Simantik Dowerah – First Post India• June 26, 2024

The International Day Against Drug Abuse and Illicit Trafficking, observed every year on 26 June, serves as a global reminder of the urgent need to combat the menace of drug abuse and illicit trafficking. This day aims to raise awareness about the severe impact of drug addiction on individuals, families and communities worldwide. It also emphasises the importance of prevention, treatment and rehabilitation efforts to address this complex issue.

Governments, organisations and individuals come together on this day to advocate for policies and actions that promote a drug-free world, supporting those affected by addiction and working towards sustainable development and peace. The day calls for solidarity and collective action to safeguard public health and build healthier, safer societies for all.

On the occasion of the International Day Against Drug Abuse and Illicit Trafficking, Firstpost interviewed Dr Prabhat Chand, professor at the Department of Psychiatry, Centre for Addiction Medicine & NIMHANS Digital Academy VKN ECHO, Bangalore to gain insights into drug abuse trends in India and its broader societal implications.

How grave is drug abuse in India and how have their usage patterns changed over time?

Drug abuse in India is a significant public health challenge affecting diverse populations across the nation. The most abused substances after alcohol are cannabis and opioids. According to national surveys, the prevalence of cannabis users is 3.1 crore and about 72 Lakh are problem users. The opioid use increased significantly from 0.7 per cent to 2.1 per cent (i.e., 2.3 crore) during the same period. Other substances such as sedatives (1.08 per cent), inhalants (0.7 per cent), cocaine (0.10 per cent), amphetamines (0.18 per cent), and hallucinogens (0.12 per cent) also contribute significantly to the drug abuse landscape. The International Day Against Drug Abuse and Illicit Trafficking on June 26th, 2024, with the theme ‘The evidence is clear: invest in prevention,’ underscores the urgency of this issue.

How do socio-economic factors influence vulnerability to substance abuse in India? What are the demographics mostly affected and at high risk?

Socio-economic factors such as peer influence, societal pressures, difficult childhood and lack of access to supportive environments significantly influence vulnerability to substance abuse in India. The demographics mostly affected and at high risk include young male adults aged 18-25, people from low socio-economic backgrounds and those with lower educational attainment. Over the years, the age of onset for first substance use has been decreasing consistently.

What are the primary challenges in accessing addiction treatment facilities across different tiers of cities in India?

Access to treatment facilities varies significantly across different regions and city tiers. The treatment gap for addictive disorders is as high as 75 per cent, as per various national surveys. It means 75 out of 100 people with addictive disorders do not have access to care. The challenge is twofold – 1. Accessibility of care 2. Quality of care. For example, for opioid use disorder, Opioid against treatment (OAT) is evidence-based care across the world. But in India, the supply of OAT is available in very few places. That means people have to travel far to access the care. It is well known that addiction is a chronic brain condition and needs good aftercare. These are compounded by strong social stigma and low awareness. This emphasises the need for significant investments to enhance treatment options and optimise resource allocation based on national survey evidence.

How does stigma impact treatment-seeking behaviours in rural areas compared to urban centres?

Social stigma and low awareness about available treatment options significantly impact treatment-seeking behaviours. This leads people with addictive disorders to seek treatment at the later stage of the addiction cycle. Also, the studies show that more than 50 per cent of patients likely have comorbid psychiatric disorders, which also makes care more challenging. Bridging this gap requires tailored health service information campaigns to inform users and the general population about the available treatment services.

What strategies are recommended to bridge the treatment gaps between urban and rural areas, especially in smaller pockets and villages?

To bridge the treatment gaps – 1. Increase access to care 2. Making knowledge the effective interventions to the health care providers 3. Early identification by physicians, nurses or healthcare providers 4. Identification of high-risk youth and provider of holistic support 5. Integrate common substance use along with routine care like hypertension or diabetes.

Integrated care models and effective coordination between drug supply control and entities focused on demand reduction and harm reduction are crucial. Additionally, targeted outreach and education programmes can help prevent substance abuse and identify people in need of treatment at an earlier stage.

Why is it crucial to address gender disparities in treatment-seeking behaviours?

Addressing gender disparities in treatment-seeking behaviours is crucial because men predominantly access services compared to women. Tailored health service information campaigns are necessary to engage women and marginalised communities effectively, ensuring equitable access to treatment and support services. By promoting inclusivity in treatment access, India can foster a supportive societal framework that empowers people affected by substance abuse.

How can integrated care models improve outcomes for people with co-occurring substance abuse and mental health disorders?

Integrated care models can improve outcomes by providing comprehensive services that address both substance abuse and co-occurring mental health disorders. This necessitates significant investments to enhance treatment options and ensure effective coordination between drug supply control, demand reduction, and harm reduction entities. Such models are essential for addressing the multifaceted nature of substance abuse and its associated mental health issues.

What role do government policies, healthcare providers, NGOs and communities play in tackling the drug abuse crisis in India and how can collaboration be enhanced to achieve better outcomes?

Government policies, healthcare providers, NGOs and communities play a crucial role in tackling the drug abuse crisis in India. Collaboration among these entities can be enhanced by fostering coordination between drug supply control and demand reduction efforts, expanding treatment accessibility, promoting inclusivity in treatment access, and implementing targeted outreach and education programmes. By prioritising evidence-based strategies and fostering a supportive societal framework, India can empower people affected by substance abuse to reclaim their lives and contribute meaningfully to society. Sustained efforts in prevention, treatment infrastructure expansion and effective policy formulation are essential to achieving better outcomes and paving the way towards a healthier, drug-free future for Indian citizens.

Healthcare providers like doctors can use the ‘Addiction Rx mobile app’ as a guidance tool for screening, assessment and intervention in addictive disorders. This app is developed as a part of the standard treatment guidelines by the Ministry of Health and Family Welfare DDAP Addiction Rx app: iOS and Android.

The doctors, counsellors and nurses can discuss the cases and enrol in certificate courses at the NIMHANS Digital Academy ECHO weekly tele-platform to learn best practices.