Authors
Hamzullah Khan ¹
Final year MBBS
Khyber Medical College
Peshawar, Pakistan

Mir Hassan Khan ²
Senior Research Officer,
Pakistan Medical Research Counsel,
Khyber Medical College
Peshawar, Pakistan

Correspondence:
Mr Hamzullah Khan
Room No 104, Qasim hall hostel,
Khyber medical college,
Post office: campus branch,
University of Peshawar,
Postal code: 25120,
Peshawar, PAKISTAN
Phone number: 0092-301-5912063
Email: hamza_kmc@yahoo.com

Cannabis is the derived flowering top of the hemp plant, cannabis sativa. It contains the euphoric element, tetrahydrocarbinole as well as cannabinol and canabiniol. It is classified as a hallucinogenic. It is prepared as bhung, majun, hashish, marijuana, charas and ganja.⁽¹⁾

Smoking is a major risk factor for coronary artery diseases and lung diseases. According to a WHO report, percentage of people aged 18 year and above, in Pakistan, who smoke is 3.8% offemales, 15 - 30% of males.⁽²⁾ It is well documented that cannabis is the main psychoactive substance detected in the blood of drivers suspected of driving under the influence of psychotropic drugs.⁽³⁾ Smoking of marijuana is significantly associated with chronic bronchitis (cough and phlegm), but it has not been firmly established whether it also leads to a reduction in lung function.⁽⁴⁾

British drug control laws were in force in Pakistan until February 1979 when the President of Pakistan promulgated the Prohibition (Enforcement of Hadd) Order, 1979. Under this Order more severe penalties are prescribed for those who violate the regulations of import, export, manufacture or processing of any intoxicants, the term which refers mainly to products of cannabis, opiates and coca derivatives. The Prohibition Order, 1979 and the Dangerous Drugs Act 1930 were amended in December 1983 to provide for further increases in punitive sanctions for offenders violating drug control laws and even more severe sanctions for offenders who are recidivists.⁽⁵⁾

The present study was therefore designed to determine the causes of initiation and promotion of cannabis smoking among local transport drivers of Peshawar.

A descriptive observational study was conducted in the main wagon and bus stop in city, Haji camp bus stop and roadway house Hashtangri, from October 2004 to September 2005.

A total of 400 smoker drivers were included. Of the total 181 (45.25%) were cannabis smokers. Only cannabis smokers were further studied.

Inclusion criteria were all smokers who smoke cannabis in cigarettes/or any other ways. Heroin addicts, only cigarette smokers with no cannabis added, those who were snuffing naswars, and intravenous drug users, were all excluded from the study.

A detailed history of the respondents was taken with the help of a pre-designed questionnaire, prepared in accordance with the objectives of this study. Family history smoking was also recorded from each client. The questionnaire contained preliminary information regarding age, sex, address and education of the respondents. It also contained information about causes of initiation and promotion of cannabis among local transport drivers in Peshawar.

Finally statistical analysis of the data was performed and association of risk factors with cannabis smoking was studied.

Sampling:
A total of 400 smoker drivers were included. Of the total 181 (45.25%) were cannabis/marjuana smokers. Only cannabis smokers were studied in detail.

Age range:
The age range of the cannabis smokers was from 16 years to 65 years of age with a mean age of 35.5 years.

Education of the respondents:
Out of the total number of cannabis smokers 43% were illiterate and 40% had primary education. Fifteen percent had matriculated. (Table 1)

Smoking habits of the respondents:
The distribution of smoking habits recorded was: cigarette smoking alone 19%, snuffing 23%, cannabis smoking 42.25%, heroin and cannabis smoking 3%. (Table 2)

Number of pack years of cannabis smoking:
Forty three percent had more than ten pack years of cannabis smoking. (Table 2)

Exposure of the respondents to cannabis:
The exposure state of the respondents was: to compensate fatigue 39.21%, influence from friends 31.49%, parents were smokers 11.6%, pleasure to smoke 8.83%. (Table 3)

