Drug abuse in northern India

Abstract

The use of alcohol in India has been known since the dawn of history. Early Indo-Aryans (2000 B.C.) used alcohol freely in the form of " Somras ". In Charak's treaties on Ayurved 1 medicine, the whole of chapter 24 is devoted to the effects, harmful or not, of the excessive use of alcohol. The use of alcohol as an anaesthetic in child-birth is also described by the author.

Details

Author: K. C. DUBE
Pages: 49 to 53
Creation Date: 1972/01/01

Drug abuse in northern India

Observations concerning the Delhi and Agra regions

Dr. M.B.B.S., D.P.M. (London), F.A.P.A., F.A.M.S K. C. DUBE Professor of psychiatry, and Superintendent, Mental Hospital, Agra, India

The use of alcohol in India has been known since the dawn of history. Early Indo-Aryans (2000 B.C.) used alcohol freely in the form of " Somras ". In Charak's treaties on Ayurved 1 medicine, the whole of chapter 24 is devoted to the effects, harmful or not, of the excessive use of alcohol. The use of alcohol as an anaesthetic in child-birth is also described by the author.

Alcohol indulgence has generally been confined to the lower castes and/or the lower strata of society. The higher caste groups and orthodox society as a whole have always frowned upon this habit, considering it to be immoral and degrading. The Hindu religion forbids the use of alcohol.

In recent times, alcohol indulgence in India has increased. In Delhi alone the consumption of alcohol doubled in the ten-year period 1957-67. Psychiatric problems associated with alcohol abuse are not often seen : people having such problems rarely seek treatment in hospitals or clinics. Other drugs, too, have long been used for their intoxicating effects. Among them, the use of cannabis is fairly common, while the use of opium has declined in popularity; daturais mixed with cannabis to make it more potent.

Cannabis(Indian hemp): The earliest reference to this substance is found in 800 B.C., and its use becomes fairly common from A. D. 1000. In Indian legends, it appears as a favourite drink of the God "Shanker" (Shiva) who indulged in the ecstasies of bhangand datura.If one visits the famous Vishvanath temple (Temple of Shiva) at Varanasi, the most sacred of the Hindu shrines in India, one finds that the highly poisonous datura fruit is an essential offering to the deity. Devotees of Shiva, among whom are a large number of Sadhus, or ascetics, habitually use this drug to provoke hallucinations and sense the feeling of timelessness it gives. Cannabis grows wild all over northern India, especially in the sub-Himalayan Terai regions. The various preparations of hemp used as intoxicants are:

1. Written by "Charak ", 1st century B.C.

Bhang:The dried leaves of the plant Cannabis sativa L. are ground to a fine paste with black pepper and sugar. This is either rolled into a pill and eaten or consumed as a beverage mixed with milk or water enriched with almonds. Intoxication produces a feeling of grandiose cheerfulness, augments physical hunger and the sex drive and induces deep sleep after a few hours.

Majun:A sort of confectionery prepared from bhang. It is sold in the shape of lozenges and has the same effect as bhang.

Ganja:The resin-coated flowering tops of the cannabis plant. It is mixed with tobacco and smoked in a" chilam" (earthenware pipe). It is also smoked in bidis(the small Indian cheroots) or in cigarettes. Smokers become lethargic and experience pleasant sensations. It also produces visual hallucinations. The effect of the drug is quicker when smoked than when taken orally. The first stage symptoms of cannabis intoxication are characterized by excited gestures and uncontrolled laughter, foolish talk and behaviour. These are followed by hallucinations, general disorientation and clouding of the mind. The subject may become delirious and turn violent, feel giddy or complain of tingling and numbness of the limbs, become drowsy and later fall into a stupor.

Charas(hashish): Resin exuded from the flowering tops of the cannabis plant. This, like ganja, is smoked. It is the most potent of cannabis preparations.

In some States in India, the sale of ganja and bhang is permitted through licensed vendors, although in other States it is banned. The sale of charas, however, is completely banned.

Datura:A highly poisonous plant whose use in conjunction with one of the hemp preparations often results in cases of acute poisoning. Its effects are similar to those of atropine.

Opium:This strong habit-forming drug is produced mainly in Madhya Pradesh and East Uttar Pradesh. Opium is generally eaten in crude form, or is smoked as "chandu" or "madak ". Chanduis prepared from the scum resulting from boiling opium in a copper vessel. Madakis made by grinding up opium with acacia leaves and rolling the resultant mixture into small balls to be smoked in a pipe.

