Drug Abuse

Introduction:

“If current trends continue, 250 million children alive today will be killed by tobacco” – W.H.O.[1]

Drug abuse is a generic term for the abuse of any drug, including alcohol and cigarettes. Drug means a habit-forming substance which is taken pleasure or excitement and which induces sleep or produces insensibility. They take drugs to forget pain, sorrow, insult, and to escape from reality. Drug is generally prepared from opium and other harmful substances and chemicals. this intoxicating evil is introduced in the market under various names chars, bhang, or ganja, are abused throughout the country with a turnover of around $500 billion, the numbers of drug addicts are increasing day by day, millions of people all over the world.Consume one drug or the other most drug users being in the productive age group of 18-35 years, At the national level, drug abuse is intrinsically linked with racketeering, conspiracy, corruption, illegal money transfers, terrorism and violence threatening the very stability of governments next to petroleum and arms trade it is the third largest business in the world.According to UN report, one million heroin  addicts are registered in India, and unofficially there are as many as nearly five million.[2] June 26 is celebrated as International Day against Drug Abuse and Illicit Trafficking every year.[3]  Thousands of men and billions of dollars are involved in drug traffic. That is why it is so difficult to keep it under control.

Concept:

Any substance (usually chemical) which influences our bodies or emotions when consumed may be called a drug, i.e. it is a chemical substance, that, when put into your body can change the way the body works and the mind thinks. These substances may be medicinal i.e. prescribed by a doctor for reducing minor ailments or problems, e.g. lack of sleep, headache, tension, etc. but are also used without medical advice, used for an excessively long period of time and used for reason other than medical ones. The use of such drugs is usually legal. Some drugs may be non-medicinal in nature. Their use is illegal e.g. heroin. Another group of drugs are those that are legal, but are harmful for the person if consumed in excess, regularly, e.g. alcohol. There are other substances like cigarettes, coffee, tea etc. which can be termed as socially accepted legal drugs. But these are not seen as harmful. Some drugs like alcohol, brown sugar, etc. are dangerous and addictive.[4]

According to Julian (1977) drug is any chemical substance with affects bodily function, mood, perception or consciousness which has potential for misuse and which may be harmful to the individual or the society.[5]

“In the last five years, the number of drug abuse cases in females and youngsters in the age group of 14-16 has increased substantially. College students not only take drugs but are also peddling drugs these days for easy money. The drugs are easily available at cheap rates in slum areas,” said IndrajitDeshmukh, counsellor at Practical Life Skills, a rehabilitation center.

Drug:

A drug is any substance other than food that when inhaled, injected, smoked. Consumed, absorbed via a patch on the skin or dissolved under the tongue causes a physiological change in the bode. Abuse means departure from correct, legal, proper or reasonable use misuse, maltreatment resulting in emotional, mental or physical injury to its victim.[6]

Abuse:

To use something for the wrong purpose in a way that is harmful or morally wrong.[7]

Drug abuse:

Complusive, excessive and self-damaging use f habit forming drugs or substances, leading to addiction or dependence, serious physiological injury (such as damage to kidneys, liver,heart) or psychological harm such as dysfunctional behavior patterns, hallucinations, memory loss or death. It is also called substance abuse. Substance abuse is an alternative term for drug abuse[8].

Drug-driven HIV/AIDS: India is home to one of the largest HIV/AIDS epidemics in the world. In this context, there is rising concern about the large number of IDUs and the attendant risk of HIV. Sentinel surveillance data from 2003 indicates a rise from 7.4% to 14.4% in HIV prevalence amongst injecting drug users in New Delhi. In 2 of the 6 states now into a ‘generalized’ epidemic, there is a strong IDU-HIV link. There is also rising concern about the drug abuse/HIV nexus between IDUs, female sex workers, their partners, the non-substance using partners of IDUs and the so-called “general population”. The link is strong and is seen as one cause of the ‘feminization of the epidemic’ in India.[9]

Causes:

Drug abuse often occurs alongside other conditions like mental illness. While mental illness itself is not thought to cause drug abuse, one condition may indicate, and be complicated by, the other. One of the causes of drug abuse may be the attempt to manage the symptoms of an underlying mental illness.[10]

There are certain life circumstances, particularly among younger users, that are risk factors for, rather than the direct cause of, drug abuse. An adolescent or pre-adolescent may be trying to gain attention from an inattentive parent or escape an abusive one by using drugs; prolonged attempts through drug use can be a cause of drug abuse.

