Abuse of Prescription Drugs Rises Among Stressed Iraqi Soldiers
Mustafah Saleh, went to a doctor’s office in Baghdad for Artane. He said he became addicted after being proscribed the drug to combat the side effects of schizophrenia medicine.
BAGHDAD — For an Iraqi Army soldier patrolling Baghdad’s unpredictable streets, each 12-hour shift is an exercise in terror and uncertainty.
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So Ahmed Qasim pops a small white tablet called Artane to help him through his duties.
“For me, it helps me to get the job done,” he said. “I can’t bear working without taking Artane. It makes me happy and high, but I still can control myself.”
The abuse of prescription drugs, widely available in Iraq on the black market and through private pharmacies, has significantly increased since 2003, doctors and other health specialists say, nourished by the stresses of the war and the lack of strict government regulation.
Dealers do a brisk business in tranquilizers, painkillers and other drugs, specialists say, and drug abuse is a problem in the prisons and among Iraqis who live in poor neighborhoods or who are unemployed.
But in recent years, Iraqi soldiers and police officers have also turned to drugs to ease the stresses of their jobs. In particular, they are abusing artane, a medication that is used to treat Parkinson’s disease and that can have euphoric effects when used in high doses.
“They believe that this Artane allows them to become courageous, to become brave,” said one doctor, who spoke on the condition of anonymity because he was not authorized to speak publicly. about the issue.
“They take it so that there is no anxiety, no fear,” he said, “so they can break down doors and enter houses with no shame.”
No clear evidence exists that the misuse of prescription drugs has a significant effect on how soldiers and police officers perform their duties. Nor are any figures available on how widespread drug abuse is in the security forces or whether most of those who use the drugs do so daily.
But Mr. Qasim, 26, estimated that one out of three soldiers in his army unit take Artane or other drugs while on duty. Jalal Ammar, 45, an Iraqi police officer, said “probably 30 percent” of the police officers he worked with used Artane and other medications. Dr. Amir al-Haidari, the manager of drug addiction programs for the Ministry of Health of Iraq, said that alcohol abuse was once a bigger problem than prescription drug abuse, “but after the American invasion of Iraq, alcohol became limited because of the security situation and religious restraints.”
Now, he said, “the long duties, the suicide attacks and the killing are all factors that drive the security forces members toward Artane and other drugs.”
Dr. Haidari added that the Health Ministry had begun a campaign to close private pharmacies that sell drugs illegally and to place more restrictions on prescriptions. He said the problem was no worse in the security forces than among civilians.
The ministry, Dr. Haidari said, is also trying to open more treatment centers for addicts. Only one hospital in Iraq, Ibn Rushid psychiatric hospital in central Baghdad, has a ward devoted to treating alcohol and drug abuse.
Gen. Ahmed al-Khafaji, an official at the Interior Ministry concerned with police affairs, denied that drug abuse was a significant issue among Iraqi police officers.
“We don’t accept any kind of addiction within the security forces or our troops from the police,” he said, adding that any police officer who was found to abuse drugs “will be dismissed from our ministry forever.”
Maj. Gen. Qassim Atta of the Iraqi military said that the soldiers in Baghdad “have very good mental health and high spirits.”
Asked about the abuse of prescription drugs, he said, “Maybe there are some negative points here and there, but you cannot generalize based on such cases.”
On the street, Artane, Valium and other drugs are known by nicknames, including “the capsule,” “the eyebrow” and “the cross.” Mr. Ammar said that when police officers talked among themselves about the drugs, they referred to them as “appetizers” or “takeout.”
Drug use is forbidden in the Iraqi security forces, but Mr. Qasim said that soldiers took drugs discreetly and that “everyone in the army knows about it.”
Still, he said, “you can’t take them clearly in front of the officers.”
Qais, the owner of a private drugstore who would give only his first name because his activities are illegal, says that he sells Artane and other drugs without prescriptions and that he has been arrested three times. However, he has used bribes to avoid prosecution, he said.
“I don’t deal with strangers unless they come through my known network,” he said. “I have some people who distribute the drugs, and they are well-trusted people. I have other customers who take large amounts of drugs, and they come in from time to time or I deliver it to them in specific locations.”
Because of the stigma attached to drug addiction, many addicts do not seek treatment, doctors said. When soldiers or police officers do go to Ibn Rushid for help, they arrive in civilian clothes and are often reluctant to reveal their military status.
One patient who sought treatment at the hospital for Artane addiction in the spring told a doctor that he was in the army, but he became visibly alarmed when a visitor began asking him more questions about his job.
In a rare study of drug addiction, conducted at Ibn Rushid several years ago, the researchers, Dr. Amir Hussein and Dr. Shalan al-Abbudi, found that cases of prescription drug abuse had increased substantially from 2002 to 2004. In 2004, 58.4 percent of the patients admitted to the addiction unit were there for prescription drug abuse, compared with 27 percent in 2002. Cases of alcoholism dropped to 40.8 percent in 2004 from 73 percent in 2002.
Artane was by far the most popular drug abused by the addicts, the study found, with Valium a close second. Other drugs included Ativan and Mogadon, also tranquilizers, Somadril, a muscle relaxant drug in the same class as Artane, and codeine cough syrup.
Unlike some tranquilizers and drugs like cocaine or heroin, Artane does not produce physical addiction. but can produce psychological dependence. But the drug’s label warns that alcohol, barbiturates or narcotics can intensify its effects.
Psychiatrists familiar with Artane abuse say that addicts vary in how frequently they use the drug, sometimes taking it only when they are under stress.
Keith Humphreys, a professor of psychiatry at Stanford University School of Medicine who specializes in drug addiction and advises Iraqi psychiatrists on mental health treatment, said that widespread Artane abuse was almost unheard of elsewhere.
“It’s been very strange for me having worked in the field 20 years in the U.S. and never having seen an Artane addict,” Dr. Humphreys said, “yet that is almost always the first kind of case Iraqi colleagues ask me how to treat.”
Nazar Amin, a psychiatrist at Sulaimaniya University in the northern Kurdish region of Iraq who has studied Artane abuse, said that it began before the war between Iraq and Iran, when some athletes started using the drug in training.
But Artane abuse increased during the war and became common in prisons, where relatives or guards smuggled it to inmates.
“As far as I know, the addiction is mostly psychological rather than physical,” Dr. Amin said.
A 25-year-old police officer in Baghdad said he began taking Artane and Valium two years ago “to escape the bitter reality” and continued to use the drugs.
The police officer, who spoke on the condition of anonymity for fear of repercussions from his superiors, says he often uses Artane for night shifts, while guarding the police station or “going on a mission in the scary and dark streets of Baghdad after midnight.”
He has seen “so many explosions and picked up so many corpses, including those of my colleagues,” he said. “Anyone would collapse under such high stress.”
“We don’t commit suicide,” he said, “and that’s why we resort to Artane and other drugs.”
# Mudhafer Aa-husaini and Erica Goode
# NY Times
# December 20, 2008