research paper on drug abuse in india

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Substance use and addiction research in India

Affiliation.

• 1 Department of Psychiatry, De-Addiction Centre, National Institute of Mental Health and Neuro Sciences, Bangalore - 560 029, India.
• PMID: 21836677
• PMCID: PMC3146212
• DOI: 10.4103/0019-5545.69232

Substance use patterns are notorious for their ability to change over time. Both licit and illicit substance use cause serious public health problems and evidence for the same is now available in our country. National level prevalence has been calculated for many substances of abuse, but regional variations are quite evident. Rapid assessment surveys have facilitated the understanding of changing patterns of use. Substance use among women and children are increasing causes of concern. Preliminary neurobiological research has focused on identifying individuals at high risk for alcohol dependence. Clinical research in the area has focused primarily on alcohol and substance related comorbidity. There is disappointingly little research on pharmacological and psychosocial interventions. Course and outcome studies emphasize the need for better follow-up in this group. While lack of a comprehensive policy has been repeatedly highlighted and various suggestions made to address the range of problems caused by substance use, much remains to be done on the ground to prevent and address these problems. It is anticipated that substance related research publications in the Indian Journal of Psychiatry will increase following the journal having acquired an 'indexed' status.

Keywords: Alcohol; India; drugs; research; substance use.

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Decriminalization of drug use in India

A long overdue legal reform.

Ambekar, Atul

Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India

Address for correspondence: Prof. Atul Ambekar, Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India. E-mail: [email protected]

Received September 01, 2022

Accepted September 01, 2022

A news item which appeared in certain media outlets in 2021 caught the attention of many people who are concerned about drug addiction in India. These media reports hinted that the Government of India was mulling reforms in the Narcotic Drugs and Psychotropic Substances (NDPS) Act (1985) to decriminalize personal consumption of illicit drugs.[ 1 ] Indeed, three decades after enacting the NDPS Act – termed as “draconian” by many experts – it is certainly time to ask whether the provisions in the law which make consumption of certain psychoactive substances a criminal offense are justified? Has this law been effective in reducing drug use?

Punishment as Deterrence to Prevent Drug Use

The genesis of the NDPS Act of India (as well as similar laws in most countries) can be traced to the three United Nations (UN) International Drug Conventions: 1961 (on narcotic drugs), 1971 (on psychotropic substances), and 1988 (on precursor chemicals), to which India is a signatory. Concern for the “health and welfare of humankind” is the premise on which the three UN conventions are based. Parties to this convention are required to, inter alia , take practicable measures to control diversion and abuse of NDPS. Most countries have interpreted this as an obligation to enact laws which make all the activities related to controlled drugs – production, trafficking, sale, and even consumption – criminal offenses attracting punishments of varying severity. It is believed that the fear of punishment acts as a deterrence which prevents people from using illicit substances.

However, a growing body of research in the fields of addictive behaviors and criminology has established the limited effectiveness of deterrence as an approach to prevent drug use. For instance, the Canadian Senate Special Committee on Illegal Drugs (2002)[ 2 ] examined the prevalence of cannabis use in “prohibitionist” (i.e., countries with stringent drug laws which explicitly regarded drug use as a criminal act) and “liberal” countries (i.e., those with more permissive drug policies). The committee could not find a discernible pattern; the prevalence of cannabis use was not less in the prohibitionist countries (like Sweden, the USA, and Canada) as compared to more liberal countries (like the Netherlands, Australia, and Sweden). A study compared experienced cannabis users from two contrasting drug policy environments: San Francisco (cannabis use criminalized) and Amsterdam ( de facto decriminalization) and concluded that while criminalization was associated with higher risk and fear of arrest, it did not significantly affect access to drugs.[ 3 ] Indeed, while deterrence does not work, even undergoing actual arrest and punishment has been shown to not affect drug consumption. Data from a 21-year longitudinal assessment of drug use and related arrests in New Zealand showed that among those cohort members who were arrested or convicted for a drug offense; 90% did not change their pattern of use and 5% reported increased use![ 4 ]

