This document discusses the history of substance abuse in India and how it has changed over time. It notes that drug use was traditionally accepted and regulated by cultural norms, but became criminalized by foreign influence and laws in the late 20th century. It describes how substance abuse in India is now at unprecedented levels, with new drugs, younger users, and urban professionals representing the "new profile" of drug addicts. Trafficking routes have also expanded due to India's proximity to major drug producing regions.

1. WHY LEARN ABOUT
ADDICTIONS????
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2. CASE 1
RAVI, 35 year old, being
treated for hypertension for
last 5 years
Comes with severe central
chest pain
Diagnosis: Ischemic heart
disease
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3. Case 2
 Poonam and her
husband, married
for 3 years.
 Primary infertility
 Inv done
 Started treatment
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4. Case 3
 Sunil, 27 years old, comes
for epigastric pain off and
on.
 Treated as Gastritis
 Once presents as severe
pain in abdomen.
 BP 90/60. p-130
 Diagnosis: Acute
Pancreatitis
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5. Case 4
 Sunita, 26 years old,
works as house maid
 Comes for recurrent
aches and pains
 Once presents with
severe pain in ear
with bleeding
 Diagnosis: HBH
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6. Case 5
 Gautam, 28 year olf ,
works in BPO
 Comes with recurrent
cough with expectoration
for last 2 years
 Diagnosis: COPD
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7. Case 6
 Shekhar presents
with fever, weight
loss cough for last 15
days
 Diagnosis:
Tuberculosis
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8. Case 8
 Manish, 20 years old
 Brought in as an
emergency case with
head injury after
RTA
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9. CASE 9
 Saniya comes with
heavy bleeding, almost
in shock
 Saniya missed her
periods.
 UPT POSITIVE
 Tried pills for abortion
which she brought on
internet
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10. ARE WE MISSING
SOMETHING?
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11. IS THERE CAUSE BEHIND THE
CAUSE?
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12. DID WE ASK THE H/O
DRUG ABUSE?
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13. DRUG ABUSE??
 LIKE WE TAKE PULSE
 LIKE WE TAKE BP
 LIKE WE CHECK BSL
 LIKE WE ASK FOR LMP IN ALL WOMEN
DO WE AND SHOULD WE ASK FOR H/O OF
DRUG USE IN EACH AND EVERY
PATIENT?
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14. GLOBAL BURDEN OF DISEASE
STUDY, 2013
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15. But is this drug abuse
phenomenon new in our
country?
YES AND NO
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16. OUR HISTORY
 The Hindu mythology
says that during Amrit
Manthan one of the “14
Jewels” that the ocean
delivered was Varuni-
the Goddess of wine.
 5000 B.C.: The
Sumerian people used
the “joy plant”, which is
believed to be opium.
Amrit Manthan
Sumerian Civilization

17. OUR HISTORY
 Smoking of Cannabis is known in
India since 2000 B.C.
 The Code of Hammurabi (1792-1750
BC) the oldest known form of legal
code, had guidelines and regulatory
provisions for preventing alcohol
abuse. King Hammurabi
(1792-1750 BC)
Code of Hammurabi

