Changing trends in heroin abuse in India : an assessment based on treatment records

Sections

ABSTRACT
Introduction
Results of the study
Distribution of heroin addicts by year
Age
Education
Occupation and marital status
Duration of use and amount of heroin used
Abuse of heroin in combination with other drugs
Discussion

Details

Author: D. MOHAN, ADITYANJEE , S. SAXENA , S. LAL
Pages: 19 to 24
Creation Date: 1985/01/01

Changing trends in heroin abuse in India : an assessment based on treatment records

D. MOHAN, ADITYANJEE *
S. SAXENA
S. LAL Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India

ABSTRACT

The study of drug addicts who were treated in the drug-abuse facilities of the All India Institute of Medical Sciences during the period from 1981 to May 1984 indicates a steady increase in the number of heroin addicts who sought treatment in those facilities. The majority of heroin addicts were under 30 years of age (87.6 per cent), unmarried (67.6 per cent), had reached either high school or college (80.0 per cent) and reported having taken up to one gram per day (56.6 per cent) of the drug for one year or less (63.8 per cent). Heroin was mainly smoked (74.3 per cent) and in some cases inhaled, sniffed or injected. Up to1981 there were no heroin addicts recorded in the treatment facilities. Other studies in India support this evidence. On the basis of the recency of heroin addiction in India, and its trend and development in other countries of the region, the authors predict a rapid increase in heroin addiction and in the manufacture of heroin in the country.

Introduction

This article summarizes the data on heroin addicts who were treated in the drug-abuse facilities of the All India Institute of Medical Sciences (AIIMS). These facilities consist of an out-patient clinic and an in-patient unit of eight beds, which was the first such unit specialized for treatment of addicts in the country. The treatment facilities have been in operation for the past six years.

Results of the study

The study covers 105 heroin addicts who were treated for their addiction during the period from 1981 to May 1984. Up to 1981 there were no heroin addicts recorded in either of the two treatment facilities. All of the heroin addicts treated in the facilities were males. The study includes information on socio-demographic variables, addiction histories and other data relevant to heroin abuse.

* Former staff member of AIIMS : currently a staff member of the National Institute of Mental Health and Neurological Sciences.

Distribution of heroin addicts by year

The number of recorded heroin addicts by year is as follows :

1981 9
1982 20
1983 41
1984 (first four months)
35

The above data clearly show that there has been a steady increase in the number of recorded heroin addicts from one year to the next. During the first four months of 1984 heroin addicts were over one third (37.8 per cent) of all drug abusers treated in the two facilities of AIIMS.

Age

The majority of the addicts were under 30 years of age, and almost two thirds were under 25 years of age, a period during which they should have been either attending school or college, or commencing theircareers. The distribution of heroin addicts by age group was :

 

Number

Percentage

15 - 20
10 9.5
21 - 25
56 53.3
26 - 30
26 24.8
31 - 35
6 5.7
Over 35
7 6.7

Education

The majority ofheroin addicts had reached either high school or college. Their distribution by the level of education reached, though not necessarily completed, was :

 

Number

Percentage

Primary school or less
6 5.7
Middle school
12 11.4
High secondary
36 34.3
College
48 45.7
Unknown
3 2.9

Occupation and marital status

Regarding occupation, 54.3 per cent of the addicts were either unemployed or employed only from time to time. Of the rest, l 6.2 per cent were employed in hotels, the tourist industry or businesses, 17.l per cent were salaried employees and 12.4 per cent students.

Most of the addicts were unmarried (67.6 per cent).

Duration of use and amount of heroin used

The majority of addicts used heroin one year or less, while approximately one third used it more than a year. The distribution of addicts by duration in months of heroin use was :

 

Number

Percentage

Below 6
25 23.8
7 - 12
42 40.0
13 - 24
18 17.1
25 - 36
9 8.6
37 - 48
2 1.9
Above 48
7 6.7
Unknown
2 1.9

The distribution of addicts by the amount of heroin used, in milligrams per day, was :

 

Maximum use (Number)

Percentage

Use during 24 hours preceding treatment (Number)

Percentage

0 - 250
7 6.7 24 22.8
251 - 500
21 20.0 25 23.8
501 - 1000
31 29.5 33 31.4
1001 - 2000
20 19.0 5 4.8
Above 2000
17 16.2 3 2.9
Unknown
9 8.6 15 14.3

Approximately, 23.8 per cent of addicts indicated that they had sought treatment after attempting self reduction in dose.

The great majority of addicts smoked heroin (74.3 per cent) ; others used heroin by inhaling, sniffing, or intravenous or intramuscular injection, Over 11 per cent of addicts injected the drug.

Abuse of heroin in combination with other drugs

A substantial percentage * of heroin addicts were also involved with other drugs, abusing cannabis (49.5 per cent) ; alcohol (45.7 per cent) ; opiates (20.9 per cent) ; sedatives (14.3 per cent) ; stimulants (13.3 per cent) ; and hallucinogens (8.6 per cent). Heroin addicts used opium, codeine sulphate and pentazocine when heroin was not easy to find. The addicts used sedatives and stimulants synergetically to enhance heroin effects.