Additional risk factors contributing to the causes of drug abuse include:[11]

• Unstable home environment, or mental illness of the parent
• A poor relationship with parents
• Use of drugs by friends
• Permissive attitude towards their own drug use and the drug use of the adolescent
• Poor achievement in school
• Availability of drugs from friends
• Fashion in rich families
• Financial Problems

Drug Use and Abuse

Using drugs to cure or prevent an illness or improve one's health may be called drug ‘use'. Using drugs (medicinal/non-medicinal) in quantity, strength, frequency or manner that damages the physical or mental functioning of an individual, is termed as drug abuse. This means that even taking medicines in excess or too often or too long or for the wrong reasons or in the wrong combination implies drug ‘abuse. According to Paul Fuqua (1978) drug abuse is the use of substance in such a way that it leads to such personal and/ or social consequences as impaired physical or mental health, impaired malnutrition, loss of productivity, and involvement in socially disruptive or illegal activities.

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.[12]

Extent and Nature of Drug Abuse

Globally, United Nations Office on Drugs and Crime(UNODC) estimates that, in 2009, between 149 and 272 million people, or 3.3% to 6.1% of the population aged 15-64, used illicit substances at least once in the previous year. About half those numbers are estimated to have been current drug users, that are, having used illicit drugs at least once during the past month prior to the date of assessment.[13]

 While the total number of illicit drug users has increased since the late 1990s, the prevalence rates have remained largely stable, as has the number of problem drug users,1 which is estimated at between 15 and 39 million. Cannabis is by far the most widely used illicit drug type, consumed by between 125 and 203 million people worldwide in 2009. This corresponds to an annual prevalence rate of 2.8%-4.5%. In terms of annual prevalence, cannabis is followed by ATS (amphetamine-type stimulants; mainly methamphetamine, amphetamine and ecstasy), opioids (including opium, heroin and prescription opioids) and cocaine. Lack of information regarding use of illicit drugs – particularly ATS - in populous countries such as China and India, as well as in emerging regions of consumption such as Africa, generate uncertainty when estimating the global number of users. This is reflected in the wide ranges of the estimates.[14]

While there are stable or downward trends for heroin and cocaine use in major regions of consumption, this is being offset by increases in the use of synthetic and prescription drugs. Non-medical use of prescription drugs is reportedly a growing health problem in a number of developed and developing countries. Moreover, in recent years, several new synthetic compounds have emerged in established illicit drug markets. Many of these substances are marketed as ‘legal highs' and substitutes for illicit stimulant drugs such as cocaine or ‘ecstasy.' Two examples are piper zines and ephedrine, which are not under international control. A similar development has been observed with regard to cannabis, where demand for synthetic cannabinoids (‘spice') has increased in some countries. Sold on the internet and in specialized shops, synthetic cannabinoids have been referred to as ‘legal alternatives' to cannabis, as they are not under international control. The control status of these compounds differs significantly from country to country. In terms of treatment demand, the picture varies between regions. Cannabis contributes significantly to treatment demand in most regions, but it is particularly prominent in Africa and Oceania. Opiates dominate treatment demand in Europe and Asia, whereas cocaine is the main problem drug in South America.[15]

Shukla[16] reported that 38.3% of the rural population in Uttar Pradesh was habitual substance users. In a study conducted in rural community in Bihar prevalence of alcohol/drug use was found to be 28.8% of the study population[17]

