"Afghanistan will one day be a world leader," begins the Afghan joke, which Murtaza tells me with a laugh, "when everyone else flies to Mars."

Murtaza Majeed grew up in Afghanistan, where he currently lives, but has also lived in the Czech Republic and Sweden for the past few years. He worked as an international coordinator Youth RISE and currently coordinates the "Center of Excellence", a harm reduction service located in Kabul, founded by Murtaza together with Czech psychotherapist Jakub Černý under the auspices of the Brno non-profit organization Podané ruce. It is quite a rarity to come across an Afghan working in the field of drugs, given the difficult repressive situation in this country. And so our conversation could hardly go elsewhere.

I was wondering how to start this conversation in a light way, and I wonder how you would introduce yourself.

I am human (smile), I am 33 years old, I live partly in Afghanistan and I have been working in the field of drugs and harm reduction for over ten years. More specifically, I consider myself a harm reduction (HR) activist

Harm reduction activist, it sounds like a taboo…  

I like to call myself that, precisely because the philosophy of harm reduction is not one of the most popular in the world. People are still too sensitive to this label. "HR activism" means raising awareness of this philosophy, asking all questions to governments that are unable to accept this approach and applying this approach. And most importantly, to bring HR to all areas of drug use as a comprehensive care for people who use drugs.

How did you start working in HR?

I started as a field worker and partly a translator for an HR organization in Kabul. The fieldworker's job is to visit places where people who use drugs gather every day. The field worker has a pile of clean needles on hand and other tools that he can exchange or provide to users, including condoms. So I went there, discussed with users, exchanged "dishes" and tried to connect them as much as possible with the contact center where I worked. Simply put, you go to the "battlefield" in the morning and hand out clean needles to users.

You mention the battlefield yourself, has anyone ever challenged you to a duel?

No, but once a needle stuck in my leg, they're everywhere in certain places.

Does this mean that you lived for a while thinking you might have HIV?

No, because we had PEP - 100% a functional antiviral drug that, if given early, although quite painfully, effectively kills HIV.

How would you explain the concept of harm reduction?

There are different ways to look at harm reduction. Ideally, we could define HR as the provision of health and social care to people who use drugs and do not want or are unable to stop using them. It is also about defending their human rights to social care and trying to integrate them into society as normal citizens and give them access to medical care and subsequent recovery. HR is therefore in the interest of public health, which it not only promotes The health of people who use drugs, but also for the benefit of society as a whole, creates truly effective measures against the damage that drug use can cause. In short, it is about providing basic health care to all without exception in order to protect the health of people who use drugs, to prevent deaths from overdose, to prevent HIV or jaundice and other deadly diseases.

And does the Center of Excellence provide such measures?

The Center of Excellence is about developing materials, disseminating information and raising awareness - creating awareness of this issue and possible solutions among professionals in society and people working in the field of public health. We have realized that although we are facing a major problem of drug use here, people have no idea what addiction is. Even doctors do not understand addiction. The whole idea behind the Center of Excellence is therefore in educating society to view the problem of drug use as a disease rather than a taboo, and also to help the users themselves. We try to enable them to return to their families and make available the possibilities of proven treatment methods instead of a non-functional detox. At the same time, we were aware at the outset that there were almost no directives / materials applicable to Afghanistan that carried the know-how to tackle the drug problem. Therefore, our next goal is to create "more user-friendly" manuals that clearly explain the philosophy of harm reduction and advise on how to deal with drug use. In Afghanistan, there is almost no data mapping the drug situation, which causes this problem to be ignored by international governments or donors who follow the motto: "Where there is no data, there is no problem. "

What's next besides CoE on your daily list?

I smoke weed from morning till night. (laughter)

I also used to coordinate the international organization Youth RISE, which was my second job. The idea of Youth RISE is again to promote health and the same harm reduction values in access to young people who use drugs. So in short - we are trying to uphold the rights and improve the conditions of young people who use drugs.

Isn't that too controversial for society? This would be described by our Czech National Drug Control Center as the spread of drug addiction…

But I do controversial things. I'm breaking taboo (laughs). For some reason, I'm constantly doing things I shouldn't. I even dated a white girl.

