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)
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