In North America, cannabis, opioids and cocaine make up similar shares of total treatment demand. ATS does not dominate any one region but makes a sizable contribution to treatment demand particularly in Asia and Oceania, but also in Europe and North America. In terms of the health consequences of drug use, the global average prevalence of HIV among injecting drug users is estimated at 17.9%, or equivalently, 2.8 million people who inject drugs are HIV positive. This means that nearly one in five injecting drug users is living with HIV. The prevalence of Hepatitis C among injecting drug users at the global level is estimated at 50% (range: 45.2%-55.3%), suggesting that there are 8.0 million (range: 7.2 – 8.8 million) injecting drug users worldwide who are also infected with HCV. Deaths related to or associated with the use of illicit drugs are estimated between 104,000 and 263,000 deaths each year, equivalent to a range of 23.1 to 58.7 deaths per one million inhabitants aged 15-64. Over half of the deaths are estimated to be fatal overdose cases. According to the World Drug Report of 2010, there were 871,000 heroin user and 674,000 opium users in India in 2008.[18]

In a survey conducted by the Ministry of Social Justice and Empowerment, in 2001, there were 2 million opium users and 8.7 million cannabis users. However, trends and patterns of narcotics and drugs consumption over the years have shown significant shifts. For instances, while the component of opium use among the drug addicts has been decreasing from 23.1 per cent in 1997 to 9.2 per cent in 2000, the share of cannabis has been increasing incrementally from 5.7 per cent to 9.4 per cent. The share of heroin has also witnessed increase from 12.7 in 1997 to 18.5 per cent in 1999. Most interestingly, the component of other psychotropic drugs has increased from 16.2 per cent to 23.2 per cent between 1997 and 2000.[19]

The nature of drug use in India Rural versus urban background:

In this NHS, 51.6% of the subjects came from a rural background and the remaining 48.4% were from urban India. They resembled each other on most of the parameters. The monthly income was slightly higher among the subjects from an urban background. People from an urban background more often reported heroin abuse, injecting drug use (IDU) and needle sharing. In contrast, users of other opiates and cannabis were generally from a rural background. A marginally higher percentage of urban users had been introduced to drug use earlier, i.e. before the age of 20 years (42% versus 34%). ‘Ever use’ versus ‘current use:’ It was observed that many ‘ever users’ were ‘current users’. The proportion of ‘current users’ as part of ‘ever users’ was around 80% for alcohol, 70% for cannabis and 65% for opiates. Thus, drug use, once initiated, appears to continue in a majority of cases.[20]

"During the period of March 2000 to November 2001, a national household survey on the extent of pattern and trends of drug abuse in the country was undertaken under the sponsorship of ministry of social justice and empowerment and UN office on Drugs and Crime the results of which were published in 2004. Based on projections, it was estimated 2 million persons use opiates drug and 62.6 million persons were alcohol users.... efforts are underway to conduct an advanced survey across the country," stated the affidavit filed before the division bench comprising Chief Justice G Rohini and Justice R S Endlaw. The affidavit, submitted by Central government's counsel SumeetPushkarna, was in response to a PIL that alleged a total lack of any governing or controlling body relating to the running of de-addiction and rehabilitation of alcoholics and drugs de-addiction Centers in Delhi and across the country.

Refuting the allegations that around Rs 300-400 crores is spent on de-addiction centers and there is no coherent or proper policy in place for the running and maintaining such de-addiction centers, the government said that on an average only Rs 30 crores were spent annually under the scheme. "Further the scheme categorically mentions the minimum standards in the services being delivered by the de-addiction centers," it said.[21]

