This presentation was done on the 'First Qilu Doctoral Forum on Health Economy and Policy' Conference on 15th May 2019 at Shandong University, Jinan, China

1. Health & Economic Burden
of Drug Addiction in Asia
By
Dr. Syeda Zerin Imam
Health & economic burden of drug addiction 1

2. What is drug addiction
drug abuse interprets as the chronic or habitual use of any chemical substance to alter states of
body or mind for other than medically warranted purposes; such as a. physical dependence b.
withdrawal. In other words, addiction is defined as a chronic, relapsing disorder characterized by
compulsive drug seeking and use despite adverse consequences. It is an oppressive nature of the
drug use despite physical and psychological harm to the user and society and it includes both licit
and illicit drugs. It is considered a brain disorder, because it involves functional changes to brain
circuits involved in reward, stress, and self-control, and those changes may last a long time after a
person has stopped taking drugs. frequently used broad range of substances (including alcohol and
inhalants) that can fit the addictive profile is referred as the substance use. The term ‘substance’
according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) refers to a drug
of abuse, medication, or a toxin.
Substances are classified into 11 classes:
Health & economic burden of drug addiction 2

3. No. Names
1. alcohol
2. amphetamine (or other sympathomimetics)
3. caffeine
4. cannabis
5. cocaine
6. hallucinogens
7. inhalants
8. nicotine
9. opioids
10. phencyclidine (PCP) or similarly acting arylcyclohexylamines
11. sedatives-hypnotics or anxiolytics
Health & economic burden of drug addiction 3

4. Toxic effects and addiction risk of major illicit and licit
psychoactive substances
Drug category Acute toxicity Chronic toxicity Relative risk
of addiction
Alcohol and
related drugs
(benzodiazepines,
barbiturates)
Psychomotor impairment,
impaired thinking and
judgement, reckless or
violent behavior; lowering of
body temperature, respiratory
depression
Hypertension, stroke, hepatitis,
cirrhosis, gastritis, pancreatitis,c/
organic brain damage, cognitive
deficits, foetal alcohol
syndrome,c/ withdrawal effects:
shakes, seizures, delirium treme
3
Health & economic burden of drug addiction 4

5. Drug category Acute toxicity Chronic toxicity Relative risk of
addiction
Cocaine,
Amphetamines
Sympathetic overactivity:
hypertension, cardiac
arrhythmias, hyperthermia; acute
toxic psychosis: delusions,
hallucinations, paranoia, violence,
anorexia
Paresthesias, stereotypy,
seizures, withdrawal
depression, chronic rhinitis,
perforation of nasal septum
1
Caffeine Cardiac arrhythmias, insomnia,
restlessness, excitement, muscle
tension, jitteriness, gastric
discomfort
Hypertension, anxiety,
depression, withdrawal
headaches
5
Health & economic burden of drug addiction 5

6. Drug category Acute toxicity Chronic toxicity Relative risk of
addiction
Cannabis
(marijuana,
hashish)
Psychomotor impairment;
synergism with alcohol and
sedatives
Apathy and mental slowing,
impaired memory and learning
(brain damage?), impaired immune
responseb/
4
Nicotine Nausea, tremor, tachycardia;
high doses: hypertension,
bradycardia, diarrhoea, muscle
twitching, respiratory paralysis
Coronary, cerebral and peripheral
vascular disease, gangrene, gastric
acidity, peptic ulcer, withdrawal
irritability, impaired attention and
concentration, retarded foetal
growth, spontaneous abortionb/
2
Health & economic burden of drug addiction 6

7. Drug category Acute toxicity Chronic toxicity Relative risk of
addiction
Opiates Sedation, analgesia, emotional
blunting, dream state; nausea,
vomiting, spasm of ureter and bile
duct; respiratory depression, coma,
synergism with alcohol and
sedatives; impaired
thermoregulation; suppression of
sex hormones
Disorders of hypothalamic
and pituitary hormone
secretion, constipation,
withdrawal cramps,
diarrhoea, vomiting,
gooseflesh, lacrimation and
rhinorrhea
2
Hallucinogens
(LSD, PCP)
Sympathetic overactivity; visual and
auditory illusions, hallucinations,
depersonalization; PCP only: muscle
rigidity, hyperpyrexia, ataxia,
agitation, violence, stereotypy,
convulsions
Flashbacks, depression,
prolonged psychotic episodes
5
Health & economic burden of drug addiction 7