Prevalence:Exact figures on the prevalence of the drug habit in India are not available. The habit varies from region to region. The use of cannabis is mostly confined to northern India, and even in this region there are areas of high drug use and low drug use. In this region use of bhang is very common among Brahmins in their worship and religious activities in the holy city of Mathura and other sites of pilgrimage nearby. This is a high use area. A large number of Sadhus, among whom ganja smoking is generalized, live in this area. The opium habit is diminishing. Opium was often administered by working women to infants and children to quieten them - a custom which has now more or less disappeared. In the Agra region the opium habit is rare.

Agra study: A few years ago, a study was undertaken among the adult population in the Agra region to find out the prevalence of mental illness. Information about drug use among them was obtained. The area studied is a low drug use area. The drug habit was found to be rare among females. The prevalence found in the general adult population is shown in table 1.

TABLE 1

Drug users in the general population

 

Alcohol

Bhang

Ganja

Opium

More than one

Others

Total

Number
227 67 8 7 66 7 382
Percentage of adult population (N = 16,725)
1.36 0.40 0.04 0.04 0.39 0.04 2.27
    0.44          

As can be seen from the above table, bhang is the most prevalent drug next to alcohol. Among the intoxicants, alcohol indulgence is considered to be a more acceptable social evil. Bhang indulgence is not considered too bad. Smoking of ganja is confined to the lower social group - a habit to which much stigma is attached.

Among all drug users, the use of alcohol was 59.4% (see pie-diagram) and that of bhang 17.5%, followed

by the use of more than one intoxicant - a habit indulged in by hard core chronic addicts who will indulge in any and every intoxicant procurable.

Area: Drug use was found to be more frequent in semi-rural areas followed by rural and urban areas (industrial and non-industrial). (See bar diagram 1.) The incidence of various narcotics in different areas is given in table 2.

Full size image: 38 kB

The high incidence of drug use in semi-rural areas was due to the existence of licensed shops in areas where a considerable number of prostitutes live.

Religion and caste: Brahmins (the highest caste) use more bhang and ganja than any other caste; among them, however, alcohol indulgence is the lowest. Brahmins shun alcohol, the use of which is considered a vice and is frowned upon by their religion. The Kayasthas, on the other hand, are the leading alcohol users, a habit they acquired as courtiers in the courts of the Moghul rulers. Islam prohibits the use of alcohol, but the habit is none the less fairly prevalent among Muslims. Table 3 and bar diagram 2 give a breakdown by caste.

The incidence of mental illness was found to be significantly higher in drug users than in non-users (see table 4).

Three hundred and eighty-two mentally ill persons were found to make habitual use of various drugs. The breakdown by number and percentage according to the type of drug used is given in table 5.

TABLE 2

Drug use by area (adults)

Area

Alcohol

Bhang

Ganja

Opium

More than one

Others

Total

Total Population

Urban (non-industrial)
64 13 2 5 19 3 106 5,602
  (11.42) (2.32) (0.36) (0.89) (3.39) (0.54) (18.92)  
    2.68            
Urban (industrial)
72 20 4 2 16 4 118 7,034
  (10.24) (2.84) (0.57) (0.28) (2.27) (0.57) (16.77)  
    3.41            
Rural
57 20 1
-
19
-
97 2,777
  (10.24) (7.20) 7.56 (0.36)
-
(6.84)   (34.93)  
    2.68            
Semi-rural
34 14 1
-
12
-
61 1,312
  (25.91) (10.67) (0.76)   (9.15)   (46.49)  
    11.43            

NOTE. -- Specific rate per thousand is shown in parentheses.

BAR DIAGRAM 1

Full size image: 21 kB, BAR DIAGRAM 1

Among the mentally ill, the number of users of more than one narcotic ranks first, followed by that of users of bhang and users of alcohol, in that order. The mentally ill use bhang and ganja more frequently than alcohol, since these drugs are cheaper and more easily procurable than alcohol. This is in contrast with the mentally normal-population, which prefers the use of alcohol (see table 1). This finding seems to indicate that the mentally ill exercise little choice, and use either a cheaper drug or any drug they can get.

It has been further observed that drug indulgence was significantly higher in psychotics than in normal and psychoneurotic subjects respectively. In fact, there were fewer drug users among psychoneurotics than amongst the normal population. Manic depressive psychotics and schizophrenics use drugs decidedly more than any other category. See table 6.