Present Scenario India ranks second to Afghanistan in production of licit opium and probably the only country producing gum as found by the Indian Central Bureau of Narcotics. Opium poppy is grown in the central Indian state of Madhya Pradesh (Mansaur), Rajasthan (Kota, Jodhpur, etc.) and Uttar Pradesh (Gazipur). By the turn of the century the Indian government licensed nearly 160,000 farmers to cultivate opium on 35,000 hectares. In the year 2000 over 1,300 metric tons of opium was harvested, the largest amount in many decades. In 1999 an estimated 300 metric tons of licit opium was diverted to the black market, converted into heroin ‘brown sugar’ and sold. Ten percent of the diversion of opium gum would make India the world’s fourth largest producer of illegal opiates. Afghanistan produces almost 90% of world opium followed by Myanmar. Many of the Indian states i.e. Jammu and Kashmir, Uttar Pradesh, Manipur, Mizoram, Nagaland and Arunachal Pradesh14 have been found to indulging in illegal growing of opium poppies. Since the early 1980s use of opium derivatives like heroin has been wide spread in the major metropolitan cities of India like New Delhi, Kolkata, Chennai and Mumbai, etc. and most of what is available is impure and crude. A purer variety known as ‘white sugar’ or ‘number four’ is available in the states of Manipur, Nagaland and Mizoram, which are closest to the source of heroin. A part of the heroin available in India is trafficked from the Golden Triangle, in particular from Myanmar. In Manipur, heroin has been sold since 1973 and its use has become widespread15,16. During the 1990s injecting pharmaceuticals, in particular buprenorphine took an epidemic proportion and often used as an alternative among heroin users. It has been witnessed in all the major metropolitan cites and has not stopped17,18. Heroin, hashish and morphine base from Afghanistan, Pakistan, Myanmar and to a smaller extent Nepal gets the conduit of India for its onwards transmission. Nearly 32% of heroin seized in India has its origins in Afghanistan or Pakistan.[22]

Traditional Intoxication The tribes use drinks and drug on various occasions. The local brew like toddy, arrack and Mahua are different addictive’s used in different parts of the country in different occasions like harvest, marriage, birth or death of child or during celebration of local festival[23] Shukla in his ethnographic study of a UP village reported that alcoholic drinks and plant products had different roles and varying degrees of acceptability and values in various sub groups of the village community. The drug use pattern appearing on local levels were of two types ceremonial/ ritualistic and convivial use. The convivial use showed a wide range of variations from one social group to another, while ritualistic and ceremonial use were confounding to particular religious’ ceremonial or festive occasion. Among Rajput’s, alcohol consumption was a group ritual and the aim of drinking was purely to become inebriated as quickly as possible. Public inebriety was not forbidden for these men. It had cultural sanction19. Similar, practice have been found among the Rajput men, while taking opium in community gathering. During the moment of conviviality, they are flanked and supported by lesser mortals Bhils, a scheduled tribe. And on some rare occasions an elderly Rajput women would also indulge in similar practice of limited public inebriation, while taking opium.[24]

Addiction Pattern and Embedded Risk in rural Rajasthan swallowing and smoking of opium is very common. It comes in two forms either as a nugget or a powder. The nuggets are first dissolved in water and what is extracted in the filtering process is swallowed. The powdered form is placed into an earthen clay pipe and smoked. Heroin, brown sugar, appeared on the Indian market in the early 1980s and it effectively displaced opium and cannabis as the drugs of choice.[25]

Legal Provisions:

The introduction of death penalty for drug-related offences has been a major deterrent. The Narcotic Drugs and Psychotropic Substances Act, 1985, were enacted with stringent provisions to curb this menace. The Act envisages a minimum term of 10 years’ imprisonment extendable to 20 years and fine of Rs. 1 lakh extendable up to Rs. 2 lakhs for the offenders. The Act has been further amended by making provisions for the forfeiture of properties derived from illicit drugs trafficking.[26] Comprehensive strategy involving specific programs to bring about an overall reduction in use of drugs has been evolved by the various government agencies and NGOs and is further supplemented by measures like education, counseling, treatment and rehabilitation programs. India has bilateral agreements on drug trafficking with 13 countries, including Pakistan and Burma.[27]

Prior to 1999, extradition between India and the United States occurred under the auspices of a 1931 treaty signed by the United States and the United Kingdom, which was made applicable to India in 1942. However, a new extradition treaty between India and the United States entered into force in July 1999.