18. OUR HISTORY
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SOMRAS: ELIXIR OF LIFE

19. TRIBALS HAVE THEIR OWN
DRUGS FOR CENTURIES
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20. IT’S PART OF OUR CULTURAL
AND RELIGIOUS RITUALS
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21. MARRIAGE OR MOURNING
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22. LEGAL BHANG SHOPS
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23. KALBHAIRAV DRIKING
ALCOHOL , UJJAIN
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24. SO IT MEANS……
 For centuries we have been using drug in
one or other form
 But our society was Self regulatory
 Drug use was legitimised by cultural norms
and did not need any laws for drug control.
 It was open and free of any under-dealings
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25. THEN WHEN THINGS
CHANGED?
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26. WHEN DID THINGS CHANGED?
 1785: BRITISH WERE FOND OF TEA FROM CHINA.
 CULTIVATED AND SOLD OPIUM TO CHINA IN
EXCHANGE FOR TEA
 1960- 70: WESTERN TOURISTS INSEARCH FOR
CANNABIS
 1959: SHUT DOWN SHOPS OF OPIUM
 1961: SINGLE CONVENTION OF NARCOTICS
CONTROL ACT, UN – CRIMINALISATION OF
CULTURALLY SANCTIONED DRUGS USE & SUPPLY
 1979: ALCOHOL MADE EASILY AVAILABLE
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27. WHEN THINGS CHANGED?
 1985: NPDS ACT- ERADICATE USE OF CANNABIS
AND OPIUM
 19 80s: HEROIN NO3 (BROWN SUAGR) AND
PRESCRIBED OPIATES IN PLACE OF OPIUM
BECAUSE ITS EASY TO SALE
 1979: AFGHAN WAR, MILITARY RULE IN PAKISTAN,
TURMOIL IN SRI LANKA, UNREST IN JAMMU
KASHMIR.
 1990: LIBERALISATION OF TRADE- IMPORTED
ITEMS AND GOLD TO ARMS AND DRUGS
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28. LAST DECADE TSUNAMI OF
DRUGS
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29. OUR PAST OUR PRESENT
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30. OUR PAST OUR PRESENT
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31. OUR PAST OUR PRESENT
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32. OUR PAST OUR PRESENT
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33. Substance abuse in India is on a NEW high
NEW SCARY NUMBERS
NEW DRUGS
NEW SOURCES
NEW PROFILE
NEW CHANNELS
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34. NOTHING HAS REMAINED
THE SAME
LIKE IPL IN CRICKET, DRUG PROBLEM IN
INDIA HAS UNDERGONE A PADAGRIM
SHIFT IN OUR LAST DECADE
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35. NEW SCARY NUMBERS
 107 LAKH PEOPLE USE DRUG IN SOME FORM
 87 LAKH CONSUME CANNABIS
 20 LAKH COMSUME OPIATES
 1628 LAKH CONSUME TOBACCO
 626 LAKH CONSUME ALCOHOL
 THIS DATA IS FROM 2004 NHS SURVEY.
NO ONE KNOWS THE REAL NUMBERS TODAY
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36. 67% of rural households in Punjab
have one drug or alcohol addict
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37. OUR NOTION OF DRUG ADDICTS
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38. OUR NOTION OF DRUG ADDICTS
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39. New profile
The “new urban junkie”
has got a whole new
profile: young, educated
working, middle classes
PROFESSIONALS,
STUDENT, WOMEN.
Ref: 2008 UNODC Rapid Situation and Response
Assessment (RSRA)
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40. NEW PROFILE- NEW REASONS
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• Stay awake long
• Boosting Performance
• Iron out stresses and
strains
• Feel relaxed
• Kill boredom and
loneliness of urban life
27% 0f call centre workers use drugs

41. NEW PROFILE
DRUG USE IN WOMEN ALL TIME HIGH05/27/16
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42. NEW PROFILE- NEW DRUGS
 43 % were found to
use “drug cocktails”
 64 % injecting
painkiller
propoxyphene
 76 % using
buprenorphine.
 16 % women resort to
sleeping pills and 18%
to painkillers.
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43. NEW PROFILE
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44. NEW PROFILE
Age of initiation of hard drugs is 17.
12% of drug addicts are
below the age of 15
31% in the age group of
16-25 years
56% in the age group of
25-35 years.
Source:National Commission for
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45. “IT’S COOL”
A 2010 study on 2,000 Shimla school
students by the NGO Youth Enlightening
the Society along with Indira Gandhi
Medical found that over 55 % boys and 24
% girls are regular drug users, with 29 %
hooked to cannabis, cough syrups and
opium.

