Need for a Research Consortium in Jammu and Kashmir

Prof. (Dr.) Geer Mohammad Ishaq

Prof. (Dr.) Mohammad Ashraf Ganie

J&K Research Consortium stands committed to rejuvenate the research ambience within J&K and come up with innovative ideas regarding multi-disciplinary research and academic collaborations

Union Territory of Jammu and Kashmir has made considerable progress in the recent past in the fields of education and research. During this period a good number of new universities and colleges have been established while older universities and institutions have progressed by leaps and bounds in terms of scientific research. Universities like Kashmir University, SKAUST-Kashmir, Shri Mata Vaishno Devi University and research institutions like IIIM, Jammu/Srinagar, SKIMS deemed University have left an indelible impression for themselves in terms of good quality, high impact research, as depicted by various research indices, after developing some state-of-the-art infrastructure for carrying out cutting edge research. Other universities and research institutions like IUST, CUK, BGSBU, GMCs, SKAUST-J, NIT and IIT have also done fairly well by publishing some impactful and commendable research articles and reviews. Infrastructure including laboratories and equipments installed during this period at these institutions has laid a strong foundation for taking the scientific research to all new heights in times to come. Hon’ble Lieutenant of Jammu and Kashmir, Sh. Manoj Sinha has also time and again in his public interactions and monthly radio/television broadcasts been emphasizing upon the importance of harnessing innovation and undertaking quality research of international standards at our academic and research institutions. Need of the hour is to pool all resources including high-end equipments and trained manpower and create common facilities in these universities and institutions that could be made available and accessible to all so that an optimum resource utilization is ensured and output of research is not only increased but drastically improved too. 

In consonance with our local needs and demands and in order to accelerate research activity in J&K, it is imperative that we identify thrust areas of our research following which we need to devise a common research policy for all our research institutions and universities based on the mutually acceptable terms and broadly applicable contours. This will pave way for a uniform, useful and productive approach of identifying our problems and devising solutions to them through scientific research. This is where a consortium of all research institutions and universities of J&K will come handy and provide a platform for mutual exchange of views, opinions and ideas on scientific research besides devising policies and procedures for sharing of mutual resources, infrastructure and other research facilities. New National Education Policy (NEP-2020) also calls for dissolving all silos and compartments into which our academicians, researchers, educational and research institutions and departments have been working so far. It lays emphasis upon mutual sharing of not only ideas but also the facilities for innovation-incubation and research. In view of the significant divergence of streams towards super-specialization, we need to keep generating cross talk between different streams since there is a possibility of losing sight of the latest advancements, recent developments and potential research opportunities in these areas. Research consortium will comprise of a collegium of the best brains in scientific research and thus serve as a hub of incubation for novel and innovative research ideas of high importance. Such pooling of wisdom and creative talent will ultimately benefit the entire UT of Jammu and Kashmir in emerging as a leader of scientific research in the country. 

The idea of J&K Research Consortium was originally conceived during 3^rd J&K Medical Science Congress organized by Sher-i-Kashmir Institute of Medical Sciences (SKIMS) on December 30-32, 2019. This conference included a seminar and panel discussion on "Strategies for enhancing research in Jammu and Kashmir” and a brainstorming session on "Establishing a Research Consortium in J&K". Main theme of the event was “Revitalizing the field of medical sciences in J&K” and the event was supported by the J&K Science, Technology and Innovation Council. Renowned medicos, acclaimed researchers, accomplished academicians and reputed administrators participated in this conference besides scholars and students from various universities and research institutions of J&K. Hectic deliberations were held on significant issues concerning biomedical research including financial, infrastructural and manpower requirements for undertaking credible and cutting edge research; policies, procedures and incentives required for collaborative, context-specific and need-based research; need for undertaking translational and socially-relevant research; importance of integrity and ethics in research. Several thrust areas were identified in the fields of non-communicable diseases, oncology, cardiology, endocrinology, psychiatry, rural health, microbiology, nutrition, bioinformatics, neurology, geriatrics, immunology, child health, ophthalmology, genetics, environment, agriculture, veterinary sciences and ayurveda, with a view to identify potential research problems for undertaking collaborative and inter-disciplinary research under the aegis of J&K Research Consortium. Subsequently heads of all research institutions and universities of J&K were invited to be the patrons of the proposed consortium and nominate nodal officers for coordination with their respective institutions. It was resolved that one coordinator will be designated from each participating educational and research institute of Jammu and Kashmir and a research consortium will be established for promoting collaborative research work in J&K. 

Second meeting of the J&K Research Consortium is now scheduled to be held in the month of September, 2023 that will be jointly organized by the University of Kashmir, SKIMS, Srinagar and Central University of Kashmir at a suitable venue in Srinagar. Vice-Chancellors of all universities of J&K and heads of all research institutions and medical colleges are expected to grace this occasion and participate in further brainstorming on drafting a constitution of the proposed consortium, finalizing its aim and objectives, functions and priorities. Thrust areas of research in J&K will be prioritized and chosen for undertaking research, MOUs are expected to be signed between partnering institutions and research collaborations will be fostered during this event. The scope of collaboration on academic and research activities to be pursued through J&K Research Consortium shall inter alia include: 

1.     Undertaking collaborative research work in the areas of mutual interest.

2.  Mutual sharing of facilities like infrastructure and equipments, databases, e-resources, laboratory and library facilities.

3.     Mutual exchange of visiting faculty, research scholars and students.

4.     Joint organization and conduct of symposia, seminars, workshops and conferences.

5.     Joint publication of research papers, books and patents.

6.   Joint project proposal writing, funding application and execution. 

J&K Research Consortium stands committed to rejuvenate the research ambience within J&K and come up with innovative ideas regarding multi-disciplinary research and academic collaborations. It will devise plans for preparing and undertaking joint research projects as well as policies for involving external funding agencies. It will strive to grow its sphere of activities in research in an incremental manner with a view to develop a comprehensive research plan with short and long-term objectives by assessing and reviewing ongoing research activities, driving collaboration to improve and extend research impact, deploying infrastructure and resources and developing a robust funding plan. JK research consortium will have due representation from all research centres, prominent academic institutions and universities of J&K and shall provide a common platform to foster multi-disciplinary research in J&K. Coordinators from all educational and research institutions will be a part of this consortium who will identify thrust areas of research and work in unison. Consortium will have clearly defined objectives, functions and plan of action for research and will devise strategies to address contemporary issues and challenges in areas of scientific research, thereby identifying solutions to some of the most intriguing research problems of the region. 

Though initially J&K Research Consortium will promote inter-disciplinary biomedical research with focus on non-communicable diseases (NCDs) locally at UT level, with the passage of time its purview and scope will be broadened to foster research collaborations with reputed institutions at national and international level too. However, objectives, contours and modus operandi of any such mutual relationship will be properly defined by Memoranda-of-Understanding duly signed by authorized signatories of the collaborating institutions. Further the consortium will make efforts to explore and utilize funding opportunities from reputed national funding agencies like ICMR, DBT, DST, UGC, AYUSH and other funding agencies at the national level for its thrust areas of research and thereby provide financial assistance to its collaborating universities and institutes for undertaking research in these areas. In due course of time consortium will make efforts towards establishment of research centres within Universities with a view to address some of the most pressing and contemporary issues and challenges in the biomedical field. Necessary approval from the government will be sought before establishing such centres where world-class, high-end research will be undertaken to bring out tangible solutions to the burgeoning scientific and biomedical problems of the region. The idea of such consortium has received wide appreciation from national and international researchers and is expected to serve as a model for rest of the country. 

