A multi-pronged approach to de-addiction – prevention, integration and rehabilitation – is at the centre of first drug de-addiction policy prepared to deal with growing problem of drug abuse in J&K. Seen as a total shift from present practice which focuses only on de-addiction, this document aims at checking the environment where not only fall into dangerous world of drug abuse is curtailed, but sources from where the menace reaches the end-user are plugged too. From prevention to rehabilitation, the policy, prepared by Government Medical College Srinagar’s Institute Of Mental Health and Neurosciences (IMHANS), Kashmir, directorate of health and other departments, would go a “long way in finding a solution to a decades old problem”, if implemented properly, commented a senior medico.
“This strategy, where both demand and supply chain is blocked in tandem holds promise for drug ravaged state.” An entire chapter in the document has been dedicated to prevention of substance abuse which is seen as a statement in itself. As per the policy, there are many levels of prevention. The basic concept that people need to be told what drugs end up doing to an addict is cornerstone of any prevention strategy and improving living conditions while promotion of physical and mental health can go a long way in reduction of substances of abuse.
Although, not much has been talked about how a healthy environment can be created in schools, other educational institutions and work places, the policy leverages a lot of weight on the fact that risky behavior could be reduced by reducing “stressors” in everyday life. Psychiatrists believe that many mental health issues take birth in schools as a result of an educational system that has little scope for accepting a child with any kind of difficulty, physical or learning. These issues, if not dealt with timely, add up as a risk factor that could end up in substance abuse. To address this, involvement of teachers, peer leaders and counselors in development of life skills and guidance on coping techniques have been underlined as a strong promoter of “life and social skills, self-control, emotional awareness, communication, drug-resistance”, in the policy. In addition, involving religious organisations in creating aversion about substances abuse and calling religious beliefs as “important protective factors” are key highlight of the policy. “Faith-based organizations can go a long way in preventing substance abuse,” it emphasizes upon. However, what is more vital, in view of prevailing circumstances, is that access to substances of abuse needs to be stalled. “Knowledge about potential abuse of various medications, about identifying drug-seeking and manipulative behaviours and also about existing laws guiding sale of various medications is important” states the policy while talking about laxity in implementation of existing laws. The draft policy seeks “laws needed for restriction of sale of solvent containing compounds especially to minors. There should be special directions to teachers and parents to supervise the use of solvent containing products by children and adolescents”.
A recent study carried out at IMHANS had reported that two-thirds of people affected with substance abuse were in the age group of 11-20 years. Another of its study brought to fore “increased use of medicinal opioids among youth in Kashmir valley”.
They also reported increased use of multiple substances as modes of addiction. Another doctor said the fact that many among young generation are grossly involved in substance abuse and age of initiation to drugs has been found to be as low as nine years the society needs to put together all its efforts to protect this generation from falling in trap of drugs. The first step in this direction is to plug channels of drugs, including legal drugs like tobacco and alcohol, he said, adding measures are needed to prevent increasing production and trade of prohibited drugs across the states. “This becomes essential in the current scenario of increasing influx of labour-class population into the state, as well as efflux of youth to outside of state in search of employment and educational opportunities”.
Any breach of laws must be punished according to existing laws, but the experts call for instating stricter laws against the “rampant misuse of prescription medications and reckless sale of medication with psychoactive properties at medical shops”. According to database with GMC, 6157 patients with history of substance abuse visited OPD in 2016-2017 and their number was 6550 between January 2017 and December 2017. Psychiatrists call it “tip of the iceberg” given that treatment seeking is quite low in the affected population, due to a variety of factor. The basic impediments to treatment seeking are low access and high prevalence of stigma.
While a centrally sponsored scheme promises increased access to drug de-addiction by funding dedicated centers across the state, psychiatrists and experts who have designed J&K’s policy have a different take on the issue. They argued that strategies to eradicate previously stigmatized diseases like Tuberculosis and Leprosy have taught healthcare planners that “isolation leads to increased stigmatization and feelings of shame and exclusion, which impedes case finding and makes treatment difficult, let alone eradicating the disease”. To address these issues, stigma and access, the policy advocates integrating de-addiction system with main healthcare system.
This integration needs to be in terms of location and well as functionality so that substance abuse is treated “just like any other disease”, said the doctor, adding it will help in addressing the emerging issues associated with substance abuse, such as “increasing use of hard drugs, emergencies like overdose, withdrawal complications and other medically co-morbid conditions”. While the policy is already in public domain for suggestions, it has already received a thumbs-up from prominent psychiatrists and planners of healthcare policies from outside. Dr Vivek Benegal, in a review of J&K’s newly drafted drug de-addiction policies has called it “the most detailed and well written, especially the emphasis on demand reduction”. He has called for more emphasis on screening of vulnerable youngsters.
Dr Benegal is a professor at Center for addiction medicine and National Institute of Mental Health and Neurosciences. Another experts, Dr Ajit Avasthi, who heads department of psychiatry, PGI Chandigarh and was proponent of Punjab’s de-addiction policy, has called the draft “educative and comprehensive” that covers almost all aspects of the problem while Dr Atul Ambedkar, who is chief investigator on National Survey on de-addiction and author of many books on the subject, has termed the policy “pragmatic and comprehensive”. However, the fact that the policy would need over a dozen departments to coordinate and perform in order to bring about a reduction in substance abuse in the state presents both an opportunity and a challenge.
Only a strict monitoring and stringent accountability, as well as commitment from state government can make a difference. Or else, Kashmir’s young will continue to fall in abyss of drugs.