Discussion

Prior to 1981 , no heroin addicts were reported from the facilities of AIIMS or from other centres in the country. Two studies that concentrated on drug abuse, recorded in the casualty emergency services, failed to observe any heroin addictions [ 1,2] . Amphetamine and methaqualone abuse was reported among the young in the 1960s [ 3] , which led to a stricter control of amphetamines in 1974. The multi-centred survey of university students carried out in 1977, as well as other surveys, showed that cannabis, alcohol and hypnotic sedatives were the main drugs of abuse [ 4] .

The AIIMS study shows that the majority of heroin addicts were young men, whose consumption was usually up to a gram of heroin per day and the duration of their use of heroin usually did not exceed two years. Similar trends have been observed by another in-patient study in Delhi during approximately the same period [ 5] . From other large cities a rapid increase has again been reported [ 6] . These observations attest to the relative recency of the phenomena and portend the possible problems. In Delhi, two recent reports have pointed out the rapid increase in heroin abuse [ 7,8] as well as a rising trend in alcohol Consumption that had been reported earlier [ 9] . Current increase in heroin addiction is a development that, because of its dramatic impact and its public health and social costs, needs urgent attention.

The reasons for such a rapid rise in heroin abuse in the populations of cities are not difficult to explain, and were predicted much earlier [ 10-12] . It is assumed that one of the major factors that has led to a rapid increase in heroin abuse in India was the spill-over effect of the increased heroin availability in neighbouring countries. Westermeyer pointed out the possibility of the adverse effects of anti-opium laws in a country [ 13] , but failed to predict its spill-over effects on neighbouring countries. Among other factors that are likely to have contributed to the current increasing trend in heroin addiction is the popular abuse of cannabis and alcohol among students and out of school youth. In this study, all heroin addicts smoked tobacco Cigarettes ; 49.5 per cent of them also abused cannabis and 45.7 per cent alcohol. It is known that among people engaged in hard physical labour cannabis is commonly used to relieve fatigue. Heroin is not difficult to introduce to such a vulnerable population. The extent of a possible further rapid spread of heroin addiction Can also be predicted on the basis of the fall in street prices of heroin, which are one-tenth lower in 1984 than two years ago.

* The percentages do not add to 100 because some addicts used heroin with more than one drug.

On the basis of these data it is possible to predict some of the changes that may take place. The further spread of heroin abuse may occur with geometrical progression as has happened in other Asian countries. In spite of all official efforts some local manufacturing of heroin from the illicit raw opium in the country may take place, if it is not already doing so. It is expected that both domestic and international pressures will be put on the authorities for more stringent legal penalties for infractions relating to opiates. The rationale for such pressures would be valid, so long as they were not extended to cover the vast raw-opium consuming rural population, on whom the counter-productive effects of such pressures have been demonstrated. The Government of India needs urgently to further strengthen its machinery to prevent diversion of raw opium from growing areas, as well as to re-evaluate policy options relating to rural opium users, who are not going to be cured of addiction overnight [ 4] .

It can also be predicted with a reasonable degree of certainty that the quality of urban life is likely to deteriorate rapidly if heroin addiction takes root. The effects may be most acutely felt by middle-class nuclear families and by a large number of people who live in congested slum areas. Such a development may be reflected in increasing crime rates, rising number of alcohol- and drug-related problems and deteriorating social structures.

References

01

D. Mohan and others, "Patterns and prevalence of drug overdosage in casualty emergency services : a multi hospital study in Delhi" (New Delhi, Ansari Nagar, 1981).

02

Adityanjee, "Patterns and prevalence of psychiatric emergencies, in casualty emergency area of a general hospital", doctoral thesis (unpublished, 1983).

03

R. N. Banerjee, "Prevalence of habit forming drugs and smoking among college students : a survey", Indian Medical Journal, No. 57, 1963, p. 194.

04

Government of India, Expert Committee Report on Drug Abuse in India (New Delhi, Ministry of Health and Family Welfare, 1977).

05

G. C. Munjhal, "Pattern of heroin addiction as seen in psychiatric clinic", personal communication, G. B. Pant Hospital (New Delhi, 1984).

06

P. K. Muttagi, "Patterns of heroin addiction in Bombay : a change over four years", personal communication (1984).

07

D. Monan and others, "Substance abuse patterns in India : an overview", Journal on Substance Abuse, 1983, pp. 15 - 18.

08

S. Saxena and D. Mohan, "Rapid increase of heroin dependence in Delhi : some initial observations", Indian Journal of Psychiatry, No. 26, 1984, pp. 44 - 45.

09

D. Mohan aud H. K. Sharma, "Alcohol: friend or foe", Impact of Science on Society (Paris, United Nations Educational, Scientific and Cultural Organization, 1984), pp. 133 - 139.

10

D. Mohan, M. G. Thomas and G. G. Prabhu, "Adolescent drug abuse and psycho-social co-relates", New Development in Paediatric Research, Ghai, ed. (New Delhi, Interprint, 1977), pp. 1007 - 101l.

11

11. D. Mohan, A. K. Prabhakar and P. N. Sharma, "Prevalence and patterns of drug abuse among Delhi university students", Indian Journal of Medical Research, No. 66, 1977, pp. 627 - 636.

12

D. Mohan, M. G. Thomas and G. G. prabhu, "Prevalence of drug abuse amongst high school students : a replicated study", Indian Journal of Medical Research, No. 68, 1979, pp. 99 - 105.

13

J. Westermayer, "The pro-heroin effect of opium laws in Asia", Archive of General Psychiatry, No. 33, 1976, p. 435.