Thus, it appears that fear of punishment is not an effective deterrence for drug consumption. Why do then lawmakers tend to rely so heavily on strong drug laws aimed at punishing drug users? For the purpose of any criminal punishment, various types of justifications are cited, many of which perform overlapping functions: retribution, incapacitation, deterrence, rehabilitation, or reform. Arresting and putting in jail someone for merely consuming a substance satisfies none of these justifications. Since drug use is practically a victimless crime, retribution and incapacitation cannot be valid goals of punishment from a human rights perspective. For the sake of argument, maybe one can try justifying punishment with reform or rehabilitation as a goal (if the criminal justice system is geared toward providing treatment and rehabilitation to people convicted of the offense of drug use). Indeed, the compulsory drug treatment systems that exist in some countries (notably in Southeast Asia) are justified using a similar perverse logic – compulsory long-term detention in residential settings in the name of treatment instead of a jail term as punishment. However, scientific evaluations have concluded that there are no improved outcomes with compulsory treatment and in fact, there may be harms in terms of human rights abuses, forced labor, and lack of adequate nutrition.[ 5 ] Rightly, the UN agencies have been calling for closing such compulsory treatment facilities, which remains a work in progress.[ 6 ]

In fact, the UN system does not just stop at recommending voluntary treatment with consent for drug addiction. It has explicitly called upon the member states to reform “…punitive laws that have negative health outcomes and counter established public health evidence” including laws that “…criminalize or otherwise prohibit drug use or possession of drugs for personal use.”[ 7 ] In other words, a call for decriminalization of drug consumption. This contrasts with the position of the UN system as understood by the national governments a few decades ago which resulted in the framing of prohibitionist policies and punitive drug laws across the world.

Understanding Decriminalization

Regarding laws and policies about the consumption or possession of illegal drugs, a variety of terms appear in the literature which sometimes confuses the average citizen. Decriminalization, the most well-known term refers to either removal of criminal penalties ( de jure ), or an operational decision of nonenforcement of criminal penalties ( de facto ). Depenalization refers to the removal of all penalties or reduction of severe penalties. These two terms must be distinguished from legalization through which a previously illegal act is made a legal (though regulated) act. For instance, Canada has now legalized the trade and consumption of cannabis, meaning it is possible legally to sell and consume cannabis products in Canada (though within a regulatory framework). With decriminalization, on the other hand, the act of using drugs remains prohibited (but not punished), although selling drugs attracts punishments. It can be understood with the example of underage alcohol consumption in India. Most Indian states prescribe a minimum legal age for drinking. Drinking by a person below that age does not attract penalties but someone selling or serving alcohol to an underage individual can be prosecuted.[ 8 ] In other words, drinking by an underage individual is not legal but decriminalized.

Many countries across the world appear to be paying heed to the evidence staring them in the face and making reforms in their drug laws and policies. Portugal is the most notable example. In 2000, Portugal decriminalized possession of a small amount of all drugs for personal consumption and instead instituted a system whereby people who use drugs can easily access health and welfare services without stigma or fear of punishment. Eventually, the impact of these reforms has been visible. Contrary to the popular (mis) perception, after decriminalization, the prevalence of drug use among young people in Portugal reduced, not increased. There has been a noticeable improvement in many other parameters such as a reduction in health complications of drug use such as HIV, improved treatment seeking, and an overall reduction in petty crimes.[ 9 ] Subsequently, many countries have been on a path to bring about legal reforms aimed at decriminalizing drug consumption, although the progress is slow.[ 10 , 11 ]

Indian Scenario

With this background, it is useful to examine the situation in India, specifically the drug use scenario. Our figures for the prevalence of the use of most of the drug categories are much below the global average, except for opioids which is three times higher (the current use of opioids in the general population: India 2.1%; world 0.7%).[ 12 ] It must be noted that opioids are the drug category associated with the highest burden of disease and disability among all illicit drugs. The drug use situation has worsened in India since the NDPS Act was enacted in 1985. Experts have commented how the NDPS Act came into being without adequate debates and discussions by the legislature. However, looking at the records of the parliamentary debate in 1985, it appears that deterrence of punishment was the primary objective behind this law. Parliamentarians sought to heavily punish not just the drug traffickers but even the consumers.[ 13 ]

The NDPS Act 1985 explicitly criminalizes the consumption of NDPS, except for medical and scientific reasons. The act achieves this by including “use or consumption” among the various terms for defining “illicit traffic” (such as production, manufacture, sale, transportation, etc.). Further reinforcement of drug consumption as a crime comes through section 8 of the act which lists various prohibited activities – “No person shall………produce, manufacture, possess, sell, purchase, transport, warehouse, use, consume ,……any narcotic drug or psychotropic substance” (emphasis added). Finally, section 27 prescribes punishment for the consumption of any narcotic drug or psychotropic substance – rigorous imprisonment for 1 year and/or a fine of 20,000 rupees.