And how does your surroundings view it?

They say that a Western woman cannot be a good wife, that they are not led to do so. Recently, a friend asked me if I realized how many Western men were looking for their wife in Asia because they couldn't stand "theirs."

And what do you think about that?

I asked him if he realizes how many Asian women can't stand their Asian men, but he has no choice…

What would you say about the country you come from?

Afghanistan is the world leader in opium production and supplies the world with heroin out of about 90 %s. It is a country that has undergone many changes caused by the political crisis, from the civil war to the neighboring wars accompanied by the drug war, which is closely linked to all this. The rest of the world is aware that Afghanistan is the main architect of the global "heroin problem." However, the fact that heroin produced in Afghanistan is also widely used in Afghanistan is ignored. Statistics show that there are 3 million people living here who use drugs. The number of problematic users is also alarming - about 1 million people. Problematic means they live on the street and without a roof over their heads.

How do you think the war is related to drug use?

The current situation is really challenging. Immigrants from neighboring countries who fled the war are returning, and there is a dramatic atmosphere inside the country caused by war and violence. All of this easily leads people to "hook up" on drugs. The main problem is heroin. We have very many intravenous users, a low number of available services and no research. The problem is hardly talked about at all.

"A lot of children are hired by drug criminals to carry drugs…"

What was it like when you were growing up?

My generation, along with the following, are generations of people who grew up in a war when shooting was the order of the day. During the war, the situation was much, much worse than it is today, because the children could not go to school due to the constant explosions. And when it was possible to go to school, there was no teacher to take over. So almost no one received standardized school attendance or adequate education. And children were playing with guns and rifles… for war… Most people lost their jobs and there were generally quite unrest between the government and the people. It was a very bad situation, both economically and socially. It was common for children to make a living from street work. It often happened that because of the problems caused by the war, the parents could not work, so the children had no choice but to take over the cash registers and find a way to make money to make a living for the family. It was usually a very demanding job - from selling ice and small items on the street to cleaning shops. Many children were hired by drug criminals to carry drugs, which was a very lucrative offer of earnings. According to the law, children cannot be punished even if they are caught in the act. They are usually sent to a detention center, a youth prison, and released after a few weeks.

What kind of people can such a generation grow up in?

Traumatized. Young people are facing trauma caused by war and killing. And that led us all to post-war Afghanistan, where we have been living in "peace" since 2001. By the way, the new millennium was also a time when the number of users in Afghanistan was really high. Even then, we held a global lead in drug use. Young people have filled the gap caused by the daily traumas associated with neglect, deprivation and also the fact that they do not have the classic life of young people, livelihoods, entertainment or education. Drugs have become a very welcome tool with which you can escape reality and feel good, experience fun. Not only that, many have become addicted to work. There are many known cases where people forced to work day and night and started using opium to have more energy. At the moment, however, it is heroin, which about ten years ago became a very widespread substance that young people today ride…

What about the use of other substances?

The truth is that the drug scene is constantly changing. Cannabis has long been a well-established and tolerated drug.

At the moment, we also have a worrying increase in the use of almost exclusively smoked methamphetamine and MDMA in the form of tablets smuggled into Afghanistan.

How does Afghan society view drug users and use?

Traditionally, drug use in society is taboo. People find it a great shame to find out that their child or family member is using drugs. Often, expulsion from the house follows, and the dependent person has no choice but to live on the street, which makes the whole situation even more problematic for users. The reason for being kicked out of the house is usually social norms, which say that a person who uses drugs is completely unusable. And this is what social norms lead to this thinking, together with the lack of a clear approach to drug use. People have no idea what addiction is or how to approach it. The family usually loses hope and considers the child dead. Sooner or later, he will really die of an overdose or some disease related to drug use and street life, because treatment options are very scarce.

So what do you think is addiction?

First of all, the dependence is always different. In most cases, it is about filling in an "empty space" or "killing pain" - emotional or physical. Our company is brought up to ever greater competitiveness, which is associated with the fastest possible pain relief and a quick escape from ourselves. And this is the moment when addiction appears on the scene.

