Drug addiction can be cured with counselling, behavioural therapies, medications and willing compliance of patient
They live in shadows on the edge of the cities and towns, sleeping in dark alleys strewn with discarded needles, waiting desperately till they are able to collect enough money for their next fix. The money does not come easy . Smuggled illegally by vendors driven by greed who prey on easy victims such as young boys, including, schoolchildren, the costs are high. They are well beyond the reach of the average addict, especially, after the government has declared an all out war against all narcotic drugs such as, heroin and cannabis, the two most popular drugs .
Yet, despite roping in law enforcement authorities and enlisting the help of international Drug enforcement bodies, our island continues to be flooded by illegal drugs, smuggled via the famed drug ring in fishing boats, inside suitcases, and inside their bodies.
Most youngsters become addicts by change through peer pressure, or falling victim to false claims of drugs that promise excellent performance at examinations . The danger is that once hooked, it is very difficult to let go, with the health of the victims deteriorating rapidly.
The Sunday Observer spoke toEmeritus Professor of Forensic Medicine and Toxicology, University of Colombo and former Chairman, National Dangerous Drugs Control Board, Professor Ravindra Fernando on the health impacts of ingesting drugs. how to detect a user early and treatment options available to them.
Excerpts...
Q. The Prime Minister recently charged that substance and addiction was the greatest threat against youth in Sri Lanka. Do you agree? Have you any statistics which could back up this claim?
A. Yes, I agree. Treatment data from rehabilitation centres and law enforcement records highlight that trend and prevalence of drug use among youth is increasing. According to our survey findings many young people initiate drug use, below 24 years of age.
For example, in 2016, arrests showed that over 11,500 persons arrested for cannabis were below 29 years and arrests for heroin showed that over 2,920 persons arrested were below 29 years.
Q. How were these statistics collected? At district level? Regional level? Provincial level? Do they reflect drug abuse at national level?
A. The Research Division of the National Dangerous Drugs Control Board (NDDCB) conduct and undertake research studies on the prevalence, aetiology and legal, medical, social, cultural and economic implications of the abuse of dangerous drugs as empowered by section 7 (f) of the NDDCB Act. The Board conducts research studies and prevalence surveys quarterly and bi annually covering the selected locations island-wide. The surveys and research studies were conducted at district, provincial and national level.
In addition, the NDDCB maintains an online database to collect information on drug related arrests and treatment. The Drug Abuse Monitoring System (DAMS) is a computerized information system, which collects information on persons arrested for drug offences and persons seeking treatment for drug abuse in the country. Information is collected from drug law enforcement agencies and drug treatment agencies on a monthly basis and the NDDCB produces reports quarterly and bi annually for policy making.
According to the reported data of DAMS database, there is an increasing trend in drug abuse among youth in Sri Lanka.
Q. What do they reveal in terms of new information regarding drug abuse among Sri Lankans island wide?
A. According to our findings there is a trend of abuse of pharmaceutical drugs. The drugs include tramadol, a pain killer.
According to data from research on current drug users, 72(7%) of persons used tablets and 16 of them used tablets daily. Of the tablet users 50 used pseudoephedrine, 39 used tramadol, 36 used morphine and 31 used diazepam.
Q. How many drug abusers in the country comprise 1) children? 2) youth? 3) older persons still in the prime of their lives? and 4) elderly?
A. Of the total drug users, 41% were between 26 – 35 years and 28% between 36 – 50 years. Of the heroin users, 39% were between 36 – 50 years, 38% between 26 – 35 years, and 15% between 19 – 25 years. The majority of the heroin users were between 36 – 50 years. According to our findings, 33% of the sample were tablet users and were between 26-35 years. Most of them used different types of tablets.
Q. What are the symptoms one has to watch out for in a drug abuser? How can parents recognize their child is on drugs? What are the signs?
