International Day Against Drug Abuse and Illicit Trafficking 2012 – June 26 Drug Abuse in India
Dr.M.A. Aleem MD., DM (Neuro)HOD & Professor of Neurology
KAPV Govt. Medical College and AGM Govt. Hospital
Trichy.
Introduction
The epidemic of substance abuse in young generation has assumed alarming dimensions in India. Changing cultural values, increasing economic stress and dwindling supportive bonds are leading to initiation into substance use. According to the World Health Organization (WHO) substance abuse is persistent or sporadic drug use inconsistent with or unrelated to acceptable medical practice[1].
The picture is grim if the world statistics on the drugs scenario is taken into account. With a turnover of around $500 billions, it is the third largest business in the world, next to petroleum and arms trade. About 190 million people all over the world consume one drug or the other[2]. Drug addiction causes immense human distress and the illegal production and distribution of drugs have spawned crime and violence worldwide. June 26 is celebrated as International Day against Drug Abuse and Illicit Trafficking every year.
The theme for this year is global action for healthy communication with out drugs
Today, there is no part of the world that is free from the curse of drug trafficking and drug addiction. Millions of drug addicts, all over the world, are leading miserable lives, between life and death. India too is caught in this vicious circle of drug abuse, and the numbers of drug addicts are increasing day by day.
According to a UN report, One million heroin addicts are registered in India, and unofficially there are as many as five million. What started off as casual use among a minuscule population of high-income group youth in the metro has permeated to all sections of society. Inhalation of heroin alone has given way to intravenous drug use, that too in combination with other sedatives and painkillers.
The pharmaceutical products containing narcotic drugs are also increasingly being abused. The intravenous injections of analgesics like dextropropoxphene etc are also reported from many states, as it is easily available at 1/10th the cost of heroin. The codeine-based cough syrups continue to be diverted from the domestic market for abuse.
Drug abuse is a complex phenomenon, which has various social, cultural, biological, geographical, historical and economic aspects. The disintegration of the old joint family system, absence of parental love and care in modern families where both parents are working, decline of old religious and moral values etc lead to a rise in the number of drug addicts who take drugs to escape hard realities of life.
Drug use, misuse or abuse is also primarily due to the nature of the drug abused, the personality of the individual and the addict’s immediate environment. The processes of industrialization, urbanization and migration have led to loosening of the traditional methods of social control rendering an individual vulnerable to the stresses and strains of modern life. The introduction of synthetic drugs and intravenous drug use leading to HIV/AIDS has added a new dimension to the problem, especially in the Northeast states of the country.
Drug abuse has led to a detrimental impact on the society. It has led to increase in the crime rate. Addicts resort to crime to pay for their drugs. Drugs remove inhibition and impair judgment egging one on to commit offences. Incidences of teasing, group clashes, assault and impulsive murders increase with drug abuse. Apart from affecting the financial stability, addiction increases conflicts and causes untold emotional pain for every member of the family. With most drug users being in the productive age group of 18-35 years, the loss in terms of human potential is incalculable. The damage to the physical, psychological, moral and intellectual growth of the youth is very high.Adolescent drug abuse is one of the major areas of concern in adolescent and young people’s behavior.
What types of prescription drugs are abused?
Three types of drugs are abused most often:- Opioids—prescribed for pain relief
- CNS depressants—barbiturates and benzodiazepines prescribed for anxiety or sleep problems (often referred to as sedatives or tranquilizers)
- Stimulants—prescribed for attention-deficit hyperactivity disorder (ADHD), the sleep disorder narcolepsy, or obesity.
How can you help prevent prescription drug abuse?
- Ask your doctor or pharmacist about your medication, especially if you are unsure about its effects.
- Keep your doctor informed about all medications you are taking, including over-the-counter medications.
- Read the information your pharmacist provides before starting to take medications.
- Take your medication(s) as prescribed.
- Keep all prescription medications secured at all times and properly dispose of any unused medications.
