1) What are the common drugs of abuse?
Common drugs in India are smoking (cigarettes, beedis) & chewing tobacco (gutkha, pan masala), alcohol, cannabis (ganja, bhang, charas), opioids (heroin, opium, injection Buprenorphine, capsule Spasmoproxyvon, cough syrups), Sedative-Hypnotics (sleeping pills, Alprazolam, Diazepam) and Inhalants (typewriter correction fluid).
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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