The label of “draconian” on the NDPS Act notwithstanding, the law does strive to distinguish drug users (i.e. possession for personal consumption) from drug traffickers (i.e. dealing in drugs with commercial motives) through prescribing a graded structure of penalties. Thus, for every scheduled drug or substance, threshold quantities have been defined as “small quantities” below which an offense of possession attracts lesser degrees of punishment. Another ostensibly progressive feature of the NDPS Act is the provision of “Immunity from prosecution to addicts volunteering for treatment” (section 64A). In practice, however, this section is seldom utilized. People charged with drug possession must admit the guilt and prove that they are “addicts” for the court to divert them to treatment instead of jail. Since the onus of proof of being an “addict” is with the accused (while the prosecution claims that the accused is a trafficker), this provision is rendered useless.[ 14 ]

Thus, in effect, the NDPS Act continues to treat people who use drugs as criminals and sends them to jail when they can be helped more by facilitating access to health care and support. Is punishment necessarily a bad thing? Are there any adverse consequences of punishing people for using drugs?

Why Criminalize Drug Use at All?

The arguments against criminalizing drug use can be philosophical in nature, rooted in contemporary understanding of human rights (considering the basic principle of crime and punishment), and based on a utilitarian perspective. Proportionality – meaning, the level of punishment should correspond to the severity of harms caused by behavior to others or society – is a key philosophy of the rule of law.[ 15 ] If people who use drugs are not harming anyone else, should drug use attract punishment at all? There is growing support for this view worldwide that while drug trafficking needs to be curtailed (and hence deserves to be punished); drug consumption need not attract punishments. Hence, the United Nations Office on Drugs and Crime has recommended that “…for offenses involving the possession, purchase, or cultivation of illicit drugs for personal use, community-based treatment, education, aftercare, rehabilitation, and social integration represent a more effective and proportionate alternative to conviction and punishment.”[ 16 ]

Besides such philosophical arguments against the criminalization of drug use, there are more practical considerations as well. Putting all the people who use drugs in jail is simply neither feasible nor cost-effective. In India, estimates of people using various illicit drugs run into crores: about 2 crores for cannabis, 2 crores for opioids, and 1 crore for sedatives. It is unimaginable to punish each of these drug users with a jail term since we simply do not possess the infrastructure for the same. More importantly, a substantial proportion of resources of our drug law enforcement and criminal justice systems get diverted toward punishing drug users. These resources can be more efficiently utilized by targeting large-scale drug traffickers. For instance, analyses of the reports by the National Crime Record Bureau indicate that in any given year most of the cases booked under the NDPS Act are for possession of drug use as opposed to drug trafficking.[ 17 ] Research has established that in India, the deterrent punishment has not resulted in lowering drug crimes.[ 18 ] It appears that for the drug law enforcement agencies, people who use drugs represent a low-hanging fruit who can be easily caught and sent for punishment. Simultaneously, the large-scale drug trade continues to flourish as evident by the data on both – drug consumption and drug seizures.

Going Forward

The status quo should not be acceptable. The law (as well as its implementation) is in urgent need of reform. However, it is heartening to hear the voices of reason from some quarters. Some ministries within the Government of India have explicitly called for decriminalizing personal drug consumption.[ 19 ] A professional society of psychiatrists, the Addiction Psychiatry Society of India has formally provided its inputs to the government in the form of a discussion paper, which is publicly available.[ 20 ] The momentum needs to continue to build up. Going forward, it will be important to remember that reforming the drug laws while necessary is not sufficient. The country needs to invest heavily into making health and welfare services available for people who use drugs aimed at the prevention of drug use and treatment and rehabilitation of drug use disorders. It will also be important to avoid falling into the two, often encountered traps. One of these is compulsory treatment instead of jail term which is often framed as a progressive and liberal move. Any coerced intervention for drug use disorders falls foul of the provisions of the Mental Health Care Act (2017) and should not be acceptable. Another trap is decriminalization, but only for some (ostensibly less harmful) drugs. Punishing people with a jail term for using any substance is not justifiable and hence creating the artificial categories of soft versus hard drugs is not logical.

To bring about the desired reforms, the role of psychiatrists will be paramount in creating the environment in the country through participating in and enriching the public discourse and through direct advocacy with the government and people's representatives. It is pertinent to recall the three types of behaviors that we the psychiatrists are intimately concerned with, and which have been (unfairly) criminalized by society: (i) same-sex relationship or homosexuality, (ii) suicide attempts, and (iii) consumption of psychoactive substances. The psychiatric fraternity has played an exemplary role in advocating legal reforms in India for the first two of these criminalized behaviors and we deserve to be congratulated for the same. Are we ready to accept the challenge of passionately advocating for the third?