(First author teaches at the University of Kashmir whereas second author is a renowned endocrinologist working at SKIMS, Srinagar. Views expressed are their own and not of the institutions for which they work)

Three years of NEP-2020: Accomplishments made in higher education

Continuous monitoring of its implementation and evaluation of its short, mid and long-term goals and objectives is required at this juncture besides framing IDPs for its future implementation

 

National Education Policy (NEP-2020) is not only the new education policy framed and implemented in India after a gap of 34 years but is also the first education policy of the world in twenty first century that aims to revamp all aspects of the education sector in India by fostering revolutionary changes in infrastructural development, curricular reforms, pedagogical innovation, augmentation of human resource, administrative reforms, institutional governance, restructuring evaluation and examination system, harnessing research innovation, skill development, community outreach activities, student exchange programmes, industry-academia interaction, innovation and start-up incubation, promotion of open learning, e-governance and workflow automation. The vision of NEP-2020 focuses on strengthening India's educational infrastructure and making quality education accessible and affordable to every citizen, thus enabling the creation of a vibrant and knowledgeable society. All the three pillars on which higher education stands viz., the teachers who teach, students who are taught and the curriculum that is taught are going to witness a paradigm transformation under the auspices of NEP-2020. This policy aims to foster creative, analytical and critical thinking among students so that they become well-rounded, engaged, productive and contributing citizens for building an equitable, inclusive and progressive society and thereby achieve the goals of education in real sense. 

Commemorating third anniversary of the NEP-2020 implementation and inaugurating Akhil Bhartiya Shiksha Samagam at Bharat Mandapam jointly organized by the Union Ministry of Education and the Ministry of Skill Development & Entrepreneurship in Delhi on July 29, Prime Minister Shri Narendra Modi said that NEP seeks to make India an epicentre of emerging technologies and a nursery of new possibilities for the whole world. He said that NEP-2020 aims to establish an education system in India by the year 2040 that is second to none, with equitable and affordable access to the highest-quality education for all learners regardless of their socio-economic, cultural or religious backgrounds. Under the visionary leadership of Prime Minister Narendra Modi, NEP-2020 represents an important milestone towards creating a transformative, inclusive and innovative education system aligned with India’s goals and aspirations envisaged during ‘Azadi Ka Amrit Kaal’. Speaking at this occasion, Union Minister for Education, Skill Development and Entrepreneurship, Shri Dharmendra Pradhan said, “In India’s journey towards a ‘Viksit Bharat’ in 2047 NEP-2020 is giving tangible form to the vision of holistic, comprehensive and multidimensional education system envisioned by great personalities like Mahatma Gandhi, Gurudev Rabindranath Tagore, Swami Vivekananda and Maharshi Arvind”. He emphasized that the transformative reforms under NEP-2020 aim to cultivate responsible citizens well-equipped with global skills and ethics, capable of contributing in India's sojourn towards self-reliance i.e., ‘Aatm Nirbhar Bharat’ (Ref: PIB, Delhi dt. July 29). 

After hectic brainstorming and fully comprehending various provisions of NEP-2020 soon after its notification, colleges and universities all across India devised their action plans for its implementation, on which they have made considerable progress over the past three years. Some of the measures taken by higher education institutions during the academic sessions 2021-2022 and 2022-2023 include introduction of LOCF (Learning Outcome-Centric Framework) based multi-disciplinary, holistic, and flexible curricula; digitization of education with Academic Bank of Credits (ABC) and facilitation of credit transfer through National Academic Depository (NAD)/Digi-locker System; implementation of Multiple-Entry and Exit (MEE) options; facilitating online education through MOOCs (Massive Open Online Courses), SWAYAM, SWAYAM PRABHA and e-PG Partshala; adopting the National Curricular Credit Framework (NCrF) for four-year under-graduate programme (FYUGP); promotion of experiential learning through innovative teaching pedagogies and internships, dissertations, community outreach, industrial training, educational tours, field trips etc. Reportedly more than 30 million new students have attended online courses on Swayam and Swayamprabha portals over the last three years. E-learning at school level has been expanded through DIKSHA that houses more than 3600 textbooks from 29 states, 1.44 lakh e-Contents and more than 300 courses. 

Ever since the implementation of NEP-2020 commenced, consistent improvement in Gross Enrolment Ratio (GER) at the primary school level has been witnessed. Gender Parity Index in school education has also increased from 0.94 in 2014 to 0.99 in 2020 and more than two lakh additional classrooms have been constructed along with 2.36 lakh toilets for children in schools. Experts in education believe that the 50% target fixed for achieving gross enrolment ratio by the year 2035 shall be achieved ahead of the target year by virtue of innovative approaches envisaged in the policy. Based on the expert visits made by this author over the past two years to several reputed universities across India as Member-Coordinator of the NAAC peer team with a view to assess those universities for NAAC accreditation, it has been observed that most of the colleges and universities have understood the policy well and have initiated necessary actions towards its time-bound implementation though the pace of implementation appears to be sluggish at this juncture and needs to be accelerated further in times to come. Union Territory of Jammu and Kashmir was probably the first among all the UTs and states in India to start implementation of the policy and Universities like Kashmir University and SKAUST-K were among the first few universities in India that endeavoured upon the path of implementation of this epoch-making education policy under the dynamic leadership of their respective Vice-Chancellors. UGC took a lot of time in finalizing a new student-centric “Curriculum and Credit Framework for Undergraduate Programmes (CCFUP)” and ultimately notified it in December, 2022. However, in anticipation of its notification universities and institutes of J&K under the guidance of Higher Education Department of J&K started making admissions as per the new policy last year based on the draft of curriculum framework notified by UGC in March, 2022 and are now aligning themselves with the final version of the framework during the current academic session with a few necessary modifications being made here and there in tune with the local requirements. 

In spite of the considerable progress made in the implementation of NEP-2020 so far there is a lot that still needs to be done particularly in terms of infrastructure development, human resource management, curricular reforms and pedagogical improvement besides student placement and community engagement. During post-NEP period a lot of emphasis is being laid upon skill enhancement, innovation-incubation and entrepreneurship development and a remarkable progress has been made in terms of registration of new start-ups. Union Minister of State for Commerce and Industry Sh. Som Prakash in reply to a question on February 8, 2023 said that the number of recognized startups has increased from 445 in 2016 to 86713 in 2022. He further added that more than ten thousand start-ups have been established in the IT sector followed by over eight thousand start-ups in healthcare and life science sector. With its startup ecosystem evolving as one of the most vibrant and colourful one in the world, these advancements will definitely help our country emerge as a global start-up hub. Apart from supportive government and a massive pool of technical talent comprising of more than one million engineers graduating from various universities every year, this accomplishment has been made possible by the fact that India has more than 750 million internet users that is expected to further increase to one billion by the year 2025. 

In the year 2015 Govt. of India launched DigiLocker with the aim of providing its citizens with a secure and easy-to-use platform for storing and sharing their digital documents. Though it faced challenges in terms of its user adoption during its initial phase, soon after implementation of NEP-2020 it received a flip and started gaining momentum with the government’s continuous efforts to promote digitalization. With a steady rise in its user acceptance and adoption over the past few years, DigiLocker has now reached a remarkable milestone of 15 crore registered users by 2023 with over 150,000 daily user sign-ups (Ref: digilocker.gov.in). Further with the establishment of Academic Bank of Credits (ABC), a national level facility that provides a variety of services like credit accumulation, verification, redemption, exchange and authentication of academic awards from one programme to another, the much-required flexibility of multiple-entry-multiple-exit has been made possible. As on June 6, 2023 a total of 1990 academic institutions have registered themselves on National Academic Depository (NAD) and more than 13 crore awards have been uploaded (Ref: nad.gov.in). Thus, NAD is proving effective in ensuring transparency and transformation through digitization by providing a credible, authentic and convenient mechanism for access, retrieval and validation of academic awards. 

