This article has first been published in Ahram Online on 26/06/2013
Ahmed*, 30, from the Nile Delta city of Mahalla, describes his painful addiction to Tramadol, a pharmaceutical painkiller which has, in recent years, become one of the most popular drugs among Egyptian addicts.
The head of the rehabilitation centre which treated Ahmed confirmed to Ahram Online that Tramadol is the most common drug used by his patients, while heroin, which is much more costly, comes in second.
"Until I die, I will love drugs," says Ahmed, who has now been clean for four years and three months. "I have come to the realisation that in most cases, the things you love with madness are the things that will lead to your destruction."
Like many young Egyptian addicts, Ahmed cites "curiosity" as the reason for starting.
His group of friends in Mahalla all used the popular painkiller, which he claims made it very hard to stop. He describes needing the feeling of "escape, elation and energy" Tramadol afforded him, which shifted his problem from a psychological addiction to a physical dependency.
Assistant professor of psychology at the American University in Cairo (AUC) Mona Amer says that a number of factors lead to drug abuse in Egypt.
These include a number of "macro" factors such as the availability of drugs, the cultural environment which promotes or condones its use, and mainstream culture, in addition to some "micro" factors such as peer pressure, and more individual factors like curiosity, boredom and seeking escape.
Post-revolution Egypt’s changing social structure, together with urbanisation and crippling unemployment rates, are other major factors contributing to addiction.
Tramadol: An affordable fix
Tramadol was only upgraded in severity to "scheduled drug" last year, meaning that users must get have a doctor’s prescription in order to purchase it.
The drug has seen an explosion in popularity as a result of its affordability in Egypt, explains programme officer Faisal Hegazy at the United Nations Office on Drugs and Crime (UNODC). A pack of 20 pills costs between LE3 ($0.43) and LE7 ($1). It is easily found on Egypt's streets.
After the 2011 Egyptian revolution, there was a large influx of Tramadol in shipments from China, adds Dr. Rasha Tawfiq, member of well-known Muslim preacher Amr Khaled’s "Stop Drugs, Change your life" campaign.
Consequently people were easily able to access the drug through the black market instead of having to go to a pharmacy with a prescription and get the pills.
This has contributed to its widespread abuse.
According to a recent but unpublished report by the National Centre for Criminological and Social Studies, which was conducted across 10 of Egypt's governorates and studied some 25,000 cases, 50 percent of all psychotropic substance abusers in Egypt use Tramadol, Hegazy explains.
However, Tramadol is not the only illegal substance plaguing Egypt.
The country's most popular drug, which has become increasingly prevalent in the lower-income bracket as it has become more available, is hashish or cannabis. It is so engrained in society that it has become normalised in some parts Egyptian popular culture, including appearing in films.
Classification of cannabis in Egypt has varied from it being labelled a "soft drug" to a "gateway drug" meaning there is a fear of it leading to dependence on a harder substance such as heroin. AUC academic Amer believes it should not be dealt with lightly.
She says it has a highly addictive potential. "Despite the myth that cannabis is calming, after alcohol it is the drug most linked to violence." She adds that an increasing number of people have been hospitalised in Egypt for dependence on the drug.
Egypt: A main transit spot
The geographical positioning of Egypt has contributed to the nation's growing drug issue.
Egypt is considered a main transit country for the most important drugs in the world, as it lies between the Mediterranean Sea, the Red Sea and the Suez Canal.
UNODC's Hegazy explains that Egypt is therefore in the middle of the world’s main routes for drug trafficking.
Opiates and heroin comes through Egypt from Afghanistan to supply the European market.
Cannabis travels from Morocco through Sahel and Sahara countries en route to the rest of the Middle East region.
Amphetamines produced in Eastern Europe travels via Egypt to the region and on to South Asia, Hegazy explains.
Additionally, opiates and cannabis are grown in areas in the Sinai Peninsula and Upper Egypt, with most being locally consumed.
Cairo, in particular, seems to be a key epicentre of drug abuse. According to a 2009 report by the Cairo Medical College in collaboration with the ministry of health, the percentage of drug abuse in Cairo is 7 percent higher than the world average of 5 percent. Abuse is most prevalent in the impoverished districts.
The porousness of Egypt's borders and the security vacuum post-revolution has also contributed to the flood of illicit drugs.
Salma*, 27, a recreational drug user, affirms this. After the 18-day uprising against former president Mubarak in 2011, she noticed the market open up more, drugs becoming cheaper as dealers laced the original product to sell it quickly to inexperienced users who do not know what it is supposed to taste like.