(Epilogue: On March 15, 2022, the following self-explanatory headline appeared in the newspaper, the Hindustan Times: “No plan to decriminalize personal consumption of drugs, says Centre”).

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Drug Addiction and Its Impact on Indian Society and the Laws Related to Drug Usage

Rhythm patel.

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Student at Gujarat National Law University, Gandhinagar, India

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Addiction of drugs has become a global issue and the leading cause of death. India has seen a rise in drug addiction in recent years. Drug addiction is being initiated as a result of changing societal norms, rising economic stress, and weakened family support. In recent years, India is seeing a rise in suicides cases due to extravagant usage of drugs. Adolescent drug addiction is also a big problem, since more than half of people with drug use problems start using drugs before the age of 15. Even if the drug addiction has been there for a long time, it can be cured. However, the government must take certain measures to reduce drug use in the future, such as public awareness programmes, family counselling and by stringent sanction. In order to control addictions in drugs, and prohibit their possession, dispersion, sale, import and trade in India, the Narcotic Drugs and Psychotropic Substances Act was passed. Psychotropic agents can affect the consciousness of an individual while drugs alleviate anxiety. Violations of this law may lead to the imprisonment or fines or both depending on the seriousness of the offence determined by its gravity. The penalty may be reduced if the drugs are used for personal use. In addition, since its introduction the legislation has been revised several times. The current paper highlights the causes of drug abuse, its impact on family, suicides due to drug usage, impact of drug usage on children, drug usage and its effect on mental health, connection between drug usage and crime and describes the treatment and prevention of drug abuse and addiction for proper management of the problem and the laws related to the Drug usage in India.

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International Journal of Law Management and Humanities, Volume 4, Issue 4, Page 950 - 966

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution -NonCommercial 4.0 International (CC BY-NC 4.0) (https://creativecommons.org/licenses/by-nc/4.0/), which permits remixing, adapting, and building upon the work for non-commercial use, provided the original work is properly cited.

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Substance Abuse among Young People in India - Approaches at Curbing the Menace

12 Pages Posted: 20 Mar 2013

Dr. Gautam Ghosh

Date Written: March 18, 2013

India also has a huge at-risk to substance abuse young population with 40% being below the age of 18 years. As observed a notable proportion of teens in West Bengal, Andhra Pradesh, Uttar Pradesh and Haryana have been using gateway drugs. Every year, about 55,000 children take up to smoking generally hailing from low socio-economic strata. This risky behavior is often initiated during childhood and adolescence, as more than 70% of adult smokers report that they started smoking on a daily basis prior to age 18. Substance abuse creates a huge hindrance for survival, protection, growth and development of healthy children, which is fundamental for improving quality of life. Protecting children from substance abuse has to be considered the most essential and urgent need for creating a ‘World fit for Children’ and for a meaningful achievement of the ‘Millennium Development Goals’. This paper looks at the extent, patterns and trends of substance abuse problem among children in India, primarily through review of studies and also substantiates it with the field based observations by linking personal experience of working with marginalized children with a national level NGO running the Ministry supported Drug De-Addiction Centre and Integrated Child Protection Scheme. The paper will also discuss the existing challenges in addressing the substance abuse problem while emphasizing the need to focus beyond the bio-medical and behavioral modification approach based intervention. It also suggests comprehensive approaches for substance abuse intervention that would address the full spectrum of determinants in the complex Indian context.

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Drug abuse in India – an analysis

