Drug/substance abuse

Prevention and Control

 Definitions
• A drug is any substance (other than food) that produces changes in the physical or mental
functioning of an individual.
• Drug use is taking a drug for medical purposes like treating an illness, protecting the body against a
disease or to relieve pain or tension.
• Drug abuse is taking a drug for other than medical reasons in amount, strength, frequency and
manner that damages the physical and mental functions.
• Addiction is the result of drug abuse, which produces both dependence and drug tolerance.
• Dependence
➢ Physical dependence
➢ Psychological dependence
➢ Tolerance:
• Addiction as a Disease- Characteristics of addiction
➢ IT IS A PRIMARY DISEASE- Addiction as such is a disease and not a symptom of a
psychological disorder.
➢ IT IS A PROGRESSIVE DISEASE- The disease progresses from bad to worse.
➢ THE DISEASE IS TERMINAL
➢ IT IS A PERMANENT DISEASE
 Substance abuse
• Substance abuse refers to the harmful or hazardous use of
psychoactive substances, including alcohol and illicit drugs.
• Psychoactive substances are substances that, when taken in or
administered into one's system, affect mental processes.
• The use of psychoactive substances causes significant health and
social problems for the people who use them, and also for others in
their families and communities.
 Substance abuse
• Alcohol
• Opiates (Narcotics)-Natural (Raw opium), Semi-Synthetic Narcotics
(Heroin), Synthetic (Buprenorphine and pentazocine)
• Cocaine
• Amphetamines
• Hallucinogens
• Prescription And Over-the-counter Drug Abuse
 Substance abuse
• CANNABIS- • Hallucinogens • Stimulants • VOLATILE
cannabinoids • LSD (Lysergic acid • Amphetamines- SOLVENTS
• Ganja/Marijuana diethylamide) volatile
• Ecstacy hydrocarbons
• Hashish/Charas • PCP(Angel’s dust- (MDMA-3,4- and petroleum
• Hashish Oil Phencyclidine) methylenedioxy derivatives like
• Mescaline methamphetami petrol, paints, nail
• Bhang ne) in the tablet polish remover,
• Psilocybin or capsule form ether, glue,
• Cocaine/Crack benzene, varnish
thinner and
lighter
 Substance abuse-Opiates
• Raw opium (from milky fluid from unripe poppy plant, Papaver somniferum)-
small balls, lumps or bricks (oral and inhalation), Morphine (IV-mostly, IM,
SC), Codeine (PO)
• Semi-Synthetic Narcotics- Heroin (diacetyl morphine -semi-synthetic
derivative of morphine) (RoA- IV inj, Inhalation with tobacco in cigarettes,
chased- burnt and fumes taken by mouth)
• Pure heroin (white crystalline powder, called ‘white sugar’ by abusers)
• Poor quality heroin- color is not white but brown-inferior quality is called
‘brown sugar’.
• Synthetic Narcotics -produced only in the laboratory (Buprenorphine and
pentazocine)
• Buprenorphine- PO, IV (commonly), IM, SC
 Substance abuse- CANNABIS
• Cannabis drugs are made from the Indian hemp plant — Cannabis sativa.
• This plant has been cultivated for centuries in many parts of the world for the
tough fiber of its stem and for the plant’s psychoactive properties.
• When its mind-altering properties came to light, the cultivation of cannabis
was banned.
• Its therapeutic potential and possible medicinal properties are being studied.
• Cannabis drugs do not have any medical use.
• More than 60 constituents, known as cannabinoids, occur naturally in, and
only in, the cannabis plant.
• The chief psychoactive substance among them is delta-9-tetra-
hydrocannabinol, commonly referred to as THC.
 Substance abuse- cannabinoids
• Ganja/Marijuana
➢ Prepared from the dried leaves and flowering tops of the plant
➢ Commonly referred to as grass, pot or stuff
➢ Color- from grayish-green to greenish-brown
➢ Texture - dry, leafy material to a finely divided tea like substance
➢ Usually smoked in the form of hand-rolled cigarettes (‘joints’ or ‘reefers’) or pipes
specially made for this purpose.
➢ It is mixed with tobacco and smoked. The proportion of ganja and tobacco is altered
according to the need and desire of the user.
 Substance abuse- cannabinoids
• Hashish/Charas
➢ Resinous secretion of female cannabis plant-collected and dried
➢ THC content (5 to 15%)
➢ Hashish is smoked like ganja and sometimes baked with food and eaten.
• Hashish Oil
➢ Produced by a process of repeated extraction of the resin of the cannabis plant to get a high
concentration of THC.
