Every day, India sees 10 suicides related to drug abuse– and only one of them is from Punjab

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Even though its state government finds it hard to address or even accept it, that Punjab has a drug abuse problem is widely known. However, recent government data shows that this is not limited to the North Indian state.

Data tabled before the Rajya Sabha on Thursday during the ongoing Monsoon session of the Parliament showed that India records about 10 suicides due to drug or alcohol addiction. The data, provided by the National Crime Records Bureau, showed that the states of Maharashtra, Madhya Pradesh, Tamil Nadu and Kerala are at the top of the table of drug-related suicides.

According to the National Crime Records Bureau, there were 3,647 such suicide cases in India in 2014, of which Maharashtra reported the highest, at 1,372. This was followed by Tamil Nadu, with 552 cases and Kerala, with 475.

Punjab reported 38 such cases. However, as calculations by Scroll.in show, the incidence of drug-related suicides – the number of cases divided by the population – in the state was much lower than the national average.

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State of states

As the chart shows, this comes to about 1.4 suicides per million people, based on the population of Punjab as per the 2011 Census. In comparison, the national average is three suicides per million of the population. The drug-related suicide rate in Kerala, for instance, is at least 10 times as high as in Punjab.

Meanwhile, the Union Territory of Andaman and Nicobar Islands stands out as an outlier with almost 37 such instances in a population of just about three lakh.

Calculations show that though Maharashtra may have reported the highest number of drug-related suicides in the country, Kerala topped the list in terms of incidence rate.

Additionally, at least 12 states and Union Territories had a higher incidence of these cases than the national average. These include Haryana, Telangana, Mizoram and Tripura. The national capital of Delhi, however, reported only 2 cases per million people.

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Not the whole story

In a silver lining of sorts, the number of drug-related suicides in India in 2014, though still high, had reduced since 2012 and 2013. There were more than 4,000 cases in 2012 and in the subsequent year, it shot up to 4,500. More than 25,000 people committed suicides due to drug abuse in the 10-year period between 2004 and 2013, according to National Crime Records Bureau. A study by the United Nations estimated that drug abuse killed more than two lakh people in the world in 2014.

The National Crime Records Bureau data, however, doesn’t reflect the prevalence of drug abuse in the country. It only compiles suicides that were reported to the police and where the cause was established as drug or alcohol abuse. The actual number of deaths due to abuse is estimated to be much higher. And the number of drug users will be several times more.

It also doesn’t take away from the gravity of the drug use problem in Punjab, one that the state government has vehemently tried to downplay or deny. In a recent video campaign, the Shiromani Akali Dal–Bharatiya Janata Party combine tried to dispel concerns about it by having the hockey captain claim it doesn’t exist.

The state is also seeing resistance from its own officials in implementing a scientific programme to reduce drug abuse even as official surveys have shown that there are more than 10 lakh drug addicts in the state. According to a report in the Times of India, officials said the state’s image will take a hit if the project moves ahead and “criticism from outside” is holding up the implementation of the programme.

– Chhavi Goel

Case Study- http://www.google.co.in/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjt47_qtO3SAhVJrY8KHYbMD-AQFggbMAA&url=http%3A%2F%2Fwww.indiaspend.com%2Fcover-story%2Fpunjab-drug-addiction-16-or-as-dy-cm-says-0-06-86253&usg=AFQjCNFCWoWhb7_7W7vDt3DrijyUegXQEQ

Sniffing and Snorting Dangers?

The variety of substances that are abused on a daily basis could surprise many. While drugs – both illegal and prescription – are often abused, as well as alcohol, there are a number of other substances that have made their mark.  The murky world of substance abuse that is no longer restricted to cocaine, marijuana, heroin, Ecstasy and the like. Concern over this disturbing trend is growing as many children are suffering the inevitable health consequences of these habits. The frightening part is that the kids don’t realize that these seemingly innocuous habits damage the health as much as smoking marijuana and doing cocaine

For one Indian boy, that substance is whitener ink. At lunch break every day, the student doesn’t open his tiffin box. Instead, he rushes to the fields behind his school somewhere and vigorously sniffs his handkerchief to get high on the whitener he has poured into it.

