Pattern and prevalence of substance use and dependence in the Union Territory of Chandigarh: Results of a rapid assessment survey

Pattern and prevalence of substance use and dependence in two districts of Union Territory of Jammu & Kashmir: Special focus on opioids

Background:

Kashmir has been at the centre of conflict between India and Pakistan after partition of erstwhile British India in 1947. While research suggests that conflict exposure may result in increased substance use, the prevalence of substance use disorders has remained an under-searched area in Kashmir.

Method:

We employed respondent-driven sampling (RDS) for recruiting substance users from two districts of Kashmir. Estimation of substance dependence was done using benchmarkmultiplier method.

Results:

Prevalence of any substance dependence was estimated to be 1.95% while as for any opioids, it was 1.80%. Heroin was the most common opioid with last year use by 84.33% respondents. Current prevalence of injection drug use was 0.95% and heroin was the most common opioid among Injection Drug User (IDU), being used by 91.12% IDUs followed by Pentazocine (5.92%).

Conclusion:

Our results indicate that RDS was a feasible and acceptable sampling method for recruiting 'difficult to reach 'participants like illicit substance users including IDUs. Our results further demonstrate that opioids are highly prevalent in Kashmir and heroin injection is not uncommon. All these findings call for attention from policy makers as opioids are one of the important contributors to mortality and morbidity related to substances.

Sociodemographic and clinical profile of drug treatment seekers attending the State Psychiatric Hospital and Drug De-addiction Center at Agartala, Tripura

BACKGROUND

Substance use disorders have become a widespread public health problem, especially in the northeastern states, and limited studies have been undertaken to reflect the picture of the same.

AIMS

The aim of the study was to study the sociodemographic and clinical profile of drug treatment seekers attending a State Psychiatric Hospital and De-addiction Center of Northeastern India.

MATERIALS AND METHODS

It was a cross-sectional hospital-based study conducted from October 2018 to August 2019. Two hundred and ten consecutive treatment-seeking patients, fulfilling inclusion and exclusion criteria and diagnosed with the International Classification of Diseases version 10 for substance dependence, were included in the study.

RESULTS

Most common abused drug was opioids (42.9%), followed by alcohol (14.3%), whereas 29.0% were people who inject drugs. Peer pressure in 55.2% and curiosity in 32.9% were reported to be the most common causes for initiating substances. Hepatitis C was the most common (52.4%) comorbidity related to intravenous drug users.

CONCLUSIONS

Results of the current study will definitely encourage further large-scale community-level studies to assess the prevalence of substance abuse in the state as well as in drug policymaking.

Tapentadol, the new kid on the block in India: Is it time to worry?

BACKGROUND AND OBJECTIVES

Large-scale prospective case series of tapentadol abuse or dependence in India is not available. Hence, we aimed to study the prevalence and profile of tapentadol users in a treatment-seeking population.

MATERIALS AND METHODS

The study had prospective and retrospective arms. We collected 8-month prospective data by face-to-face interviews (n = 70) and 8-year retrospective data from case notes (n = 26) with either tapentadol misuse/abuse or dependence in patients attending a de-addiction center.

RESULTS

The prevalence of tapentadol abuse or dependence was 25% among the pharmaceutical opioid users. Concurrent use of other opioids was seen in >80% of participants of both the arms. Major sources of tapentadol were chemists (without a prescription) (53%) and doctors (prescriptions) (40%). Patients in the tapentadol dependence group had a significantly higher dose, duration, and pharmaceutical opioid use.

CONCLUSION

India needs awareness promotion, training, availability restriction, and provision of treatment for tapentadol abuse or dependence.

What makes non-cirrhotic portal hypertension a common disease in India? Analysis for environmental factors

In India, an unexplained enteropathy is present in a majority of non-cirrhotic intrahepatic portal hypertension (NCIPH) patients. Small intestinal bacterial contamination and tropical enteropathy could trigger inflammatory stimuli and activate the endothelium in the portal venous system. Groundwater contaminated with arsenic is an environmental factor of epidemic proportions in large areas of India which has similar consequences. Von Willebrand factor (a sticky protein) expressed by activated endothelium may promote formation of platelet microthrombi and occlusion of intrahepatic portal vein branches leading to NCIPH. Environmental factors linked to suboptimal hygiene and sanitation, which enter through the gastrointestinal (GI) tract, predispose to platelet plugging onto activated endothelium in portal microcirculation. Thus, NCIPH, an example of poverty linked thrombophilia, is a disease mainly affecting the lower socio-economic strata of Indian population. Public health measures to improve sanitation, provide clean drinking water and eliminate arsenic contamination of drinking water are urgently needed. Till such time as these environmental factors are addressed, NCIPH is likely to remain 'an Indian disease'.

