Opium: Afghanistan's new front line

War torn and ravaged by division, Afghanistan has become the focus for the worldwide fight against child drug addiction

By the time she was 22, Shukofar had suffered nine miscarriages. She carried the babies until about six months, before losing them all. Poor, uneducated and lacking access to proper medical care, she turned to the fix-all panacea in rural Afghanistan: opium. Smoking the drug, she was told, would keep her calm, stop any bleeding and allow her to carry to full term.

By the time she eventually gave birth to her first son, Shukofar was an addict.

Like many new mothers, she was constantly exhausted after the birth of her baby, and so she gave the child opium too, to keep him quiet and allow her to rest. Baby Nasruallah became an addict, as did her second child, Jaweed.

Shukofar, now 28, is pregnant again. But she is determined to be a better mother. Along with her children, now five and two, she is undergoing treatment at a revolutionary drug rehabilitation centre in Mazar-e-Sharif in northern Afghanistan, one of only six centres for women and children in a country with a drugs problem that no one yet quite knows the scale of. "I wanted to sleep all the time," Shukofar said, describing life as an opium addict: "I couldn't take care of my two children. Now I am better than before. Now I feel like I am a [proper] mother and I take care of my children."

Shukofar and her children are fortunate. The waiting list for treatment is lengthy and there are only 20 beds for women and 15 for children. The oldest child having treatment is 12 years old.

Researchers started looking into the problem of child drug addiction in Afghanistan in 2008. Over two years, they went into the homes of 50 known opium smokers to assess whether the children were affected too. In the first year, 61 per cent of children tested positive for opiates. In the second year, 74 per cent tested positive.

"We found everything saturated in opium smoke," said Thom Browne, chief of the Office of Anticrime Programme's Criminal Justice Division at the Bureau of International Narcotics and Law Enforcement Affairs (INL).

They established the children were becoming addicted in a number of ways: they were inhaling their parents' second-hand smoke; they were absorbing it through their skin because it was on toys, blankets and pillows and parents

were giving it to them as a medicine and pain reliever. Parents were also giving them heroin paste as a "babysitting" method so they could work weaving carpets. In some provinces, during the opium harvest, farmers would also have their children score the poppy and, again, they would absorb it through their skin.

"They built up such high tolerance that the levels inside both the adults and children would actually kill a western addict," said Mr Browne. "Our researchers said they had never actually seen levels this high."

Aid groups in Afghanistan have expressed concern that despite billions being poured into the country in aid, a large proportion of the next generation – in a country where in some rural villages all the population is addicted to opiates – will be addicted to drugs.

But a silver lining exists. Although the research has identified a horrifying epidemic, the research now being done in Afghanistan on how to treat child addicts is starting to be used as a blueprint for the rest of the world.

"No one ever thought to look for child addiction before," said Mr Browne. "Unfortunately, as we are looking more, we are starting to find it."

Researchers are now finding children as young as five to eight addicted to crack cocaine in Brazil, with similar problems suspected in Chile, Argentina, Paraguay and Uruguay, as well as child soldiers in Africa addicted to amphetamines given to them to boost their confidence.

Afghanistan gets "beaten up in the press for having 93 per cent of the world's opium supply," said Mr Browne. "But it's at the forefront of developing protocols for child addiction that have never been done before." It is a gradual process, but the lessons learned in Afghanistan are now being preached around the world. French paediatric surgeons working in Afghanistan told the international researchers at a UN meeting in Vienna in March 2011 that they were "astounded" by the levels of anaesthesia required to knock a child out in order to operate. They had never considered testing children so young for drugs, but can now administer safer levels of anaesthetic.

Recovering child addicts are very different from their non-addicted peers, explained Dr Abdul Mobeen, programme director of Shahamat Health and Rehabilitation Organisation, working in his clinic in Mazar-e-Sharif: "The children are mentally undeveloped [and] they don't like to get involved in activities. They don't want to play, they don't want to learn. They like to sit in a dark place and don't want to mix with other children."

Pewaly Loden, who is a teacher at the treatment centre said: "These children, their parents are also addicts. Their mothers and fathers don't pay attention to them or take care of them. It's new for them, the things we do for them."

Because they know no other existence, the children do not really understand that they are addicts. But they are taught, during their treatment, that drugs are bad, that they are dangerous and that they should not use them.

It is this research that those at the coalface of treating addicted children are hoping will provide answers for children around the world. INL researchers are also monitoring patients during their reintegration into the community and are conducting hair and urine tests on patients to assess whether, one year after the treatment is over, they are still drug free.

"We want to determine if the treatment model we're using is effective in helping to reduce relapse and drug use rates," said INL's Mr Browne.

INL along with the World Health Organisation, the UNODC – the UN's drug and crime division – the Medical University of Vienna, and Johns Hopkins University is studying the children over the long term, research that they hope will eventually lead to the successful treatment of children in Afghanistan, and in the other areas afflicted by high incidents of drug-addicted children.

"Addiction to hard drugs at these ages has never been seen before," said Mr Browne." It's going to have to be a lifetime study following the kids. Drugs are bad for anyone – we're talking about your heart, your liver, your lungs. Conception through early childhood is a period of rapid brain development. The results of exposure to drugs in the womb, during infancy and childhood can result in lifelong problems with learning, behaviour and development."

Back at the treatment centre, we find 10-year-old Habib. According to the doctors, he was in a pretty bad state when he came in with his mother but he has progressed well. He now even takes newly admitted children under his wing and tells them they are going to be ok.

"I would like to stay here for a long time," Habib said. "I am better than before. I am happy and I don't use opium.

"When I finish my treatment I will go back home and find new friends who are not addicts," the former young addict said.