Cocaine & Amphetamine (Ecstasy tablets) use is rare in India.
2) What are licit & illicit drugs?Smoking & chewing tobacco and alcohol are licit (legal) drugs in most states in India. All other drugs are illicit (illegal), hence possession, use, etc. are punishable offences.
Narcotic pharmacological product use without appropriate physician’s prescription is considered illicit.
Different age limits exist for use of alcohol / tobacco products in various states of India.
In some countries all drugs (including tobacco & alcohol) are illicit, e.g. Saudi Arabia.
In some countries cannabis is a licit substance (in certain areas/districts), e.g. Denmark.
3) What are the socio-demographic characteristics of an average drug user?Overall males use drugs much more than women. The pattern of use of licit drugs differs from that of illicit drugs. Licit drug use is prevalent between the ages of 16 to 60 years in all economic strata, more so in young adults. Illicit drugs are mainly used in lower & lower middle economic groups. Cocaine & Amphetamine use is rare and seen in some young adults from higher economic backgrounds.
4) What is the vulnerable age of slipping into Drug Abuse?Youngsters between the ages of 16 and 21 years are most prone to initiating alcohol & drug use.
5) What is the natural history of Drug Abuse?Many adolescents experiment with smoking & alcohol in their late teens. This usually occurs at parties. Some also try cannabis and rarely illicit drugs. Most of them outgrow these tendencies and move into adulthood as teetotalers. Some may continue with regular use of a single drug, e.g. cigarette smoking, or use drugs occasionally, e.g. alcohol.
Regular drug use results in several adverse consequences in the personal, social, occupational spheres of users in the 20s, 30s & 40s. Some quit intermittently and some quit for long durations. Most users usually quit drug use in their late 40s. Some may continue lifelong.
6) What are the medical harm associated with Drug Abuse?Medical harm depends on type, amount, duration of drugs use, and certain protective factors.
Tobacco use is related to lung cancer (smoking), oral cancer (chewing), heart disease, chronic obstructive pulmonary disease (COPD), dental problems, chronic bronchitis, impotence in males & fetal defects in unborn children (in pregnant women)
Chronic alcohol use may lead to hepatitis or cirrhosis of liver, gastritis, pancreatitis , depression, impotence in males, cardiomyopathy, high blood pressure, neuropathy, obesity, predispose to some cancers (mouth, gullet, liver, colon and breast) and accidents – automobiles, domestic & workplace (injury, fire, drowning). Hooch use can cause severe illness & permanent blindness.
All drugs produce harm according to the route of intake. Those drugs that are inhaled cause respiratory tract infections and may predispose to tuberculoses of lungs. Those drugs which are injected can cause infections of the veins, infection in the blood, abscesses in various internal organs & muscle, and spread blood-brone infections (e.g. Hepatitis B & C) if needles are shared between users.
Opoids & sedatives may be dangerous if overdosed. Inhalants may produce burns in mouth, nostrils, abnormal heart rhythms & sudden death.
Protective factors include good nutrition, drug use restricted to social occasions (e.g. alochol) and regular contact with treatment facility.
7) What are the non-medical consequences of drug use?These are in the context of marriage, family, society, workplace, finances & the law.
Marital complications: Disapproval of drug use by the spouse, deteriorating interpersonal relationships, impotence in males, frequent fights, separation & divorce.
Familial complications: Disapproval of drug use by family members, frequent fights, embarrassing events due to intoxication.
Social complications: Misbehavior with others, loss of prestige in society & social standing, alienation, exclusion of drug user & family from social occasions by other members of the society.
Occupational complications: Irregular work habits, absenteeism, poor work output, accidents due to intoxication, misbehavior & insubordination, frequent complaints, salary deductions, loss of pay, sacking, unemployment, difficulty on re-acquiring job, frequent change of jobs.
