Opioid Addiction in North Indian States (Punjab)
- 1. Department of Psychiatry, Swami Vivekanand Drug-deaddiction and treatment centre, India
Garg PD (2018) Opioid Addiction in North Indian States (Punjab). J Addict Med Ther 6(1): 1038.
Punjab represents a sacred portion of our country. The rich history of this ancient land has given its people a sense of native pride. Punjab is a blessed region of India that once stood witness to countless victories and triumphs. This land was once hallowed by saints. But now the Punjab people are tragically turning their backs on their state’s values. As a result, the tornado of illegal drugs is sweeping through India is sucking Punjab into the mess. Now this sacred land, the State of Punjab is facing the problem of Substance abuse and dependence in very shocking way. Injectable Drugs have raised the incidence and prevalence of HIV and HCV infection among youth. Punjab is witnessing villages of widows (where all men died of drugs) like Maqboolpura, almost everyone knows someone who died of drug overdose. From very rich to extremely poor, everyone seems to be dying. Even the school children nowadays are most susceptible to drug addiction. Drug abuse has not spared the females also, a number of females are also being found to be abusing drugs and only a few of them seek treatment due to social stigma. Also, there are lot of persons affected by drug abuse in jails, convicted males including the female inmates.
Major concerns have been raised by the two major surveys. One of them is conduted by PGIMER Chandigarh entitled by “Epidemiology of Substance Abuse and Dependence in the state of Punjab (India).” This survey shows some of its highlights as follow
1. 6% are aged 11-60 yrs residing in Punjab have been dependent on any substance in their lifetime.
2. 2 Million are alcohol dependent , 1.6 Million are tobacco dependent,1 in 120 of the source population in currently dependent on opioid and estimated no. of dependent persons is 0.17 million.
Overall the substance use was predominant in men and more common in the rural areas.
The other survey was conducted by all India Institute and SPYM (Society for Promotion of youth and masses) in collaboration with NDDTC AIIMS. According to this study, the no. of addicts in the state of Punjab is between 2.32 Lakh and was hooked to opioids. Sampling design used in first study was multistage (Stratified Random Sampling), Household Rapid assessment, respondent Driven Sampling. Duration of the study was June 2016-June 2017 at PGIMER, Chandigarh.
In this study, from 6398 households, 13,925 respondents were interviewed. Estimated population of 1.7 lakh was addicted to opioid (Table 1). 61.6% and 1 in 4 were using injectable Opioids (Heroin), one third were abusing Buprenorphine. Most common cause of starting abuse of opioid was Fun (69.9%) followed by peer pressure (43.9%).
Second study, PODS (Punjab Opioid Dependence Survey), The Aiims finding translated to 837 opioid dependents per 100,000 people in Punjab, or 0.84 percent of the state’s 28 million population. This alone is more than three times as much as the corresponding all-India figure for all types of drug dependents, based on a Ministry of Social Justice and Empowerment estimate of three million drug dependents nationwide, which is 250 per 100,000, or 0.25 percent of the Indian population.the duration of PODS study was from Feb. 2015-Feb.2016. The sampling technique used was respondent driven sampling complied with multiplier technique. Demographic profile found in this study was as follows – Males 99%, Literate and educated were 89%, 54% were married and 83% were employed, among this population 99% used Punjabi as their mother tongue. Most common drug used among opioids users was heroin (53%) and 33% were injecting drug users. Reason for starting drug abuse was peer influence in 75%, and 80% ever tried to quit and 35% ever received any help for quitting. Estimated number of opioid dependent in punjab = 2,32, 856 (Table 2 and Table 3).
Among those 76% were in the age group (18-35yrs). 27% are unskilled workers, 21% are farmers, 15% businessmen, 14% transport workers & 13% skilled workers. 56% belong to rural areas. 53% are addicted to heroin, 33% to opium/doda/phukki, 14% to pharmaceutical opioids. 29% inject drugs, of these 90% inject heroin.
With the change of political power in the state, there is shift of policy of govt. towards outpatient based treatment and the programe named OOAT (Outpatient Opioid Assisted Treatment) has been started. The model has been initially started in the 3 districts of punjab Amritsar, Tarntaran and Moga respectively and will be soon started in other districts also.
Under OOAT, a medical officer, a staff nurse, a data entry operator, counselors have been appointed in each OOAT centre. BPN is being provided to drug addicts in out patient department as substitution therapy. Emphasis is more given on the OPD based treatment. Central policy is to avoid duplicacy that the patient will not be able to take another dose on the same day from another OOAT Clinic.
Recently the chief minister appealed to one and all to become a part of anti-drugs campaign of the govt, stating that it was the collective responsibility of all to rescue youth from clutches of drugs. Initiative taken in this field is assignment of DAPO (Drug abuse Prevention Officer).
Table 1: Estimated population addicted to opioid.
|Name of study||Epidemiology of substance abuse and dependence in the state of Punjab.||Punjab opioid dependence survey (PODS).|
|Conducted by||PGIMER, Chandigarh.||NDDTC, AIIMS New Delhi in collaboration with SPYM.|
|Estimated No. of opioid abusers in Punjab||1.7 lakh||2.32 lakh|
|Sampling method used||Multistage stratified random sampling||Respondent driven sampling complied with multiplier technique.|
|Duration of study||June 2016-june 2017||Feb 2015-feb 2016|
Table 2: Demographic Profile of Opioid dependent Individuals in Punjab: (PODS).
|Literate and educated||89%|
|Punjabi as mother tongue||99%|
Table 3: Drug-Use profile Of Opioid Dependent Individuals In Punjab: (Pods).
|Most common opioid drug: Heroin||0.53|
|Using drugs through injecting route||33%|
|Most common reason for starting opioid use||0.75|
|Ever tried to quit||80%|
|Ever received any help for quitting||35%|
OBJECTIVE OF DAPO PROGRAM
To remove the threats of drugs and making the society safe, secure and crime free. All employees of Punjab government are eligible for applying as DAPO officer.
Responsibilities of DAPO
- To organise awareness campaigns and educate public and facilitation of de addiction of victims
- To identify and protect the vulunerable persons and promote sports, positive activity in the locality by coordination with administration.
- Aim is to raise awareness in the villages and locality level discussions and lectures on the ill effects of drugs
- Disseminate awareness material like pamphlets, literature, posters etc. organise and facilitate plays and cultural programmes.
- Reducing social stigma and encourage victims towards deaddiction centres.
- Co ordinate with authorities, deaddiction centres and community organizations.
40,000 people taken from Amritsar alone. More than 4.25 lakh DAPO Volunteers had already registered on the DAPO website as a part of the campaign.