Showmeneel: Drugs in Bangladesh

Drugs in Bangladesh

The landscape of drugs in Bangladesh

Overview
Bangladesh landscape and social profile
Why take the drug?
Drug profiles- major drugs of abuse
1. Tobacco
2. Cannabis
3. Moonshine
4. Opioid based drugs

i. Phensidyl

ii. Tidigesic

iii. Pethidine

iv. Heroin

e. Yaba (Amphetamine-like stimulants (ATS))

E. Sources

[A] Overview

Bangladesh, a country situated in the Indian peninsula and itself is the delta of the Ganges river, is no stranger to illicit drugs trade and its consumption by the populace. The country is largely poor with half its population within rural settings. With this in account, Major illicit drugs being used by the populace are opioid drugs; largely being Phensidyl (a cough syrup) and buprenorphine (injectable opioid). Heroin and the newly emerging amphetamine, Yaba; coinciding with a surge in production by neighbouring Bhurma according to the UNODC (United nations office on drugs and crime); is also growing into a major drug of consumption. While these drugs may be a rising problem in the past decade, Tobacco and Cannabis have historically been a component of Bangladeshi culture and is still grown, trafficked and produced in the country- illicitly in the case of cannabis.

[B] Bangladesh landscape and social profile

Bangladesh is a country situated in south Asia and is bordered by India and Bhurma with the Bay of bengal to its south. Historically part of the Indian subcontinent, and by extension the former British empire, Bangladesh was formed in 1971 where it split from Pakistan as a Muslim majority state. The country itself is the delta of the river Ganges and thereby endures tropical conditions, with seasonal flooding and cyclones (tropical storms) being common (Fig. 1). The country, much like the south asian contingency, is among one of the poorest; nearly half of its population is below the poverty line. In addition they have one of the highest population densities in the world, being 800 people per km² in some areas, as contributed with its small landmass and having the world's eighth highest population [2].

Residents of Bangladesh are deemed as bangladeshi with bengali being the national language. Its landscape, while beautiful, is ever changing as it progressively develops as a country, and much like any other, its drug landscape does too. In 1990, The Bangladeshi government issued the narcotics control act in order to control and regulate the production and movement of drugs [3,4]. With its introduction, there was a shift in accepting drug use as a treatable condition as opposed to criminal. Drug legislation is governed by the NNCB- the national narcotics control board; its policies being implemented by the department of narcotics control (DNC). It should be noted that attempts to police illicit drugs and its trafficking is also done in collaboration with the United Nations office on Drugs and Crime (UNODC)

Fig.1: Map displaying the major production of opioids in the South east asian area [5]

Consistent world drug reports made by the UNODC and the DEA have recognised neighbouring Bhurma as a major site of illicit drug production, second only to Afghanistan [2] (Fig. 1). Thus Bangladesh is used as a major route for drugs trafficking towards western countries. This major drugs route is recognised as the ‘golden triangle’ of which Bhurma, India and Bangladesh is involved [3]. Drugs move through the ‘porous’ [1] Bengali border control through either land, air or sea. This has been nationally recognised by the DNC as a significant problem they face for many years [3].

[C] Why take the drug?

Illicit drugs all have an associated level of euphoria (pleasure) when taken by users via its various routes of administration. The differences in administration can account for the differences in speed and effect of the drug in question. Before I can get to the drugs in question and explain addiction, there are two principles that I need to explain first; tolerance and withdrawal. They are always present in drug use and more violently so in prolonged drug admission.

The body is constantly changing to its environment. It is why you sweat when hot or why you feel hunger and fatigue as your energy falls. The body wants to maintain a 'perfect' environment and adjusts bits of your body to make it so. Drugs can artificially induce these changes and adjust the body towards either a positive or negative output. As with most drugs, especially so in illicit drugs, the more drug you use- the more you resist them. Thus each drug application will need to be stronger to reach the same 'highs'. This response of the body is appropritely named tolerance. When an individual takes a drug and develops tolerance to it, it means that their body has shifted from being 'neutral'. The greater this difference from being 'neutral', the more violent the body will react to restore them. Much like extreme cold is met with extreme shivering and mild cold will be greeted with mild shivering. This return to neutral and the bodies reactions to them are called withdrawal.

Now, Addiction can be produced by either of these processes. Initially an individual will take an illicit drug to become 'positive'; for example to get 'high'- essentially to feel good and happy. When the drug wears off the body withdraws back to negative, which in this case is to be sad. So the next drug amount is bigger (tolerance) and the consequent withdrawal also rises- in this case growing more sad. So youcan imagine when you have used the drug chronically, withdrawal becomes severe which in this scenario produce depression in the user. Thus the addiction is psychological; the addict will continually take the drug to prevent depression.

Alternately, addiction can be physical. In the case of opioids for example, taking the drug produces physical calm in breathing and heart rate. Withdrawal would direct the body to higher breathing and heart rates. Thus addicts may take the drug to prevent this effect. Addiction can be a combination of the two forms or only one.

[D] Drug profiles- major drugs of Bangladesh

Table.1: figures garnered from the DNC website detailing the number of drugs that have been seized in their respective years [4]. The UNODC estimate that there is approximately 10 times more drugs still in circulation than from what has been removed [2].