8. Drug delivery method
Swallowing cracked cocaine
1. Swallowing: Pills, Food, and Drink- When a person takes a drug
orally, whether it is alcohol or a pill, the drug is absorbed through the
lining of the stomach and intestines, and then into the bloodstream.
Alcohol is one of the most famous addictive substances that requires
ingestion. Other drugs that are ingested through the stomach include
“club drugs” like ecstasy and MDMA, and hallucinogens like DMT and
mushrooms. Because of the slow release, it is easy for people to take
too much of a drug because they initially don’t feel the effects of the
drug, and this can lead to overdose.
Health & economic burden of drug addiction 8

9. 2. Smoking- Smoking is a faster way to get
addictive substances into the bloodstream than
ingestion. The internal lining of the lungs allows
oxygen to pass into the bloodstream so that it
can be delivered to organ systems, from the
brain to the intestines. Smoking an addictive
substance takes advantage of this system to
release drugs into the bloodstream faster. These
drugs include: Tobacco, Marijuana, Crack
cocaine, Opium, Meth, Salvia, PCP, and other
hallucinogens and Some prescription drugs
Health & economic burden of drug addiction 9

10. 3. Snorting- Snorting substances is one of the faster methods
for getting high. The thin nasal lining allows tiny blood vessels
to absorb the drug, releasing the substance almost directly into
the bloodstream.
Snorting high-dose painkillers like OxyContin puts the individual
at a much greater risk of overdose and death. These substances
include: Methamphetamines, Amphetamines, including
prescription amphetamines like Ritalin, Heroin, MDMA,
Rohypnol or other CNS suppressants and Ketamine.Health & economic burden of drug addiction 10

11. 4. Injecting- Injecting is likely the fastest method of getting high
from addictive substances, because the individual puts the
drugs directly into the bloodstream. Drugs that are injected
into the body include: Heroin, Steroids, Prescription
medications used illegally, Barbiturates, Benzodiazepines,
Cocaine, Methamphetamine and Crack cocaine.
People who inject drugs are at a much greater risk of catching
an infectious disease because of needle-sharing. While any
unclean drug paraphernalia can lead to infectious disease
spread, unclean needles mean that blood is shared between
users. This increases the spread of hepatitis B, hepatitis C, and
HIV. Injection drug use can also spread other viral or bacterial
infections, including STIs, which rely on bodily fluids to spread.
Individuals who inject drugs are at greater risk of developing
skin and muscle infections because of the constant exposure to
foreign substances.Health & economic burden of drug addiction 11

12. 5. Inhalants, Topical Absorption, and Suppositories- Some
prescription medications are created to be inhaled, absorbed
through the skin, or used rectally or vaginally as a suppository.
However, addictive substances can also be ingested in this
manner. Paint thinner, corticosteroids, nitrites, aerosol sprays,
and other addictive substances are abused in a method
colloquially called huffing. This involves using a soaked rag or
balloon to inhale the drug.
Health & economic burden of drug addiction 12

13. 6. Patch- Much less common is the use of patches on the skin, or suppositories, to absorb drugs into the bloodstream.
Suppositories are becoming more common as a way to take advantage of the thin skin in the vagina or rectum,
bringing effects that are similar to snorting drugs. These methods can lead to infections in any of these areas, as
well as damage to the surrounding skin, muscles, and nerves. People who ingest drugs in this manner are also at
risk of overdose or long-term organ damage related to drug addiction.
Health & economic burden of drug addiction 13

14. Health & economic burden of drug addiction 14

15. Addiction and Poverty
Addiction is by far most costly for the poor. If the victim is at the poverty level, a pack of cigarettes per day
can consume 10% of his/her family’s monthly income. Even worse, if he/she is a heavy substance abuser,
he/she might even be spending half or more of his/her monthly income on drugs. substance addiction can
even create poverty in future generations. Due to this drug habits, abuser’s children may receive inadequate
education and struggle with budgeting and time management. They may even mimic the same habits of the
abuser and develop addictions themselves;
Cost of Buying Drugs
People with substance addiction, paying for it can get expensive, regardless of the substance. Even
something that can be cheap, such as alcohol, can drain their bank account over time, especially if they find
the need to use more to get their desired effect. To put this into perspective, if someone drinks a cheap $5
6-pack of beer every day, that’s $150 each month. That’s almost $1,000 in 6 months to support this habit.
Now switch out the $5 beer to a more expensive drug like, cocaine or heroin and the cost skyrockets. Some
people can easily spend more than $10,000 each year to support their addiction.
Health & economic burden of drug addiction 15