The dark truth about whiteners is that this slow poison is a stationery product available ubiquitously for just Rs.27 for 15ml. Shops close to school campuses stock whiteners. There’s no control over the sale of whiteners as it is not a drug under the purview of the Narcotics Drugs and Psychotropic Substances Act. Whitener is abused as an inhalant in India. Whitener exerts its effects through trichloroethane, a volatile solvent. Inhalants include other substances such as petrol and toluene. These substances are cheap, accessible and readily available to children and adolescents. 

Inhalants are volatile (easily evaporated at normal temperatures) substances that produce chemical vapors that can be inhaled to induce a psychoactive, or mind-altering, effect. People from both urban and rural settings abuse inhalants

Young people abuse volatile solvents by deliberately inhaling available vapours 15–20 times over 10-15 minutes.

Inhaled organic solvents like toluene cross from the blood into the brain within minutes. In the brain cells, solvents act on specific receptors to produce effects similar to those of alcohol. Toluene is a common solvent in thinner and paint. Toluene enhances dopamine release.

Multiple Gateways to The Harm-

Inhalants can be breathed in through the nose or the mouth in a variety of ways, such as—

  • “sniffing” or “snorting” fumes from containers;
  • spraying aerosols directly into the nose or mouth;
  • “bagging” — sniffing or inhaling fumes from substances sprayed or deposited inside a plastic or paper bag;
  • “huffing” from an inhalant-soaked rag stuffed in the mouth; and
  • inhaling from balloons filled with nitrous oxide.

 

The Hazardous and The Hazards –

Common household items that are used as inhalants and are extremely dangerous include:

  • Nail polish remover
  • Canned air
  • Rubber cement
  • Spray paint
  • Paint thinners
  • Felt-tip markers
  • Air fresheners
  • Butane
  • Cooking spray
  • Whipped cream cartridges or cans

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From alcohol, tobacco and marijuana to heroin, cocaine and LSD, the addiction grows on a person in a way that the brain’s chemistry is altered altogether. Addiction, as defined by NIDA, is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences. It is considered a brain disease because drugs change the brain—they change its structure and how it works. Some people may mistakenly think that those who use drugs lack moral principles or willpower and that they could stop their drug use simply by choosing to. In reality, drug addiction is a complex disease and quitting usually takes more than good intentions or a strong will. Drugs change the brain in ways that make quitting hard, even for those who want to.

The initial decision to take drugs is voluntary for most people, but repeated drug use can lead to brain changes that challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs. Consequently, choosing to take drugs no longer remains a voluntary action. With continued use, a person’s ability to exert self-control can become seriously impaired; this impairment in self-control is the hallmark of addiction. Brain imaging studies of people with addiction show physical changes in areas of the brain that are critical for judgment, decision-making, learning and memory, and behavior control. Scientists believe that these changes alter the way the brain works and may help explain the compulsive and destructive behaviors of addiction.

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Alcohol and HIV—The Connection

National AIDS Control Organisation of India estimated that 2.39 million people live with AIDS in India. (2008–09)

11 percent of Indians were binge drinkers, against the global average of 16 percent.(WHO)

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Alcohol and HIV have an overwhelming impact on morbidity and mortality in the world’s populations both separately and together. They rank among the top 10 leading causes of death. Their dynamic interaction increases the risk for HIV infection and complicates their treatment. How this combined epidemic is expressed for individuals, their families, and their cultural contexts and the wider institutions that serve them is explored in a publication by National Center for Biotechnology Information

It helps to arrive at a more complete understanding of the role that drinking plays in the lives of individuals and communities. There are many questions that arise in context of alcohol drinking in India that this case study aids to shed light on such as-

  • Where does drinking take place?
  • What types of alcohol are drunk?
  • Are youth who begin drinking at an earlier age at greater risk, and if so, of what?
  • What are the variations in HIV and other risks related to alcohol use?
  • Are there gender differences in men and women’s perception and use of alcohol?
  • How this repertoire of individual and group behaviors is linked to HIV risk, particularly sexual risk under the influence of alcohol