In recent years India is facing a major problem with the illicit use of drug, drug trafficking, consuming and so on. It is a complex phenomenon which has various social, cultural, biological, geographical, historical and economic aspects. The processes of industrialization, urbanization and migration have led to loosening of the traditional method of social control. The spread and entrenchment of drug abuse needs to be prevented. The sole aim of the research is to find out the generic answer on it. The researcher believed that improvement in the systems can yet be made. Introduction – : A drug is a chemical substance whether or not obtained from natural sources which is taken for the pleasant effects it produces. It has to be understood that drugs in common use differ in their pharmacological effects. The word " drug " relates not to any one particular kind of drug but to various kinds of narcotic substances, which may differ from one another in its effects both qualitatively and quantitatively. The international convention on Drugs to which India is a signatory has classified drugs into two categories. Such as Narcotic drugs and Psychotropic substances. Drug abuse means taking a drug to reasons other than medical and amount strength, Frequency or manner that damages the physical and mental functioning. The researcher here states that the uses of drug damage the physical and mental health of the individual but also kills him. It ruins his family and social values. The main drugs of abuse in India are cannabis, heroin and opium. Mostly they are used for cultural and traditional reasons, because of easily availability and local cultivation. However there is reported increase in abuse of prescription drugs such as morphine ephedrine morphine, proxyvon, diazepam and codeine based cough syrups. The majority o f addicts are between 15 to 35 years of age and it is the most productive age group of the country. There is also increasing abuse of drugs and psychotropic substances among out of school children, street children. This problem is also spread in the rural areas. The abuse of inject able heroin is particularly widespread in the northeastern state of Manipur, Nagaland and Mizoram. Traditional abuse of opium still continues in the states of Rajasthan, Punjab, Madhya Pradesh, Utter Pradesh and Gujarat. With every addict, the life of a whole family is affected. Drug addiction is the compulsive use of psychoactive drugs, to the point where the user has no effective choice but to continue use. Drug addiction has 2 components Physical dependency and Psychological dependency. 1)Physical dependency occurs when a drug has been used habitually and the body has become accustomed to its effects. The person must then continue to use the drug in order to feel normal or its absence will trigger the symptoms of withdrawal.

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DrRanjeeta Dwivedi

In close collaboration with the World Health Organization, the Commission on Narcotic Drugs adopted a convention on psychotropic substances, and India enacted the NDPS Act in 1985 to prevent drug addiction. Abuse of drugs (such as morphine, opium, heroin, cocaine, brown sugar, etc.) spells disaster not only for the addicts but also for their families and society as a whole. The process of drug addiction sets in when a person, knowingly or unknowingly, begins to consume narcotic drugs as a medicine for sound sleep at night or to get stimulation for work. Rather than confronting the facts of reality, he wants to stay in his fantasy world. Gradually, he becomes addicted to drug consumption, and his dependence on these intoxicants increases at a faster rate. Finally, he reaches a stage where he cannot live without the drug since it has become his life habit.

Indian Journal of Pediatrics

Debasish Basu

Objective To study the demographic and clinical profile of adolescent subjects (≤18 yr) presenting to a state-funded drug deaddiction centre in north India. Methods Data on demographic and clinical features were extracted from available case notes of adolescent patients who presented to the centre during 1978–2003 (n=85). Results Many adolescents came from nuclear family (63.5%), of urban background (83.5%), and were school dropouts (54.1%). Mean age-at-first-use of the primary substance was 14.8 yr and mean age at first presentation was 17 yr. The commonest used primary class of substance was opioids (76.2%) and the commonest used opioid was heroin (36.5%). More than half of the subjects (54.2%) were also nicotine dependent at the time of presentation. The most common reason for starting the use of drugs was curiosity (78.8%). About one-fifth (21.2%) of the subjects indulged in high-risk behaviour such as having sexual intercourse with multiple sexual partners. Nearly half of the subjects had positive family history of either drug dependence (40.2%) or psychiatric disorder (5.5%). Conclusion The results suggest that the development of substance dependence in children and adolescents is a combination of familial and social vulnerability factors, including the drug culture of the social milieu.

Irfan Iftekhar

Drug abuse remains a complex and pressing issue, with far-reaching consequences for individuals, families, and society as a whole. This article offers a retrospective analysis, delving into the evolution of drug abuse prevention, treatment, and policy. By examining the past, we gain valuable insights into the innovative approaches, challenges, and triumphs that have shaped our understanding and response to this pervasive menace. Through a multidisciplinary lens, we explore the transformative power of prevention, the critical importance of comprehensive treatment, and the role of enlightened policies in addressing drug abuse.

International Research Journal Commerce arts science

The young generations are the worst victims of evils of drug addiction. Substance abuse as a social phenomenon is all the more worrisome because of its prevalence among youth. Over the last two decades or so, countries all over the world have seen an alarming rise in the incidence of substance abuse amongst the most productive and crucial section of its population. The young people are in their perennial search for happiness and they find a shortcut to happy life in drugs. But before realizing that they are chasing shadows, they get trapped in and in the end the futility of their search stares at them on the face. This paper deals with Causes of Drug use, impact of drug usage, and the need for intervention and the methods of prevention of drug addiction.

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• J Family Med Prim Care
• v.6(3); Jul-Sep 2017

Drug abuse: Uncovering the burden in rural Punjab

Bhuwan sharma.