➢ Highly potent with a thc concentration (20 to 60%)
➢ Dark viscous liquid
➢ Usually dripped on cigarettes and smoked.
• Bhang
➢ Least potent of all cannabis drugs
➢ Dried parts of the plants — leaves and stem
➢ Brown leafy material with dried twigs mixed in it.
➢ Usually brewed with tea or milk and drunk.
 Substance abuse
• Opiates
• Raw opium (from milky fluid from unripe poppy plant, Papaver somniferum)- small balls,
lumps or bricks (oral and inhalation), Morphine (IV-mostly, IM, SC), Codeine (PO)
• Semi-Synthetic Narcotics- Heroin (diacetyl morphine -semi-synthetic derivative of
morphine) (RoA- IV inj, Inhalation with tobacco in cigarettes, chased- burnt and fumes
taken by mouth)
• Pure heroin (white crystalline powder, called ‘white sugar’ by abusers)
• Poor quality heroin- color is not white but brown-inferior quality is called ‘brown sugar’.
• Synthetic Narcotics Synthetic narcotics are produced only in the laboratory. Buprenorphine
and pentazocine are the most widely abused synthetic narcotic drugs.
• Synthetic Narcotics Synthetic narcotics are produced only in the laboratory. Buprenorphine
and pentazocine are the most widely abused synthetic narcotic drugs.
 Prevalence
• Drug addiction has markedly increased during past three decades all over the world, including India, and
has assumed epidemic proportions according to the WHO.
• The highest incidence of the epidemic is found in the slum areas.
• An idea of its prevalence can be had from the fact that at an annual global turnover of more than 800
billion dollars, the narcotics industry is second only to defence industry.
• According to a recent estimate, it may well become the largest organized industry in the world if the
present rate of growth continues.
• Over 50 million people in the world are addicted to hard drugs (drugs having high risk for health
hazards, addiction, and the impact on public order e. g heroin, cocaine, amphetamine, LSD and ecstasy)
and narcotics.
• Soft drugs- not risk free but risk are less than those with hard drugs. E.g hash, marijuana, sleeping pills
and sedatives
• The number in India is 3 to 5 million, 2 lakh of which are in Delhi alone. In India, there are one million
heroin addicts, two million opium addicts and several million cannabis addicts.
• It may be mentioned that the ratio of drug abusers to alcoholics having serious alcohol abuse problems
is 1:30.
• Psychoactive substance use poses a significant threat to the health, social and economic
aspects of families, communities and nations.
• Globally, the prevalence of alcohol use disorders is significantly higher than the prevalence
of drug use disorders.
• Generally, alcohol and drug use disorders are more common among males than among
females.
• According to WHO Report 2002, 8.9% of the total burden of disease is due to use of
psychoactive substances; tobacco accounted for 4.1%, alcohol 4%, and illicit drugs 0.8% of
the burden of disease .
• There are 2 billion alcohol users, 1.3 billion smokers and 185 million drug users globally
(WHO 2002).
• These three psychoactive substances have different disease burden on different age
groups.
• Illicit drug use causes mortality earliest in life, alcohol also mainly (65%) before the age of
60, while 70% of the tobacco deaths occur after the age of 60.
• The use of different substances varies in different WHO regions as in Europe
and South-East Asia tobacco use is the largest burden while alcohol is the
largest burden in Africa, the Americas, and Western Pacific.
• 155 to 250 million people, or 3.5% to 5.7% of world’s population aged 15-64
used other psychoactive substances, such as cannabis, amphetamines,
cocaine, opioids, and non-prescribed psychoactive prescription medication
(WHO-2008).
• Globally, cannabis is the most commonly used substance (129-190 million
people), followed by amphetamine type stimulants, then cocaine and opioids.
• People who inject drugs (psychoactive drugs for non medical purposes)
are at increased risk of HIV, hepatitis B and hepatitis C.
• Around 13 million people inject drugs globally and 1.7 million of them
are living with HIV; injecting drug user accounts for approximately 10%
of HIV infections.
• The estimated global prevalence of hepatitis C in people who inject
drugs is 67%.
 Indian scenario
• Opioids - commonly used by IDUs
• Includes: heroin (‘smack’ / ‘brown sugar’) as well as pharmaceutical opioids (such as
buprenorphine, pentazocine and dextro-propoxyphene).
• North-eastern region- heroin and dextropropoxyphene are the most commonly used
opioids
• Metropolitan cities such as Delhi, Mumbai, Chennai and Kolkata- impure heroin
(smack), and buprenorphine
• Karnataka, Andhra Pradesh, Chattisgarh- Pentazocine inj.
