Substance abuse is rapidly assuming epidemic proportions in our society engulfing a significant population of our youth who are otherwise meant to be our nation-builders. Statistics regarding magnitude of the menace of substance abuse in our society emerging from various de-addiction centres of J&K are quite worrisome and alarming and therefore call for a systematic and scientific approach for countering. Such an approach may include a slew of measures described as under.
Generate credible evidence through research
First step towards fighting the menace of substance abuse has to be the generation of credible, scientific evidence about the incidence, prevalence, epidemiology, mortality and morbidity of this menace in our society through context-specific and need-based research. We need to have the accurate statistics for chalking out our combat strategies and planning our prevention, de-addiction and rehabilitation programmes well. Figures that are often quoted about the magnitude of involvement of our youth in drug abuse are usually found to be obsolete and redundant. We need to have latest facts, figures and scientific analysis of not only the incidence and prevalence data but its socio-economic and health impact too.
Convert evidence into a policy framework
Evidence generated through well-designed scientific studies need to be translated into a robust policy framework for action. Already we have a drug de-addiction policy notified by the Govt. of J&K on January 11, 2019 that may be revisited and reviewed in light of the latest data emerging from the epidemiological studies. A meticulous procedure for persistent monitoring and evaluation might have been laid out in the policy document per se which needs to be utilized for its timely review. Need for a revision and review of the policy after just two and a half years of its execution arises from the fact that over a period of just three years between 2016 and 2019 a mind-boggling 945 percent rise in the number of addicts has been reported at just one hospital and a radical shift from abuse of prescription medicines like sleeping pills to narcotic drugs like heroin has also been reported during this period in a pilot study conducted by the Institute of Mental Health and Neurosciences (IMHANS). This study revealed that 1.9 percent population in the twin districts of Srinagar and Anantnag is abusing substances of various kinds that translates into 17,000 people, out of whom 87.3 percent were found to abuse opioids and heroin was the most widely used opioid drug (GK dt. June, 26, 2020).
Translate policy into action
A sad fact of our part of the globe is that mostly our policies remain confined to paper and are not fully implemented well in time as was the case with our premier drug policy that was devised, approved and promulgated in 2012 by the J&K govt. Even if they are implemented the pace is often sluggish. Unless policies translate into action on ground, they are worth the piece of paper on which they are written. Timelines and roadmap for implementation of the policy in a systematic and well-organized manner must be laid out in the policy document itself which does not unfortunately happen quite often. Take for instance NEP-2020, there is no clear roadmap laid out for its time-bound implementation in the policy document itself. An online, real-time dashboard showing progress made in the implementation of various policy provisions must be made mandatory for every notified policy. Role and responsibilities of each and every stakeholder in its timely implementation must also be specified in clear and unambiguous terms. Furthermore, a step-wise approach needs to be adopted for policy implementation on the basis of well-designed algorithms that includes measures like agenda setting, policy formulation, adoption and implementation, organizational reform, capacity building, monitoring and evaluation, periodic review and re-implementation in the next cycle.
Supply reduction strategies
Supply reduction includes a broad range of strategies and actions that are required to stop or minimize the production, manufacture, sale and distribution of illicit drugs. Vulnerability of the entire country in general and J&K in particular in serving as a transit route and consequent hotspot of narcotics and illicit drugs becomes evident from the fact that India is sandwiched between the golden crescent countries like Iran, Pakistan and Afghanistan and golden triangle countries like Myanmar, Thailand and Vietnam, that have historically been the hubs of opium cultivation since hundreds of years. Somehow till recent times India had remained untouched by this scourge but not so any more. This menace is assuming dangerous and alarming proportions in the entire country now particularly in states/UT like Punjab, Haryana, Rajasthan and now J&K. Notwithstanding the fact that only a multi-dimensional approach can be effective towards curbing the menace of drug abuse and evolving a drug-free society, it needs to be emphasized that stringent law enforcement is without any doubt the most important and crucial step required for the same. Though attempts to treat and prevent drug abuse through tough penal sanctions alone for drug users have historically failed, unless trafficking and supply of substances of abuse is not reduced to a very large extent, no amount of hard work on the demand front is going to yield good results. Deterrent punishments and penalties need to be awarded by the courts to all the convicts of drug abuse. Only when the region is cleared of all kinds of substances of abuse on a sustained basis, can the demand side activities mentioned below prove to be fruitful in countering this menace.
Demand reduction strategies
This includes a range of policies and programs that seek to reduce the desire, demand, craving and preparedness to obtain and use illicit drugs. It includes a host of measures aimed at informing and educating the masses and enhancing awareness about the socio-economic, medico-legal impact and harmful effects of drug abuse on health. It highlights the adverse effects on the vulnerable populations including women and children in particular. Emphasis is laid during demand reduction upon primordial and primary prevention of drug abuse. Primordial prevention informs the community about the potential risk factors and consequences of substance abuse as well as the means to avoid those factors. It also seeks to improve over-all living and working conditions of the people besides healthy and drug-free environment at schools and work-places and also to promote overall physical and mental well-being in the community by adopting healthy lifestyles, hygienic and nutritious food intake and regular exercise. Similarly primary prevention measures seek to embrace the protective factors and reduce the impact of risk factors targeting the populations at risk and focussing on decreasing their vulnerabilities. It also aims at training the teachers and community health workers in identification, risk reduction and timely medical help for the children and adolescents having traumatic life experiences which makes them vulnerable to substance abuse. Awareness about ill effects of drug abuse needs to be incorporated into the curricula at all levels of education and the teachers too need to be acquainted well with the signs and symptoms of potential substance abuse.
Harm reduction strategies
It includes policies and programmes that focus directly on reducing the harm resulting from the use of illicit drugs, both to the individual and the community at large. Harm reduction encompasses measures that take the victims of substance abuse out of the quagmire through a sustained de-addiction process that includes medical interventions like drug treatment, psychotherapy, counselling and rehabilitation services. Psychotherapy helps them break the vicious cycle of negative feelings, behaviours and actions and trains them in adopting effective coping strategies against stress and intriguing thoughts. Rehabilitation of drug abuse victims on the other hand is of paramount importance as drug abuse is fraught with stigmatization and therefore de-stigmatization needs to be achieved by bringing them back into the mainstream of society and providing them ample opportunities to earn their own livelihood. This will also include adequate education and counselling of their families and communities to treat them well and help them in resuming their normal life. Rehabilitation thus includes empowerment of the victims to stay away from drugs and live a joyful life with their families and communities. Harm reduction also includes secondary and tertiary prevention measures for those who have already fallen prey to the menace of substance abuse and the focus is now on reducing further harm and complications and salvaging the remnants of their physical and mental health from the ill-effects of the disorder.
Based on the outlook that substance abuse is a psycho-socio-medical problem and not necessarily a “self-acquired affliction”, that can be handled through community-based interventions, a multi-dimensional approach needs to be adopted to counter the menace that should include measures towards prevention and control as well as towards treatment and rehabilitation. Strategies need to be devised that simultaneously address supply, demand and harm reduction side of drug abuse control. An effective partnership, coordination and collaboration between various govt. agencies and multiple stake-holders needs to be fostered. Drug de-addiction policy notified by the J&K government in the year 2019 must be implemented in letter and spirit, constantly monitored for its effectiveness and regularly reviewed and revised for making necessary amendments in the same with a view to make it highly effective, focused, productive and goal-oriented policy.
Prof. Geer Mohammad Ishaq teaches at the Department of Pharmaceutical Sciences, University of Kashmir.
Disclaimer: The views and opinions expressed in this article are the personal opinions of the author. The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.