PAKISTAN'S ADDICTS TRADE CHASING THE DRAGON FOR DEADLIER PURSUIT

LAHORE, Pakistan - They crouch on sidewalks in the brief camaraderie of
drug users, small clusters of men in filthy pajamas fumbling with syringes
and plastic packets and tin foil. In a few moments they disperse, one
staggering off while another keels over in solitary oblivion.

Sometimes, the men stumble to the door of the Nai Zindagi (New Life)
drop-in and needle-exchange center. Inside, they are offered a shower and a
nap, a clean syringe and first aid for abscesses and stomach cramps. The
doctor, S.M. Sayeed, shows clients how to avoid injecting drugs into
arteries, which causes swelling and pain.

He also tells them about HIV and AIDS. It is a disease few Pakistani
addicts have heard of, although an increasing number risk exposure to it as
they switch from the traditional culture of smoking and inhaling heroin to
the fast-growing trend of injecting tranquilizers and painkillers.

"I always chased [inhaled heroin] before, but I've been injecting
[sedatives] for about 18 months now. It's cheaper, it works faster, and
everyone was pushing me to try it," said Sanaullah, 32, a bleary-eyed man
slumped on a straw mat in the shelter's nap room.

Sanaullah said he did not know about AIDS, but he and several other clients
said they had been told by counselors at Nai Zindagi (pronounced "nigh
ZIN-da-gee") that there was a serious "syringe sickness" and that they had
to stop sharing needles to avoid getting it.

"We don't preach, we just make them aware," said Jawad Akhtar, a staff
member. "We tell them, if they want to shoot drugs, don't take the extra
risk. If they start keeping needles for their own use, that's a big change
in itself."

Pakistan is a major outlet for heroin from next-door Afghanistan, the
world's largest producer of opium poppies from which heroin is made, and it
has developed a large population of addicts in the past 20 years. An
estimated 3 million people are habitual drug users, and about half are
addicted to heroin.

Until recently, most Pakistani addicts smoked heroin or heated it on tin
foil and inhaled the fumes, a method known as "chasing the dragon." Now,
according to a 1999 study by the U.N. Drug Control Program in Pakistan,
injecting pharmaceutical drugs is fast becoming the preferred method of
substance abuse.

The most popular drugs to inject are opiate painkillers, antihistamines and
tranquilizers. They cost about half the price of heroin, and they are legal
and widely available because pharmacies do not require prescriptions, and
injecting them delivers a faster high.

But needles are also a major source of transmitting AIDS. The disease is
relatively unknown here, with less than 200,000 cases of HIV reported to
date. But the skyrocketing use of intravenous drugs, according to the
United Nations, is a "warning sign of the potential for an epidemic of HIV
infection" among Pakistani addicts.

One recent study of 200 injecting addicts by Nai Zindagi found that none
were HIV-positive and most had been injecting for only a year. But an
alarming 89 percent were infected with hepatitis C, another illness spread
through needles.

"We still have a window of opportunity to reach people, but we have to act
fast before Pakistan becomes like Burma, Vietnam, India and other countries
where AIDS is growing rapidly," said Tariq Zafar, the director of Nai Zindagi.

The government is becoming alarmed, too, and officials acknowledged that
while Pakistan has worked hard to eliminate opium poppy cultivation and
drug smuggling, it has done far too little to treat addicts and educate the
public about the interlinked dangers of drugs and AIDS.

"Frankly, we know very little about it," said Mohammed Aziz Khan, an
anti-narcotics official at the Interior Ministry. "Rehabilitation and
reducing demand have been our areas of tremendous weakness. Now we see AIDS
coming, and we know we won't be immune if we have a lot of intravenous users."

There are 73 drug treatment centers in Pakistan, but most offer only
detoxification and serve only a tiny fraction of the country's addicts.
Pakistani jails are crammed with drug addicts - about 30 percent of all
inmates - who rarely receive treatment and report that drugs are widely
available behind bars.

Nai Zindagi, a private program founded 10 years ago, is one of the few
places that offer treatment, education and vocational training for addicts
in recovery.