• Punjab and Haryana- buprenorphine inj.
• As per the HIV sentinel surveillance report, HIV prevalence among IDUs in India is
7.2%.
• However, some states have much higher HIV rates among IDUs such as HIV
prevalence among IDUs is 21% in Punjab, 18% in Delhi and around 12% in Manipur
and Mizoram.
• Psychoactive substance use by drivers has been associated with
impaired driving and increased accidents risk.
• Health and social problems associated with use of and dependence on
tobacco, alcohol and illicit substances can be prevented by greater
awareness by individuals, families and societies to use appropriate
public health actions.
 Govt. programs for prevention of substance
abuse
• Drug De-Addiction Programme (DDAP)
• Adolescent Health Programme – under this, program launched is Rashtriya
Kishor Swasthya Karyakram (RKSK)
• National Action Plan for Drug Demand Reduction (NAPDDR) (2018- 2025) by
Government of India Ministry of Social Justice and Empowerment
• Nasha Mukt Bharat Abhiyaan
• National Policy on Narcotic Drugs and Psychotropic Substances (NDPS) in
2012
• National Programme for Tobacco Control (NTCP)– renamed as National
Program for Tobacco Control and Drug Addiction Treatment (NPTCDAT)
 Drug De-Addiction Programme (DDAP)
• The activities to reduce the drug use related problems 2 categories- supply
reduction and demand reduction.
• Supply reduction -- aims at reducing the availability of illicit drugs within the
country
• NCB under the MHA and the Department of Revenue as the administrator of
the Narcotic Drugs and Psychotropic Substances (NDPS) Act, 1985
• Prevention of Illicit Traffic in Narcotic Drugs and Psychotropic Substances
(NDPS) Act,1988.
• The demand reduction activities focus upon awareness building, treatment
and rehabilitation of drug using patients.
• These activities are run by the Ministry of Social Justice and Empowerment
as the nodal Ministry and to some extent by the Ministry of Health and
Family Welfare.
 Drug De-Addiction Programme (DDAP)
• Operated by: Ministry of Health & Family Welfare
• MHFW provides financial grants for augmenting post abuse treatment
facilities in selected Central Government Hospitals/ Institutions and the
Government Hospitals/ Institutions in North-East States.
• Under this program, a National Nodal Centre, the “National Drug
Dependence Treatment Centre (NDDTC), Ghaziabad (U.P.)”, has been
established under AIIMS, New Delhi.
• The other DDTCs receiving regular annual recurring financial assistance under
this program are PGIMER, Chandigarh and NIMHANS, Bangalore.
• The purpose of these centres is not only to provide de-addiction services and
rehabilitation services to the patients but also to conduct research and
provide training to medical doctors in the area of drug de-addiction.
 Other related programs
• Drug Treatment Clinics (DTC) scheme is another strategy for enhancing the
provision of treatment services
• National Programme for Tobacco Control (NTCP)– renamed as National
Program for Tobacco Control and Drug Addiction Treatment (NPTCDAT)
• This one of total 8 Tertiary Care Programs for Non-Communicable Diseases
and e-Health.
• Adolescent Health Programme – under this, program launched is Rashtriya
Kishor Swasthya Karyakram (RKSK) (launched by MoHFW- 7th January 2014
to reach out to 253 million adolescents) - Adolescent Friendly Health Services
(AFHS) are present in district health facilities to provide counseling on
substance abuse and many other issues
• National Action Plan for Drug Demand Reduction (NAPDDR) (2018-
2025) by Government of India Ministry of Social Justice and
Empowerment
• Revised w.e.f 01-04-2020
 Hospitals under DDAP
• National Drug Dependence Treatment Centre (NDDTC), AIIMS, , New Delhi
• Department of Psychiatry, PGIMER, Chandigarh
• National Institute of Mental Health and Neuro Science (NIMHANS), Bangalore
• New Civil Hospital, Surat (GUJ) Gujarat
• Many others
 Acts in India
• Article 47 of constitution of India - bring about prohibition of the consumption of
intoxicating drinks and drugs, which are injurious to health.
• India follows 3 UN Conventions
• Single Convention on Narcotic Drugs, 1961, Convention on Psychotropic Substances,
1971 and Convention against Illicit Traffic in Narcotic Drugs and Psychotropic
Substances, 1988.
