Dr Abhishek Chowhan
“A 19 year old boy from an upper middle class family started using alcohol and cannabis when he was 14 years of age to conform to the peer groups. Initial experiments during social gatherings rapidly developed into regular intake of atleast 4-8 drinks three to four times a week within a span of one year. He would frequently land home in an inebriated state helped on feet by his friends. In absence of any significant parental intervention his drug seeking status increased till one year ago when tried heroin for the first time under peer pressure and got addicted to it in just two days. Of late he started injecting heroin and dangerous practices like needle sharing followed. Over a span of six months his health status degraded, he lost 15 kilograms of weight, developed tricuspid valve endocarditis(a type of heart infection) and started having frequent bouts of fever. Now he presented in the psychiatry OPD for de-addiction along with a lot of medical complications to get rid of heroin primarily because many of his friends have died due to heroin overdose and associated complications. This is a classical case of a drug user due to this enormous epidemic of drug addiction.”
An epidemic is a rapid spread of an illness to a large number of people in a given population within a short span of time. Recently the cases of drug addiction has risen sharply Jammu and Kashmir, particularly so in Jammu province. This spurt of addiction is threatening to pose a great danger to the integrity of our well knit society. Drug addiction is demon that corrupts the society morally, financially, legally, physically and psychologically. This epidemic of addiction can be considered to be a type of propagated epidemic wherein the transmission is largely person-to-person. Herein, the affected individuals become an independent reservoir leading to further transmission. In epidemiology of addiction we call it addiction or dependence due to peer pressure. Peer pressure is the influence of an individual of group on other person which forces him to change his attitudes, beliefs, morals and habits. This can be both positive and negative but in case of addiction it is largely latter. The methodology employed in peer pressure to force a person conform (e.g., to try a drug) is in the form of pleading, coercing, threatening, black mailing or avoiding. Due to such tactics person is made to play by the rules of peer group or to leave it altogether. In absence of parental supervision, presence of stressors or personality deviations and easy availability of drugs, the child can fall in trap of drug addiction.
This epidemic of addiction in Jammu is part of a large pandemic which is sweeping large parts of India mainly north India and is thus a spill effect. If not controlled adequately this may spread uncontrollably and may end up in a catastrophic way. Similar things happened in United States of America in 80’s and 90’s with rapid rise of drug addiction, drug related violence, organised drug trafficking having the epicentre at New York and then engulfing whole of the country like a storm. In India, the recent data reveals a shameful truth. As per government data India has witnessed a fivefold increase in drug use in last three years. As per the latest data provided by UN office on drugs and crime there are about 8.7 million cannabis users and 2 million opiate users in our country. Mizoram, Punjab and Manipur are the most affected states in India. With Jammu’s proximity to Punjab it is also getting badly affected by the drug trade. Another misfortune of Jammu and Kashmir is its proximity to ‘golden crescent’ and its being a major transit point in drug trade. The golden crescent is the name given to one of the world’s two principal areas of illicit opium production (other being golden triangle), located at the crossroads of Afghanistan, Pakistan and Iran. If figures from treatment seeking population for de-addiction in various psychiatry OPD’s in Jammu are analysed, there is about five fold rise in patients of heroin addiction and two fold rise in alcohol use cases during the last two years. Almost all of these increased cases are due to rampant increase of these drugs in younger population (under 25 years of age). As per a recent survey commissioned by National Commission for Protection of Child Rights (NCPCR), about 15% of adolescents from Jammu and Kashmir are using heroin and 7-8% are using inhalents. The figures for alcohol, cannabis, tobacco and other drugs are also disturbing.
The most sinister aspect of this epidemic is the rise of opioid addiction particularly the injectable use of heroin which carries its own complications like infections (especially HIV) and overdose deaths. Heroin overdose deaths are rapidly climbing the ladder of accidental deaths in India but the figures are often under-reported due the associated medico-legal hitches. Opioid or heroin addiction is particularly difficult to quit without medical help because of the severe nature of the withdrawal symptoms associated with it which forces an individual to continue the drug use. However, untreated substance users are more likely to fall or relapse into criminal behaviour. The disturbing fact is this that even though drug use is rapidly rising in women (particularly sleeping pills), very few of them seek any medical intervention for it. This is because of significant systemic, cultural, social, structural and personal barriers in accessing substance use treatment.
The best strategies to deal with this epidemic of addiction are: have an effective disease surveillance system, quickly arrange help for the sufferers, have a legitimate way to guarantee the safety of help seekers and help providers and limit availability of the drugs. As far as first two are concerned, the main methods which should be used are effective policy making and monitoring, proper data collection, reporting, establishing manpower, setting up of de-addiction centres under guidelines (of which our region has none, ‘unfortunately’ ) and making people aware of this deadly menace. The last two deals with efficient policing, stringent law enactment, proper and complete implementation of narcotic drugs and psychotropic substance (NDPS) act, preventing drug availability, avoid unwanted harassment of those who want to quit and incorporating drug abuse treatment into criminal justice system. It is disheartening to know that many prisons make only detention a priority but not treatment with a trained professional. Co-ordination between criminal justice system, de-addiction specialists and other social service agencies can go a long way in ameliorating this deadly menace.
(The writer is a Consultant Psychiatrist, Govt Hospital Gandhi Nagar, Jammu.)