The causes of the excessive use of narcotics by the mentally ill can vary. Intoxication may either work as a catalyst in a deteriorating mental condition or act directly in producing mental disturbance.

TABLE 3 Drug use by caste (adults)

Caste

Alcohol

Bhang

Ganja

Opium

More than one

Others

Total

Total Population

1. Brahmins
8 25 4 1 16
-
54 2390
  (3.35) (10.46) (1.67) (0.42) (6.69)   (22.59)  
    12.13            
2. Kshtriya
31 19 1 3 21 1 76 2895
  (10.71) (6.56) (0.34) (1.05) (7.25) (0.34) (26.25)  
    6.90            
3. Vaish
22 5
-
-
3
-
30 1180
  (18.64) (4.24)     (2.54)   (25.42)  
4. Jatav
32 3
-
-
7
-
42 3461
  (9.24) (0.87)
-
-
(2.02)
-
(12.13)  
5. Kayastha
11 1
-
-
2 1 15 364
  (30.22) (2.75)
-
-
(5.49) (2.75) (41.21)  
6. Khatri
38
-
-
3 5
-
46 2360
  (16.10)     (1.27) (2.12)   (19.49)  
7. Others
85 14 3
-
12 5 119 4075
  (20.86) (3.43) (0.74)   (2.94) (1.23) (29.20)  
    4.17            

NOTE. - Specific rate per thousand is shown in parentheses.

BAR DIAGRAM 2

Full size image: 26 kB, BAR DIAGRAM 2

TABLE 4 Incidence of mental illness among drug users and non-users

Drug

Population

Number of cases

Rate/100

Users
382 26 6.81
Non-users
16,343 581 3.56
 
-------------
---------
 
  16,725 607  
 
P <0.01
   

Case histories of recent admissions to the Agra Mental Hospital were scanned. Among 358 consecutive admissions 100 persons were found to be habitual drug users. Cannabis was the commonest drug used, followed by alcohol. No case of opium use was found. Sixty-seven per cent of users were under 30 years old; in 81% of the cases, drug use started before the age of 30.

In these cases, 56% belonged to a lower social class, 41% to a middle class and the remaining 3% to the upper class. The majority of them (71%) were either illiterate or had only had primary education. More than half of the users were chronic addicts.

TABLE 5 Drug use among mentally ill subjects

 

Alcohol

Bhang

Ganja

Opium

More than one

Others

Total

Number
5 7 1 2 8 3 26
Percentage
19.23 26.92 3.85 7.69 30.77 11.54  

TABLE 6 Specific percentage of drug users in psychotics and psychoneurotics

Mental disorder

Total number of cases

Number of drug users

Specific percentage

Psychotics:
           
(i) Schizophrenia
63   8   12.70  
ii) Manic depressive psychotics
37 193 6 19 16.22 9.84
(iii)Organic psychosis
93   5   5.38  
Psychoneurotics
  367   7   1.91
Normal subjects
  16,118   356   2.21

Psychotics - Psychoneurotics:P<.01

Psychotics - Normal subjects:P<.01

Forty-one per cent of the bhang users had been addicts for more than 5 years and 67% for more than 2 years. Among the users of ganja, 23 % used the drug for more than 5 years and 57 % for more than 2 years. Twenty-eight per cent of alcohol users had been drinking for less than 2 years and the remaining 72 % had used intoxicants for a longer period of time. Frequency of drug use varied from rare to regular. Bhang was found to be used quite frequently in 65 % of the cases, arid on occasion in 35%. Ganja was used frequently in 86% of the cases. With regard to alcohol, 36% of users were casual users; the others were frequent users.

A cause of concern is the extensive use of drugs by students and youth in general. A recent survey at Delhi University revealed that while 2 years ago only 2% of the male students and none of the female students in the various colleges had used drugs, there are now about 200 confirmed drug addicts on the university campus. Nearly 5,000 students (5% of the student body) use habit forming drugs. Almost 50% of the male students and 8% of the female students have had drug experience at some time or other in their lives. Besides cannabis, alcohol, heroin and LSD have also been introduced among the students although their use is still limited at present.

The drug habit is spreading fast. In the larger cities, more and more young students, especially those who come from better homes, are falling prey to this habit. India's cities are presently seeing a sudden influx of hippies, a large number of whom are given to the use of dependence-producing drugs. This has furthered the spread of the drug cult.