In conclusion a fairly good beginning has been made so far and now we need to scale up the already implemented components of NEP-2020 and build further on the gains made thus far. Higher education institutions need to develop a set of way-forward strategies in the form of Institutional Development Plans (IDPs) to actualize the vision, mission and objectives of NEP-2020. IDP is a documentary framework through which higher educational institutions can develop their own indicators, fix their achievable targets and timelines, prioritise their actions, assess their financial needs, assign roles and responsibilities among their stakeholders and overcome their constraints towards implementation of NEP-2020. Action plan for its future implementation may include the introduction of new-age innovative programs, as well as dual degree programs, with an aim to expand the horizon of opportunities in higher education, extension and research. Further the provisions of the policy relating to examination and evaluation system need to be fully implemented that seek to revolutionise the assessment process by ensuring regular, formative and competency-based assessments that focus on skill development of students, testing their higher-order thinking and conceptual clarity. In nutshell, NEP-2020 is a testament of India’s commitment to provide quality education to all and shaping a generation of empowered individuals ready to lead India's journey towards progress and development. We all need to contribute our bit towards its effective implementation. 

(Author teaches at the University of Kashmir. Views expressed are author’s own and not necessarily of the institution that he works for)

Multiple dimensions of drug abuse Part-V Administrative and Regulatory Dimensions

There is need to convert evidence-based data into robust policy and practice and thereafter take concrete action for simultaneous supply, demand and harm reduction due to drug abuse 

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 aspects 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 was a historic milestone and an important step towards curbing this menace. This policy needs to be implemented in letter and spirit, constantly monitored for its effectiveness and regularly reviewed and revised for making necessary amendments from time to time with a view to make it even more effective, focused, productive and goal-oriented policy. 

Generate credible evidence through research 

First step towards fighting the menace of substance abuse in our society has to be the generation of credible, scientific evidence about the incidence, prevalence, epidemiology, mortality and morbidity related to this problem through context-specific and need-based research. We need to have accurate statistics for chalking out our combat strategies and planning our prevention, de-addiction and rehabilitation programmes well. 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. Further by interviewing drug abuse victims in large numbers we can generate credible scientific evidence regarding causative factors, pathways of propagation, motivational factors, abuse practices, persistence, withdrawal and recovery from drug abuse that would be of immense help in devising mitigation measures and undertaking policy revision for its future implementation. 

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 and the fact that more than four years have passed since the policy was devised and promulgated. A meticulous procedure for persistent monitoring and evaluation laid out in the policy document per se needs to be utilized for its periodic review. Need for a revision and review of the policy also arises from the fact that over a period of just three years between 2016 and 2019 a startling 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), Srinagar. 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 found to be the most widely used opioid drug (GK dt. June, 26, 2020). 

Translate policy into action 

In our part of the globe a historical fact has been that our policies usually remain confined to paper and are not fully implemented well in time as was the case with our premier drug (medicine) 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. An online, real-time dashboard showing progress made in the implementation of various policy provisions must be made mandatory for every policy notified by the govt. 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 indicators for achievement of various targets, fixed timelines, 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. 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. Special courts need to be set up for hearing drug related cases on a fast-track basis and deterrent punishments and penalties need to be awarded by the courts to all the convicts of illicit drug trafficking. Further there is need for the establishment of a “Directorate of Drug Abuse Control, De-addiction and Rehabilitation” as an overarching umbrella organization which would comprise of representatives from the departments of Health, Education, Excise, Agriculture, Sports, Employment, Intelligence and Police. This directorate can have people deputed from above mentioned departments on full-time basis who will work and lend full support in achieving its objectives. It shall function in consonance as well as in compliance with the laws, statutes, rules and regulations in vogue at present. 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 substance 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 overall living and working conditions of the people besides healthy and drug-free environment at schools and work places. It also aims 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 re-integrating 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 substance use disorder. Proposed Directorate of Drug Abuse Control, De-addiction and Rehabilitation can take adequate preventive, curative, educative, control and rehabilitative measures simultaneously to tackle the menace of drug abuse in the society (concluded). 

(Author teaches at the Department of Pharmaceutical Sciences, University of Kashmir and holds the additional charge of Director, Centre for Career Planning and Counselling of the University)

Multiple dimensions of drug abuse Part-IV: Demographic and Geographic Dimensions

 Government of India has in recent times launched a massive crackdown on supply channels of illicit drugs and come down heavily upon traffickers showing zero tolerance and according severe punishments to those found involved in the trade

Vulnerability of the entire country in general and J&K in particular in serving as a transit route and consequent hotspot of narcotics drugs and psychotropic substances becomes evident from the fact that our country is sandwiched between the golden crescent nations including Iran, Pakistan and Afghanistan and golden triangle countries like Myanmar, Thailand and Vietnam, that have historically been the hubs of opium cultivation since ages. Though India had been used as a transit route by the drug traffickers since a long time, till recent times it had itself remained untouched by this scourge but not so any more. Now as a result of the rising greed of the peddlers unfortunately it has transformed from a transit route to a destination for narcotics and illicit drugs though Govt. of India is countering this menace with an iron hand and taking all necessary measures to eradicate it from its roots. 

This menace is assuming dangerous and alarming proportions particularly in northern border states like Punjab, Haryana, Rajasthan and of late in the UT of J&K. Earlier Punjab was considered as No.1 state in drug addiction but as per the available figures it appears that J&K has replaced Punjab from the top slot now since we have more than 10 lakh drug abusers of whom more than 60000 are females as per a recent survey conducted by the National Drug Treatment Centre, Ghaziabad (NDDTC), AIIMS, New Delhi. Earlier drug abuse used to be considered a favourite pastime of uneducated people mostly belonging to lower segments of the society who would most often resort to the use of charas, bhang, ganja and sleeping pills but now there are no such class differences valid any more. At present, drug abusers belong to all age groups, all the genders, all segments of the society, diverse occupations, rural as well as urban dissent, employed as well as unemployed status, irrespective of their religious beliefs and ethnic origins. More than 90% of abusers now use injectable opioids like heroine and prescription drug abuse has now been largely replaced by heroin and cocaine. A sharp rise has also been witnessed in the number and quantum of seizures of hard drugs like Heroin, Cocaine, LSD (Lysergic acid diethylamide), MDMA (Methyl​enedioxy​methamphetamine), CBCS (codeine-based cough syrups), other amphetamine like stimulants, by the Narcotics Control Bureau of India (NCBI) and that too of the drugs in their injectable form. Drug and Food Control Organization of J&K too has in a series of raids conducted in recent times on transport and courier agencies, hotels, shops etc seized large quantities of tapentadol, spasmo-proxyvon, tramadol, codeine and other prescription drugs worth lakhs of rupees. 

As per the National Survey on Extent and Pattern of Substance Use in India conducted by the Ministry of Social Justice and Empowerment through National Drug Dependence Treatment Centre (NDDTC) of All India Institute of Medical Sciences (AIIMS) New Delhi there are nearly 10 lakh drug addicts in Jammu and Kashmir that includes 108000 male and 36000 female Cannabis addicts whereas 534000 males and 8000 females are addicted to Opioids and 160000 males and 8000 females are using sedatives of different kinds. During this survey 127000 males and 7000 females were found using inhalants and a large number of males and females were addicts of Cocaine, Amphetamine-Type Stimulants (ATS) and Hallucinogens in Jammu and Kashmir (Ref: Report of the Ministry of Social Justice and Empowerment, Govt. of India, 2019). Further the Ministry in reply to a question in the parliament has reported that out of 46 Addiction Treatment Facilities (ATFs)  established in in the government hospitals across the country, 10 are running in the UT of J&K; out of 340 of Integrated Rehabilitation Centres (IRCs) established for drug addicts, that provide treatments and supportive services like preventive education, awareness generation, motivational counselling, detoxification/de-addiction, after care and re-integration into the social mainstream to the drug abuse victims, one is running in J&K. Similarly, out of 40 Community-based Peer-led-Intervention (CPLI) Centres that focus on vulnerable and at-risk children and adolescents and engage such children through peer educators for awareness generation and life skill activities, two are running in J&K. These important centres definitely need to be augmented in J&K in future. 