Name of drug	Units	2009	2010	2011	2012 (up to March)
Heroin	Kg	21.19	9.52	8.092	2.860
Cannabis	Kg	2101.019	3672.847	4518.099	660.828
Illecit distillation (Moonshine)	Litre	22671.05	17706	27115.41	10705.17
Codeine (Phensidyl)	Bottle	58875	45531	30422	9285
Pethidine/Morphine	Ampoule	92	91	295	114
Buprenorphin injection	Ampoule	18600	23457	12467	5234
Yaba (Amphetamine-like substance)	Number	4051	14458	75857	31412

Traditionally, Bangladesh have been smuggling cannabis for many years, only in the 1980s did heroin became part of that smuggling ring. The drug landscape of bangladesh in more recent years have been driven largely by opioid drugs and the emergence of amphetamines. Opioids are natural products that when administered, either orally or with the aid of a needle, are 'painkillers' with the added bonus of giving euphoria to the user. A UNODC report published in September 2005 highlights the major illicit drugs consumed by Bangladeshis. [2]

a) Tobacco

While legalised in many countries around the world, and thereby not illicit, tobacco is still a drug that is part of the bangladeshi landscape. It displays similar characteristics as other illicit drugs in that it causes calm/euphoria in the user on each administration and users require more to maintain that level. Bengalis take tobacco in two forms; either smoked and/or smokeless (chewed). Tobacco is produced and consumed in high amounts and according to a world health organisation report in 2009 finding that with a sample size of ~10,000, 43.3% consume tobacco in both forms. The report found that females largely chewed tobacco (94.7%) while males largely smoked tobacco (54.6%). [10]

Fig. 2: Paan with its varying ingredients that is chewed in Bangladesh. The ‘brown string’ is the tobacco that is chewed, alternatively found as a white paste thusbeing called ‘shada’ (literally ‘white’ in bengali)

b) Cannabis

Cannabis production has traditionally been largely produced- DNC seizures going into the 4500 kg mark for 2011 [2] (Table 1). The drug is illicit in the country and is administered much like tobacco via a smoked or smokeless route. The active form of cannabis is THC (tetrahydrocannabinol) and when administered makes the user calm, passive and hungry additionally giving hallucinations and killing pain (analgesic). A drug treatment centre in Dhaka found ~17% taking the drug [2] whereas the world drug report 2012 stated only 3.3% of bangladeshis use the drug.

Fig. 4: Cannabis leaves that are ground and placed in a roll in order to be smoked

c) Moonshine

Bangladesh is officially an Islamic country and thereby enforces the laws of Islam, nne of which is the ban of alcoholic consumption and production. Moonshine is an alcoholic beverage, that also can develop similar responses in users like other drugs of dependence. Alcohol on the other hand presents a unique situation in that there is no specific response like other drugs; affecting the whole body. Whilst not a public issue amongst the bengali landscape, illegal production and limited fermentation of alcohol is still present.

Fig. 5: The process of moonshine production, a traditional alcohol distillation process. This process however does have health risks associated with them in producing ‘pure’ alcohol that can be toxic

d) Opioid based drugs

Opioids are naturally occuring substances and harvested from poppies. The leaves of poppy plants look like cabbage leaves, being sensitive to growing conditions. Flooding, moisture (which breeds fungi) and dry winds will kill the crops [6]. Opioid based drugs all present similar actions in the nervous system producing euphoria, killing pain and the potentially lethal effects of vomiting and slowing breathing rate. The sciency definition is that all the drugs effects are reversed by applying naloxone and most are clinically used for pain relief- they are that effective!

i. Phensidyl

The largest illicit drug consumption in Bangladesh is phensidyl (Fig. 3): a codeine-based cough syrup. Its large consumption which is largely smuggled through north-east india according to the times of india [1]. The drug is now illegal in Bangladesh and is a significant issue amongst bangladeshis. Treatment centres find ~65% of admittants are using this drug [2]. Despite being an oral medicine, the codeine brings about mild opioid effects with prolonged use displaying symptoms of insomnia, memory loss and skin conditions. The drug is largely popular among individuals between the ages of 8-20, made accessible due to it being cheap and its ease of access; no prescription being required.

Fig. 6: Phensidyl cough syrups that are largely produced in India. The medicine, which has codeine (opioid), is now banned in Bangladesh due its mass abuse.

ii. Tidigesic (Buprenorphine)

Tidigesic, also known as buprenorphine, is a semi-synthetic that has concentrated effectiveness. The drug has been used clinically to ‘wean’ individuals from ‘harder’ drugs such as heroin to avoid the dreaded ‘cold turkey’ withdrawal. However the drug on its own merit can also produce the same effects as other opioid drugs and is often taken by inhaling the substance. Alternatively, multiple drug use is reported with injecting drug users with buprenorphine. DNC (Table 1) seizures of buprenorphine suggests popularity unlike pethidine.

iii. Pethidine

Pethidine is an opioid much like morphine that is injected into users. The difference resides in its quicker action, and consequent ending, of the drug and a greater toxicity to users when injected.

iv. Heroin

DNC seizures of heroin is not as large in comparison to other drugs however the rise in reported trafficking of heroin is rising [9]. Heroin addicts report the most frequent to treatment centres for example ~45% was found to take the drug in a Dhaka treatment centre [2]. Heroin as an opioid has more extreme effects in comparison to others in the same group and thus greater level of addiction potential and wirthdrawal effects. The 2012 World drug report only note 0.4% taking opioids.

Fig. 7: Typical heroin administration via the use of a needle.

e) Yaba (Amphetamine-like stimulants (ATS)) [12]

Yaba is the street name for the synthetic drug that seems to be coming from neighbouring Bhurma with reports such as in (18 May 2012) Chittagong where 20,000 amphetmine tablets were seized [9]. Seizures have been very recent with sharp increases by the DNC for 2011. The drug itself is named literally for ‘madness drug’. Yaba is normally found as a red pill that is swallowed and produces euphoria and raises the body activity. Users become more awake, alert and physically active although the cooldown is felt after many hours being the opposite of intial effects; confusion and aggression. The effects of ATS are lost before being completely removed from the body thus users take repeated tablets to sustain their euphoria, However the more the drug is used, energy reserves are depleted and an eventual ‘crash’ occurs; users can end up sleeping for days.