Credits:

The spread and entrenchment of drug abuse needs to be prevented, as the cost to the people, environment and economy will be colossal. The unseemly spectacle of unkempt drug abusers dotting lanes and by lanes, cinema halls and other public places should be enough to goad the authorities to act fast to remove the scourge of this social evil. Moreover, the spread of such reprehensible habits among the relatively young segment of society ought to be arrested at all cost. There is a need for the government enforcement agencies, the non-governmental philanthropic agencies, and others to collaborate and supplement each other’s efforts for a solution to the problem of drug addiction through education and legal actions.[28]

The Indian government has taken a significant step to help alcohol and drug abusers by launching a national toll free helpline number – 1800-11-0031. The helpline was started to set in motion the Indian Prime Minister Narendra Modi’s plan to eradicate the menace of drug abuse from the country and assist the existing victims in successful rehabilitation.

Preventing Addiction

There is limited evidence on the treatment and preventive strategies of drug abuse in adolescents, with very few studies from the developing nations and India in particular. Research shows that rates of tobacco use, harmful alcohol use, and illicit drug use in adolescents can be reduced by a combination of regulatory, early-intervention, and harm reduction approaches.[29] Studies from other low income countries have showed that community based and school based preventive strategies are effective in reducing drug and alcohol consumption among adolescents .[30]The need of the hour is to 72 investigate the efficacy of these interventions in the Indian setting and to formulate policies based on an evidence base.

Although often neglected, we need to give special attention to our young community who have never abused drugs.

The old saying, "Preventing addiction is more effective than curing it," may seem idealistic, but it demonstrates a mindset that Indians need to adopt. While many programs aim at presenting alternatives to addicts, we need to remember the community that has never abused drugs.

Creating healthy and attractive alternatives to drug abuse can curb the number of first time users. The United Nations Office for Drug Control and Crime Prevention recently came out with a handbook to help communities prevent drug abuse. Some basic prevention ideas include:[31]

Promotion of Health: The community needs to promote healthy lifestyles through personal and cultural practices. By setting an example of health you will discourage damaging and dangerous lifestyles.

Focus on people and encouragement of social interaction: Promoting social interaction between old and young can only be done in a social environment. Create this environment through organized activities that all ages can partake in.

Local involvement of young people and respect for cultural values: The activities you chose should focus on young people. Be sure to respect cultural traditions of the community.

Encouragement of positive alternatives: Develop these alternatives with cultural values in mind, and understanding what appeals to the younger generation.

Long-term perspective: Don't be discouraged if results aren't immediate. Preventing drug use takes time

Keeping a long-term perspective is important.

Community development: Focus on developing the fundamentals of your community. Education, health and social services, housing, sanitation, and income-generating activities are important ideas to focus in on.

Drug policy of India:

A drug policy is the policy, usually of a government,[32] regarding the control and regulation of drugs considered dangerous, particularly those which are addictive. Governments try to combat drug addiction with policies which address both the demand and supply of drugs, as well as policies which can mitigate the harms of drug abuse, and for medical treatment. Demand reduction measures include prohibition, fines for drug offenses, incarceration for persons convicted for drug offenses, treatment (such as voluntary rehabilitation, coercive care,[33] or supply on medical prescription for drug abusers), awareness campaigns, community social services, and support for families. Supply side reduction involves measures such as enacting foreign policy aimed at eradicating the international cultivation of plants used to make drugs and interception of drug trafficking. Policies which may help mitigate the effects of drug abuse include needle exchange and drug substitution programs, as well as free facilities for testing a drug's purity.