Additionally, there are three Outreach-and-Drop-in Centres (ODICs) in J&K out of 71 such centres established by the Ministry across India to provide safe and secure space of treatment and rehabilitation for substance users with provision of screening, assessment and counselling and thereafter provide referral and linkage to treatment and rehabilitation services for substance abuse. Govt. of India also supports setting up of District De-addiction Centres (DDACs) in those districts across the country where there are no IRCA, ODIC and CPLI centres. At present, 15 DDACs are supported by the Ministry out of which there are five in Jammu and Kashmir. Ministry of Home Affairs, in reply to a question regarding menace of narcotics, informed the Lok Sabha that Narcotics Control Bureau (NCB) has destroyed poppy on 288 acres of land in J&K in 2018, 1123 acres in 2019, 893 acres in 2020, 292 acres in 2021 and 88 acres in 2020. Official figures reveal that the govt. actions related to destruction of cultivated cannabis have shown an upward trend from the year 2018 when cannabis was destroyed on 37 acres of land followed by 295 acres in 2020, 523 acres in 2021 and 443 acres in 2022. 

In a very frightening and dangerous turn of events govt. drug de-addiction centre established at the SMHS hospital has reportedly registered a 945 per cent increase in patients since 2016-2017. While a total of 489 patients visited its OPD between April 2016 and March 2017, 3622 visited in the next 12 months, and 5113 patients in the 12 months after that, thus showing a whopping 1000% increase in the number of patients within a short span of three years. Between April and June 2019, as many as 1095 more patients have visited this facility. Same is the case with the total number of drug addicts admitted to the centre. From 116 patients in 2014, the number has risen every subsequent year — 203 in 2015, 207 in 2016, 374 in 2017 and 624 in 2018. All these figures present a very grim scenario that must serve as an alarm enough to wake up all sections and stakeholders of the society from their deep slumber, put their hearts and minds together and evolve an effective and fool-proof mechanism to curb this menace. Since the problem is multi-dimensional, a multi-pronged approach alone can be of help in extinguishing the blazing fire. While chairing a Regional Conference on "Drug Trafficking and National Security" in New Delhi on July 17, 2023, Union Home Minister Sh. Amit Shah jee declared that more than ten lakh kilograms of narcotic drugs worth around 12000 crore rupees have been destroyed by the Narcotics Control Bureau in a single year in various parts of the country in coordination with ANTFs of all states and announced that in order to realise the dream of a drug-free India, the drug destruction campaign will continue actively in future too. Drugs destroyed also include 356 kilograms destroyed by Jammu branch of NCB (ANI News dt. July 17, 2023). This shows the firm resolve of the Govt. of India to eradicate this menace in coming years. 

So far as the economics behind this menace are concerned, as per a study conducted by the Institute of Mental Health and Neurosciences (IMHANS), GMC, Srinagar, entitled, “Prevalence and Pattern of Substance Use in 10 districts of Kashmir: A 2022 survey” heroin worth Rs. 9 lakhs, Cannabis worth Rs. 1 lakh and pharmaceutical opioids worth Rs 1.30 lakh are being consumed in Kashmir every month. IMHANS data also reveals that in the year 2022 alone 41,110 people sought treatment for substance abuse in Kashmir which is double the number of people who sought treatment in 2021 (23,403) and it was found that heroin addicts on an average spend Rs. 88,000 per month on this drug in Kashmir which implies that almost a million rupees are spent by each addict every month on heroin (GK dt. July 7, 2023). By those standards drug industry appears to be a multi-million industry in J&K. This study has also estimated the economic burden of heroin abuse in the two districts of Srinagar and Anantnag based on prevalence and extrapolation findings. “The expenditure on consumption of opioids in two districts of Srinagar and Anantnag is Rs 3,74,90,329," notes the study (Deccan Herald dt. June 6, 2021). Therefore, in view of the seizure of large quantities of psychotropic substances by DFCO in J&K and of narcotic drugs by Narcotics Control Bureau of India countrywide in the recent past, a massive crackdown on supply channels of illicit drugs and substances of abuse seems to be inevitable and indispensable under the given circumstances. Govt. of India has in recent times come down heavily upon traffickers and traders of narcotic drugs, showing zero tolerance to such heinous acts and has also accorded severe punishments to those found involved in the illicit trade. Such hard hitting campaigns need to be continued on regular basis in future with greater speed and frequency (to be concluded).

Multiple dimensions of drug abuse Part-III: Biological and Medical Dimensions

We need to fully understand the neurobiology behind drug abuse as well as its types, signs and symptoms, risk factors, health hazards and treatments in order to manage it well

After having discussed some of the psycho-social and religious dimensions in the previous two parts of this article series, it is time to discuss important biological and medical factors governing drug abuse. 

Biological Dimensions 

In order to understand the neurobiology behind drug abuse we need to understand the role of chemical substances released inside our brain called neurotransmitters namely Dopamine and Serotonin. They are the chemical substances or neurotransmitters synthesized and released in the basal ganglia and limbic system of our brain that are responsible for regulating our pain and pleasure pathways. Every time these chemical substances are released by the nerve cells almost 80 percent of the substance released is reabsorbed back by the same neuron that releases it and only 20 percent interacts with the receptors and elicits a biological response. After interacting with their receptors these neurotransmitters are metabolized or degraded by enzymes. However, drugs like Cocaine and Heroine inhibit this reabsorption by blocking the neuronal transport system and constantly maintain a high concentration of Dopamine and Serotonin at the nerve junction called synapse whereas they should have been ideally stored back in their neuronal storage vesicles inside the neuron. This explains the neurobiology behind a constant craving for the drug because the moment drug intake is stopped by the abusers, brain feels deprived of the pleasure due to falling levels of dopamine or serotonin at the synapse and evokes a withdrawal syndrome that is manifested by a host of physical and psychological symptoms like body ache, shivering, muscle cramps, lethargy, sweating, vomiting, diarrhoea, palpitations, restlessness and immense discomfort. That is how these substances of abuse hijack the dopaminergic and serotonergic neurotransmission system by triggering a vicious cycle of drug intake-pleasure-drug deprivation-craving-motivation to take more drug-reward after intake in terms of pleasure and repetitive reinforcement of the cycle. This is what causes enslavement of abusers to these drugs who can’t live without consuming them and can go to any extent to procure and use them, leading to rise in criminal activities and anti-social behaviour of drug abusers. Therefore, there is need to make our budding generation aware about this brain hijacking process triggered by substances of abuse so that they remain aloof from them and do not fall prey to their slavery and dependence. And those who have already been entrapped and enslaved by them need to break their shackles of slavery and set themselves free from this scourge. 