16. Loss of Productivity and Income
Abusing drugs can make a person significantly less productive. Many addicts lose their jobs and
remain unemployed as a result of their addiction. Others end up in jails, prisons, or long-term
rehabilitation facilities, which can result in years of lost productivity. It can be difficult to get the
victim back in the workforce after years of unemployment due to drug abuse.
Social security and retirement benefits can also be affected, so even after recovery, the victim could
continue to experience the financial impact of that addiction habit for years.
Over a lifetime, addiction can cost an addict thousands of dollars in lost productivity potential.
Health Care, Insurance Costs, and Legal Fees
Being a drug addict can result in serious health problems. This is already a huge and life-threatening
cost; however, it also comes with increased health care fees and insurance premiums. Another cost
that may often be overlooked, is the increase in car insurance premiums and fines an addict incur as
a result of his/her addiction. Getting arrested for driving under the influence of drugs or alcohol
may result in a 300% increase in the abuser’s car insurance premiums, significant legal fees, and
let’s not forget jail time.
Other payments should also may need to make include; fees for attorney services, educational
courses, and drug-related fines.
Health & economic burden of drug addiction 16

17. Morbidity and mortality
Globally, it is estimated that drug-related deaths account for between 0.5 and 1.3 per cent of all-cause
mortality for people aged 15-64 years. It is estimated that there are 211,000 drug-related deaths annually,
with younger people facing a particularly high risk. There are increased risk of unwanted and accidental
deaths. Psychological collapse, suicide, self injury, road accidents, death due to drug induced morbidity are
common among the addicts.
Impact on the environment
There are some significant impact on the environment due to drug cultivation. The illicit manufacture and
disposal of drugs and pharmaceuticals cause significant environmental contamination, owing to the
precursor chemicals required for manufacture, the manufacturing process itself and the active ingredient or
substance. Disposal introduces those substances into the environment in sewage, from where they can enter
sediment, surface and ground water and the tissues of vegetation and aquatic organisms. As a result, wildlife
and humans can be chronically exposed to very low doses of drugs and the chemicals used in their illicit
manufacture.
Parallelly we can figure out the land used in coca and opium cultivation could be used for food, vegetable
and crops generation. So huge land can be misused for the drug production.
Health & economic burden of drug addiction 17

18. Drug related crimes
The first opportunity to describe the drug related crimes is to tell about the psychopharmacological crime.
It is the crime committed under the influence of drugs. It is a major problem world wide and in Asia it is
one of the basic criminal offence. Studies showed more than half of the total criminal activities
accomplished in the Asian region was under the influence of drugs at the time of offence.
Another set of criminals can be identified who commit such offence to obtain money for drugs. And
creates huge loss to the person and the government.
Another one is found which is called systemic crime which generally occur in the drug turf between the
buyer and the seller when the deal goes awry.
But all this criminal offence leads the addict and the related people in the get entrapped into the labyrinth
of loosing money.
Health & economic burden of drug addiction 18

19. An imposed burden for the country
In addition to other social, political, racial and health problems hazards caused by drugs and its health and
economic consequences are a kind of imposed burden for the country. Drug trafficking and that trafficking
related morbidity, drug induced related health disorders, subsequent mental disorder, their rehabilitation
and counselling is a result of big budget activity. Which is actually unreasonably an added tariff to the
existing problems of the society.
Asia talk
In Asia we have found the huge number of populations with high density and availability of different culture and trade
and if we observe politically there are huge restlessness in between different countries. So anti-social group may take
the advantage of this situation to create the devastating effect to the opponent or to the innocent population to put
them into hell permanently.
Health & economic burden of drug addiction 19

20. Map of Asia
Map of Golden Crescent and Golden Triangle
https://en.wikipedia.org/wiki/Golden_Crescent
https://en.wikipedia.org/wiki/Golden_Triangle_(Southeast_Asia)#cite_note-3
Health & economic burden of drug addiction 20

21. Nationwide Findings
Survey results suggest between 2.5 and 2.9 million Afghans use drugs – 11% of the population – and 1.9 and 2.3 million use opiates – about 7% of the population.
Approximately 0.9-1.1 million use cannabis, about half the rate of opioid users.[1] The survey provides data on use, not addiction or abuse. Without access to
advanced data examining social, environmental, and psychological factors, an estimate of Afghanistan’s addiction rate remains impossible.
The survey found drug use in 31% of all households, including 11% in urban centers and 39% in rural areas. Among adults, the survey suggested 13% would test
positive, including 8% in urban locations and 15% in rural locations.
Rural drug use by household reached as high as 86% among rural villages in Ghor province, while the highest urban rate reached 28% in Zaranj, the capital of Nimroz
province. By population, 49% of residents in rural villages of Ghor Province tested positive.
Children
Nationally, 9% of Afghan children under the age of 14 tested positive for drugs, overwhelmingly opioids, including 2% in urban areas and 11% in rural areas – over
500% higher in these locations. The data indicates that between 1.0 and 1.2 million children would test positive for one or more drugs, and 0.7-0.8 million would test
positive for opioids.
According to the survey, 90% of children testing positive for opioids are most likely not active drugs users. Most are probably being provided opioids by adults or
exposed to second-hand smoke and third-hand residues in the home. According to the survey, less than 1% of children are active drug users.
Health & economic burden of drug addiction 21