Internalized stigma and its correlates among treatment seeking opium users in India: A cross-sectional observational study

Opium has been used in India since ancient times for social, recreational, religious and medicinal purposes. Opium users seem to constitute a distinct sub-population among opioid users, who have minimal complications, better functioning and socio-cultural acceptance. Prominent levels of stigma have been reported against people who use opioid drugs, but the same cannot be extrapolated to opium users. There is a vast number of opium users in India, and it is prudent to understand the stigma faced by them to better address their problems. Hence, in the current study we aimed to assess the internalized stigma and its correlates among opium users who seek treatment at a tertiary care drug treatment centre in North India. 117 adult male participants having opioid dependence (opium being the most common opioid in last 3 months) were assessed using Internalized Stigma of Mental Illness (ISMI) scale - Hindi version. The stigma scores were in the mild to moderate range, which was less than that found in previous studies among heroin and alcohol users in similar setting. Moreover, higher stigma scores were associated with lower educational status and higher proportions of income spent on substances. This is the first study to document stigma among opium users. Further research needs to be conducted to understand the determinants of stigma in this population.

Epidemiology of dependence on illicit substances, with a special focus on opioid dependence, in the State of Punjab, India: Results from two different yet complementary survey methods

BACKGROUND

We used two different yet complementary methods to capture the 'hidden population' of illicit substance users in the state of Punjab, India: Rapid Assessment Survey (RAS) and Punjab Drug Use Monitoring Survey (P-DUMS).

METHODOLOGY

For the RAS component, following a pilot study, Respondent Driven Sampling was used to recruit 6600 community-dwelling substance dependent persons aged 11-60 years from all the 22 districts of Punjab. Size was estimated using benchmark-multiplier method, and prevalence was calculated by projecting these data to the source population. For the P-DUMS component, data were collected on 7421 inpatients from 75 government de-addiction centres from 19 districts of Punjab.

RESULTS

Subjects In both RAS and P-DUMS were primarily opioid dependent (88% in RAS and 83% in P-DUMS). Heroin (inhaled/injected) emerged as the commonest opioid in both RAS (46%) and P-DUMS (52%), though 30.5% of the RAS sample also used the prescription opioid tramadol. Using the benchmark-multiplier method, 0.27 million (2.5% of the source population) were estimated to be opioid dependent, of which nearly 78,000 (0.7% of the source population) were injecting opioid users (IDUs), predominantly heroin (62%) but also buprenorphine (32.5%). High-risk behaviour was reported by nearly 60% of IDUs. Only 14% of the RAS sample had ever visited any de-addiction centre, and only 2.8% individuals had been admitted to a de-addiction centre in the past year.

CONCLUSION

There is a substantive problem of opioid dependence in this difficult-to-reach population of Punjab, with low treatment access. Misuse of prescription opioids along with IDU also raises concern.

Substance use and dependence in the Union Territory of Chandigarh: Results of a household survey using a multistage stratified random sample

BACKGROUND

Substance misuse is a global health and social problem with major adverse consequences. A number of regional studies on prevalence of substance use and dependence have been carried out in India; but methodologically robust data from Chandigarh are sparse.

METHODOLOGY

A house-to-house survey was carried out to estimate the prevalence of substance use and dependence in an adequate multistage-stratified random sample in the Union Territory (UT) of Chandigarh, using standardized instruments and predefined measures. Two thousand individuals (1000 each from urban and rural sites) from 743 households were interviewed.

RESULTS

Lifetime use of any substance was reported in 21.26% households (8.01% of all respondents; 13.6% males and 1.01% females). Current use was reported in 6.55% of respondents. Prevalence rates of both lifetime and annual/current substance dependence were 2.96% (4.74% for males and 0.72% for females). Alcohol (6.72%) was the most common substance to be ever used by respondents, followed by tobacco (3.34%), opioids (0.17%), and hypnotics (0.04%). Lifetime dependence rates were found to be 1.76%, 2.28%, 0.04% and 0.17% for alcohol, tobacco, hypnotics, and opioids, respectively. None reported the use of cannabinoids, inhalants, or stimulants. Substance users were more likely to be married, employed, and in higher income group as compared to those who never used substance. Only 3.78% substance users had ever sought treatment for the same.

CONCLUSION

Substance use is prevalent in the UT of Chandigarh, with a higher prevalence in males. Substance users hardly ever seek treatment for substance use. This highlights the need of awareness and community-level services for the treatment of substance use disorders.