Our youth need to know that there are better and smarter ways of pleasure seeking other than drugs and substances of abuse. Several research studies have suggested that protein-rich diet, exercise, sleep and sunlight have a direct impact on the structure and functioning of human brain and on the maintenance of sound mental health. Some of the foods like chicken, eggs, fish, soy products, soy milk, dairy products, nuts, seeds, pineapple etc increase serotonin levels in our brain and thereby promote mental health and improve our mood and behaviour. They also boost our immune system and keep us stress free. Serotonin is a feel-good neurotransmitter produced by nerve cells made from the essential amino-acid tryptophan. Tryptophan itself is important for brain function and plays an important role in sound sleep. We cannot synthesize tryptophan in our bodies, so we need to obtain it from our diet. However, tryptophan is found in many foods whereas serotonin is not. Therefore, eating a balanced diet rich in tryptophan is an essential way to support mental as well as physical health with positive benefits on energy levels, mood, behaviour and sleep. Sufficient secretion of serotonin inside our brain is a vital element for sound physical and mental health because the neurotransmitter has a significant impact on emotional well-being, mood stabilization and physical coordination. It is also important for good bone health, reduction of anxiety and depression, faster healing of wounds, healthy bowel habits and restful, rejuvenating sleep. Therefore, by opting for physical exercise, sound sleep of adequate duration, exposure to sunlight, intake of arginine rich protein diet like eggs, honey, nuts, bananas, spinach, seeds etc and meditation we can maintain our mental balance, stay calm and relieve ourselves of all sorts of stress, worries and anxieties. 

Medical Dimensions 

Medical dimensions of drug abuse include types and definitions of drugs, drug abuse, misuse, substances of abuse, dependence, addiction, epidemiology including incidence, prevalence, mortality and morbidity due to drug abuse, signs and symptoms, risk factors, diagnosis, treatment, prevention, complications, rehabilitation, individual and overall public health impact of drug abuse. It also includes aspects like access and affordability of drug de-addiction treatments and reintegration strategies including creation of livelihood generation opportunities for drug abuse victims. It goes without saying that the impact of drug abuse on the health and well-being of an individual is huge and can severely damage one’s lungs, liver, kidneys and cause acute cardiovascular, dermatological and gastrointestinal disorders besides badly affecting one’s immune system, orientation, memory, concentration and learning abilities. Withdrawal or abstinence syndrome, that is caused when the drug abuse is abruptly stopped by the victim makes things even worse and therefore needs immediate de-addiction treatment. Some of these damages are permanent that cannot be reversed by any means and some have a lasting impact upon one’s physique, mental health, persona and character. Therefore, resorting to drugs is as good as committing suicide or leading to self-harm and destruction. It amounts to disabling, crippling and converting oneself into a vegetable and thereby confining oneself into darkness of drugs for no logical reason whatsoever. When one can use the bounties of Almighty Allah like a sound mind and a sound heart in a sound body for creative, productive, fruitful, constructive and progressive activities, there is no tangible reason why one would make them subservient to the slavery of drugs and destroy his career, reputation, public impression and entire life. 

Socio-economic impact of drug abuse is even worse than its medical and health impact because it not only cripples a person physically but financially, intellectually and emotionally too. They become outcasts in the society and are looked down upon by everyone though that is not justified. They are abhorred, discredited and renounced within their family as well as friend circles. Therefore, drug abusers pay a huge price for their momentary pleasure and temporary excitement. Some of them lose their jobs and businesses, other fail in their crucial examinations and some get divorced too. Therefore, timely deaddiction treatment is a must for those who have fallen prey to this menace following which they can be rescued, rehabilitated and brought back into the mainstream. For this to happen government needs to establish drug de-addiction and rehabilitation centres in every district as envisaged in the drug de-addiction policy of the UT. De-addiction treatments need to be made readily available, affordable and accessible at these de-addiction centres and livelihood generation opportunities need to be made available to them for sustaining themselves and their dependents. Drug abuse detection kits need to be made available and used at schools, colleges, highways for timely detection and deterrence against drug abuse. 

Both parents and teachers need to be well aware about the signs and symptoms as well as about the risk elevating factors of drug abuse that include easy availability of drugs and money, peer group pressure, emotional distress, performance pressure, eccentric personality traits, social seclusion and other unfavourable circumstances. They need to be alert about the changing habits, attitudes, behaviours and daily routines of their children and may occasionally snoop into their rooms to make sure there is nothing like razor blades, aluminium foils, insulin syringes, cigarettes, sniffing straw etc lying around in their rooms and belongings. Teachers too need to be vigilant about any sudden or gradual changes in the performance, responsiveness, attitudes and behaviours of their students and can report the same to their seniors, parents or counsellors and arrange a counselling session for them. While parents need to be cautious about the pocket money given to and spent by their wards because abundant pocket money and easy availability of drugs in their vicinity could make their children potential candidates for drug abuse, teachers too need to keep the students engaged in creative and recreational activities like sports, cultural and community-based group activities so that their energies and curiosities get channelized in the right direction. Government in turn needs to create adequate avenue of recreation and sports activities like indoor and outdoor stadia, youth clubs, gymnasia, wellness centres, swimming pools etc for the proper orientation, utilization and promotion of youth energy and talent. Last but not the least sufficient number of adequately trained and well qualified psychiatrists and clinical psychologists needs to be made available in every district and sub-district hospital and educational institution. 

(Author teaches at the Department of Pharmaceutical Sciences, University of Kashmir and holds the additional charge of Director, Centre for Career Planning and Counselling of the University)

Multiple dimensions of drug abuse Part-II: Psychological dimensions

Establishment of psychological-cum-career counselling cells in all educational institutions can help students overcome troubling emotions and disturbing thoughts besides helping them choose a right career at an appropriate time

Socio-economic, physical, emotional and mental stress produced by the ever-increasing needs, demands and challenges of the contemporary times push the populations in general and youth in particular towards uncertainty, insecurity, instability and fallibility. As a result, some of the budding youth studying in schools and colleges often tend to make mistakes and wrong decisions in absence of proper guidance and supervision. Under peer group pressure or due to lack of awareness they sometimes try to seek refuge in drugs and other substances of abuse and end up becoming addicts. Marking their entry into the dark world of substance abuse they begin with “experimentation” either under peer pressure or out of curiosity and eagerness to experience the temporary ‘excitement’. Then they switch over to “regular use” to continue with the artificial euphoria that lands them into “risky use or abuse” and finally they become physically and psychologically subservient to drug abuse and turn into full time “addicts or dependents”. Therefore, protecting adolescents from adversity at the right stage, promoting socio-emotional learning and psychological well-being, and ensuring access to mental health care are critical for their health and well-being during adolescence and adulthood. This underlines the need to have psychological counsellors at all educational institutions including schools, colleges and universities who can patiently listen to the youngsters, try to understand their mental health needs, offer them coping strategies for overcoming stress and other deviations from normal behaviour through professional psychological counselling. 

High school level marks the beginning of adolescence, a tumultuous and transformative phase in the lives of children. This is the time when they begin to have their own likes, dislikes, outlooks and perceptions about issues, people, ideologies and surroundings, develop their own perspectives and desire to take their own decisions. At this stage it becomes important to channelise their curiosity, enthusiasm and energy towards the right direction through proper guidance and mentoring, in absence of which they may seek refuge in drugs, substances of abuse, bad company, illegal activities and sometimes even fall prey to anti-social elements without realizing its ill effects on their career and future life. Furthermore, the parental pressure to perform well in the examinations, score a high percentage of marks, steer through cut-throat competitions and secure admissions in a reputed college or university are the prime concerns that they usually face. To make things worse, traditions of unfair comparisons and unhealthy competitions in the society besides undue expectations of parents put additional burdens on their feeble shoulders. Parents often fail to appreciate the unique personalities and hidden talents of their children and often force them to be a part of the rat race for medical and engineering admissions. All this often leads to immense pressure, frustration, anxiety and depression among the children. Under such circumstances a caring and empathetic psychological counsellor back at school can serve as a pro-social adult for such students who feel frustrated, helpless and rebellious and can adjust their behaviours, help them identify troubling emotions and thoughts besides teaching them develop coping mechanisms and counter strategies for the same using psychotherapy or talk therapy. Through psychotherapy they can help such students break the vicious cycle of repetitive negative beliefs and thoughts that are followed by perpetual negative feelings and emotions (obsession) and are then ensued by negative behaviour and actions (compulsion). They can help and train them when and how to divert their attention from negative to positive thoughts and feelings. Psychological counsellors can also counsel the parents of such children, rationalize, balance and align their behaviour and expectations in the right direction, thus helping the students get relieved from their unbearable burdens of unrealistic expectations. 

