary American drug overdose epidemic in international perspective. Population and development review. 2019 Mar;45(1):7-40.

19. Kpae G. Illicit Drug Abuse and Criminal Behaviour among Adolescent: Therivers State Experience. Journal of Research and Opinion. 2019 Oct 29;6(10):2516-25.

20. Dar FJ, Khan AH, Siddiqui I, Ghani F. Pattern of drugs of abuse identified in chemical samples. Journal of the College of Physicians and Surgeons Pakistan. 2010;20(9):608.

21. Otorkpa, O.J. Pattern of Drug Abuse among Adolescents in Lokoja Metropolis of Kogi State, Nigeria. Journal of Applied Life Sciences International. 2019 May 10:1-9. DOI: 10.9734/JALSI/2019/v20i330084.

22. Kalsoom U, Farid K. Substance use among students of professional institutes of Khyber Pakhtunkhwa. Journal of Postgraduate Medical Institute (Peshawar-Pakistan). 2014 Jan 14;28(1).

23. UNODC Report drug use in Pakistan, 2013

24. Datta D, Pandey S, Dutta S, Verma Y, Chakrabarti A. Descriptive epidemiology and high risk behavior of male prescription opioid abusers: Cross-sectional study from Sikkim, North East India. Indian journal of psychiatry. 2015 Jul;57(3):284.

25. Lo SY, Winston-McPherson GN, Starosta AJ, Sullivan MD, Baird GS, Hoofnagle AN, Greene DN. Cannabis Legalization Does Not Influence Patient Compliance with Opioid Therapy. The American journal of medicine. 2019 Mar 1;132(3):347-53.

26. Nasir MJ, Khan AS, Tabassum I. Socio-Economic Profile of Drug Abusers Attending a Treatment Center in Peshawar, Pakistan. The Journal of Humanities and Social Sciences. 2015 Dec 1;23(3):57.

27. Chand P, Jayaram N, Murthy P. Iatrogenic tramadol addiction. Indian Journal of Medical Sciences. 2017 Mar 28;69(1):57-8.

28. Williams AR, Hill KP. Cannabis and the current state of treatment for cannabis use disorder. FOCUS, A Journal of the American Psychiatric Association. 2019 Apr 10;17(2):98-103.

29. Lewis N, Sznitman SR. Engagement with medical cannabis information from online and mass media sources: Is it related to medical cannabis attitudes and support for legalization?. International Journal of Drug Policy. 2019 Feb 21.

30. Haines-Saah R. Cannabis and Mental Health: Insights from Canadian Research. Canadian journal of psychiatry. Revue canadienne de psychiatrie. 2019 May;64(5):302.

31. Smart R, Pacula RL. Early evidence of the impact of cannabis legalization on cannabis use, cannabis use disorder, and the use of other substances: Findings from state policy evaluations. American journal of drug and alcohol abuse. 2019 Nov 2;45(6):644-63.

32. The Usman T, Khan MM. Drug trafficking from Afghanistan to Pakistan and its implications. Journal of the Research Society of Pakistan. 2013 Dec 1;50(2).

33. Aslam N. Substance use among Pakistani Youth-Current Situation, Preventive and Intervention Strategies. Pakistan Journal of Medical Research. 2019 Apr;58(2):44.

34. Ahmer S, Salamat S, Khan RA, Iqbal SP, Haider II, Khan AS, Zafar M. Pattern of benzodiazepine use in psychiatric outpatients in Pakistan: a cross-sectional survey. Clinical Practice and Epidemiology in Mental Health. 2009 Dec;5(1):9.

35. Iqbal SP, Ahmer S, Farooq S, Parpio Y, Tharani A, Khan RA, Zaman M. Benzodiazepine use among adults residing in the urban settlements of Karachi, Pakistan: A cross sectional study. Substance abuse treatment, prevention, and policy. 2011 Dec;6(1):19.

36. Olfson M, King M, Schoenbaum M. Benzodiazepine use in the United States. JAMA psychiatry. 2015 Feb 1;72(2):136-42.

37. Shahid M, Khan MM, Saleem Khan M, Jamal Y, Badshah A, Rehmani R. Deliberate self-harm in the emergency department: experience from Karachi, Pakistan. Crisis. 2009 Mar;30(2):85-9.

38. Ahmed H, Hakani G. Awareness and use of Methamphetamine (ICE) among the people of Karachi, Pakistan. World J. Pharm. Res. 2018 Oct;7(17): 34-43.

39. Plüddemann A, Flisher AJ, McKetin R, Parry C, Lombard C. Methamphetamine use, aggressive behavior and other mental health issues among high-school students in Cape Town, South Africa. Drug and alcohol dependence. 2010 Jun 1;109(1-3):14-9.

40. Sau M, Mukherjee A, Manna N, Sanyal S. Sociodemographic and substance use correlates of repeated relapse among patients presenting for relapse treatment at an addiction treatment center in Kolkata, India. African health sciences. 2013;13(3):791-9.