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Detection of addiction in medical professionals -an eye opener

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  • 1. Dr.Anil Batta,J Biosci Tech, Vol 2 (3),2011, 305-311 DETECTION OF ADDICTION IN MEDICAL PROFESSIONALS—AN EYE OPENER Dr.Anil Batta Associate Professor, Dep’t of Medical Biochemistry, Baba Farid Univ. of Health Sciences Faridkot Punjab IndiaAbstract:The medical professionals are vulnerable to substances of abuse/addiction due totheir ready accessibility to the substances of abuse. Of particular concern is thefinding of a lack of gender differences in problematic drinking with the pattern offemale addicts drinking rates for women approximating that of men by the end ofmedical school. There is higher percentage use of alcohol, tranquillizers and Key words:narcotics among medical students. Majority of the substance-abusing doctors are Narcotics,graduates, belong to medicine specialty (21%) and majority of them prescribe tranquilizer,drugs to themselves (37%). Medical student abuse is the major risk factors. medical professionals,Despite paucity of studies in Indian population, substance use is reported between PGIMER, CHD32.5% to as high as 81.2% among medical students, interns and house physicians.In spite of the treatment dilemmas, the physicians do respond favorably totreatment. These findings have implications in planning preventive andinterventional strategies for this professional group. This study explores theattitudes and perceptions of medical students concerning patients with addictionsand policy issues related to drugs. Over 100 students from PGIMER studentsresponded to an anonymous survey concerning their experience and trainingregarding addictions, and their level of support or opposition for various drugpolicy approaches. Quantitative and qualitative epidemiological investigation ofsubstance use within a student population was seen during their mandatorypreventive health visit at the OPD medical facility. The purpose of this study wasto assess the prevalence of psychotropic (Narcotics) & tranquilizers drugconsumption by students undergoing medical courses of Post Graduate Institute ofMedical Education & Research, Chandigarh India to verify aspects related to thoseaddictions. Among psychotropic drugs, Narcotics & other psychotropic drugs likedextropropoxyphenes, morphine, pethidine & tranquilizers were more frequentlyused by the students. It was found to be 45.2% and 55.3% respectively.1. INTRODUCTION environmental stress all can be factors. Peer pressure can lead to drug use or abuse, but atPhysical addiction that gets (progressively) least half of those who become addictedworse, but it’s a sort of emotional crisis that have depression, attention deficit disorderis being pushed away. My belief is its a post traumatic stress disorder, or anotherspiritual crisis that is being batted away by mental health problem. Children that growtaking drugs. And the trouble is, the more up in an environment of illicit drugdrugs you give an addict, the more drugs an abuse may first see their parents using drugs.addict needs. Drug abuse can lead to drug This may put them at a higher risk fordependence or addiction. Medico’s who use developing an addiction later in life for bothdrugs for pain relief may become dependent, environmental and genetic reasons.although this is rare in those who dont havea history of addiction. The exact cause of People who are more likely to abuse ordrug abuse and dependence is not known. become dependent on drugs include thoseHowever, a persons genes, the action of the who:-drug, peer pressure, emotional 1. Have depression, bipolar disorder,distress, anxiety neurosis and anxiety disorders, and schizophrenia 305
  • 2. Dr.Anil Batta,J Biosci Tech, Vol 2 (3),2011, 305-3112. Have easy access to drugs drug source; uses drugs to "fix" negative3. Have low self-esteem, or problems with feelings; begins to stay away from friends relationships and family; may change friends to those4. Live a stressful lifestyle, economic or who are regular users; shows increased emotional tolerance and ability to "handle" the drug.5. Live in a culture where there is a high social acceptance of drug use Daily preoccupation - the user loses any motivation; does not care about school andCommonly abused substances include: work; has obvious behavior changes;Opiates and narcotics are powerful thinking about drug use is more importantpainkillers that cause drowsiness (sedation) than all other interests, includingand sometimes feelings of euphoria. These relationships; the user becomes secretive;include