Overview of Drug Abuse in India and its Management by Prof Dr Sanjev Dave.pptx
- 1. DRUG ABUSE in India Overview & Management Prof. Dr Sanjev Dave Dean Academics Assoc Prof Community Medicine Autonomous State Medical College, Hardoi (UP)
- 2. Contents • Introduction • Definitions & Terminologies in Drug Abuse • Epidemiology of Drug Abuse- Global & Indian Scenario • Current Scenario of Drug Abuse in Indian States • Drugs Abuse -Types & Consumption Pattern in India • Drug Abuse Management Strategies in India • Summary • Take Home Message • References
- 5. Introduction Drug abuse- emerged as a serious concern Adversely affecting ---physical and socio-economic well-being of country. Enormous presence on public health across various sections of society. Epidemic of drug abuse in younger generation---alarming dimensions in India.
- 7. Drugs ILLEGAL -Drug Drugs • ---chemical substances, used for cure of a disease or for any reasonable purpose. -------substances which alters normal bodily function, resulting any psychological or behavioral change. ILLEGAL DRUG • A chemical substance which is not used legally, or as prescribed by the physician
- 12. Drug Addiction Drug Addiction -----Obsessive and repeated use of dangerous amounts of drugs and the -----appearance of withdrawal symptoms when not using drugs. Withdrawal symptoms-Physical symptoms, such as sweating, tremors and tension that accompany abstinence from the drug. Drug addiction can be both physical and psychological
- 14. EPIDEMIOLOGY Global & Indian Scenario of Drug Abuse
- 15. Drug -terminology • CURRENT USE is defined as use (even once) within preceding 12 months. • HARMFUL USE is defined as current use of the substance, along with scores on WHO ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) between 4 and 26 (for alcohol, between 11 and 26), and experiencing any harmful consequence of substance use within last three months. • DEPENDENCE is defined as current use of the substance along with scores on WHO ASSIST more than 26.
- 16. The inaugural Global Drug Policy Index, released on Sunday by the Harm Reduction Consortium, ranks Norway, New Zealand, Portugal, the UK and Australia -----as the five leading countries on humane and health-driven drug policies Drug Addiction- Global Scenario India's rank - 18 out of 30 countries.
- 22. DRUG -FIRs Scenario • The highest number of drugs related FIRs have been registered between 2019 to 2021 in Uttar Pradesh (31,482) • followed by Maharashtra (28,959), and Punjab (28417). • The data shows that Punjab registered 11,536 FIRs under NDPS Act in 2019; 6,909 in 2020 and 9972 in the year 2021.4
- 28. Substance Children & Adolescents (10-17 years) Adults (18-75 years) Opioids 1.80 1,90,00,000 MAGNITUDE OF DRUG ABUSE IN THE COUNTRY Alcohol 1.30 15,10,00,000 Cannabis 0.90 2,90,00,000 Sedatives 0.58 1,10,00,000
- 31. SUBSTANCE ABUSE IN INDIA NATIONAL SURVEY RESULTS (2019) • Ministry of Social Justice and Empowerment (MoSJE), Government of India, commissioned a National Survey alongwith • The National Drug Dependence Treatment Centre (NDDTC), • All India Institute of Medical Sciences (AIIMS), New Delhi – Extent and Pattern for Substance Use in India. – Conducted in all the 36 states and UTs of the country, – in collaboration with ten other medical institutes and a network of 15 NGOs.
- 33. Alcohol Alcohol is the most common psychoactive substance used by Indians (among those included in this survey). Nationally, about 14.6% of the population (between 10 and 75 year of age) uses alcohol. In terms of absolute numbers, there are about 16 crore persons who consume alcohol in the country. Use of alcohol is considerably higher among men (27.3%) as compared to women (1.6%). For every one woman who consumes alcohol, there are 17 alcohol using men. Among alcohol users, country liquor or ‘desi sharab’ (about 30%) and spirits or Indian Made Foreign Liquor (about 30%) are the predominantly consumed beverages. States with the highest prevalence of alcohol use are Chhattisgarh, Tripura, Punjab, Arunachal Pradesh and Goa
- 34. At the National level as many as 19% of current users of alcohol consume alcohol in a dependent pattern. The prevalence of dependent pattern of alcohol use in the general population (10—75 years) is estimated to be 2.7%, or 2.9 crore individuals. States with high prevalence (more than 10%) of alcohol use disorders are: Tripura, Andhra Pradesh, Punjab, Chhattisgarh, and Arunachal Pradesh. Alcohol
- 35. An additional 2.5% of people in the country (about 2.7 crore individuals), consume alcohol in a harmful manner. 5.2% of the population (more than 5.7 crore individuals) are affected by harmful or dependent alcohol use and need help for their alcohol use problems. Nearly one in five al c oho l us e r s suff e r s from a l c oho l dependence and needs urgent treatment Alcohol
- 39. Cannabis and Opioids After Alcohol, Cannabis and Opioids are the next commonly used substances in India. About 2.8% of the population (3.1 crore individuals) reports having used any cannabis product within the previous year. The use of cannabis was further differentiated between the legal form of cannabis (bhang) and other illegal cannabis products (ganja and charas). Use of these cannabis products was observed to be about 2% (approximately 2.2 crore persons) for bhang and about 1.2% (approximately 1.3 crore persons) for illegal cannabis products, ganja and charas. States with the highest prevalence of cannabis use are Uttar Pradesh, Punjab, Sikkim, Chhattisgarh and Delhi.
