Bhang Cultivation Endangers Pakistan’s Youth
By Dr Mahjabeen Islam
Toledo, Ohio

Amid the Covid confusion and the Karachi rains came the curious news that Pakistan plans bhang cultivation. Pakistan’s addiction treatment professionals were not consulted. And we are very concerned about the fallout of this decision on the mental health of Pakistan’s youth. And how adolescent cannabis is associated with the development of psychosis and schizophrenia at a later age.
The Control of Narcotic Substances Act of 1997 defines the cultivation of bhang as illegal, but Pakistan’s 2020 Cabinet, noting the potential influx of $1 billion in three years, the strength of hemp rope and the medicinal uses of cannabidiol has agreed to the industrial cultivation of cannabis.
Bhang is an edible mixture of the buds, leaves and flowers of the marijuana plant and has been used in the Subcontinent since 1000 BC. Hemp is also derived from the marijuana plant, and has industrial uses in making rope, clothes, shoes, paper. THC or tetrahydrocannabinol, the active ingredient in bhang, is addictive, helps relieve pain, increases the appetite, and reduces nausea and vomiting. Cannabidiol is a low-potency THC product with multifarious claims of reducing pain to controlling seizures. The only FDA approved indication for cannabidiol is for two rare types of childhood seizures. All the other claims for cannabidiol are not borne out by research. And it is unregulated and frequently contains high doses of THC.
In my addiction practice I am able to help patients achieve sobriety from a variety of addictive substances, from heroin to amphetamines. But cannabis addiction is usually very resistant to all forms of treatment. Cannabis causes relaxation and euphoria, but in the acute stage can cause a violent psychosis, especially when used in a pure form, which is what is easily found in Pakistan. Long-term use in teenagers results in psychosis at a later age, and use in adults causes slowed reflexes, sleepiness, memory loss and cognitive issues, presenting the picture of dementia.
In June 2020 the Journal of the Pakistan Medical Association published my article on Pakistan's alcohol, opioid and methamphetamine crisis. The neurobiology of addiction is explained in the article and it is basically all a matter of receptors. If your endocannabinoid receptor enjoys marijuana, you are likely to become addicted. Per capita Pakistan is the most heroin-addicted country in the world! And the crisis of alcohol, opioids and methamphetamine, or Ice, is ravaging society, especially our young. For the longest time we have known that marijuana is the gateway drug. And it becomes a matter of progression from marijuana to Ice and heroin. The article also details how little Pakistan spends on addiction treatment.
Medical marijuana has been approved in some states of the US only because of the powerful marijuana lobby and the US Congress being itself on sale to the highest bidder. In my research for this article, it appears that there are is a powerful and persistent marijuana, I mean, bhang lobby, in Pakistan. And it has clearly succeeded.
As addiction specialists we practice evidence-based medicine, relying on scientific studies to guide our management. This, combined with years of experience, allows us to make both individual and national recommendations.
Cannabis use is widespread in Pakistan, true. And everyone does not develop psychosis with cannabis use. The neurobiology of addiction, as well as its consequences, are not completely known, and it appears that there is a vulnerability to the serious adverse effects of cannabis. We are unable to tell who has this vulnerability and who does not.
The claim is that this bhang cultivation will be tightly regulated and overseen by the government. In Pakistan’s environment this is a delusional claim at worst and an optimistic one at best. The message that goes out loud and clear to Pakistanis is that cannabis is being officially cultivated and its use is really not an issue.
For every condition in Medicine we weigh the risk-benefit ratio of each management option. So, in this bhang situation the benefit of cultivation is the $1 billion over three years. The risks are worsening of the addiction crisis in Pakistan, psychosis developing in the vulnerable, driving while impaired and thus increased traffic fatalities, progression of use from marijuana to hard drugs and individual and family financial devastation.
Pakistan has a very youthful population. Minister for Science and Technology Fawad Chaudhry and Prime Minister Imran Khan while salivating over the billions from bhang, need to clearly understand that they will have consigned some of Pakistan’s youth to a terrible future. We should in fact work toward a university-affiliated addiction center that can be the national repository of statistics and research, guide addiction treatment and participate in health care policy as related to addiction. Even with this bhang issue, there is more to it than just money.
(Dr Mahjabeen Islam is certified by the American Board of Addiction Medicine and is a Fellow of the American Society of Addiction Medicine. She practices in Toledo, Ohio, USA. - mahjabeen.islam@gmail.com)