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Drugs of Abuse & Social Consequences

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Sankalp संकल्प Rehabilitation Trust provides care and support to street-based drug users and seeks to prevent the spread of HIV/AIDS in Mumbai, India.

Sankalp संकल्प Rehabilitation Trust provides care and support to street-based drug users and seeks to prevent the spread of HIV/AIDS in Mumbai, India.

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  • 1. Drugs of Abuse and Social Consequences of Drug Use in India Eldred Tellis Sankalp Rehabilitation Trust
  • 2. Kinds of Drugs Used
    • Alcohol
    • Hallucinogens
    • Cannabis/Cannabinoids
    • Sedatives-hypnotics
    • Cocaine and other stimulants
    • Opioids
  • 3.  
  • 4. Nature’s Own Pleasure Systems
    • Brain’s own Opiate – Endorphins
    • Brain’s own Cannabis – Anandamide
    • Cocaine/ Amphetamine – Dopamine
    • Tobacco – Acetyl Choline
  • 5.  
  • 6. How Drugs are Used
    • Non injecting drug use
        • - oral , sublingual
        • - snorting, sniffing, inhaling, smoking
    • Injecting drug use
    • - Intravenous
    • - Intra muscular
  • 7. Psychiatric Complications of Alcohol Dependence
    • Hallucinations
    • Delusions
    • Memory decline
    • Lack of judgment
    • Personality changes
    • Depression
  • 8. Alcohol Induced Psychosis
    • Delusion
    • Hallucination
    • Other thought disorders
      • Delusion of Infidelity, Persecution
  • 9. Personality Changes
    • Drunken brawls
    • Dramatic, histrionic
    • Antisocial personality traits
    • (which came first?)
  • 10. Hallucination
    • Perception without any stimuli
  • 11. Hallucination
    • Auditory
      • Many drugs-Alcohol, withdrawal
      • Cannabis
      • Hallucinogens
    • Visual
      • Alcohol withdrawal
      • Cannabis, Hallucinogens
    • Tactile
      • Cocaine
    • Olfactory
    • Gustatory
  • 12. Delusion
    • False
    • Fixed Belief
    • Unshakeable
    • Not keeping with cultural belief
    • Infidelity (alcohol)
    • Persecution (many drugs)
    • Reference (many drugs)
  • 13. Delirium Tremens
    • Disorientation
    • Visual Hallucination
      • Animals, Insects
      • Threatening
      • Lilliputian
    • Auditory Hallucination
    • Heightened Withdrawal symptoms
  • 14. Cannabis
    • Acute Phase
      • Psychosis
      • Intoxication
    • Chronic usage
      • Amotivation syndrome
  • 15. Benzodiazepines
    • Initially started as prescription medicine
    • Withdrawal symptoms
    • Severe anxiety
    • Autonomic arousal symptoms
  • 16. MDMA (Ecstasy) Short Term Side Effects
    • Raised heart rate, BP
    • Short term memory lapses
    • Increase in body temperature
    • Decrease in body sodium balance
  • 17. Effects on Spouse
    • Depression
    • Anxiety
    • Personality change
    • Marital discord
  • 18. Effects on Children
    • Emotional disorders
    • Scholastic backwardness
    • Conduct disorders
    • Risk of substance abuse
  • 19. Opiates
    • Drug seeking behaviour
    • Theft, Prostitution
  • 20. IV Drug Abuse
    • Risk of HIV, Hepatitis B and C
    • Related psychiatric problems
  • 21. Drugs Injected by IDUs in India
    • Heroin
    • Injectable pharmaceutical opioids like
    • Morphine,
    • Pethidine,
    • Pentazocine (Fortwin*),
    • Buprenorphine alone or in combination with other drugs,
    • Propoxyphene (Spasmoproxyvon* - Dextropropoxyphene plus Dicyclomine)
    • Injectable Benzodiazepines like Diazepam (Calmpose*)
    • Injectable Anti histamines like Promethazine (Phenargan*), Chlorpheniramine (Avil*)
    • Cocktails of the above
    • * The trade names mentioned do not imply a pejorative connotation
  • 22. IDU PREVALENCE IN INDIA Reported in 24 states - NACO IDU Expert Group
  • 23. IDU Estimates in India
    • HIGH:
    • 1,100,000
    • Aciejas, Friedman, et al (2006)
    • LOW:
    • 223,121 (NACO)
    • 300,000 (UNODC)
  • 24. DUs in India are:
    • Young people
    • Away from mainstream services
    • Not very visible / stigmatized / marginalized/criminalized
    • Live on the streets (especially in metro cities)
    • Outside the experience of policymakers and bureaucrats
    • Have no political importance
    • Moving to pharma injecting
  • 25. Away from the Mainstream!!
  • 26.
    • Shift towards riskier mode of use -
    • non Injecting to Injecting
    • Shift from non-injecting heroin to injectable pharmaceuticals occur:
      • when heroin is scarce
      • when the cost of heroin is increasing
      • when there is an observable reduction in
      • purity levels
      • when police enforcement is vigilant
    • Easy availability and the low cost of injectable pharmaceuticals
  • 27. Drugs Used and Injecting Behavior Rapid Assessment in Goa, Kerala, Mizoram, Maharashtra (Pune only) Tamil Nadu and Uttar Pradesh covering 29 sites - SHARAN 2006