- 40. Cannabis and Opioids The proportion of people with problem cannabis use (i.e. those with harmful or dependent pattern of cannabis use) is rather modest. At the national level, about 0.25% (one in eleven cannabis users) suffers from cannabis dependence
- 41. Cannabis and Opioids About 2.1% of the country’s population (2.26 crore individuals) use opioids which includes Opium (or its variants like poppy husk known as doda/phukki), Heroin (or its impure form – smack or brown sugar) and a variety of pharmaceutical opioids. Nationally, the most common opioid used is Heroin (1.14%) followed by pharmaceutical opioids (0.96%) and Opium (0.52%). Sikkim, Arunachal Pradesh, Nagaland, Manipur and Mizoram have the highest prevalence of opioid use
- 42. Cannabis and Opioids About 0.70% of Indians (approximately 77 lakh individuals) are estimated to need help for their opioid use problems. A far higher proportion of Heroin users are dependent on opioids when compared with users of other opioids like Opium and Pharmaceutical Opioids. Of the total estimated approximately 77 lakh people with opioid use disorders (harmful or dependent pattern) in the country, more than half are contributed by just a few states: Uttar Pradesh, Punjab, Haryana, Delhi, Maharashtra, Rajasthan, Andhra Pradesh and Gujarat. However, in terms of percentage of population affected, the top states in the country are those in the north east (Mizoram, Nagaland, Arunachal Pradesh, Sikkim, Manipur) along with Punjab, Haryana and Delhi.
- 46. Sedatives and Inhalants About 1.08% of 10-75 year old Indians (approximately 1.18 crore people) are current users of sedatives (non-medical, nonprescription use). States with the highest prevalence of current Sedative use are Sikkim, Nagaland, Manipur and Mizoram. However, Uttar Pradesh, Maharashtra, Punjab, Andhra Pradesh and Gujarat are the top five states which house the largest populations of people using sedatives
- 47. Sedatives and Inhalants Inhalants (overall prevalence 0.7%) are the only category of substances for which the--- Prevalence of current use among children and adolescents is higher (1.17%) than adults (0.58%).
- 48. Sedatives and Inhalants 0.20% people using other drugs like sedatives and inhalants also need help. At the national level, an estimated 4.6 lakh children and 18 lakh adults need help for their inhalant use (harmful use / dependence). In terms of absolute numbers, states with high population of children needing help for inhalant use are: Uttar Pradesh, Madhya Pradesh, Maharashtra, Delhi and Haryana.
- 50. Other categories of drugs Cocaine (0.10%) Amphetamine Type Stimulants (0.18%) and Hallucinogens (0.12%) Used by a small proportion of country’s population.
- 59. Psychoactive drugs commonly involved in drug abuse • Sedatives Drug Alcohol(ethanol)-Reduce tension Barbiturates Nembutal(Pentobarbital) Seconal(Secobarbital) Veronal(Barbital) Tuinal(Secobarbital and amobarbital)
- 60. Risk Factors • Aggressive behavior in childhood • Lack of parental supervision • Poor social Skills • Drug experimentation • Availability of drugs at school
- 62. Addiction may lead to • Heart disease • Cancer • HIV/AIDS • Hepatitis B and C • Stroke • Lung disease
- 64. People Who Inject Drugs There are about 8.5 Lakh People Who Inject Drugs (PWID). Opioid group of drugs are predominantly injected by PWID (heroin – 46% and pharmaceutical opioids – 46%). A substantial proportion of PWID report risky injecting practices. High numbers of PWID are estimated in Uttar Pradesh, Punjab, Delhi, Andhra Pradesh, Telangana, Haryana, Karnataka, Maharashtra, Manipur and Nagaland.