At college level, students feel quite exuberant with enthusiasm and energy. This is an enthralling and exhilarating phase that marks a new turn in the life of a student towards his future. Experience of the new place, new people, new classmates, new environment and a new life can sometimes be difficult for a few to handle particularly those with a shy and introvert kind of personality. New ambience could throw new challenges of social behaviour, networking, intermingling and forming new friendships and relations besides issues related to self-esteem for some students that in turn could cause stress, social anxiety, depression, abnormal behaviour and unusual thoughts. Therefore, a psychological counsellor could be a very helpful source of support for such students where they can get counselling regarding their career, courses, relationships, adapting to the new atmosphere and in tackling personal emotional and mental health issues. Such kind of psychological counselling could boost their morale and improve their performance in their chosen stream and help them overcome their inhibitions, constraints and limitations in their participation in extra-curricular activities like sports, music, fine arts, winter and summer camps, hiking, mountaineering, nature exploration etc. They can be counselled about social anxiety issues, substance abuse and day-to-day stress. Appropriate professional help could help them receive suitable medical and non-medical interventions wherever needed and thereby excel in their career without falling prey to anti-social and immoral activities. This way they will be well-equipped to handle such challenges and be mentally strong to face them upfront. 

Parents and other family members of the victims in particular have a very significant role to play in identifying potential abusers, developing a supportive and caring environment within the family, counseling and educating the abusers about the ill-effects of drug abuse, helping the abusers to return back to their normal life and get rid of the substances of abuse, while at the same time rehabilitating them and boosting their morale and confidence to start afresh as a normal human being capable of standing on their own feet and living an independent life. Parents need to be cautious about the pocket money given to and spent by their wards because abundant pocket money and easy availability of drugs in their vicinity could make their children potential candidates for drug abuse. Bad company and emotional insecurity or instability could only make the things worse for them. They need to be alert about the changing habits, attitudes, behaviours and routines of their children and occasionally snoop into their rooms to make sure there is nothing like razors, aluminium foils, insulin syringes, cigarettes lying around in their cupboards and bags. Teachers too need to be vigilant about any sudden or gradual changes in the performance, responsiveness, attitudes and behaviours of their students they can report the same to their seniors, parents or counsellors and arrange a counselling session for them. Teachers need to keep the students engaged in creative and recreational activities like sports, cultural and community-based group activities so that their energies and curiosities get channelized in the right direction. Moral and value-based education needs to be made an inevitable component of the curriculum so that the students do not go haywire.  

Adolescents who are suffering from any kind of personality or psychiatric disorders are particularly vulnerable to social exclusion, discrimination, stigma that in turn affects their readiness to seek help and exposes them further towards risk-taking behaviour, physical and mental illnesses. Suicide is the fourth leading cause of death worldwide among 15- to 19-year-old children. Therefore, the consequences of failing to address adolescent mental health conditions can extend to adulthood, impairing both physical and mental health and limiting their opportunities to lead fulfilling lives as adults. Physical, emotional and social changes, including exposure to poverty, abuse, or violence, can make adolescents vulnerable to mental health problems. Psychological counsellors at primary school level can identify and help children suffering from disorders like schizophrenia, anxiety and panic disorders, phobias, mood disorders like bipolar disorder, eating disorder, autism, obsessive-compulsive disorder, post-traumatic stress disorder, personality disorders or learning disabilities. Since parents are not medically trained to notice the symptoms and diagnose these disorders, barring a few of them who are doctors by profession, they often fail to identify these disorders and get timely medical intervention for the same, often leading to increasing severity and progressive complications with advancing age.  Availability of a psychological counsellor at school can ensure constant observation of kids through their class teachers leading to timely diagnosis and early treatment of psychological and personality disorders besides better outcomes of education. Therefore, all educational institutions must engage psychological counsellors to support students in managing their mental health and staying away from drugs and other substances of abuse. 

Quite often it has been observed that inability or failure to make a right career choice at an appropriate stage in life and landing into a career that is contrary to one’s liking leads to utter frustration among the budding youth and generates negatives thoughts, emotions and behaviours making them vulnerable to substance abuse and mental disorders. Therefore, making suitable professional career counselling facilities available at schools and colleges for the timely guidance of students can be of immense help in saving them from the quagmire of frustration, chaos and confusion in life. As such, apart from a psychological counsellor, all our educational institutions need to establish career counselling cells wherein services of professionally qualified and well-trained career counsellors can be made available for fulfilling the counselling needs of our students through psychometric testing and personality profiling. Establishment of career-cum-psychological counselling cells in all educational institutions could mark a good beginning towards immunising our society from the dreadful disease of drug abuse (To be continued). 

(Based on the excerpts from a talk delivered by the author on June 26: International Day Against Drug Abuse and Illicit Trafficking  at National Institute of Technology (NIT), Srinagar, organized by CAUSE and DSW, NIT, Srinagar. Author teaches at the Department of Pharmaceutical Sciences, University of Kashmir and holds the additional charge of Director, Centre for Career Planning and Counselling of the University)

Multiple dimensions of drug abuse Part-I: Social dimensions

 Substance use disorder is a multi-dimensional problem that can be tackled effectively by adopting multi-pronged strategies at different levels with active involvement of all stakeholders

Drug abuse, that is more appropriately termed as ‘Substance-Use-Disorder’ owing its derivation to the rising trend of abuse of multiple substances and volatile solvents apart from opioids and prescription drugs, is more of a bio-psycho-social disease or disorder than a self-inflicted affliction, with definite socio-politico-economic and medico-legal dimensions. Etiological or causative factors of this disease, that has of late assumed shape of a dreadful monster ready to swallow and engulf our budding youth and developing nation, too are a lot more complex and diverse than just emotional distress or pleasure-seeking yearning of abusers and so are its confounding and risk elevating factors. Therefore, this scourge needs to be viewed through all relevant prisms and perspectives and all its associated dimensions need to be studied well leading to a multi-pronged, multi-faceted and multi-dimensional strategy to tackle the menace effectively and decisively. Any half-hearted, superficial or unidimensional approach will simply be a waste of time, resources and energy yielding very little or no benefits in terms of curbing this menace. 

Since the problem is deep-rooted, its solution too demands an in-depth exploration and excavation for its conclusive extermination from the depths of our society. This article series seeks to discuss some of the multiple dimensions governing this malaise and multipronged strategies needed to effectively control the same. While first and second parts of this series will discuss psycho-social and religious dimensions; third part will dwell upon medico-legal and biological dimensions; fourth part will shed light upon geo-political and economic dimensions and finally fifth and last part of this series will deliberate upon administrative and regulatory dimensions of this menace. Focus will be on the problem as well as its solution. 