Drugs subject to control vary from jurisdiction to jurisdiction. For example, heroin is regulated almost everywhere; substances such as qat, codeine are regulated in some places,[34] but not others.

Most jurisdictions also regulate prescription drugs, medicinal drugs not considered dangerous but that can only be supplied to holders of a medical prescription, and sometimes drugs available without prescription but only from an approved supplier such as a pharmacy, but this is not usually described as a "drug policy".

International treaties

The International Opium Convention, signed in 1912 during the First International Opium Conference, was the first international drug control treaty. It went into force globally in 1919 when it was incorporated into the Treaty of Versailles in 1919. A revised Convention was registered in League of Nations Treaty Series in 1928. It also imposed some restrictions—not total prohibition—on the export ofIndian hemp (cannabis sativa forma indica). In 1961 it was superseded by the international Single Convention on Narcotic Drugs to control global drug trading and use. The Convention banned countries from treating addicts by prescribing illegal substances, allowing only scientific and medical uses of drugs. It did not detail precise drug laws and was not itself binding on countries, which had to pass their own legislation in conformance with the principles of the Convention.[35]

The major drug laws of India are the Narcotic Drugs and Psychotropic Substances Act (1985) and the Prevention of Illicit Trafficking in Narcotic Drugs and Psychotropic Substances Act (1985).

Narcotic Drugs and Psychotropic Substances Act

The Narcotic Drugs and Psychotropic Substances Bill, 1985 was introduced in the Lok Sabha on 23 August 1985. It was passed by both the Houses of Parliament and it was assented by the President on 16 September 1985. It came into force on 14 November 1985 as THE NARCOTIC DRUGS AND PSYCHOTROPIC SUBSTANCES ACT, 1985 (shortened to NDPS Act). Under the NDPS Act, it is illegal for a person to produce/manufacture/cultivate, possess, sell, purchase, transport, store, and/or consume any narcotic drug or psychotropic substance.

Under one of the provisions of the act, the Narcotics Control Bureau was set up with effect from March 1986. The Act is designed to fulfill India's treaty obligations under theSingle Convention on Narcotic Drugs, Convention on Psychotropic Substances, and United Nations Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances. The Act has been amended three times - in 1988, 2001, and most recently in 2014. The Act extends to the whole of India and it applies also to all Indian citizens outside India and to all persons on ships and aircraft registered in India.

The Prevention of Illicit Trafficking in Narcotic Drugs and Psychotropic Substances Act is a drug control law passed in 1988 by the Parliament of India. It was established to enable the full implementation and enforcement of the Narcotic Drugs and Psychotropic Substances Act of 1985.

Narcotics Control Bureau

The Narcotics Control Bureau (NCB) is the chief law enforcement and intelligence agency of India responsible for fighting drug trafficking and the abuse of illegal substances.[36]It was created on 17 March 1986 to enable the full implementation of the Narcotic Drugs and Psychotropic Substances Act (1985) and fight its violation through the Prevention of Illicit Trafficking in Narcotic Drugs and Psychotropic Substances Act (1988)[37]

Cultivation/production/manufacture, possession, sale, purchase, transport, storage, consumption or distribution of any of the following substances, except for medical and scientific purposes and as per the rules or orders and conditions of licences that may be issued, is illegal.[38]

Punishment:[39]

Anyone who contravenes the NDPS Act will face punishment based on the quantity of the banned substance.

a. where the contravention involves small quantity (1 kg), with rigorous imprisonment for a term which may extend to 6 months, or with fine which may extend to â‚¹10,000 or with both;

b. where the contravention involves quantity lesser than commercial quantity but greater than small quantity, with rigorous imprisonment for a term which may extend to 10 years and with fine which may extend to â‚¹1 lakh;

c. where the contravention involves commercial quantity, with rigorous imprisonment for a term which shall not be less than 10 years but which may extend to 20 years and shall also be liable to fine which shall not be less than â‚¹1 lakh but which may extend to â‚¹2 lakh.]Childline.india .com