22. Source: http://www.jfmpc.com/article.asp?issn=2249-4863;year=2017;volume=6;issue=3;spage=558;epage=562;aulast=Sharma
Health & economic burden of drug addiction 22

23. In Asia every year there is a burden of 12 billion dollars collected
Along with that all the countries do not have proper addiction
rehabilitation and treatment centers. Which constrains patients seek
treatment in the private rehabilitation center, which is very much costly
for the patients.
There are different duration of treatment, generally starts with one
month, three months and lasts depending on the severity of the
addiction. In terms of detoxification it needs 500-1000 $ per day. And
so on for the next ongoing days. Along with that they have different
fees for counselling per session, physical exercises terms each day etc.
Along with the rehabilitation there are medication, food and shelter. So
it has additional charges.
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27. https://dataunodc.un.org/drugs/treatment/asia
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28. Reference
1. The term addiction as used in this booklet is equivalent to a severe substance use disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5, 2013).
2. Goldstein RZ, Volkow ND. Dysfunction of the prefrontal cortex in addiction: neuroimaging findings and clinical implications. Nat Rev Neurosci. 2011;12(11):652-669. doi:10.1038/nrn3119.
3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed, text revision. American Psychiatric Association, Washington, DC; 2000, p. 191
4. National Geographic Atlas of the World (7th ed.). Washington, D.C.: National Geographic. 1999. ISBN 978-0-7922-7528-2. "Europe" (pp. 68–69); "Asia" (pp. 90–91): "A commonly accepted division
between Asia and Europe is formed by the Ural Mountains, Ural River, Caspian Sea, Caucasus Mountains, and the Black Sea with its outlets, the Bosporus and Dardanelles."
5. "Population of Asia. 2018 demographics: density, ratios, growth rate, clock, rate of men to women". www.populationof.net. Retrieved 29 September 2018.
6. Centers for Disease Control and Prevention. CDC health disparities and inequalities report: United States, 2011. MMWR. 2011;60(suppl). Available from http://www.cdc.gov/mmwr/pdf/other/su6001.pdf
[PDF - 3MB]
7. Galea S, Nandi A, Vlahov D. The social epidemiology of substance use. Epidemiol Rev. 2004;26(1):36–52.
8. Pathan MA, Nahar JS, Rahman W, Ahmed HU, Chowdhury NF, Alam MT. Risk and protective factors in
substance dependence: An update. Bang J Psychiatry 2010 Dec;24(2):44-48.
9. Tice P, Lipari R, van Horn. Substance Use among 12th Grade Aged Youths, by Dropout Status. Rockville, MD: Center for Health Statistics and Quality, Substance Abuse and Mental Health Administration;
2017. http://www.samhsa.gov/data/sites/default/files/report_3196/ShortReport-3196.pdf. Accessed June 4, 2018.
10. Chen C-Y, Storr CL, Anthony JC. Early-onset drug use and risk for drug dependence problems. Addict Behav. 2009;34(3):319- 322.
doi:10.1016/j.addbeh.2008.10.021
11. Lander L, Howsare J, Byrne M. The impact of substance use disorders on families and children: from theory to practice. Soc Work Public Health. 2013;28(0):194-205.
doi:10.1080/19371918.2013.759005
12. Simmons LA, Havens JR, Whiting JB, Holz JL, Bada H. Illicit drug use among women with children in the United States: 2002–2003. Ann Epidemiol. 2009;19(3):187-193.
doi:10.1016/j.annepidem.2008.12.007
13. Shankaran S, Lester BM, Das A, Bauer CR, Bada HS, Lagasse L, Higgins R. Impact of maternal substance use during pregnancy on childhood outcome. Semin Fetal Neonatal Med 12(2): 143-150, 2007.
14. https://learn.genetics.utah.edu/content/addiction/delivery/
15. Office of National Drug Control Policy. (2012). Cost benefits of investing early in substance abuse treatment.
16. https://drugabuse.com/financial-toll-addiction/
17. Institute for Health Metrics and Evaluation. GBD Results Tool. Seattle, WA: IHME, University of Washington; 2016.
18. https://onlinelibrary.wiley.com/doi/full/10.1111/add.14234
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