Jesus Dueñas Becerra*
All India Institute of Medical Sciences, India
*Corresponding author: Sharma HK, Former Senior Research Officer, All India Institute of Medical Sciences, New Delhi, India
Submission: May 27, 2019;Published: August 20, 2019
ISSN 2578-0042 Volume5 Issue1
The author has the privileged to work in the field of substance use disorder (SUD) at a premier medical Institute in India and carried out research work in this field over the last four decades. The present review is a reflection of research studies carried out and suggest evidence-based intervention strategies. A developing society like India is a good example of fast altering drug scenario from tranquility to turmoil state and a challenge to public health in terms of rise in associated mortality and morbidity.
In Indian context, it is interesting to note the pathway from traditional use of plant products like cannabis (bhang and marihuana), raw opium and home-brewed alcoholic beverages to more potent and alien substances in the last few decades. The surge in the use of synthetic substances of differing dependence potential has altered long prevailing traditional patterns of substance use, especially in the metropolitan cities and a few north-eastern states. Heroin, chars (hashish) and distilled alcoholic beverages have become the new preferred moodaltering substances in urban areas . The opiate use and its spill over phenomenon became an epidemic in magnitude in urban population. The reason for such a situation can be well perceived into cosmopolitan nature of drug users and changes in institutions such as the family, social structures and cultural processes which give meaning to such behavior. Preference and use of psychotropic substances like spasmoproxyvon, buprenorphine and opioids in 1990’s change the scenario further and challenge to law enforcement and health care agencies . A recent National Survey on extent and pattern of substance use in India, conducted by All India Institute of Medical Sciences, New Delhi assessed harmful and dependent use and found that 29 million alcohol users and 7.7million opioid users need treatment and help for these psycho-active substances . The rise in Over the counter drugs (OTC) like tranquilizers and designer drugs in urban and semi-urban population make this phenomenon more complex. The clinical data indicates a trend towards “poly drug use” among the users of potent drugs. Drugs like buprenorphine, Fortwin, Avil and diazepam have been found to be used parentally, especially among heroin users. There has been a sharp rise in sero prevalence among injectors in north-east and other parts of the country. The prevalence of intravenous drug users, their HIV serological status, the demographic pro ile, high risk behavior, the spread of infections to other group is an example of emerging challenge for the public health and social system.
The response towards altering drug use pattern remains uneven. The Government of India has enacted stringent law through Narcotic Drugs and Psychotropic Substances Act,1985 and even kept death penalty in a subsequent amendment in 1989 but many issues and challenges remain to tackle this bio-medical and social phenomenon. A few issues identified through empirical research work are as follow:
Poly drug use is now a growing pattern of drug misuse/dependence. To compliment the effects of preferred drugs, user select a substitute from a range of narcotics and psychotropic drugs. There is a tendency among users to switchover from cannabis and tobacco products to opium and its derivatives. When these drugs are not available, they switched over to licit and illicit alcohol, which sometimes prove fatal. Statistics reveal that at least 25,426 people committed suicide due to drug and addiction related problems from 2004 to 20014 across India. This comes down to an average 2,542 suicides every year, 211 per month and 7 per day .
Another dimension in altering drug scene is an early age of initiation. The adolescents have initiated the world of the relatively senior groups of drug users. This early initiation gives a pseudo feeling of maturity and hedonistic pleasure to them. The trend is also responsible in the making of the hard-core drug users (drug dependence). As time passes, these teenagers find themselves caught into the intricate web of the drug users and peddlers in illegal activities.
A large number of these remains out of public health domains and rarely seek treatment. For those who seek treatment, it has also been observed that recovery and rehabilitation do not find its permanent place in the life of these users. The process of treatment, recovery and rehabilitation if done in a comprehensive and holistic manner would make outcome that would be more purposeful and lasting in nature.
There is a need to take into consideration the socio-cultural perspective of substance abuse in a pluralistic and diverse culture like India. The materials and techniques to be adopted to impart the messages to the affected population must be culturally sensitive, socially acceptable and economically viable. At the end, it can be inferred safely that fast altering drug use pattern requires a multipronged strategy and simplistic solutions adopted earlier may not help in a long way. The important parameters for consideration are increasing trend in morbidity and mortality associated with highcontent alcoholic beverages, tobacco intake and use of synthetic drugs and preference of poly drug use.
© 2018 Sharma HK. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and build upon your work non-commercially.