heroin, opium, codeine, meperidine may begin dealing drugs to help support(Demerol), hydroxymorphone (Dilaudid), habit; use of other, harder drugs mayand oxycodone (Oxycontin). increase; legal problems may increase.Central nervous system (CNS) stimulants Dependence - cannot face daily life without Include amphetamines, cocaine, drugs; denies problem; physical conditiondextroamphetamine, methamphetamine, and gets worse; loss of "control" over use; maymethylphenidate (Ritalin). These drugs have become suicidal; financial and legala stimulating effect, and people can start problems get worse; may have broken tiesneeding higher amounts of these drugs to with family members or friends.feel the same effect (tolerance). SymptomsCentral nervous system depressants include 1. Some of the symptoms and behaviors ofalcohol, barbiturates (amobarbital, drug dependence include:pentobarbital, secobarbital), 2. Confusionbenzodiazepines (Valium, Ativan, Xanax), 3. Continuing to use drugs even whenchloral hydrate, and paraldehyde. These health, work, or family are beingsubstances produce a sedative and anxiety- harmedreducing effect, which can lead to 4. Episodes of violencedependence. 5. Hostility when confronted about drug dependenceHallucinogens include LSD, mescaline, 6. Lack of control over drug abuse - beingpsilocybin ("mushrooms"), and unable to stop or reduce alcohol intakephencyclidine (PCP or "angel dust"). They 7. Making excuses to use drugscan cause people to see things that arent 8. Missing work or school, or a decreasethere (hallucinations) and can lead to in performancepsychological dependence. 9. Need for daily or regular drug use to functionExperimental use - typically involves 10. Neglecting to eatpeers, done for recreational use; the user 11. Not caring for physical appearancemay enjoy defying parents or other authority 12. No longer taking part in activitiesfigures. because of drug abuseRegular use - the user misses more and 13. Secretive behavior to hide drug usemore school or work; worries about losing 14. Using drugs even when alone 306
  • 3. Dr.Anil Batta,J Biosci Tech, Vol 2 (3),2011, 305-311Opiates and narcotics are usually in the 2.1. Processing of sampleurine 12 to 36 hours after the last use, To 20 cc. of urine add conc. Hcl was used sodepending on the amount used and how as to get pH between 3 & 4. Reflux theoften the drug was used. contents in a flask, burner & condenser for 1 ½ an hour. Allow this to cool down forCNS stimulants such as cocaine can be about an hour.found in urine for 1 to 12 days, againdepending on how often the drug was used. 2.2. Extraction Procedure Refluxed urine is thoroughly washed withCNS depressants such as Valium and Xanax 20 cc. Hexane. Then add sodium carbonateare found up to 7 days after the last day of to get alkaline pH (8--9). Drug is extracteduse, mostly depending on the substance used from urine with chloroform & propyland how quickly the body removes it (its alcohol ratio of 4/1. Total volume of thehalf-life). extraction mixture is 100 ml. Transfer theMost hallucinogens also can be found in the contents in a separating funnel & collect theurine up to 7 days after the last use. lowermost layer in a neat & dry beaker.However, evidence of marijuana can be Evaporate the contents so that only residuefound for up to 28 days after its last use in is left.regular users. 2.3. Spotting of Extracted Drug2. METHOD Dried residue obtained in a beaker is dissolved in a drop of methanol. This isThis study was carried out with students of spotted on mica plate so that differenceall years of the medical course invited to between the two is not >1/2 cm. & distanceparticipate anonymously by answering a from bottom is 2 cm. Along with the sampleself-applied questioaire. It was based upon the known sample is also spotted acting asthe World Health Organizations Guidelines standard of the drug.for Student Substance Use Survey andincluded 25 questions about drug addiction. 2.4. Development of spotted plate:To carry out a quantitative and qualitative Put the spotted plates in the jar & leftepidemiological investigation of substance mobile phase to run up to 15 cm. mark. Takeuse within a student population was seen out the plates & put them in oven for 5during their preventive health visit at the minutes at about 100’C.PGIMER medical facility. 2.5. Separating the plates Cool the plate & spray this with sprayingThin Layer chromatography is a method in reagent Iodoplatinic acid. (made with thewhich mobile phase moves by capillary help of 1N Hcl, Potassium iodide & platonicaction across a uniform thin layer of finely chloride). Alternately a UV lamp is muchdivided stationary phase bonded on to plate. better device. But for this we need labeledDrugs when applied to the plate & Silica to quote the glass plate.developed with the mobile phase, they moveacross the plate at different rates & hence 2.6. Detection of Drugseparated. Keeping in view cost effective Locate the drug positive samples & compareand reasonably accurate method of TLC was them with morphine standard which wasused. 307