Any addiction?

In my opinion, being addicted does not necessarily mean being addicted to drugs. Addiction takes many forms. We can be addicted to sex, work, Facebook… and also drugs. But if you get caught up in drugs, thanks to the stigma that drugs carry, your addiction is taboo. Thus, the trauma from which a person runs away from drugs is compounded by the fear and pain associated with the loss of family, friends, social status or position at work. And all this is closely linked to the lack of information about addiction.

People think that pain is everywhere, as is trauma (which is most often the reason why "one gets caught"), and that there are simply weaker natures among us that turn to drugs.

Isn't that so?

I don't think so. It's about which drug is yours. Some take drugs routinely but do not become addicted, others do. It's about what kind of addiction you choose. There are people addicted to love.

And if you decide to end your addiction?

The only model of therapy available in Afghanistan is direct detoxification without any medication. Up to 95 % patients return to use. This makes the use itself much more problematic, as it is obvious that the company cannot handle it. The current approach is based on "Say NO to drugs". However, once you say YES, your whole life is ruined with almost zero chance of returning to normal. And if someone manages to give up the use, they usually have to deal with mistrust and suspicion of those around them who do not know how to deal with such a situation.

What do you see as an effective way to treat addiction?

First of all, I would like to say that I believe that treatment is not for everyone, for various reasons. Above all, it is the situation in which users find themselves, the life with addiction that they lead, the choices they make, and ultimately the trauma they carry.

There is no definitive treatment for addiction in the world. However, to provide people who use drugs with a safe environment with access to health services through harm reduction projects, to enable them to use social services as well as to make mental health care accessible, I consider a good way to effective treatment (editor's note: drop in center model).

There are several treatment options. In the case of heroin addiction, this is opioid substitution therapy, which is one of the more successful and which we are trying to expand in Afghanistan. It is currently only available to 71 patients. Then there is the already mentioned detox. In essence, it is about offering people who want to get rid of addiction as many therapeutic options as possible. One of the other ways I try to make it accessible to users is treatment using ibogaine - an alkaloid that comes from an African plant called Iboga tabernanthe.

Ibogaine? Can you say more about that?

I usually tell everyone that it's not a silver bullet - that's how ibogaine is often talked about. It is just another treatment option for drug addicts. Ibogaine acts on an unknown mechanism to activate growth factor in the brain, regenerate new cells and eventually restart addiction receptors. It is usually a three-day "trip", after which most graduates physically stop needing the drug and for three to six months the often insurmountable desire disappears. And this is the right time to start psychological and social care, which will allow them to work on the traumas and PTSD they carry with them, either as the initial reason for use or as a direct consequence of it. Ibogaine is not a definitive solution to addiction, but it can be a tool to break it. In most cases, the patient will have the opportunity to feel psychosocial stability, and this is a good start to the path to victory.

What is the risk associated with ibogaine?

The administration of ibogaine is preceded by several medical examinations. It is necessary to undergo heart and blood tests. It is the responsibility of the person administering the substance to check the resulting values, otherwise it may risk the user's life. The main problem with ibogaine is legislation. Ibogaine is not classified as a drug, it is classified as a first class drug. Therefore, most of the therapies that take place in the world are conducted underground - illegally and such are risky. Those who administer the substance also take risks because they do not have access to the necessary medical care and, in the event of a patient's poor reaction, cannot take him to the hospital because they have administered the substance illegally. This increases the potential risk that ibogaine carries.

And yet do you trust him?

I believe that if ibogaine is prescribed clinically and administered under professional medical supervision and the necessary follow-up care, then its use is not dangerous. It is a hope especially for those for whom conventional methods are short.

Thanks for the interview.

The philosophy of harm reduction is not one of the most popular in the world

Young people are facing trauma caused by war and killing

The administration of ibogaine is preceded by several medical examinations

 

eshawar (courtesy of Murtaza)
eshawar (courtesy of Murtaza)
eshawar (courtesy of Murtaza)
eshawar (courtesy of Murtaza)
eshawar (courtesy of Murtaza)
eshawar (courtesy of Murtaza)