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46. TRADITIONAL DRUGS
 Tobacco: 162.86 crores
 Alcohol: 62.46 crores
 Cannabis: 8.75 crores
 Opiates: 2.04 crores
 Sedative/ Hypnotics: 0.29 crores
Source : NHS 2004
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47. NEW DRUGS
 Hookahs
 Ketamine
 LSD
 Meth
 Meow Meow
 Cocaine
 Heroin
 Synthetic Cannaboids……..
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48. NEW DRUGS
Alcoholic Energy Drinks: RED BULL, SPARK
Alcoholic Whipped Cream
Bath Salts (Ivory Wave)
K2/Spice
Pocket Shots
Vaporizers
Bromo-Dragonfly
The “2C” Family• Kratom
ITS AN ERA OF DESIGNER DRUGS
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49. NEW PSYCHOACTIVE SUBSTANCE- NPS

50. NEW COCKTAILS
“Cough syrup and rum, pepsi or coke, with
crushed spasmo proxyvon tablets and iodex.”
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51. EVERY CITY HAS IT’S OWN DRUG OF
CHOICE
 LUKNOW RAVES ON YABA
 KOLKATA DOTHS ON METH
 MUMBAL SWEARS BY ICE
 CHENNAI HUB ON KETAMINE
 DELHI HIGH ON ECSTASY
 BANGALORE SNIFF TUOLENE
 MANIPUR INJECTS ALL
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52. India is flanked by the Golden Crescent on the West
and Golden Triangle on the East, the two main
sources of over 90% of the world’s illicit supply of
opium and other drugs
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TRADITIONAL CHANNELS

53. TRADITIONAL CHANNELS
 Heroin enters India through Jammu,
Amritsar and Rajasthan borders
 Charas comes in through Manali
 Ganja from Odisha and Jharkhand
 Cocaine comes via Africa.“
We are also a major country of transit
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54. COMING HOME-OUR MUMBAI
MUMBAI has registered the maximum
cases of drug trafficking- NRCB Data 2012
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55. NEW CHANNELS
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Drugs via Internet and couriers are in.
India is now a hub of drugs sold through
illegal Internet pharmacies and courier
companies.
For the first time in India’s history, drugs
have come out in the open; they are
visible and not illegal

56. The dark net
It is an encrypted
part of the Internet
that can only be
accessed by specific
software
India is estimated to
have between
500,000 to 1 million
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57. Bitcoin
 Bitcoin is a form of digital
currency, created and
held electronically
 No one controls it
 Encryption makes online
transactions between two
parties anonymous.
 Creation and sale of
bitcoins has become a big
market.
 One bitcoin is worth
around $265 (around Rs.
16,000).
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58. New drugs can be made at home
“MAKING SYNTHETIC
DRUGS IS NO ROCKET
SCIENCE.ONE CAN GO
TO THE INTERNET,
DOWNLOAD RECIPES
AND PREPARE THEM
IN THE KITCHEN”
www.ergoweed.com
CHRISTINA ALBERTIN,
Representative for South Asia, UNODC.
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59. ITS TRULY SCARRY
India is emerging as one of the world’s
biggest manufacturing hubs of
ephedrine and pseudoephedrine—the
precursor chemicals used in
amphetamines.
If half the world’s ATS users live in Asia
(WDR2008), India’s contribution to it
would be around 29 per cent (WDR
2009).
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60. Substance abuse in India is
literally on a new high
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It’s a disaster in making