• Article 38 of the Single Convention on Narcotic Drugs, 1961 and Article 20 of the
Convention on Psychotropic Substances, 1971 obligates countries for taking all
practicable measures for the prevention of harmful use of drugs/psychotropic
substances and for the early identification, treatment, education, after-care,
rehabilitation and social reintegration of the persons involved and also for
promoting training of personnel in these areas.
• Narcotic Drugs and Psychotropic Substances (NDPS) Act (1985) to make stringent
provisions for the control and regulation of operations relating to narcotic drugs and
psychotropic substances.
• National Policy on Narcotic Drugs and Psychotropic Substances (NDPS) in
2012 to serve as a guide to various Ministries/Departments, State
Governments, International Organisations, NGOs, etc. and re-assert India’s
commitment to combat the drug menace in a holistic manner.
 Prevention
• Preventive Education and Awareness Generation
• 6.1 Preventive education and awareness generation programs to address
specific target groups (vulnerable and at risk groups) in their neighbourhood,
educational institutions, workplace, slums etc. with the purpose of sensitising
the target groups and the community about the impact of substance
dependence and the need to take professional help for treatment.
• The programs would be carried out through collaborative efforts of other
Central Ministries, State Governments, Universities, Training Institutions,
NGOs, other voluntary organizations etc.
 Prevention
• 6.2 Though NAPDDR lists out an indicative list of programmes to address
specific target groups (Appendix-I), the implementing agencies may devise
other innovative interventions for early prevention of substance use and
dependence.
• Efforts should be made to develop a prevention strategy that is based on
scientific evidence, both universal and targeted, in a range of settings.
• With an aim to expand the outreach and specifically focus on vulnerable
groups, the implementing agencies may consider the following:
 Programs aims
• a) Programmes should start at the school level and continue with college students.
• b) Parents/teachers should be sensitised to develop skills to understand the
psychology of the youth and to help them keep away from substance use and to
accept the need for treatment if initiated.
• c) High-risk groups like commercial sex workers, mobile population like tourists and
truck drivers, children of alcohol and other substance dependents, children of HIV
affected parents, street children, prisoners and school dropouts should specifically
be addressed through these programmes.
• d) Awareness programme should be appropriate to the local culture and in the local
language. Utilization of audio visual aids such as OHPs, slides, CDs, Power Point,
films, TV and Radio Spots etc. and use of innovative methods like street plays,
puppet shows, seminars, group discussions are to be included.
• e) People holding positions of respect and credibility like Panchayat leaders,
school/college Principals/teachers/Lecturers etc. should be associated with the
programmes.
 Initiatives
• The Ministry of Social Justice and Empowerment has been mandated to reduce drug
demand.
• It coordinates and oversees all aspects of drug abuse prevention including assessment of
the extent of the problem, preventive action, treatment and rehabilitation of addicts,
dissemination of information, and public awareness and is mandated to run de-addiction
centres.
• Nasha Mukt Bharat Abhiyaan is operational with the involvement of more than 500
voluntary organizations across the country, which are assisted financially under
the NAPDDR scheme of the Ministry of Social Justice & Empowerment.
• hese NGOs have been actively involved in the implementation of Drug-Free India
campaign. Nearly 8000 youth volunteers and outreach workers of these
institutions/organizations have gone from door to door, village to village and nearby
localities, etc. to educate the people about the ill effects of drug abuse and have assisted in
the rehabilitation of victims of substance abuse.
• The Nasha Mukt Bharat Abhiyaan website provides detailed information about the
Abhiyaan and its activities, gives glimpses through the Photo & video gallery, provides IEC
resource material and information on the institutions set up by the Ministry with the aim
of Drug Demand reduction.