A. There are several symptoms and signs of drug abuse.
They include:
- Dry mouth
- Constricted (small) pupils
- Sudden changes in behaviour or actions
- Disorientation
- Cycles of hyper alertness followed by suddenly nodding off
- Droopy appearance, as if extremities are heavy
- Vomiting
- Diarrhoea
- Muscle spasms
There can be behavioural changes. They are:
- Loss of motivation and apathy toward future goals
- Lack of interest in hobbies and favourite activities
- Lying or other deceptive behaviour
- Avoiding eye contact
- Ignoring the parents
- Like to be isolated
- Close association with peer groups
In addition, an unexplained need for cash, a drop in attendance at work or school, angry and violent behaviour, lying, a change in friends and hangouts, sleep at strange hours, missing important appointments, are some features you can observe in a drug abuser. They may have bloodshot eyes or enlarged pupils, sudden weight changes (gain or loss), tremors in the hands and slurred speech.
People with an addiction usually cannot stop taking the drug on their own. They want and need more. They might try to stop taking the drug and then feel really sick. Then they take the drug again to stop feeling sick. They keep using the drug even though it is causing terrible family, health, or legal problems. They need help to stop using drugs.
Q. How can they be treated and where? What kind of treatment options are available to drug abusers?
A. Drug abuse is a chronic disease characterized by compulsive, or uncontrollable, drug seeking and use, despite harmful consequences. It causes changes in the brain that can lead to the harmful behaviours, which can be long lasting.
Drug abuse is also a relapsing disease. ‘Relapse’ is the return to drug use after an attempt to stop.
Drug addiction can be treated, but it is not easy or simple. People cannot just stop using drugs for a few days and be cured. Most patients need long-term or repeated care to stop using drugs completely and recover their lives.
Principles of successful treatment include, detoxification (the process by which the body rids itself of a drug), behavioural counselling, medication (for opioid, tobacco, or alcohol addiction), evaluation and treatment for co-occurring mental health issues, such as, depression and anxiety, and long-term follow-up to prevent relapse.
Addiction treatment must help the person to stop using drugs, stay drug-free and be productive in the family, at work, and in society.
No single treatment is right for everyone. People need to have quick access to treatment. Effective treatment addresses all of the patient’s needs, not just his or her drug use. Staying in treatment long enough is critical.
Counselling and other behavioural therapies are the most commonly used forms of treatment. Medications for detoxification are sometimes required, especially, when combined with behavioural therapies.
There are drug treatment and rehabilitation services provided by government and non-governmental organizations in Sri Lanka. The NDDCB has four treatment and rehabilitation centres located in Thalangama, Nittambuwa, Peradeniya and Unawatuna, Galle. These treatment centres follow psychological treatment methods and services are provided free of charge.
In addition, two counselling centres of the NDDCB provide services for drug addicts and their families. These centres are at All Ceylon Buddhist Congress and Sri Lanka Maha Bodhi Society premises in Colombo.
Q. In his discussion with the Youth parliament, January 9, Prime Minister Ranil Wickremesinghe also charged that it was unfortunate that substance circulation has reached even the most rural areas in the country while targeting schoolchildren as well. In what districts do you see a spike in drug abuse in the country where schoolchildren are also victims?
A. According to the available data of drug abuse in Sri Lanka, identified high prevalence areas are as follows: Colombo, Kalutara, Kurunegala, Kandy, Galle, Anuradhapura and Ratnapura Districts.
But we do not have exact figures regarding the schoolchildren who are victims of drug abuse.
Q. What kind of drugs are most prevalent in the country?
A. Cannabis and heroin are the most prevalent types of drugs.
Q. What are the main causes that drive young people to take to drugs?
A. There are many factors which cause drug initiation. According to the information given by a sample of addicts, a majority of the persons initiated drugs use for the first time due to peer pressure and 50% of drug users started to use drugs for pleasure and entertainment. Within the sample, 39% started to use drugs for the first time due to curiosity and 11% started when they were in problematic situations.
Q. What are the health impacts of drugs on regular users?
A. Malnutrition is a common health impact. The addicts are also prone to get HIV/AIDS, hepatitis B and C, tuberculosis and other infectious diseases.