Social Dimensions 

The theme chosen by United Nations for this year’s International Day Against Drug Abuse and Illicit Trafficking on June 26^th was, “People first: Stop stigmatization and discrimination” that emphasized upon the need to treat victims of drug abuse with empathy while showing no sympathy for those indulging in illicit peddling and trafficking of drugs. It calls for an end to isolation, discrimination and dehumanization of drug abuse victims and giving them the much-needed opportunities for treatment, rehabilitation, livelihood generation and reintegration back into their respective communities since they too have their own human rights. United Nations Office on Drugs and Crime (UNODC) duly recognizes the importance of taking a people-centric approach with a focus on human rights, compassion, and evidence-based practices. 

While sharing and caring, mutual respect, longing and love, coherence and compassion have conventionally been the hallmarks of human relations, social relationships nowadays appear to be undergoing a rapid transition from a close-knit, coherent and intertwined social fabric to an isolated, fragmented and self-centric style of living. Mutual relations are perpetually getting overwhelmed by the rampant use of social media and electronic gadgets leaving little scope for frequent physical interactions, sharing, caring and complementary exchanges. Of late it appears that the intensity, intimacy and depth of bonding among relations is gradually dwindling due to a whole lot of inherent and overarching factors. All this is pushing our younger generation towards the edges and forcing them to explore new ways of social engagement, entertainment and living. Consequently, they are finding temporary and deceptive solace in drugs and substances of abuse and thereby ruining their entire life and future. They are falling prey to the peddlers and getting enslaved by the short-lived euphoria of drugs. 

Need of the hour is to help drug abuse victims break the shackles of slavery and set themselves free from this dangerous entrapment. We need to give victims of drug abuse their freedom to think, plan and decide for themselves within the supportive framework of a loving and caring family and community. Being judgmental about them sows the seeds of discord and hostility among them. One should neither look down upon them nor expect them to change themselves overnight. Accepting people as they are with all their flaws, shortcomings, limitations as well as powers and strengths is the key to a sustainable relationship. As a result of our fraying social fabric our youth are getting more and more isolated and feeling lonely with very limited opportunities of recreation and relaxation. We need to revert back to social engineering through community-based, peer-led interventions and change our age-old social practices, dogmas and stereotypes. We need to treat drug abuse as a disease and accordingly help the victims overcome its sphere of influence through appropriate social, medical, educational, administrative and regulatory interventions. 

Transition from joint to nuclear families and social seclusion practices have led to shattered community linkages. Supportive families are essential for raising socially, mentally and physically healthy and well-adjusted children and preventing later adolescent problems. Factors such as lack of security, trust and warmth in parent-child relationships, lack of structure in family life, inappropriate disciplining practices and insufficient limit-setting can render children at greater risk of isolation, problematic behaviours and subsequent substance abuse and mental health disorders. Therefore, family skills training programmes have been found to be effective in preventing many of these risky behaviours, including substance abuse. There is need to adopt innovative approaches to keep the drug threat at bay. Parents and other family members of the victims in particular have a very significant role to play in identifying potential abusers, developing a supportive and caring environment within the family, counseling and educating the abusers about the ill-effects of drug abuse, helping the abusers to return back to their normal life and get rid of the substances of abuse, while at the same time rehabilitating them and boosting their morale and confidence to start afresh as a normal human being capable of standing on their own feet and living an independent life. Parents need to be cautious about the pocket money given to and spent by their wards because abundant pocket money and easy availability of drugs in their vicinity could make their children potential candidates for drug abuse. Bad company and emotional insecurity or instability could only make the things worse for them. They need to be alert about the changing habits, attitudes, behaviours and routines of their children and occasionally snoop into their rooms to make sure there is nothing like razors, aluminium foils, insulin syringes, cigarettes lying around in their cupboards and bags. 

Other than parents, young adults spend most of their time with their teachers thus making them one of the important stakeholders in curbing the menace of drug abuse. Teachers can be of great help in detecting, identifying, counselling, hand-holding, supporting, encouraging, rehabilitating, remedying, mainstreaming and managing the young drug abusers attending their classes. Regular awareness and counselling programmes through outdoor camps, open air theatres, dramas, painting competitions, video displays, street plays etc need to be conducted by every school and college across the region against drug abuse in order to acquaint the students with the dangers and consequences of such addiction. Awareness about ill effects of drug abuse must be incorporated into the curriculum at all levels of education. Teachers too need to be acquainted well with the signs and symptoms of potential substance use disorder and in the event of any sudden or gradual changes in the performance, responsiveness, attitudes and behaviours of their students they can report the same to their seniors, parents or counsellors and arrange a counselling session for them. Teachers need to keep the students engaged in creative and recreational activities like sports, cultural and community-based group activities so that their energies and curiosities get channelized in the right direction. Moral and value-based education needs to be made an inevitable component of the curriculum so that the students do not go haywire. Modern day teacher has to be a friend, a philosopher, a guide, a counsellor, a mentor and sometimes a ‘caregiver’ too. ‘Care’ translates into interventions that are in the best educational, emotional and psychological interests of the students. As suggested by Deiro (1996), “Students value adults who value them”. Thus, students who are living in seemingly intolerable situations but have a pro-social adult outside their home environs who cares about them will adjust their behaviour to carefully safeguard that relationship. 

At the community level, constitution of block and district level monitoring and vigilance committees with active participation of police, traffic police, medical health officers, school and college teachers, principals, religious preachers, housing societies, Mohalla committees, drug control and excise officials can go a long way in not only creating awareness and preventing abuse but also in identifying magnitude of the problem in each locality and motivating the abusers towards return, reintegration and rehabilitation. Social engineering is of crucial importance in preventing drug addiction. Perpetual sermons through religious preachers during weekly religious congregations, mass prayers and gatherings can have a durable impact in discouraging drug abuse. In Islam use of alcohol as well as all kinds of intoxicants has been clearly prohibited in Holy Quran, Surah Al-Ma’idah [5:90-102], wherein substance abuse has been declared an act of Satan that takes a person away from success, freedom and welfare in life. Therefore, prohibition of drug abuse by all religions needs to be propagated and disseminated constantly to curb the menace. Religious beliefs have a strong influence upon individuals and therefore religious sermons by the respective heads can be highly effective in controlling the problem. Mohalla committees need to identify drug abusers in their own localities, counsel them and their parents, offer them all kinds of monetary, psychological and logistic support in rescuing the victims from the clutches of drug abuse and subsequently treating, reintegrating and rehabilitating them back into the mainstream. Constant monitoring, vigil and intervention at the locality level can prove to be highly effective in overcoming this scourge (To be continued). 

(Based on the excerpts from a talk delivered by the author on June 26: International Day Against Drug Abuse and Illicit Trafficking  at National Institute of Technology (NIT), Srinagar, organized by CAUSE and DSW, NIT, Srinagar. Author teaches at the Department of Pharmaceutical Sciences, University of Kashmir and holds the additional charge of Director, Centre for Career Planning and Counselling of the University)

Advent and the Rise of Evolutionary Medicine

Understanding diverse dimensions and facets of evolutionary medicine will lead to innovative approaches in disease detection and management through genome mapping and genetic engineering

Rapid technological advancements over the past few decades are leading to a deeper understanding of the etiology (causation) and pathophysiology (mechanisms) as well as therapeutics (treatment) of the disease. More we understand the phenomena responsible for the disease more we are led towards the evolutionary changes that have occurred in our genotype (complete set of genetic material of an organism) and phenotype (set of observable traits and characteristics of an organism) over centuries and millennia together. Nobel Laureate in Physiology or Medicine for the year 2022 Svante Paabo while sequencing ancestral human genome reported that the major genetic risk factor for severe COVID-19 has been inherited from our ancestors called Neanderthals and that some other sequences in the same genome also gave modern humans much needed protection against such viruses. Thus, the problem as well as the solution ostensibly lies in our genes. Perhaps all that we need to do is to explore our genome well in order to identify such risks and protective factors among our genes. If we succeed in doing that through modern technological tools like bio-informatics (application of tools of computation and analysis to the capture and interpretation of biological data), chemoinformatics (use of chemical information with computer and information science techniques in a range of descriptive and prescriptive problems), genomics, transcriptomics, proteomics and metabonomics, we shall be in a better position to control and overcome disease. Thereby the focus of disease control shall shift from treatment and curation to protection and prevention leading to an integrated and holistic disease management system.

