DRUG ABUSE IN THE INDIAN CONTEXT- A BRIEF OVERVIEW

Drug abuse and its antecedent problems in Indian scenario.

1. Drug Dependence and Abuse DR. BAISHWANAR BANERJEE ASSISTANT PROFESSOR FMT

2. MEMORABLE QUOTES Cocaine isn’t habit forming. I should know- I’ve been using it for years -Tallulah Bankhead (Hollywood actress) I think we need to educate our doctors about addiction -Mathew Perry (American TV & Film actor)

3. Drug???? (WHO) Any substance used/ intended to be used To modify /explore Physiological systems/ Pathological states For the benefit of recipients .

4. Common substances abused

5. Substance / drug – used interchangeably Three important terms Substance INTOXICATION Substance ABUSE Substance DEPENDENCE

6. Substance Intoxication Unwanted physiological or psychological effects that cause maladaptive behaviour On examination: Clinically detectable adverse effects

7. SUBSTANCE ABUSE Excessive drug use Persistent/ sporadic Inconsistent with medical practice Recurrent and Significant adverse reactions Repeatedly in a period of 12 months No dependence

8. SUBSTANCE DEPENDENCE Cluster of behavioural, cognitive and physiological phenomenon Due to maladaptive pattern Components : Tolerance Withdrawal symptoms when use is reduced/stopped Craving Despite persistent side effects

9. Two Terms Drug ADDICTION Drug HABITUATION

10. Drug Addiction  PHYSICAL + psychological+ emotional dependency Drug Habituation  psychological+ emotional dependency + ONLY

11. Trait Drug Addiction Drug Habituation Compulsion to take drug Present (may resort to crime to even acquire drug) A psychological desire But no compulsion Dose Tendency to increase dose with time No such tendency Dependence Mainly physical Psychological Withdrawal symptoms Characteristic Symptoms+ None Pre-occupation with drug use Important alternative pleasures given up No such thing Time spent Activities to acquire the drug Not so Persistent use despite harmful effects +++ ------- Harm Both to individual and society Minimal

12. Types of dependence Morphine type Barbiturate Type Cocaine type Cannabis type Amphetamine type

13. Drug Abusers Elbow Myositis ossificans resulting due to repeated needle punctures near the elbow in IV drug abusers Important autopsy finding

14. Withdrawal Symptoms Abstinence Syndrome Symptoms with physiological and cognitive components Occur when blood concentrations of a substance decline In an individual who had earlier maintained high levels

15. Salient features: h/o Repeated administration is necessary Opposite to the acute effects of the drugs Varies with the classes of the drugs

16. Typical withdrawal symptoms Start: 6 to 8 Hrs after stopping the drug may be delayed (depends on the drug) Stages: 1 st stage  upto 12 hrs intense fear Chills+ cold sensation Tachycardia++ sweating ++ lacrimation Myalgia yawning

17. 2 nd stage : 12- 24 hrs Increased bronchial secretions Dilated pupils Piloerection  goose flesh Tremors Symptoms of 1 st stage + 2 nd stage  COLD TURKEY

18. 3 rd stage  24 hrs to 10 days Increased sleep Abdominal pain+++ cramps All symptoms are maximal at 72 hrs Anorexia is present in all symptoms Newborn of addicted mothers  show withdrawal symptoms+++

19. Body packer ( Surgical mules) Illegal drugs  compressed into cylinders of 25 x12 mm  heat sealed in plastic film  wrapped again in multiple layers of latex (condoms, balloons, foil)  swallowed  drugs such as loperamide is taken (decrease gut motility) SMUGGLING

20.  once they reach foreign country  take laxatives  retrieves the packets These packets may not burst But due to passive diffusion may have symptoms

21. Body stuffer Syndrome Persons arrested swallow illegal drugs For concealing the evidence Ears/ mouth/ vagina/rectum  “Body pushers” May not be well wrapped serious reactions Seen on X-ray/ CT

22. Volatile substance abuse Huffing - inhaling vapours from a cloth Bagging – inhaling and exhaling into a bag that has been filled Sniffing – from the neck of a container

23. Narcotic Drugs and Psychotropic Substance Act- 1985 Latest amendment – 2014 Prohibits a person to: Produce/Manufacture/cultivate Possess Sell Purchase Transport Store Consume Any narcotic drug/psychotropic substance

24. Punishment Based on the amount of substance kept Act has defined the small qty and commercial qty levels for each drug Small quantity  Rs 10,000/ 1 year Imp > small but <commercial qty  Rs 1 Lakh- 2 lakh /10 years imp Amendment 2014  relieved restrictions on important drugs like morphine used for pain and palliation

25. SENSATIONAL CASE

26. Designer drugs/ Party drugs Synthetic variations of well-known controlled drugs Eg : amphetamine, fentanyl, phencyclidine Similar pharmacological effects Molecularly different MLI  cannot be picked up by common chemical tests  so legally , no scientific evidence

27. NOTABLE CELEBRITIES-FARDEEN KHAN

28. TREATMENT

29. Medicolegal Importance Contaminated currency and other objects Death usually as a result of > 1 drug Embolism Cirrhosis, HIV Homicide-criminal attempts to procure drug Increased suicide Trauma  increased accidents Driving under influence- prohibited by s185 (b) of MVA,1988 Mothers abusing drugs  children- SIDS

30. MEOW MEOW & THE WALKING DEAD India’s newest drug MCAT/ White magic/ drone/ mephedrone Latest street drug hitting Mumbai Delhi Bangalore party scene THIS drug is BAD NEWS– message from older addicts Named due to the CAT in MCAT Among the cheapest drugs available Ability to stay up at all hours, increased sex drive, thrilling energy Zombies-weight loss, breakdown, drop out of college, steal, lie, cheat—Lung Problems+ Psychosis Can be mad even in home cookers

31. MEOW MEOW QUEEN