Q. Can they be rehabilitated? What are the current interventions to this end?
A. Yes, but it is not easy, because, addiction is a chronic disease, people cannot simply stop using drugs for a few days and be cured. Most patients need long-term or repeated care to stop using completely and recover their lives.
Addiction treatment must help the person do the following: stop using drugs, stay drug-free, be productive in the family, at work, and in society.
Medically assisted detoxification is only the first stage of treatment. Medications are sometimes an important part of treatment, especially, when combined with behaviural therapies. Treatment plans must be reviewed often and modified to fit the patient’s changing needs. Treatment should address other possible mental disorders. Treatment doesn’t need to be voluntary to be effective. Drug use during treatment must be monitored continuously. Treatment programs should test patients for HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as teach them about steps they can take to reduce their risk of these illnesses.
Medications help suppress withdrawal symptoms during detoxification. Detoxification is not in itself ‘treatment’, but only the first step in the process. Patients who do not receive any further treatment after detoxification usually resume their drug use. A study of treatment facilities found that medications were used in almost 80 percent of detoxifications.
Patients can use medications to help re-establish normal brain function and decrease cravings. Medications are available for treatment of opioid (heroin, prescribed pain relievers), tobacco (nicotine), and alcohol addiction. Scientists are developing other medications to treat stimulant (cocaine, methamphetamine) and cannabis (marijuana) addiction.
Q. Minister of Law and Order Sagala Ratnayaka speaking on the same issue, has reportedly said, new laws would soon be introduced against pharmaceutical drugs abuse, and that the Health Ministry, Justice Ministry and Law and Order Ministry were currently working on revising the existing laws. He also said, discussions had already been held on this matter and that in the next discussion it was possible to draft an amended bill on these laws. Your comments?
A.Yes, there are ongoing discussions I initiated several months ago to enact new legislation and change some to increase punishments and cover new psychoactive drugs coming to the market regularly.
The discussions are held with the Ministry of Health, Attorney General’s Department, Legal Draftsman’s Department, Police and the NDDCB.
Q. The Law and Order Minister also announced the establishment of the Organized Crime Prevention division and the Anti-Narcotics divisions to address the web of underworld gangs and drugs abuse. Do you think these two new divisions can bring down the level of drug abuse in the country?
A. Definitely.
Q. As a person who has been involved in the field of drug abuse for a long period, tell us about the latest inputs taken by the Health Ministry and your division to prevent drug abuse in the country, especially targeting new users?
A. The NDDCB conducts preventive education programs in all districts that target new users.
Q. What are the gaps you see in the existing system, especially, in the field of health impacts of drugs on the human body? Do you think there is enough information about this among young people who are likely candidates to drugs use and often fall prey to drug vendors selling various drugs on false claims when they are about to sit an examination?
A. We need more educational programs to cover all parts of the country.
Q. Do you have any suggestions on how young people can be made more aware about drugs while still in school? Should there be a curriculum revision where this could be a separate subject for older students about to leave school?
A. Awareness creation in schools should be done carefully. It should increase curiosity among students.
Q. Do you think President Maithripala Sirisena’s wish to make Sri Lanka a drug free country and establish drug free zones island wide could become a reality, given the high number of drug abusers in the country in spite of reduced numbers due to state intervention?
A. The President has stressed that all must unite with commitment to face the challenge of creating a drug-free Sri Lanka. He has pointed out that we must always attempt to do the difficult tasks rather than doing easy undertakings. He has said, the aim of the Government is to strengthen relevant existing laws regarding drugs.
Q. Your advice to parents, schoolchildren and teachers on the health impacts of drug abuse in a nutshell?
A. Always prevention is better than cure. Parents must look after the children so that they will not get into drug use. Children must never try drugs, whatever the pressure they face. Teachers must be aware of the potential drug problems in the schools.
Q. Your message to the public at large?
A. Help in all possible ways to get the country rid of the drug menace.