"At some point, a gram of cocaine was being sold for LE600 ($86), when I would get it for LE1, 200 ($170) [previously]," Salma explains.
According to a 2010 report by the Central Agency for Public Mobilization and Statistics (CAPMAS), the value of the drug economy in Egypt reached a record high of LE27 billion ($3.9 billion). Although there have been no new statistics recorded post-revolution, this figure is expected to have increased, Hegazy concludes.
Drug addiction, treatment and cure
Care for those addicted to drugs is woefully inadequate in Egypt, adding to the problem.
"Drug addiction needs to be understood as an illness and not a result of habit or bad upbringing as the majority of Egyptians are made to believe," says Sherif*, head of the care centre where Ahmed was treated.
Treating addiction is demanding and complicated, requiring a two-week detoxification period usually in a hospital, in addition to a rehabilitation phase, which takes months, Sherif explains.
In Egypt, Sherif adds, a large part of the population knows nothing about treatment options or even where to seek help.
Ahmed relates how he was treated in Mansoura Hospital numerous times.
"The doctors at the hospital never told me that there was anything like a rehabilitation centre. We didn’t know anything about it," Ahmed explains.
He believes the hospital’s chief doctor intentionally withheld information about rehabilitation programmes from him and fellow patients, so that he could continue making as much money as possible from their relapses.
It took two years for a nurse to suggest he visit a specialised rehabilitation facility.
Sherif asserts that rehabilitation is an essential part of the treatment because it is important for "the mind not just the body to be clean", and ensures that the patient is "ready to face life with its conditions" without resorting to drugs again.
Through a number of activities as well as spiritual and psychological treatments, the recovering addicts "start to understand that happiness does not have to be achieved through the use of drugs."
For Ahmed the rehabilitation centre was a lifeline and a place he continues to visit after traumatic events, like the death of his father last month, to counter relapsing.
"I had an uncontrollable urge to return to my old ways. I knew that as soon as I stepped out of this house I would straightaway go and get my fix," Ahmed says.
However, after locking himself up for three days, a friend, also a recovered addict, was able to bring him back to the rehabilitation facility where he could stop the downward spiral.
Many Egyptians do not have the benefit of facilities like these.
Public hospitals and some treatment centres give help and space for those unable to pay to be supported. However, most rehabilitation centers are quite costly, topping LE40,000 ($5,700), anti-drugs campaigner Tawfiq states.
While UNODC's Hegazy sees a positive increase in the number of those seeking treatment, AUC assistant professor Amer believes that there are two segments of the population who are often left out: the large bulk of the middle class, and women.
Sherif concurred that it is more difficult for women.
"As hard as it is in any case for family and other close acquaintances to believe that their child is an addict, this is a hundred times magnified with girls and women."
He sees this as a product of ignorance in society, associated with not understanding addiction as an illness. In Egyptian culture, if a member of a family is an addict this is seen as direct reflection on the failure of the parents and the child's upbringing.
Sherif's centre caters only to male addicts, when he attempted to set up a treatment facility for females only, neighbourhood members objected, claiming it would be associated with a brothel.
Youth and Society
Youth and teenagers, starting from as young as twelve, are the age group most affected by addiction in Egypt.
"Thirty four million Egyptians are youths between the ages of 10 and 30. This huge population creates a significant demand for drugs and attracts most of the cartels in terms of opening new markets and finding new users", asserts UNODC's Hegazy.
Tawfiq claimed that in their "Stop Drugs: Change your life" campaign, a key segment was visiting schools and attempting to talk to students in classes.
She describes the negative backlash they faced from the schools they visited, as teachers and heads would either deem it an "unacceptable" topic to discuss with children, or something that was not even an issue since they claimed only a small part of the population were abusing drugs.
On the other hand, one of the major challenges faced by those trying to combat addiction is the normalisation of drugs in society to the extent that characters in movies are filmed casually taking drugs for no particular purpose, as if they were smoking cigarettes, Amer asserts.
As drug use becomes more acceptable and consumption and addiction appear to be on the rise, combating the illicit drug trade in Egypt is becoming increasingly important.
"The trade not only violates national drug laws and international conventions but also involves other criminal activities including racketeering, conspiracy, bribery, corruption of public officials, tax-evasion, banking law violations, illegal money transfers, and crimes of violence and terrorism", Hegazy asserts.
The drug is part of a web of illicit activities contributing to wider problems in society. A shift in understanding of drug users and abusers is much-needed in an increasingly unstable Egypt.
*Name has been changed to protect identity.