1 Department of Community Medicine, Punjab Institute of Medical Sciences Medical College and Hospital, Jalandhar, Punjab, India

Anjali Arora

Kanwaljit singh, harinder singh, prabhjot kaur, introduction:.

Drug abuse is a global phenomenon, affecting almost every country, but its extent and characteristics differ from region to region. India too is caught in this vicious circle of drug abuse, and the numbers of drug addicts are increasing day by day. The bane of drug abuse in Punjab has acquired the proportions of a pestilence that has shaken the entire society in the state. It is observed that in Punjab “drug abuse” is a raging epidemic, especially among the young.

Methodology:

The present cross-sectional study was conducted on 400 adolescents and young adults (11–35 years) from 15 villages of Jalandhar District. Systematic sampling (probability proportionate to size) was used for the selection of study subjects. A preformed, semi-structured questionnaire was used to collect information on type and frequency of drugs abused and other sociodemographic variables. The statistical evaluation of the data was performed using SPSS software, version 21.0.

The prevalence of substance abuse among study group was 65.5% and most common substance abused was alcohol (41.8%), followed by tobacco (21.3%). A high prevalence of heroin abusers was noted among study subjects (20.8%). The prevalence of nonalcohol and nontobacco substance abuse was 34.8%. A significant association of drug abuse was observed with male gender, illiteracy, and age above 30 years.

Conclusions:

The problem of drug abuse in youth of Punjab is a matter of serious concern as every third person is hooked to drugs other than alcohol and tobacco. The other striking observations were the high prevalence of heroin and intravenous drug abuse.

Introduction

Drug abuse is a global phenomenon, affecting almost every country, but its extent and characteristics differ from region to region. Illicit drug abuse not only affects the health and lives of individuals but also undermines the political, social, and cultural foundation of all countries. Problems of drug dependence produce dramatic costs to all societies in terms of lost productivity, transmission of infectious diseases, family and social disorder, crime, and excessive utilization of health care. The picture is grim if the world statistics on the drugs scenario is taken into account. With a turnover of around $500 billion, it is the third largest business in the world, next to petroleum and arms trade. About 190 million people all over the world consume one drug or the other. Drug addiction causes immense human distress, and the illegal production and distribution of drugs have spawned crime and violence worldwide. Today, there is no part of the world that is free from the curse of drug trafficking and drug addiction. Millions of drug addicts, all over the world, are leading miserable lives, between life and death.[ 1 ]

India too is caught in this vicious circle of drug abuse, and the numbers of drug addicts are increasing day by day. The epidemic of substance abuse in young generation has assumed alarming dimensions in India. Changing cultural values, increasing economic stress, and dwindling supportive bonds are leading to initiation into substance use. According to a UN report, 1 million heroin addicts are registered in India, and unofficially, there are as many as 5 million.[ 2 ]

Cannabis, heroin, opium, and hashish are the most commonly used drugs in India after alcohol and tobacco. However, some evidence indicates that there is an increasing prevalence of methamphetamine as well.[ 3 ] Drug users are mainly young and predominately male. A National Survey (2004) on the extent, pattern, and trends of drug abuse in India found that opiates are primary drug abused and 49% of respondent's families had a history of drug abuse.[ 4 ] The study conducted by the Institute of Development and Communication revealed that a majority of drug abusers, i.e., 70% had rural background and were hooked to drugs and opium which they procured from village chemists.[ 5 ]

The National Household Survey of Drug Use in the country is the first systematic effort to document the nationwide prevalence of drug use. Alcohol (21.4%) was the primary substance used (apart from tobacco), followed by cannabis (3.0%) and opioids (0.7%). The Drug Abuse Monitoring System, which evaluated the primary substance of abuse in inpatient treatment centers, found that the major substances were alcohol (43.9%), opioids (26%), and cannabis (11.6%).[ 4 ]

A Rapid Situation and Response Assessment among 5800 male drug users[ 6 ] revealed that 76% of the opioid users currently injected buprenorphine, 76% injected heroin, 70% chasing, and 64% using propoxyphene. Most drug users concomitantly used alcohol (80%). According to the World Drug Report,[ 7 ] of 81,802 treatment seekers in India in 2004–2005, 61.3% reported use of opioids, 15.5% cannabis, 4.1% sedatives, 1.5% cocaine, 0.2% amphetamines, and 0.9% solvents.

