India and substance use, what is the way forward?

Drug use is one of the most discussed topic in India right now. The on-going investigation of Bollywood A-listers for substance use has risen a debate about drugs. In 2019, a report submitted by the National Drug Dependence Treatment Centre (NDDTC) stated that there are approximately 2.6 crore opioid users in India. It also stated that over 8.5 lakh people inject drugs into themselves and are addicted to it.

Being a country with significant volumes of licit and illicit drug cultivation, a transit route as well as a consumer market, India’s drug policy dilemmas span ‘demand’ and ‘supply’ control.

India and Drugs

Cannabis has been consumed for spiritual, medicinal and recreational purposes in the country since the classical era. The earliest known references to cannabis use dates back to 2000 B.C.

During the colonial period, the British organised opium into a large-scale commercial enterprise, consolidating and bringing cultivation of poppy and manufacture of opium through the Opium Acts of 1857 and 1878.

By the 1920s, the nationalist movement became critical of the colonial government’s profit driven drug policy. Indian leaders distanced themselves from traditional use and the removal of drugs became the agenda. Cannabis was classified as an intoxicating drug and continued to be regulated through provincial excise acts.

In the 1930s, the Dangerous Drugs Act was introduced. It was introduced to extend and strengthen control over drugs derived from coca, hemp (cannabis) and poppy plants by regulating the cultivation, possession, manufacture, sale, domestic trade and external transactions through licenses and penalising unlicensed activities. The framework of the Dangerous Drug Act remains in the current legislation.

In 1940, the Drugs and Cosmetics Act was introduced to regulate the use of medicinal drugs including cannabis and opium.

The prohibitionist sentiment became further settled by way of Article 47 of the Constitution which states: “The State shall endeavour to bring about prohibition of the consumption except for medicinal purposes of intoxicating drinks and of drugs which are injurious to health”. Although these Directive Principles of State Policy are non-enforceable, this provision is frequently invoked to justify disciplinary drug policies.

The Narcotic Drugs and Psychotropic Substances Act 1985

The Narcotic Drugs and Psychotropic Substances Act, 1985 (NDPS Act) came into force on 14 November 1985. According to the official record, the NDPS Act was introduced in order to provide adequate penalties for drug trafficking, strengthen enforcement powers, implement international conventions to which India was a party and enforce controls over psychotropic substances. The Act restricts the cultivation, possession, sale, purchase, trade, import, export, use and consumption of narcotic drugs and psychotropic substances except for medical and scientific purposes in accordance with the law.

The NDPS Act Amendments:

1989
In 1989, the NDPS Act underwent the first set of amendments, after a Cabinet Subcommittee for combating drug trafficking and abuse recommended that the law be made stricter. The changes in the Act included an extension of mandatory punishment in the case of possession of drugs. The minimum sentence was moved to 10 years with restrictions on bail, a bar on suspension and commutation of sentences, forfeiture of property, trial by special courts and mandatory death sentence for certain repeat offenders.

According to revised provisions, people caught with small amounts of drugs faced long prison sentences and hefty fines. if they successfully prove that the drug was intended for personal use, they would be subjected to a punishment of six months or one year in prison.

2001
The change was made due to the criticism regarding harsh and disproportionate sentencing structure of the Act. This time, the punishment was to be graded on the basis of the quantity of drugs involved, which, – “small”, “commercial” or “intermediate”.

2014
The third amendment of the Act in 2014 saw an introduction of new provisions. The main features included:

  • Creation of a new category of “essential narcotic drugs”. This can be specified and regulated by the central government uniformly throughout the country.
  • Widening the objective of the law from containing illicit use to also promoting the medical and scientific use of narcotic drugs and psychotropic substances.
  • Including the terms “management” of drug dependence and “recognition and approval” of treatment centres. This allowed the establishment of legally binding treatment standards and evidence-based medical interventions.
  • Revised punishment for small quantity offences from a maximum of six months to one-year imprisonment.
  • Allowing private sector involvement in the processing of opium and concentrated poppy straw.
  • Raising the rank of officers authorized to conduct search and arrest license holders for alleged NDPS violations.
  • More elaborate provisions for forfeiture of property of persons arraigned on charges of drug trafficking.

The Magnitude of Substance Use in India 2019

Although the use of cannabis and opioids has been documented in India since a long time, their is no proper data on the use or the pattern of use currently. In order to fight with the problem, it is necessary to have well researched data on the problem.

What is a psychoactive substance?

According to the World Health Organisation, the substances that, when taken in or administered into one’s system, affect mental processes. This term and its equivalent, psychotropic drug, are the most neutral and descriptive term for the whole class of substances, licit and illicit, of interest to drug policy. ‘Psychoactive’ does not necessarily imply dependence-producing, and in common parlance, the term is often left unstated, as in ‘drug use’ or ‘substance abuse’.

Use of Psychoactive Substance in India

The report states that a large number of population uses psychoactive substances all over India.

Alcohol is the most common psychoactive substance used by Indians. About 14.6% of the population used alcohol, which means, there are 16 crore people who consume alcohol in the country.

After alcohol and cannabis, opioids are the next commonly used substances in India. About 2.8% of the populate, which accounts for 3.1 crore reports to have used cannabis in the previous year.

About 2.1% of the country’s population, accounting for 2.26 crore individuals use opioids. Which includes, Opium (or its variants like poppy husk known as Doda/phukki), Heroin (or its impure form – smack or brown sugar) and a variety of pharmaceutical opioids.

Other categories of drugs such as Cocaine (0.10%) Amphetamine Type Stimulants (0.18%) and Hallucinogens (0.12%) are used by a small proportion of country’s population.

Access to treatment

According to the report, among people dependent on alcohol who tried quitting, about 25% (or about 2.6% of the total alcohol-dependent individuals) reported receiving any treatment. Among those who received help/treatment, the largest category of the source of help was ‘spiritual/religious help’ (33%) followed by a ‘government doctor or health facility’ (25%). A very small proportion (21%) of those who received any help or treatment reported receiving admission/hospitalisation for their alcohol use problems. Just about one in 38 people with alcohol dependence have received any treatment.

A similar trend is visible among those with dependence on illicit drugs. Among those affected by drug dependence, around 44% reported trying to give up drug use, of which, around 25% (i.e. about 12% of all drug-dependent people) reported receiving any help or treatment ever. The most common source of treatment was a government hospital (40% of those having received treatment). Among those who received treatment, as many as 44% reported having received in-patient treatment. Thus, among people suffering from dependence on illicit drugs, one among 20 people has received inpatient treatment/hospitalisation for help with drug problems ever in a lifetime.

What is the way forward?

Considering the huge challenge of substance abuse in the country, there is an urgent need for new policies and programs focused on helping the affected citizens. The evidence in the report highlights the fact that the youth is the most affected with substance abuse. The programs that are present are based on educating people and spreading awareness, but they are themselves very weak. Awareness programmes can play an important role in establishing substance use disorders as bio-psycho-social health conditions.

Drug usage is mostly dependent on emotional state of an individual. After consuming drugs, the emotional state of the individual amplifies, which may make a person feel better at that time, but is bound to negatively affect the person later. Currently, more than 50% youth of our country suffers from psychological problems, depression or anxiety. These situations keep amplifying due to drug use, which results in addiction. The most important thing in this situation, which will work better than any treatment is giving out mental support and positivity to people who are addicted and want to quit. Using substance may seem to be a get away for the time being, but it clearly isn’t.

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