All about Drug Abuse on International Day against Drug Abuse- Dr. Srikant Sharma

June 26 is observed as the International Day against Drug Abuse and Illicit Trafficking. Dr. Srikant Sharma talks all Drug Abuse ocn this Day.

• What is 'Listen First' understood in drug abuse?

A: Building on the success of last year, the theme for 2018 is: "Listen First - Listening to children and youth is the first step to help them grow healthy and safe." It is an initiative to increase support for prevention of drug use and is thus an effective investment in the well-being of children and youth, their families and their communities.

According to the UNODC (United Nations Office on Drugs & Crime), nearly 200 million people are using illicit drugs such as cocaine, cannabis, hallucinogens, opiates and sedative hypnotics worldwide. In December 1987 the UN General Assembly decided to observe June 26 as the International Day against Drug Abuse and Illicit Trafficking. The UN was determined to help create an international society free of drug abuse.

Around 190,000 people die due to illicit drugs every year.

• Why should awareness about drug abuse be included in the school syllabus?

A: Every minute, 5 children experiment with a drug. Approximately 85% of children start smoking to imitate adult behavior. Adolescents have a unique vulnerability for developing an addiction. The incentive reward system in brain matures before cognitive control center. Therefore, adolescents are more likely to act on impulsive, risky and addictive behavior before considering the consequences. Once addicted they are also more resistant to treatment, and more liable for relapse. About 33% of people first tasted alcohol between ages 15 to 17, 18% before this age; and 2.6% after the age of 21 years. Since the drug abusers usually start in adolescent age, hence if its bad effects are taught early in school then probably it can be prevented to a large extent. This young population lacks the knowledge regarding the grave ill effects of these drugs. Awareness is prevention. And prevention is better than cure. Otherwise, this trend will become very dangerous for the future generations.

• What is drug abuse?

A: Drugs as medicine are used to help sick people, but in drug abuse, people use drugs to alter their brain function in harmful and dangerous ways. It means any use of drugs that cause physical, psychological, legal or social harm to the user, or others who are affected by the drug user's behavior.

• What is an addiction and what are its causes?

A: Addiction is a brain disorder characterized by compulsive engagement in rewarding stimuli, despite the inherent adverse consequences.

There are essentially 3 risk factors that help in the explanation of the etiology of Addiction:

1. Genetic: Fos-B is a gene transcription factor responsible for behavioral and drug addiction. There are a wide range of genetic and environmental factors implicated in developing an addiction, each amounting to half of an individual's risk. Even in individuals with low genetic risk, exposure to sufficient high doses of addictive stimuli will lead to addiction. Studies performed on twins, where at least one suffered from an addiction, it was discovered that both had an addiction disorder to the same substance.


2. Environmental Factors: Environmental Factors as per 'National Institute on drug abuse' are lack of parental supervision, the prevalence of peer substance use, drug availability and poverty. Stress is also an important factor having proven it affects an animal's genotype. In a study of 900 court cases involving children, who experienced abuse, most were found to suffer from addiction in their adolescence or later in adult life.


3. Comorbidities (Co-Occurring) disorders: Mental health disorders such as depression, anxiety, ADHD (Attention Deficit Hyperactive Disorder) and post-traumatic stress disorder are more prone for substance use disorder. Early age aggressive behavior is also a risk factor (National Institute of drug abuse).

• What are harmful effects of drug abuse?

A- Drug abuse leads to physical, psychological, moral and intellectual decay. Harmful effect may depend on route of drug administration i.e., if intravenous (leading to Hepatitis B, Hepatitis C, HIV, Scarring of veins Cellulitis etc.), oral intake (dry mouth, jaw pain, nausea, Gingivitis, oral ulcers, teeth discoloration, oral-esophageal cancers), nasal sniff (septal perforation, nasal bleed, sinusitis, anosmia).

In Chronic Use: Chronic bronchitis, lung cancer, Hypertension, stroke, heart disease, leg gangrene. If tobacco is absorbed into systems, it causes bone osteoporosis, cancers. Tobacco amounts up to 30% of the cause of total cancer.

Smoking may cause 15 types of cancers including lung, oropharynx. esophagus, stomach, pancreas, kidney, and bladder. Approximately 80% of lung cancer cases are smokers. Smoking only 1-2 cigarettes per day doubles the risk for oral and esophageal cancer.

Ethyl alcohol 10 grams daily, increases the risk of breast cancer by 7.2%. Also, alcohol can cause cancers of head and neck, liver and esophagus.