  • 4. Dr.Anil Batta,J Biosci Tech, Vol 2 (3),2011, 305-311spotted along with the samples. Depending 6. Adequate protection staff so as to keepon Rf value we can isolate & identify drugs checks on any suicidal or homicidallike Morphine, codein, papavarine & other tendency.narcotics. Similarly by changing the mobile 7. Patients were given analgesics,phase or solvent system & spraying reagent tranquilizer, Vitamins & mineral as drug.with dye or /UV apparatus we can isolate &identify other drugs of abuse. 3. RESULTS2.7. MATERIAL A total of 100 students took part in the survey with a response rate of approximatelyThe present study was undertaken in one 50%. Preliminary results relating to ahundred students studying in various courses subsample of this study are presented hereof all years in PGIMER, Chandigarh (n = 100, mean age 20 years, 56% women).attending the OPD for a different 44% of the students consumed narcotic &psychological problem of drug de-addiction tranquilizer at least once in their life. Other& treatment Centre (DDTC) department of evaluated substances had a prevalence ofPsychiatry, Post graduate Institute of consumption lower than 1%. For the firstMedical Education Research, Chandigarh consumptions, a majority of students state to(PGIMER, Chandigarh) & those who were felt "pleasant" effects: relaxation (71%) andailing & admitted to the ward of DDTC.All euphoria (53%). 13% state to have feltof them were scanned thoroughly to rule out effects of anxiety or sadness. 25% admittaking the drugs inadvertently. Age group having had difficulties of expression, 24%was not particular & all the students doing memory deficits, 35% trouble withall medical courses were selected. They coordination or balance and 39% difficultieswere provided a test tube for collecting a of concentration. Approximately 16% hadurine sample for detecting the drugs in urine. impressions of depersonalization andThey were guarded by watch staff so that derealization. Lastly, some experiencedthey may not dodge by filling the tube with "psychotic-like" effects such as visual (10%)a water sample. Different routine and auditory (6%) hallucinations, as well asinvestigations with Liver Function Tests in referential ideas (16%), mistrust or feelingsparticular were carried out. This was taken of persecution (11%). 26% of the studentinto consideration as they may have been sample had felt at least one of these last fourtaken raw morphine which contains Arsenic. "psychotic-like" effects. : In 2000-2006,Following tests were carried out in routine 66.0% of male respondents and 52.0% ofin all the suspected cases:-- female respondents have reported any drug use during their life. The analysis of1. Serum ALT/AST/ALP/GGT. standardized data (by the place of residence)2. Routine tests like Sugar, urea, TSP/DSP showed an increase in the prevalence ofwere carried out by auto analyzer. drug use during 2006-2010.Up to 69.67 % in3. Tests according to History of Patients. boys (P<0.05) and up to 60.60 % in girls4. The food was provided by PGIMER, (P>0.05). Percentage of club drug usersCHD mess to rule out any foul play of increased significantly in girls (from 21.5%sending the medicine in food. to 29.8%; P=0.040)5. Watch & ward staff was always on alertto rule out any back door entry of drugs 308
  • 5. Dr.Anil Batta,J Biosci Tech, Vol 2 (3),2011, 305-311 Table 1 Graduates perusing post Graduate Study-Specialty wise Chronic Self Response rate Specialty Mean age±SD Gross response rate illness prescription Specialty wise Medicine 23% 35% 25±1.9 39% Psychiatry 39% 48% 24±2.9 48% Surgery 25% 29% 24±3.9 29% 41% Orthopedics 21% 15% 26±5.9 15% Table -2 Chart showing narcotic and tranquilizer addiction (Priority wise) Total Revealed Type of Drug & its sex wise prevalence Professio intake of prevalence in both sexes nal Drug Tranquilizer Narcotics Male Female Narcot Tranquilizer Narcotics Tranquilizer ics 67% 52% 64% 58% 73% 32% 100 58 Table-3 Comparative Data of the last ten years Type of drug & its Sex wise prevalence Major % prevalence in both cause Addicts Male Female sexes Tranquilizer Narcotics Tranquilizer Narcotics 2000- Sadness/ 45.4% 2006 Anxiety 67% 52% 64% 58% 73% 32% Depression 32.5% 2007- Relaxation 59.8% 2010 60.60% 67.8% 66.43% 74.32% 32.76% Euphoria 65.32% 69.67% Loneliness 29.7% Failed love 39 % affair 309