During AIDS epidemic in India, international and domestic alcohol manufacturers were seeing it as an opportunity for their products to expand in Indian middle and upper middle class communities with resources to spend on leisure time activities. Alcohol production and use has a long history in India. Recently, however, the sale and consumption of new forms of alcohol containing more pure alcohol content such as “strong beers”, and associated with higher status and prestige such as “English liquors” including whiskey, scotch and brandy, has began to replace traditional beverages with lower alcohol content and more nutritional components such as tadi madi (date wine), fenny (distilled coconut or cashew wine) and toddy (palm liquor).

In 2000, two new WHO publications highlighted the growing significance of alcohol with respect to HIV risk. The WHO Eight Country Study on alcohol and HIV (2000) included a chapter on alcohol and HIV in India, followed by an historical review of secondary data sources on the history of alcohol and its association with HIV risk in India.

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Important discoveries found in the NCBI’s case study:

  • According to research done on mobile female sex workers and male mobile workers who are clients of these FSW in 14 districts of India, alcohol consumption is common in both, females and males prior to sex, and is linked to inconsistent condom use. In some cases men who pay for sex with women outside of brothels are much more likely to avoid condom use or to use condoms inconsistently. These results suggest the importance of focusing interventions on reducing risks associated with paid sex and informal sexual transactions that take place outside of the brothel environment.
  • HIV positive patients who consume alcohol exacerbates gaps in medication adherence, and acts as a facilitator of sexual risk behavior. This population is highly understudied in the India context and as more people become seropositive, reducing alcohol risk and unprotected sex among PLWA is increasingly important, both to reduce transmission and improve health and related outcomes.
  • Central India showed that alcohol used before sex was a significant predictor of HIV seropositivity in married men 30–39, but not in single men who were probably younger
  • On the other hand, in a study of HIV risk among clients of wine shops in Chennai reported that 89% of respondents interviewed drank before having sex and that non-protection was significantly more common among unmarried men who drank before having sex. These studies have led scholars such to conclude that one viable option for HIV prevention in the Indian context is reducing alcohol consumption prior to sex in both married and unmarried men
  • Resource poor communities in Mumbai shows conclusively that daily drinking is associated with extramarital sex, higher level drinkers have more non spousal sexual partners and use protection less with them. It suggests that moderate level drinkers also may be at risk of exposure to STI and HIV and that interventions should be tailored, with cessation the goal in the case of regular daily drinkers and reduction of frequency and amount of consumption among moderate and lower level drinkers to reduce sexual risk.
  • Poor mental health and hazardous drinking is associated with both violence and HIV risk among men.
  • Violence associated with alcohol use has been shown to have an effect on HIV and STI risk exposure, primarily through forced, “rough” or painful sex between men and vulnerable or unwilling women including spouses. The evidence is accumulating to suggest that alcohol, when linked with gender norms, disinhibits men, and focuses them on meeting their perceived sexual and other needs in marriage through the use of violence or abuse
  • Venues where alcohol is sold and consumed including wine shops, addas and bars and restaurants clearly influence, endorse, support and enable risky sexual behavior.

What can be done?

  • In India, it is unlikely that “single sector” approaches alone will be effective in combating the gender based violence, risky sexual behaviors and other consequences of pervasive alcohol use. Sensitive community-based, community-controlled approaches to mediating alcohol use and its relationship to unprotected sex and violence should be undertaken with communities, including men, women, and families affected by alcohol, community organizations, distributors, media and providers.
  • Reinforce the importance of HIV risk reduction programs for men in the general population as well as other vulnerable populations such as sex workers, truckers and injection drug users, including de-addiction of alcohol as a focus of HIV risk reduction.
  • HIV prevention interventions that involve discussion of sex are not very widely supported in India.  Such interventions should be altered  accordingly so that they can be successfully implemented, sustained and disseminated in all locations of India as a model for much needed  educational and workplace approaches to prevention.

Case Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2973998/

What do you think? Does HIV risk grows due to alcohol?

@akritiarora