• How is drug abuse detected?

A- Amphetamine and codeine are detected in blood up to 12 hours, and in urine 1-2 days. Alcohol and Heroin are detected up to 12 hours in blood and 3-5 days in urine. Barbiturate and Cocaine can be detected in blood up to 12-48 hours, and urine up to 2-4 days. Benzodiazepines can be detected in blood up to 2-3 days and in urine up to 3-6 weeks.

• How are drug abusers identified?

A- Ideally parents should suspect their children if following symptoms are present like , change (increased or decreased) of appetite , unexplained weight loss or gain , abnormal walk , awake in night , red eyes , unusual lethargy , blank stare , pupils may be dilated or constricted , cold sweaty and shaking hands , puffy face , unusual smell on breath , excessive talkativeness , extreme hyperactivity , hacking cough , running nose , needle marks on arms / legs , change in personality , nausea , sudden avoidance of close friends , loss of interest in family , forgetfulness , apathetic , paranoia , irritability , excessive privacy , withdrawal and stealing.

• How does it work?

A: When a drug enters brain, it interferes with normal brain function processing. Over time drug use can lead to addiction due to its effect on the Dopamine system.

• Common drugs abused.

A: Commonest misused drug is tobacco. But commonly abused drugs in India and worldwide is Alcohol. Prescription drugs like Opioid (as pain Suppressant), Cannabis, Methamphetamine, Cocaine, Heroin etc. are also remains in this category. Alcohol (21.4%) was primary substance used, followed by Cannabis (3%) and Opioids (0.7%). State wise alcohol use prevalence is lowest in Gujarat (9 %) to highest in Arunachal Pradesh (75%).

• What’s the age at which one usually starts taking drug?

A: 15% of adolescent population (12% to 18 years) consider themselves as smokers. And 95% of regular smokers start to smoke during adolescence. These young people do not have correct information about the ill effect of drug abuse.

• What are the reasons leading to initiation of drugs?

A- Increasing economic stress, changing cultural values, experimental drugs, and false identity forming is the measure causes for initiation into drugs. Quite often it so happens that dosing drugs is romanticized and some fictional positive aspects of the same are shown. The process of industrialization, urbanization and migration have led to a loosening of the traditional methods of social control, rendering an individual vulnerable to the stressed and strains of modern life. The person concerned feels a desperate need to deal with stress, to get a momentary high or to just ' fit in ' with his or her peers, as happens in youngsters. And the concerned person believes that their survival depends on those drugs.

• Other bad effects of Alcohol abuse.

A: Traffic fatalities, violence and behavioral changes to family, friends and others are toxic things to be considered. Liver failure, cirrhosis of liver (10% people with alcoholism), liver damages, permanent brain damage (Korsakoff's Psychosis, Wernicke's encephalopathy) are also its damaging effects. More than 200 diseases are related to harmful effect of alcohol.

• What is the Scenario of Cannabis and its abuse in India?

A: In India it is known as Ganja, Charas, Bhang. Approximately. 10 million people in India use it. Heavy users may develop respiratory diseases, memory impairment, mental disturbance, digestive tract problem and sleep disturbances.

• What are the OTC (over the counter) medications abused?

A: These medicines are available without a prescription, and some are highly addictive. Few abusers later on turn to other more powerful drugs. Dextromethorphan containing pills are also commonly abused. Methamphetamine is used to suppress appetite (obese to decrease weight), increase alertness (students to combat examination pressure) and euphoric effects. Apart from highly addictive, they can damage motor skills, problem solving skills and sexual function.

• What is heroin abuse?

A: Heroin is also known as Brown sugar (20- 60% purity; adulterated by chalk, zinc or other chemicals). Smokers may get respiratory problems and injecting drug users may get Cellulitis and other dreadful infections (like HIV, Hepatitis B, Hepatitis C etc.).

• What about Opium abuse?

A: Previously it was used for diarrhea, malarial chills attacks, chronic coughs, Rheumatic pains etc. Thereafter it became abused drug. In 1813, the first Indian regulation on consumption was introduced, and later on in 1878, All India Opium Act Permitted only Licensed Vendor to cultivate and sell opium.

• What are club drugs?

A: Like Methylepedoxy methamphetamine (Street name is Ecstasy, Adam Lover's Speed), Gamma Hydroxybutyrate (liquid ecstasy), ketamine (special K) Flunitrazepam (Forget me pill), Methamphetamine (speed ice, chalk) and Lysergic acid diethylamide (Boomers, purple Haze) are also in increasing trend of being used.