Financial complications: Cost of drugs, and paraphernalia (syringes), transport, additional snacks, medical costs, diversion of household expenses for drug procurement, stealing money from home, selling household items for drugs, loans from family, friends, office and other sources.
Legal complications: Driving & traffic accidents, brawls during intoxicated state, arrest for possession or use of illicit drug, peddling of drug for sustaining drug use habit.
8) Are there any safe limits of drug use?Safe limit is defined only in the context of alcohol use. In developed nations, recommended 'safe' limits for drinking alcohol are:
Men: less than 21 units per week (no more than 4 units in any one day)
Women: less than 14 units per week (no more than 3 units in any one day)
One unit of alcohol is one small measure (30 ml) of spirits (whisky / rum /brandy / vodka).
Use of any amount of tobacco or any other drug is considered harmful.
9) What are the signs of hidden drug use?
This occurs mainly in the initial phases of drug use, and also in extremely conservative societies.
Common signs include spending excessive time alone in one’s room, bathroom, or outdoors; returning home with unsteady gait, redness of eyes, poor hygiene, decreased attendance & functioning at school / work, asking for more pocket money, borrowing money from others, stealing money or other items from home, making excuses regarding money and time spent.
10) What the treatments available for Drug Abuse?
Medications & counseling are the main modalities of treatment of Drug Abuse. Minor levels of drug use are dealt with counseling alone. For higher grades of drug use a combination of medications & counseling is used. Definite treatments are available for alcohol, smoking and opoids (heroin, injections, cough syrup, etc.).
11) Who provides treatment of Drug Abuse & where?
Psychiatrists are formally trained in Alcohol, Smoking, and Drug Addiction Treatment. Some General Duty Medical Officers (GDMOs) are also trained by the Govt. of India in Drug Abuse treatments. Treatment is available in Psychiatry Departments of Government Hospitals, NGOs & by psychiatrists in the private sector.
12) What is the role of rehabilitation?
Rehabilitation involves imparting vocational training so that a drug user can be meaningfully employed and remain off drugs in the society. It is required in a small number of drug users, especially those who have been using for several years & have lost the habit of working.
13) What is the role of involuntary admission?
Forced admission for Drug Abuse is not legally permissible. If a drug user additionally suffers from a psychiatric illness, then involuntary admission is possible if the same is certified & the patient is admitted under care of a psychiatrist.
14) What are the phases of treatment?
An initial intensive phase of medical treatment (detoxification) lasts 2-3 weeks. It provides relief of the distressing symptoms (withdrawal symptoms) occurring after stopping drug use. The second phase is called the maintenance phase and it usually of one year duration. It involves medications & counseling and aims at preventing the patient from reusing drugs.
15) What is the adequate duration of treatment?
For smoking & chewing tobacco, Sedative-Hypnotic use and inhalant use, a treatment period of 3-6 months is required.
For alcohol and opoids (heroin, injections, cough syrup, etc.), treatment of one year is usually required.
16) What is the role of family members / spouse / parents?
The role of family members should be to detect drug use, to encourage to initiate & maintain in treatment and to look out for signs of re-use (relapse). Family members need to understand that drug abuse is currently considered as a Medical Disorder.
17) What are the steps for prevention of Drug Abuse?
Increasing awareness of the common drugs of abuse, their medical, social & occupational costs, in youngsters, parents and teachers.
18) What are the legal aspects of Drug Abuse?
Alcohol and tobacco use is permissible in adults with specific age limits. Production, transport, possession and use of all other drugs is under the purview of NDPS Act of 1987 and punishable with imprisonment of 6 months &/or fine of Rs.10,000/-. Penalties increase with increase in amounts, repeat offences.
19) Is there some softer options for first time offenders?
If a person has been arrested for drug use, a provision in the NDPS Act can exempt him/her if he/she is the first time offender & agrees to undergo treatment of Drug Abuse at a government facility.
20) What is the message for youngsters?
Be aware, refuse drugs the first time & every time, help is available and do not hesitate to ask for help.
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