The bane of drug abuse in Punjab has acquired the proportions of a pestilence that has shaken the entire society in the state. It is observed that in Punjab “drug abuse” is a raging epidemic, especially among the young. According to a survey, 66% of the school going students in the state consume “gutka” or tobacco; every third male and every tenth female student have taken to drugs on one pretext or another and seven out of ten college-going students are into drug abuse.[ 8 ]

The present study was thus conducted to assess the prevalence and pattern of substance abuse and its correlates among adolescents and young adults of rural Punjab.

Methodology

The present study was conducted in 15 villages of Jalandhar district by the Department of Community Medicine, Punjab Institute of Medical Sciences Medical College and Hospital, Jalandhar, Punjab, India.

Study design

This is a cross-sectional study.

Study participants

Adolescents and young adults (11–35 years) giving written informed consent were included in the study.

Sampling technique and sample size

Systematic sampling (probability proportionate to size [PPS]) was used for the selection of study subjects. The Prevalence of Drug Abuse in Punjab ranges from 40% to 70%.[ 5 , 8 ] By taking prevalence as 50% and on applying formula:

Sample size ( n ) = Z α 2 PQ / E 2

where Z α 2 – 1.96 for 95% confidence interval (i.e., α-error = 5%)

P = Prevalence

Q = 1 − P

E = Allowable error (taken as 10%)

Final sample size ( n ) =400 subjects (approximately).

A total of 400 households were chosen from the 15 villages (PPS sample) as depicted in the Table 1 . All households in theses villages were enlisted first and then required number of households (from each village) was taken using systematic random sampling. If no eligible subject was identified in a household, the next household was approached, and if more than one eligible subject was present, the one who was contacted first was taken.

Villages covered for systemic random sampling

Operational definitions

Drug user is defined as a person who had used substance in the last 1 year.

Drug nonuser refers to a person who had never used any drug in the past in their life.

Statistical analysis

A preformed, semi-structured questionnaire was used to collect information on type and frequency of drugs abused and other sociodemographic variables. The statistical evaluation of the data was performed using SPSS software, version 21.0 (IBM SPSS Statistics, IBM Corporation, Armonk, NY, USA).

A total of 400 subjects were studied between the age group of 11 and 35 years, with the mean age of 23.32 ± 7.6 years. Out of total 400 subjects, 93.3% were males, 48% were adolescents, and 17.3% were illiterate or educated up to primary levels [ Table 2 ]. The prevalence of substance abuse among study group was 65.5%, and the most common substance abused was alcohol (41.8%), followed by tobacco (21.3%). A high prevalence of heroin abusers was also noted among study subjects (20.8%). Out of total heroin abusers ( n = 83), two-third ( n = 55) were taking the drug through intravenous (IV) route while rest of them were taking it as sniff or smoke. The median dose of heroin abuse was 1 mg (range: 0.25–5 mg). The prevalence of nonalcohol and nontobacco substance abuse was 34.8%. Other abused substances were bhukki (11%), bhang (6.3%), charas and ganja (1.5% each) [ Table 3 ]. A significant association of drug abuse was observed with male gender, illiteracy, and age above 30 years [ Table 4 ].

Sociodemographic profile of study subjects

Prevalence and type of substance abuse

Sociodemographic correlates of substance abuse

There appears to be a number of reasons for why Punjab is currently in the midst of a drug epidemic such as rampaging unemployment, easy and cheap availability of heroin, and the location of Punjab means that most of the drugs will pass through this area on its way to India.[ 8 ]

With most drug users being in the productive age group of 18–35 years, the loss in terms of human potential is incalculable. The damage to the physical, psychological, moral, and intellectual growth of the youth is very high. Adolescent drug abuse is one of the major areas of concern in adolescent and young people's behavior. A study in the Andamans[ 9 ] shows that onset of regular use of alcohol in late childhood and early adolescence is associated with the highest rates of consumption in adult life, compared to the later onset of drinking. It is estimated that, in India, by the time most boys reach the ninth grade, about 50% of them have tried at least one of the substance of abuse nature.[ 10 ] In the present study, 48% of the subjects were in adolescence age group and prevalence of substance abuse was 56.3%.