• What is drug trafficking?

A: Drug trafficking is a global illicit trade involving the cultivation, manufacture, distribution and sale of substances which are subject to drug prohibition laws. In 2006, 6 drugs type accounted for nearly all drug trafficking offences which include, Methamphetamine (33.6%), Cocaine (19.8%), Marijuana (17.6%), Heroin (14.4%), Crack (8.1%), Oxycodone (2.8%) and other (3.7%).

• How is India in the Vulnerable zone in this regard?

A: That fact that India is in close proximity to the largest producers of heroin and hashish, the Golden Triangle (Myanmar, Laos and Thailand) and Golden Crescent (Afghanistan - Pakistan - Iran) has made India's border Vulnerable to drug trafficking. Drug dependence is a major social issue in parts of India like North east, Punjab, Delhi, Goa and Maharashtra

• How is drug abuse dreadful for any nation?

A: Drug abuse not only affects the individual, but also their families, friends, various business and Govt. resources. This degrades quality of life and can force skilled workers to leave and may impede the development of those that remain.

• Which country is affected the most?

A: Iran tops the list of countries in terms of drug abuse whereas Switzerland is least affected country worldwide.

• What should be done to eradicate the drug abuse?

A- Every 12 seconds a child experiments with drug abuse. Since it is a global problem, it needs global solution. Government, Teachers, Parents, Health care personnel, NGOs and Media, all should join hands for its eradication.

• What is the Government's role in eradicating drug abuse?

A- India has bilateral agreements with 13 countries, on drug trafficking. Narcotic drugs and Psychotropic substance Act 1985 by Chaman Chaudhary, was made to prevent illicit drug trafficking. In 2010 "Preventing Drug use among children and Adolescent" was also made. Govt. is running de-addiction centers in Government Hospitals, and supporting NGOs involved in this Endeavour.

The Ministry of Social Justice and Empowerment is for prohibition and drug abuse prevention. Services given by them are Awareness generation, identification, counseling, treatment and rehabilitation of addicts.

• What is the role of Teachers?

A- There should be launch of effective programs in school which would help improving self-esteem, reduce stress, anxiety or increased activity. Teachers should try to emotionally relate to their students and keep friendly atmosphere especially with adolescent age group. There should be some chapter in syllabus to educate them about the harmful effects of drug consumption.

• What is the role of family?

A- Parents should also provide emotional support at home providing time and interest in kid’s routine activities. There should be healthy, disciplined and emotional connect between them, so that it helps building self-confidence and self-worth in growing children.

• What is Physician's role?

A: Physicians should be cautious in prescribing long-term medications like pain killers and consider medications with less abuse potential. Close monitoring of patients at higher risk, reducing the length of time between beneficial to educate patient and attendants about possible potential risks of medications including the risk of sharing them with others.

• What is De-addiction and Rehabilitation?

A: It is the process which involves concepts from medical, behavioral to psychotherapeutic treatment in order to recover from drug abuse or dependence. During the initial stages of recovery, the body must rid itself of drugs. This is called the detoxification period. Detoxification can last several days to several weeks depending on the drug. Coping with withdrawal symptoms is often the most challenging part which includes symptoms like nausea, anxiety depression, sweating, muscle aches to seizures etc.

Different medications are used to treat different withdrawal symptoms. Some of the commonest medications prescribed include Benzodiazepine which reduces anxiety and irritability as they have a sedative property. These are prescribed by physicians in regulated dose and under supervision. Another antidote medication used is Clonidine. Mainly used to treat alcohol and opiate withdrawal which acts by reducing sweating, cramps, muscle aches and anxiety, tremors and seizures. Various other medications also form a part of drug de-addiction which are prescribed by the physicians under their constant supervision and for a limited time interval.

There are various de-addiction and rehabilitation centers situated in various parts of India and world which work on specific grounds in helping and individual cope up with withdrawal and stress post recovery. After enrolling into programs of these centers, the individual is asked to stay at the center for a period of time where they work on various principles like addiction counseling, constructive recreational activities, behavioral therapy, physical and mental fitness, lifestyle balance, managing thoughts and feelings, coping up with surges and after care support. Proper schedule is provided to the individual post recovery with guidance and details of follow up visits.

• How much is Death due to alcohol?

A: Every year 3.3 million death occur due to alcohol, which amounts to 5.9 % of all deaths.

Dr. Srikant Sharma is a Senior consultant in internal medicine, Moolchand Medcity, New Delhi.