Cancer is believed to strike obese and elderly people more than the young and small creatures. However, in spite of their large body size and greater life expectancy, elephants defy this logic and exhibit less than five percent mortality due to cancer as against twenty five percent mortality in humans. Well-known secret behind this cancer resistance is that they possess twenty copies of p53 gene alongwith their forty alleles as against only one copy and two alleles in humans. No wonder p53 gene is known as ‘guardian of the genome’ because it plays a crucial role in regulating the inherent repair mechanisms of the DNA and suppresses any unwanted and uncontrolled cell growth as a result of changes or mutations occurring in DNA with each cell division cycle. Cellular senescence is yet another evolutionary adaptation found among naked mole-rats that provides them an effective form of anticancer mechanism, prevents damaged cells from dividing in an uncontrolled and autonomous fashion and developing into cancer. Further they secrete a complex "super sugar" that stops cells from clumping together and forming tumours. Tasmanian devils or Sarcophilus harrisii are also inherently resistant to cancer. If scientists succeed in unravelling these evolutionary protective mechanisms and secrets against dreadful diseases like cancer and decipher the much needed genetic code for its resistance, humanity shall be able to tackle the same with greater ease and confidence. 

Similarly, Giraffes have exceptionally high blood pressure or hypertension because a giraffe has to pump blood hard enough towards its head that lies 2 to 3 metres above the level of its heart so as to overcome the huge hydrostatic pressure generated by the tall column of blood in its neck. However, surprisingly this high blood pressure in giraffes does not result in severe vascular lesions, nor does it lead to heart and kidney failure, whereas in humans, the same blood pressure could prove to be catastrophic and cause severe vascular damages. Internal walls of the blood vessels in the legs of giraffes are highly thickened to withstand the increased hydrostatic pressure and are uniquely adapted to overcome the potentially dangerous rise in blood pressure when a giraffe rapidly lowers its head down. It is believed that the adaptation through natural selection has provided it the requisite protective mechanism, because hypertension develops as soon as the giraffe stands up and erects its neck soon after birth. Thus, evolutionary adaptations and selections have been the nature’s way of protection against disease. 

Many other animal species too exhibit highly evolved resistance mechanisms and adaptations towards different forms of human pathologies and disease. For instance, Burmese pythons can withstand congestive heart failure; brown bear (Ursus arctos) is immune to type-2 diabetes mellitus, obesity, neurodegenerative diseases, osteoporosis and chronic kidney disease; brown bears, Greenland sharks, jellyfish, rockfish, turquoise killifish, ocean quahog and naked mole rats age very slowly whereas elephant seals are resistant to ischemic heart disease. Scientists from several reputed universities of the world are working on these evolutionary resistant mechanisms using pioneering bioinformatic modelling to investigate the possible molecular interactions between different genes in these animal species and find out the secrets to their intrinsic disease resistance. A deep understanding of evolutionary biology and evolutionary medicine can enhance the biological understanding of disease and lead us to a unique perspective on how evolution can affect human health and disease. Evolutionary medicine applies the principles of evolutionary biology to health and disease and integrates evolution with medicine. It is sometimes referred to as Darwinian Medicine that has significantly contributed to a greater understanding of topics paramount to human health including aging, reproductive health, immune function, infectious disease, cancer, behavioural disorders and mental health, microbiomes, veterinary medicine, inflammation and diet. Thus, a deeper understanding of immunology and molecular biology clubbed with genomics and artificial intelligence can immensely help us unravel the nature’s secrets behind causation as well as curation of disease. 

George Christopher Williams, an American evolutionary biologist was the first to apply evolutionary theory to health in the context of senescence. His 1957 paper entitled, “Pleiotropy, Natural Selection, and the Evolution of Senescence” is believed to be one of the most pioneering and influential works in 20th century evolutionary biology. "Evolutionary biology and the treatment of signs and symptoms of infectious disease", the paper published by Paul Ewald in 1980 and the paper of Williams and Nesse published in 1991 entitled, "The Dawn of Darwinian Medicine" were key developments in this field that led to the publication of another book entitled, “Why We Get Sick”. If humanity succeeds in decoding the secrets of risk elevation and protection for various diseases that are deeply embedded inside our genes, day will not be far when modern medicines will become redundant and might be largely replaced by gene editing techniques. Gene editing or genome engineering is a group of techniques that allows the scientists to change a living organism's DNA, thus allowing genetic material to be added, deleted, translocated or altered at specified locations in the genome. As on date, one of the biggest demerits of this technology is that the insertion of DNA into the host genome could lead to impairment or dysfunction of some other gene within that organism. The way we use grafting techniques in plants and grow flowers or fruits of different varieties on the same tree, genetic engineering or gene editing could also be used for adding a gene from one species to another organism from the same or different species to produce a particular desirable characteristic or trait. This technique is already being used in research and industry and applied to the development of cancer therapies, brewing yeasts, genetically modified plants and livestock and much more.

A comprehensive and systematic mapping of genomes across full diversity of life and species is direly required to identify animal cell, tissue, organ and gene model systems for understanding disease vulnerability, resistance, and counter-resistance that could lead to the development of novel and innovative therapeutic approaches for the treatment of disease. Dynamics of the evolutionary medicine could guide us towards novel clinical approaches that target the development of treatment resistance in cancers, lifestyle and degenerative disorders as well as antimicrobial resistance. The insight that many modern human pathologies like obesity result from mismatches between the ecologies in which we have evolved and our modern environments can have significant implications on public health policies, disease identification, prevention and treatment. Additionally evolutionary principles could also be used to understand and address various aspects of human behaviour that create impediments in biomedical innovation and public health like vaccine hesitancy (Ref: Natterson-Horowitz B, et al. The future of evolutionary medicine: sparking innovation in biomedicine and public health. Front Sci 2023;1:997136).

One of the biggest health challenges of contemporary times is antimicrobial resistance that is also believed to be a part of evolution and therefore by applying evolutionary insights to antimicrobial drug resistance we can spark transformational innovations that could be instrumental in saving human lives. An excellent example of such evolutionary approach could be the discovery of evolution-proof treatment regimens for HIV and tuberculosis. It is a well-known fact that antibiotics alter the biodiversity of microbial communities and the presence of many types of antimicrobial resistance genes in soil are affected by agricultural, livestock and other human activities. Detection of antimicrobial resistance genes (resistome) in bacteria isolated from soil and drain samples from distant lands has led to the inference that antimicrobial resistance is a part of evolution and therefore can be tackled through evolutionary biology and medicine alone. Therefore, there is need to explore all dimensions and facets of evolutionary medicine followed by their application in proper understanding of the etiology and pathogenesis of disease as well as their diagnosis, prevention, treatment and management in a proactive manner. With full mapping of human genome, transcriptome, proteome, metabolome as well as microbiome in addition to the advent of new age technologies like artificial intelligence, machine learning, data analytics, robotics, nanotechnology,  immunology, molecular biology, stem cell technology, gene therapy, computational biology, bio-informatics, cheminformatics, nuclear and bio-physics, cell culture and in-vitro fertilization, sophistication and modernization of disease and drug therapy management and patient care will become a reality soon.

(Author teaches at the Department of Pharmaceutical Sciences)