The present study found the prevalence of substance abuse as 65.5%. The most common substance abused was alcohol (41.8%), followed by tobacco (21.3%). Various Indian studies have shown that alcohol and tobacco are the most abused substance.[ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ] In Uttar Pradesh, Dube et al .[ 11 ] reported that 22.8/1000 were dependent on alcohol and drugs while Thacore[ 12 ] from Lucknow gave a statistic of 18.55/1000. The important finding of these studies is that alcohol was the most common substance used (60%–98%). Epidemiological surveys[ 13 , 14 ] also revealed that 20%–40% of subjects above 15 years are current users of alcohol and 10% of them are regular or excessive users. In a rural population of Uttar Pradesh, alcohol was found to be the most common substance abused (82.5%), followed by cannabis (16.1%). Varma et al .[ 15 ] found that rates of current use of alcohol in Punjab were 45.9% in Jalandhar and 27.7% in Chandigarh whereas it was 28.1% in rural areas of Punjab.[ 16 ] Shukla[ 17 ] reported that 38.3% of the rural population in Uttar Pradesh was habitual substance users. In a study of rural Bihar, prevalence of alcohol/drug use was found to be 28.8% of the study population.[ 18 ]

A high prevalence of heroin abusers was also noted in present study (20.8%) as compared to previous reports.[ 19 , 20 ] Out of total heroin abusers ( n = 83), two-third ( n = 55) were taking the drug through IV route. The increasing consumption of nacrodrugs, especially heroin, in Punjab is basically an off-shoot of the inflow of Afghan heroin through Pakistan.[ 8 ] In a study by Singh et al .[ 21 ] in a De-addiction Center of Amritsar, Punjab, a total number of 10,568 patients were screened for urine toxicology. Out of 10,568 enrolled patients, 9815 (92.87%) patients were found patients for morphine, and out of 9815 morphine addict patients, 5785 (54.74%) patients were abusing heroin in one or the other form. Such high prevalence of heroin abuse can be attributed to its easy availability, steady supply across the border mainly from Afghanistan and Pakistan, and a thriving smuggler-police-politician nexus which is hampering enforcement action. The numbers of people starting to use heroin have been steadily rising since 2007.[ 22 ]

Prevalence of heroin addiction was reported as 0.2% in the National Household Survey[ 4 ] in India (2000–2001) and as 10.74% in a study done in De-addiction Centers in New Delhi.[ 19 ] While comparing these findings with our study, it is apparent that there is a significant change in the pattern of drug use. Heroin is a costly drug; its increasing use has also resulted in rise of economic crimes such as snatching, robbery, and theft.[ 23 ] Increase heroin use through IV route can also increase the incidences of HIV, hepatitis B and C, thus burdening the health-care system further.

In the present study, a significant association of drug abuse was observed with male gender, illiteracy, and age above 30 years. Male predominance in substance abuse is universal as proved by various studies.[ 4 , 8 , 19 ] Basu et al . studied the changing pattern of substance abuse in North India (from 1978 to 2008) observed that majority of the subjects were males and maximum prevalence of drug abuse was in the age group of 26–35 years, with no decade-wise difference.[ 20 ] The findings of the National Household Survey also observed the highest prevalence (37%) in the age group of 31–40 years.[ 4 ]

Education level has been found to have an impact on the risk of drug or alcohol abuse. One particular study from 2004 in Copenhagen included over 30,000 men and women aged 20–93 and measured schooling level, smoking, and alcohol use. This study found that those with the lowest level of schooling were most frequently heavy smokers and heavy drinkers.[ 21 ] A National Survey by the Ministry of Social Justice and Empowerment (2002) found that 29% of the drug abusers were illiterates and a significant number of them came from lower strata.[ 24 ] In a study by Kumar et al . in De-addiction Centers of New Delhi, 21% of the addicts were illiterate or educated till primary level as compared to 17.3% in the present study.[ 19 ]

We suspect that there could be some under-reporting by the abusers who can be considered as the limitation of the study. However, it gives definitive clues regarding pattern of drug use in rural Punjab. More multicenter studies are required to compare data and to generalize for the whole state.

Conclusions

The problem of drug abuse in the youth of Punjab is a matter of serious concern as every third individual is hooked to drugs other than alcohol and tobacco. The other striking observations were the high prevalence of heroin and IV drug abuse.

Recommendations

Government should plan to increase the number of de-addiction and rehabilitation centers with recreational facilities for these addicts. Various nongovernment organizations and nonprofit organizations can be involved to initiate vocational training and other employment programs for unemployed addicts. Appropriate linkages between health workers, community leaders, religious leaders, and teachers for planning prevention and rehabilitation activities for drug abuse should be established. Periodic outreach awareness camps for antidrug abuse activities in the community and government schools should be undertaken.

Financial support and sponsorship

Conflicts of interest.

There are no conflicts of interest.

Acknowledgment

We acknowledge the great help received from the scholars whose articles cited and included in references of this manuscript. We are also grateful to authors/editors/publishers of all those articles, journals, and books from where the literature for this article has been reviewed and discussed.