Effects of cannabis on health:
The effect of cannabis on respondents was: lack of interest 36.46%, decreased memory 19%, depression 16%, sedation 5.52%. (Table 4)

Table 1: Characteristics of cannabis smokers:
Total number of the respondents = 181

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Table 2: Smoking habits of the respondents:
Total number of the respondents = 400

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Table 3: Exposure of the respondents to cannabis.
Total number of the respondents = 181

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Table 4: Effect of cannabis on cannabis smoker:
Total number of the respondents = 181

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Table 5: Miscellaneous results about cannabis smokers:
Total number of the respondents = 181

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The drug abuse control programme in Pakistan is inter-disciplinary and progressive. Its main thrust consists of constant vigilance on border checkpoints by law enforcement agencies, developing in-patient and outpatient facilities for treatment and rehabilitation of addicted persons, and a preventive education programme using the mass media and students from higher educational institutions.(⁶⁾

In the present study the age range of the cannabis smokers was from 16 years to 65 years of age with a mean age of 35.5 years. Similar findings have been recorded from a study conducted to examine the differences between addicted and non-addicted university students on measures of home environment and peer relations. Participants were 45 addicts and 45 non-addicts with mean ages of 23 years, drawn from three Pakistani universities located in Islamabad, Lahore, and Peshawar.⁽⁷⁾ In our study 43% of the respondents were illiterate and 40% had primary education. Knowledge of smoking is largely associated with education, but opinions on tobacco control are dependent on both smoking status and education. The length of education was positively associated with knowledge of smoking-related risks.(⁸) The exposure state of the respondents was: to compensate fatigue 39.21%, influence from friends 31.49%, parents were smokers 11.6%, pleasure to smoke 8.83%. Frequently reported reasons for smoking (eg. tension and craving) and reasons for relapse (e.g. desire remained high, withdrawal symptoms) were related to nicotine dependence. Current female smokers scored higher on the modified Beck Depression Inventory (0-3) than current male smokers (p < 0.001). Oral health issues related to tobacco use, such as gum disease and tooth staining, were identified as factors that might motivate a quit attempt.⁽⁹⁾ In USA attendance at a tobacco industry-sponsored event at a bar, nightclub, or campus party was associated with a higher smoking prevalence among college students. Promotional events may encourage the initiation or the progression of tobacco use among college students who are not smoking regularly when they enter college.⁽¹⁰⁾

90% of our respondents agreed that cannabis is easily available to them. Peshawar is situated near to tribal areas as well as with Afghanistan. These two areas are famous for cannabis corps. Illegal smuggling from these areas might be responsible for the increasing burden of cannabis smokers. In 1984 an estimated 85 per cent of hashish on the illicit market in Canada originated in Lebanon (55 per cent in 1983), 10 per cent in India or Pakistan (31 per cent in 1983) and 5 per cent in Jamaica (2 per cent in 1983).⁽¹¹⁾ The effect of cannabis on respondents was: lack of interest 36.46%, decreased memory 19%, depression 16%, sedation 5.52%. The long-term use of cannabis, particularly at high intake levels, is associated with several adverse psychosocial features, including lower educational achievement and, in some instances, psychiatric illness. There is little evidence, however, that long-term cannabis use causes permanent cognitive impairment, nor is there is any clear cause and effect relationship to explain the psychosocial associations.⁽¹²⁾ Thirty four percent of our respondents had faced road traffic accidents. The prevalence of cannabis (3% is estimated) in the driving population in France is similar to that for alcohol (2.7%). At least 2.5% (1.5% to 3.5%) of fatal crashes were estimated as being attributable to cannabis, compared with 28.6% for alcohol (26.8% to 30.5%). Driving under the influence of cannabis increases the risk of involvement in a crash.⁽¹³⁾

From the data and discussion we conclude that cannabis smoking is common in local transport drivers. The major causes that are involved in the initiation and progression of cannabis smoking are; driving at a young age, poverty, lack of education, easy availability of cannabis, influence from colleagues and smoker parents.