- 68. Stimulants • Amphetamines(Benzedrine,Dexedrine,Methed rine,Cocaine) – Increase feelings of alertness and confidence – Decrease feeling of fatigue – Stay awake for longer periods – Decrease feelings of fatigue – Increase endurance – Stimulate sex drive
- 69. Narcotics(Opium,Morphine,Codeine,H eroin,Methadone(synthetic narcotic) Medical aspects • Alleviated physical pain • Induce relaxation and pleasant reverie • Alleviate anxiety and tension
- 70. Psychedelics and hallucinogens(cannabis,Marijuana,Hashish) • Mescaline • Psilocybin • LSD(lysergic acid diethlamide-25) • PCP(phencyclidine) – Treatment of heroin dependence – Induce changes in thought and behavior – Expand ones mind and induce stupor
- 71. Antianxiety drugs • Librium • Miltown • Valium • Xanax Alleviate tension and anxiety Induce relaxation and sleep
- 72. Etiology • Genetic factors • Psychological vulnerability • stress and desire of tension reduction • Peer groups
- 73. Psychological effects of drug addiction • Depression • Anxiety • Paranoia • Hallucinations
- 74. Psychological effects of drug addiction • Paranoia • Hallucinations • Addiction • Impaired Judgment • Impulsiveness • Loss of self control
- 75. Treatment • Professional help (Psychiatrist, Psychologist) • Pharmacotherapy/Medication • Group therapy • Behavioral intervention We help you for treatment -14405
- 76. NDPS ACT: The NDPS Act prohibits the cultivation, production, sale, purchase, trade, import, export, use, and consumption of psychotropics and narcotics except for scientific and medical purposes. Drug policy in India
- 78. National Action Plan for Drug Demand Reduction (NAPDDR) is a Centrally Sponsored Scheme, being implemented by Ministry of Social Justice & Empowerment, under which financial assistance is provided to (i) 'State Governments/ Union Territory (UT) Administrations for Preventive Education and Awareness Generation, Capacity (ii) Building, Skill development, vocational training and livelihood support of ex-drug addicts, Programmes for Drug Demand Reduction by States/UTs etc. and (iii) 'NGOs/VOs for running and maintenance of Integrated Rehabilitation Centres for Addicts (lRCAs), Community based peer Led lntervention (CPLI) for early Drug Use Prevention among Adolescents, Outreach and Drop In Centres (ODIC), District De-Addiction Centres (DDACs)' and (iv) (iii) Addiction Treatment Facilities(ATFs) in Government Hospitals. National Action Plan for Drug Demand Reduction (NAPDDR)
- 79. Recent Developments in DDAP Recently, the DDAP and the National Program for Tobacco Control (NPTC) were renamed as the “National Program for Tobacco Control and Drug Addiction Treatment (NPTCDAT).” NPTCDAT is one of the eight tertiary care programs for non-communicable diseases (NCDs) and e-health. In addition, the provision of services was extended to three more tertiary care centers, namely, AIIMS, Bhubaneswar; Ram Manohar Lohia Hospital, New Delhi; and the Central Institute of Psychiatry, Ranchi. An average budget of ₹45–51 crores has been allotted to DDAP for the institutes mentioned above during 3 years from 2019 to 2021.
- 82. Summary
- 83. Recommendations • Scientific evidence-based treatment needs to be made available for people with Substance use disorders – at an adequate scale Addiction treatment programmes focused heavily upon inpatient treatment / hospitalization (in a ‘de-addiction centre’) are unlikely to cater to the huge demand for treatment. Enhancing treatment services as outpatient clinics, which have all the necessary components (trained human resources, infrastructure, medicines and supplies, a system of monitoring and mentoring) is urgently required.
- 84. THE WAY FORWARD • Evidence-based substance use prevention programmes are needed to protect the young people Protecting the youth of the nation is of paramount importance. Research has demonstrated that best prevention strategies are those which are based on scientific evidence and which involve working with families, schools and communities in general. A conducive legal and policy environment is needed to help control drug problems
- 85. Take Home Message • Substance use is a public health concern on a global and national levels. • There is a scarcity of nationally representative systematic research on the epidemiology of substance use in India. • Drug use is a major public health issue in India. • Significant changes in the approach toward drug use have happened in the last few decades. The GoI initiatives for reducing the mental health burden in this country in general and substance use disorders (SUDs), in particular, are immense. The acts/statutes/laws/notifications are all interlinked. Stakeholders in mental health, public health, and policy-making need to upgrade themselves with the relevant statutes to curb the menace of drug use.
- 86. National Toll Free Drug De-addiction Helpline Number: 1800-11-0031
- 87. References 1. Parmar A, Narasimha VL, Nath S. National Drug Laws, Policies, and Programs in India: A Narrative Review. Indian J Psychol Med. 2024 Jan;46(1):5-13. 2. Parmar A, Bhatia G, Sharma P, Pal A. Understanding the epidemiology of substance use in India: A review of nationwide surveys. Indian J Psychiatry. 2023 May;65(5):498-505. 3. magnitude of drug abuse in the country – PIB 4. National Institute of Social Defense: https://www.nisd.gov.in/helplines.html