PSYCHEDELICS

Psychotropic drugs have the potential to induce psychedelic experiences, especially in vulnerable individuals. Their indiscriminate prescription by physicians – generalists and specialist alike – is a source of concern. It is chilling to know that pharmaceutical industry spends billion of rupees on their sales and marketing. The actual process of developing a molecule requires huge sum of money, which have its dividends in terms of financial profit. Though there is a need to keep the wheel of research and inquiry moving, the forces which drive the marked needs to be curtailed.
According to one estimate the psychotropic drug sale in Pakistan for a duration of one year (June 2003-4) were worth 2.76 billion; of these tranquilizers and hypnotics were 1.36 billion with a rising trend of 18% and 137% respectively from previous year. Situation is not any different in a developed country like United Kingdom. Department of Health data, UK, reports that General Practitioners in England wrote 12.7 million prescriptions at a cost of £20.9 million in 2002, compared to 15.8 million prescriptions worth £13.8 million in 1992. 30% of prescriptions were for 56 or more tablets. Due to rising concerns, the regulatory authorities in U.K have mandated that general practitioners will not prescribe Benzodiazepine – a tranquilizer – for more than two weeks. Those requiring a longer prescription should be referred to mental health facility.
The biggest barrier in Pakistan is the breakdown of regulatory forces. There exists a fine balance between, what is right and wrong. Physicians often cross that barriers, in a matter of convenience, often unthinkingly about the consequences of such transgression. The relationship between doctors and pharmaceutical industry is one such example. The drug companies spend millions of dollars, flying physicians to all part of the world, making trips to exotic locations in the guise of science. It is no more than a buying-off. There is robust evidence to suggest that they feed biased information to the practicing clinicians. The research, supported by drug industry, lacks soundness in terms of methodological rigor. They investigate and seek out those, who are going to have voice in their field. This is done purely for selfish reasons – to increase sales.
The rising trend of inflation, uncertain political environment and mayhem has forced marginalized individuals towards mental illness. In the scenario when there is a dearth of mental health professionals – a dismal number of 360 psychiatrists for a population 160 million- masses have no venue of help seeking. In the current situation, general practitioners are the obvious port of call. These physicians, lacking skills in recognition and management of mental disorders, prescribe psychotropic medications indiscriminately.
In a survey exploring the opinion of 360 general physicians from a representative sample of Karachi city, almost 50% reported that they would use Benzodiazepines in treating depression. Though standard antidepressants are safe and effective, only 31% suggested that they would use them in treating depression. More concerning was the fact that almost 63% general physicians were not aware of standard diagnostic criteria for depressive disorder. In this scenarios depression, the most common psychiatric syndrome, remains under recognized and in appropriately managed. The community based estimates of depression has been reported to be around 30%. This means that every third person is expected to be suffering from depression and anxiety. This is a huge burden of morbidity, which has a consequence on the psychosocial functioning of the country. The demand for services, redressing the mental health needs of the community is dire.
The sales of inject able narcotic analgesics in the drug-brothels has reached an alarming proportion. The epidemic of psychotropic’s and psychedelics needs to be curtailed. Over the counter availability of psychotropics adds to the menace of drug problem. Islamabad, on account of being miles away from the real Pakistan is oblivious to this reality. Since this has become a public health concern, the officials in the ministry of health, Government of Pakistan needs to take note of it.
This is a problem which cannot be handled by physicians alone. The prevalent mentality of patients, pill for every ill has to change. Civil society, government, media, teachers and religious scholars have to play their part.