Pattern and prevalence of substance abuse in Kashmiri population: a review

INTRODUCTION

Substance use disorders (SUDs) are highly prevalent throughout the world. According to a national survey in the United States in 2017, approximately about 7.2 percent of individuals aged 12 or above had a diagnosable SUD in the past year, 5.3 percent among them were diagnosed with an alcohol use disorder and individuals with an illicit drug use disorder were 2.8%.¹

A thorough assessment for substance use includes a detailed inventory of the type, amount, frequency, and consequences of the patient's substance use, their perception of use and readiness to change, an assessment of co-occurring psychiatric disorders, physical examination, medical history and laboratory tests, the presence in the patient's family, of substance use disorder, and review of social factors which may contribute to substance use or facilitate treatment.²

Substance abuse

Type, amount and frequency are important parameters in drug abuse. If there is unhealthy use of one substance it increases the likelihood of unhealthy use of other substances.^3,4 For alcohol, risk thresholds in the United States, defined by the National Institute on Alcohol Abuse and Alcoholism are: (a) men (under 65): five or more standard drinks (i.e.; 12 g of ethanol, the amount found in 1.5 oz. of 80 proof liquor, 5 oz. of wine, and 12 oz. of beer) in a day or more than 14 drinks on average per week; and (b) women and men over 65: four or more 12 g drinks in a day or on average more than seven drinks in a week.

Route of administration

Route of administration as follows- (a) oral- drinking, swallowing pills, and smoking; (b) subcutaneous injection- e.g. skin popping; (c) intravenous injection-e.g. shooting up inhalation- e.g. sniffing or snorting; (d) intramuscular injection- e.g. muscling.⁵ Route of administration helps in suggesting risks of medical problems, e.g., infectious disease from injection or perforated sinus from intranasal intake. Associated behaviors, such as needle sharing, can increase risks of disease. The co-occurrence of Substance use disorders (SUDs) and mental health is well documented.⁶ Patients having SUDs are at higher risk of experiencing comorbidity: (a) depressive disorder, (b) anxiety disorders, (c) bipolar disorder, (d) eating disorders, (e) post-traumatic stress disorder; (f) deficit hyperactivity disorder; and (g) schizophrenia.

There is elevated risk of SUD among individuals with personality disorders, especially antisocial personality disorder and borderline personality disorder.⁷ Patients who are actively going through withdrawal may present with anxiety, agitation, sleep disturbances, and behavioral changes. In recent nationwide study conducted by Ministry of Social Justice and Empowerment, Government of India, among representative general population (10-75) years old, about 14.6% of people are current users of alcohol with men considerably higher in number (27.3%) as compared to women (1.6%).

About 2.8% reported having used any cannabis product within the previous year. About 2.1% of country’s population uses opioids with heroin being the most commonly used opioid (1.14%).⁸ Decades of political conflict, violence, frequent clampdowns in Kashmir valley has taken a toll on mental health of people especially youth which led to increase in psychiatric disorders such as Post traumatic Stress Disorder (PTSD) and depression.^9-11 Researchers in Kashmir have focused only on identifying rates of PTSD and other common mental disorders, ignoring the fact there is a bidirectional relationship between substance use and other mental disorders.¹² In conflict ridden areas there is higher prevalence of substance use disorders shown by multiple studies but there is negligible data about Kashmir.^13,14

METHODS

Different electronic databases Pubmed, Science-direct and Google Scholar, for last 20 years were searched for articles describing drug abuse in Kashmir valley. Search strategies included terms as: ‘drug abuse’, ‘Kashmir’, ‘Youth of valley’, ‘Drug deaddiction’. Our search showed 10 results. Studies were selected according to following inclusion criteria; published between 2012-2021, 4 articles were included. Bibliographic references in the articles were manually searched and reviewed.

Drug abuse in Kashmir

In Kashmir, there has been a considerable rise in the drug addiction for last few years. Experts from the de-addiction center of the Institute of mental health and neurosciences (IMHANS) in Srinagar mention the alarming increase in the consumption of drugs in recent years. The data from the available literature mentions 1500 percent increase in patients approaching the hospital with severe neurological disturbances attributed to the drug addiction. The data available from various sources reveal 489 cases registered in the year 2016, the number later grew to 7420 in 2019.According to a report published by the United Nations drug control program (UNDCP) around 70000 people are drug addicts in Kashmir valley including 4000 women.