  • 28. Treatment-Seeking Behavior among IDUs (UNODC India, 2004)
    • A majority of drug injectors not in touch with mainstream or formal health or treatment services
    • Reasons for dissatisfaction with treatment
      • cost
      • ‘ felt needs’ of the drug users not addressed
    • Many drug injectors prefer OST
    • Treatment facilities are required for the adverse health consequences faced by IDUs
  • 29. Consequences Related to Drug Use
    • Drug trafficking, corruption and crime
    • Drug treatment & incarceration costs
    • Negative impact to the lives of young people in their most productive age and their families
    • Involvement in petty crimes like peddling and commercial sex (female/MSM IDUs) to support drug habit - come in conflict with the law
    • Major public health consequences like blood borne disease eg. hep C & IDU driven HIV epidemic
      • epidemic within IDUs
      • cross over with sexual partners leading to generalized epidemics effecting women and children
      • major cost needed for treatment
  • 30. IDU Related Health Complications
    • increased morbidity resulting from
    • - T.B., Hep. B & C, & other blood borne infections, including HIV
    • - Abscesses, wounds
    • psychiatric conditions
    • mortality, eg overdose
  • 31. HIV Prevalence Among Different Population Groups Source - HIV Sentinel Surveillance and HIV Estimation, 2006 of NACO IDU - 6.92%, MSM - 6.41%, FSW - 4.90%, STD - 3.74%, ANC - 0.60%
  • 32. HIV prevalence among IDUs in selected states Source - HIV Sentinel Surveillance and HIV Estimation, 2006 NACO
  • 33. Responses to DU/IDU & its Consequences
    • Incarceration
    • De-addiction/residential care (MOSJE)
    • HIV prevention interventions/Harm Reduction (NACO/NACP II & III)
    • - NSEP
    • - OST
  • 34. Incarceration has serious implications & is very expensive
    • Imprisonment worldwide at best estimates are in the region of US $62.5 billion per year using 1997 statistics. Direct costs include building and administering prisons, as well as housing, feeding, and caring for prisoners.
    • Prisons are incubators of diseases such as tuberculosis and HIV/AIDS, especially so when they are overcrowded. When prisoners are released, they may contribute to the further spread of such diseases.
    • Authorities should recognize that many offenders who violate drug laws, and indeed many offenders who commit other criminal acts, commit their crimes because they are themselves addicted to drugs. Authorities should find that treating offenders for their addictions is more effective and economical than processing and eventually punishing them through the criminal justice system.
    • Source -Handbook of basic principles and promising practices on Alternatives to Imprisonment’, UNODC, Vienna
  • 35. De-addiction/Residential Care
    • Aims for abstinence from drugs in long term
    • Ideal, but not so practical for many drug users eg, time in institution, treatment cost involved
    • Less attractive to DUs
    • Relapse rate is very high
    • Expensive
    • But ESSENTIAL when DUs need it
  • 36. Needle Syringe Exchange
    • Aims at safer injecting (HIV prevention) with provision of tools
    • Less expensive & has public health benefits
    • Reaches out to where IDUs are & links with other mainstream health services, but less attractive to IDUs
    • But it is not treatment & has minimal outputs in terms of addressing crime or social consequences
  • 37. OST (Opioid Substitution Therapy)
    • Both Harm Reduction & drug treatment
    • Expensive, but reduces adverse public health & social consequences
    • Very attractive and practical for IDUs
    • High retention and helps in adherence to other treatments like TB, ART etc.
    • Stabilization and social functioning of IDUs
    • CLEANER for those not ready to clean up
    • Gives time, space & support for cleaning up
  • 38. OST Coverage Achieved in 2006-07
    • Sharan: Comprehensive services through DICs and community based interventions in 7 States and 2 Union territories. IDU coverage: 20314 : OST-1775 / NSP-1953/ Referral for drug treatment-10,113
    • EHA-AIHI: Opioid substitution treatment for male and female drug users in Manipur and Nagaland. Total: 2537 [Males: 2369 - Females: 168]
    • UNODC ROSA: Total number of drug users reached: 5800
    • Regular sex partners reached: 3327/ OST-232 / 4 Prison interventions
    Source: DfID Challenge Fund Evaluation 2007
  • 39. Cost & Efficacy
    • NSEP - less expensive but minimal outcomes
    • OST - expensive but maximum outcomes
    • De-addiction/residential care - expensive but essential outcomes
    • BUT - maximum reach & best outcomes when the 3 are synergized
  • 40.
    • THANK YOU
    • Eldred Tellis
    • [email_address]
    • www.sankalptrust.org

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