  • 6. Dr.Anil Batta,J Biosci Tech, Vol 2 (3),2011, 305-3114. DISCUSSION: problematic drinking with the pattern of female rates. Drugs were most frequently Students were asked to take part in an used by, students living single in hostelinvestigation of their substance consumption room, who live alone and do not supportand their individual experiences with themselves communication with friends whonarcotics & tranquilizers in particular. use drugs, participation in the parties wherePersonality auto questionnaires were drugs are used, alcohol use, and smoking. Inperformed and the psychotomimetic effects 2006 survey, more significant relationshipof narcotics & tranquilizers were between drug use and social and behavioralinvestigated with substance use within a factors was observed. Several indicators ofstudent population seen during their drug use showed a significant increase inmandatory preventive health visit at the drug abuse among students of medicalOPD medical facility. The use of illicit schools in North India during the period ofdrugs by students and the possible 20004-2010. Multisectorial efforts andpsychological repercussions in this integrated preventive measures should bepopulation of young adults is an important applied for the prevention of epidemics ofpublic health issue. Some data in the drug use in North India & for that matter theliterature suggest a relationship between whole India. Alcohol was most used anddrugs and the occurrence of mental health was related to other drug addictions. Drugsdisorders, in particular psychotic illnesses, were most frequently used by single, maleepidemiologic surveys have shown that students, who live alone and do not supportnarcotics & tranquilizers is the most themselves, communication with friendsconsumed illicit drug who use drugs, participation in the parties where drugs & alcohol are used. In 2006 Narcotic & tranquilizers consumption is survey, more significant relationshiphighly variable among different consumers. between drug use, social and behavioralImplications for prevention strategies are factors was observed. Several indicators ofdiscussed such as educational interventions drug use showed a significant increase inbased on recognition and motivation for drug abuse among students of medicalchange. The results are consistent with the schools in North India during the period ofidea that the impact of tranquilizers & 2004-2010. Multisectorial efforts andnarcotics is easy we can isolate & identify integrated preventive measures should beother drugs of abuse. applied for the prevention of epidemics of As the present study was meant for drug use in North India & for that matter theknowing the level of addiction in students of whole India.different medical courses like Laboratory 6. REFERENCEStechnicians, nursing, Physiotherapy, B.Sc.(Medical), Radiography & in general all [1] Mohan.D and Dawan. A. Epidemiology of drugstudents doing post graduate courses. abuse behavior in substance use disorder a manual for psyching (ed) RAY.R, Drug5. CONCLUSION Dependence Treatment Centre Department of Psychiatry. All India Institute of MedicalNarcotics & tranquilizers are the drug most Sciences 2000 pp-21.used and were related to other drug [2] Margoob MA, Dutta KS drug abuse in Kashmir -addictions. . Of particular concern is the experience from a psychiatric disease hospitalfinding of a lack of gender differences in Indian journal of Psychiatry 1993 35 (3) 163-165 310
  • 7. Dr.Anil Batta,J Biosci Tech, Vol 2 (3),2011, 305-311[3] Margoob MA A study of present magnitude of [6] Dutta KS Margoob MA report on the follow up psychiatric disorders and existing treatment study on recovering drug addicts counseled and services in Kashmir (1990-1994) JK Practitioner treated at various centers being run by 1995; 4:165-168 nongovernmental organizations NGO"S/[4] Police recover 400 grams of brown sugar from 3 hospitals etc in Jammu and Kashmir 1993 report persons at Handwara Greater Kashmir Srinagar submitted to ministry of welfare Govt. of India page 3 Oct 2 2004 New Delhi[5] Vaswani M in Ray R (Editor) Substance use [7] Margoob MA Beg AA and Zafar A An disorder: a manual for physicians. (Ed) Ray R. evaluation of recovery following treatment in Drug Dependence Treatment Centre Department drug abuse in the only psychiatric disease of Psychiatry. All India Institute of Medical hospital of Kashmir Valley. Richmond Sciences Medical Sciences.2000, 175-181 Fellowship Asia Pacific Forum International Symposium Bang lore Nov 23-25 1995 311