As per Government Psychiatric Disease Hospital (GPDH) statistics 90% abusers belong to the age group of 17 to 35 years with a lifetime prevalence of drug addiction.¹⁵ A recent data of Srinagar Police control room’s (PCR) de-addiction center has released recent data that reveals that most drug abusers fall in the age group of 18-35 years.

DISCUSSION

Study by Rather et al in two districts of Kashmir valley about prevalence of substance abuse found tobacco was the most commonly reportedly substance (92.66%) ever used in lifetime, followed by opioid (90.66%). Lifetime use of cannabis, alcohol and sedatives-hypnotics was reported as 50.33%, 21.33% and 18.33% respectively. With regarding to dependence, opioids were the most prevalent illicit substances (87.33%) followed by cannabis (43.66%). There were total of 1186 substance dependent-admissions in government recognized de addiction centers in these two districts. 45% of respondents were using injectable opioids indicating a greater prevalence of injectable opioids especially heroin in Kashmir.

In previous studies among Kashmiri population, the use was predominated by non-injectable opioids which has now changed to an injection pattern. Different pharmaceutical opioids like tramadol, dextropoxyphene, codeine-containing cough syrups, etc., were used by 22% of the respondents. The prevalence rate of any substance dependence was found to be 1.95% and 1.80% for opioid dependence.¹⁶

Tufeel et al in their study reported overall prevalence of substance abuse among college students in Kashmir valley was found to be 31.3%. Most common substance being abused was tobacco in its various forms (22.5%) especially cigarette smoking (20.2%) and the least being abused was cocaine (0.3). The overall prevalence of substance abuse among male college students was more (37.5%) as compared to their female counterparts (19.6%). In this study most of the students involved in substance abuse gave failure in love affair as the reason for initiation of substance abuse (29.2%) followed by peer group pressure (26.3%). It was found that most of the substance abusers were acquiring it from the local grocery shop (52.6%) followed by friends and unknown dealers.¹⁷

Farhat et al in a study conducted at IMHANS, Government Medical College, Srinagar for the pattern of opioid abuse among patients found that majority of the participants (75%) were of young age group (20-30 years).

Oral route was the most common route (35%) of drug administration followed by chasing (13%) and intravenous (11%) routes. Diverted pharmaceutical products were the main source of opioid abuse in the studied population and more than half of them used to abuse more than one drug at a time. 50% of subjects had started to take opioid substances under the influence of their friends who were already taking these substances (peer pressure).

Pleasure as the reason for substance initiation was reported by 30% of patients and in 20% of cases it was the use of prescription opioids which led to opioid addiction in them. The desire to return to normal life was reported to be reason for seeking treatment in 70% of patients.

The other two reasons for seeking treatment were the occurrence of subsequent health issues secondary to opioid addiction (17%) and loss of self-respect of the abusing person (13%).¹⁸ Naqshbandi et al in his study carried out among 250 youth in various districts of Kashmir, 62.76% of male respondents and 56.66% of female respondents from nuclear families mentioned that gateway drugs are used in their family. 63.15% of female respondents and 44.82% of male respondents from joint families revealed that gateway drugs are used in their family.

72.36% of male respondents and 57.14% of female respondents make unemployment and conflict responsible for the increase in use of drug addiction among youth. 26.31% of male respondents and 16.32 female respondents who have smoked cigarette feel that educational stress is reason for drug addiction among youth. This study reveals that unemployment is one of the major reasons for drug addiction among youth and conflict also plays vital role increasing drug addiction among youth.¹⁵

CONCLUSION

The problem of substance abuse is deeply penetrated in our society with youth being the most vulnerable lot. Heart break due to failed love affair, peer group pressure, pleasure, and prolonged use of prescription drugs are the main reasons that contribute to substance abuse among youth. Unemployment, conflict and educational stress are other contributing factors. Over years number and types of substances of abuse have increased but tobacco still being the most common substance of abuse followed by opioids. Route of administration of opioids has changed from oral being the most common route to injectable ones. Among the injectable opioids, heroine predominates as preferred choice. To overcome this menace multipronged approach is required with interventions at family and, community level, various government agencies, NGO’s and most important by medical specialists.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

REFERENCES

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