61. MANN KI BAAT
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62. FRIENDS,
WHY CANNOT SHY AWAY FORM THIS
ISSUE ANYMORE
…………IT’S STARING AT US AND WE
HAVE TO FACE IT
AND FACE IT HEAD ON
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63. BUT ARE WE TREATING
ADDICTIONS IN OUR CLINIC?
IF NOT,
WHY???????
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64. “ WE DON’T GET PATIENTS
OF DRUG ABUSE IN OUR
CLINIC”
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65. DRUGS USE IN OUR PATIENTS
 Every 3nd
patient entering our clinic has tobacco
abuse problem and every 5th
male patient has
alcohol abuse
 Every 5th
female entering our clinic used tobacco in
some form.
 One in 100 of our patients must have used opium in
last month and 3 in 100 must have used cannabis.
 20% of our child patients have already smoked
once.
 AND THE NUMBER FOR NPS, STIMULANTS,
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66. SCREEN FOR DRUG ABUSE
 LIKE WE TAKE PULSE
 LIKE WE TAKE BP
 LIKE WE CHECK BSL
 LIKE WE ASK FOR LMP IN ALL WOMEN
WE SHOULD ASK FOR H/O OF DRUG USE
IN EACH AND EVERY PATIENT
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68. “ Patients do not want to stop
drug”.
What’s the use of screening?
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69. PEOPLE DO WANT TO QUIT
 70 percent of smokers want to quit.
 Most try to quit do so on their own,
without support, more than 95 percent
relapse
 Using evidence-based programs can
more than double success rates.
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70. “THERE IS NO TREATMENT FOR
ADDICTION”
“ONCE AN ADDICT ALWAYS AN ADDICT”
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71. ADDICTION HAS NO
TREATMENT??????
That’s true- if we miss this cases in early
stage before the “Chemical locha” take
place in the brain
HARMFUL USE VERSUS DEPENDENCY
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72. “DRUG ADDICTS ARE ADDICTS
BECAUSE OF THEIR LACK OF
MORALITY AND SELF CONTROL”.
IT’S THEIR OWN DEEDS
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Addiction is a disease of Brain
Not a fault in character

74. Which disease is not because of
our deeds?
 Heart disease
 Diabetes
 Cancer
 Blindness
 COPD………….
Are these not because of our faulty
lifestyles?
And don’t we treat all these?
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75. We can throw stones at others if we have never
committed a crime in our life
75
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76. We need to learn and unlearn….
 Express a warm and affective concern about the drug
abuse problem
 Be non directive, non-judgemental
 Be supportive/empathetic
 Not insist that the individual accept the label of
‘addict/ alcoholic’
 Be “NORMAL”
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77. “WHO HAS TIME TO COUNSEL
AN ADDICT IN A FLOODED
OPD?”
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78. BRIEF INTERVENTION TECHNIQUE
 Increase chances for the start of treatment
 Reduce dropout rates once on treatment
 Reduce aggression and violence
 Increase compliance with psychotropic
medication therapies
AND TIME FOR EACH SESSION IS BETWEEN 1 TO
5 MINS
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79. OUR PATIENTS GET/MIGHT GET
OFFENDED IF WE ASK THEM ABOUT
THEIR DRUG ABUSE HISTORY
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80. SILENT CRY FOR HELP
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81. “WE HAVE NEVER BEEN TAUGHT IN
OUR MEDICAL CURRICULUM”
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82. In which year of our medical curriculum
have we been taught about addiction
medicine?
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83. “TRULY SPEAKING, I DON’T FEEL
CONFIDENT TO FACE THIS ISSUE.”
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84. THAT’S WHY WE ARE HERE!!!!
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85. NOW COMES THE MILLION
DOLLAR QUESTION???
“ MERA KYA FYADA”
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86. Specialty in addiction medicine
is one of the best tool to beat
slack season
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87. BUY SOME THINGS ARE
BEYOND MONEY
WHAT CAN BE YOUR FEES FOR SAVING
Childhood of a child
Dream of an youth
Harmony in a family
Peace of our society
Pride of our country
THESE THINGS ARE PRICELESS
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88. ADDICTION IS EVERYWHERE
 YOUR BROTHER /SISTER
 YOUR SPOUSE
 YOUUR CLOSE FRIEND
 YOUR CHILD
 YOUR NEICE/NEPHEW
 YOUR NEIGHBOUR
 ALMOST ANYONE……………….
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89. OUR ROLE AS FAMILY PHYSIACIANS
Muktaa Charitable Foundation
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90. LET’ S BEGIN AND DO OUR
BIT……..
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91. 05/27/16
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92. Thank you
Dr Madhu Oswal Thakkar
Muktaa Charitable Foundation
www.mcf.org.in
Email: madhu.oswal@mcf.org.in
MOB: 9890044477
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