 Nasha Mukt Bharat Abhiyaan (NMBA)
• OBJECTIVES
• Nasha Mukt Bharat Abhiyaan intends to reach out to the masses and spread
awareness about substance abuse through various activities like:
• Awareness generation programmes
• Focus on higher educational Institutions, university campuses and schools
• Reaching out to the Community and identifying dependent population
• Focus on counselling and treatment facilities in hospitals and rehabilitation
centres that have been geo-tagged
• Capacity building programmes for service providers
 Nasha Mukt Bharat Abhiyaan (NMBA)
• INSTITUTIONS
• The Ministry of Social Justice and Empowerment supports organizations that work
for preventive education & awareness generation on substance abuse, capacity
building, treatment and rehabilitation. These organizations are:
• Integrated Rehabilitation Center For Addicts (IRCAs): are de-addiction centres with
inpatient facilities of counselling and treatment for drug dependent persons
• Community Peer Led Intervention (CPLI): work with the community supported by
youth volunteers for early preventive education, especially for vulnerable
adolescents and youth in the community
• Outreach And Drop In Centres (ODIC): provide facilities of screening, assessment
and counselling along with providing referral & linkage to treatment and
rehabilitation services for drug dependents
• GEO Location: Ministry supported institutions providing Drug addiction counseling,
treatment and rehabilitation and other facilities have been Geo-tagged to make
their services accessible and easier to locate
 NHP for help
• https://www.nhp.gov.in/disease/non-communicable-disease/substance-
abuse
• Substance abuse on national health portal
 NHP for help- prevention
• Prevention of drug abuse can be achieved by-
• i) To take effective and practical primary prevention measures that
protect people, in particular children and youth, from drug use initiation:
➢ by providing them with accurate information about the risks of drug abuse,
➢ by developing supportive parenting and healthy social environments and
➢ by promoting skills and opportunities to choose healthy lifestyles and
➢ by ensuring equal access to education and vocational training;
• Family, schools, workplace
• ii) To take effective measures to prevent progression to severe drug
use disorders through targeted interventions for people at risk for
such progression.
 NHP for help- prevention
• Prevention of drug abuse can be achieved by-
• iii) Raising awareness of drug-driving and its impact on road safety
including deaths, injuries, property damage and harm to other road
users among the general public. Policy-makers can reduce drug-driving
by enforcing drug driving laws. It is important not only to enforce drug
driving laws but also to counsel and, when appropriate, treat drivers
found to be impaired by drugs; especially those who are repeat
offenders or those with drug-use disorders.
• iv) Mass media can play an important role in substance abuse
prevention. They can be used to raise awareness concerning not only
the dangers of drug abuse but also the dangers of specific practices
such as injecting drugs.
 National Programmes related to prevention of
substance abuse
• Ministry of Health and Family Welfare (MoHFW) and Ministry of Social Justice and Empowerment (MSJE),
Government of India are involved with alcohol and drug demand reduction policies and drug de-addiction programme
(DDAP) in the country. Under the DDAP de-addiction centres have been established in association with various District
Hospitals and psychiatry departments of Medical Colleges. The centre at All India Institute of Medical Sciences, Delhi (AIIMS)
has been designated as the “National Drug Dependence Treatment Centre” (NDDTC) and functions as a resource centre for
the DDAP of MoHFW, GoI.
• Various E- Health web based programmes related to prevention of substance abuse such as alcohol e-Help
(alcoholwebindia.in/intervention) operated by NDDTC,AIIMS, Delhi (alcoholwebindia.in/) and m-Cessation programme
(nhp.gov.in/quit-tobacco) for tobacco cessation have been initiated by MoHFW, GoI.
• National AIDS Control Programme (NACP),MoHFW, GoI has implemented various targeted interventions programme for
IDUs such as Needle syringe programme, Opioid substitution therapy.
• The MSJE, GoI, has formulated the central sector scheme of assistance for prevention of alcoholism and substance (drugs)
abuse and social defence services which has been updated in 2015.
• The Department of Revenue, Central government acts as administrator of the Narcotic Drugs and Psychotropic
Substances (NDPS) Act, 1985 and the Prevention of Illicit Traffic in Narcotic Drugs and Psychotropic Substances Act, 1988;
• The Narcotics Control Bureau, Ministry of Home Affairs, GoI functions as an enforcement agency for NDPS Act.
• Tips for prevention of substance abuse: youth
• Don’t be afraid to say no.
• Connect with your friends and avoid negative peer pressure.
• Make connections with your parents or other adults.
• Get educated about alcohol and drugs.
 How to Identify Drug Abusers?
• Some probable signs are:
• • Academic changes
• – Poor attendance at school or college
• – Decline in academic performance
• • Physical changes
• – Slurring of speech
• – Sweating at night
• – Loss of appetite
• – Reddening of eyes
• – Unsteady gait
• – Fresh injection sites
• – Temper tantrums
• – Puffiness under eyes
• • Withdrawal symptoms
• • Other changes
• – Blood stains on clothes
• – Disappearance of articles from home.
Addicts often sell articles to obtain money
for the purchase of drugs
• Odor on breath and clothing
• – Presence of needles, syringes, strange
packets, etc. at home
• – Preference of solitude, especially
spending long hours in the toilet.
https://www.india.gov.in/spotlig
ht/nasha-mukt-bharat-abhiyaan
https://dor.gov.in/narcoticdrugspsychotropic/drugs-abuse