A countrywide public awareness campaign got underway recently to realise President Maithripala Sirisena’s concept Mathin Hnidahas Ratak (A country free of narcotic drugs). The President’s declaration of war against the country’s drugs mafia, and the targeting of students in government schools to raise awareness and carry the message of the dangers of drugs to the public, has been hailed as a step forward. The Sunday Observer spoke to Emeritus Prof of Forensic Medicine and Toxicology, University of Colombo, and Senior Prof of Forensic Medicine, General Sir John Kotelawala Defence University, and former Chairman of the National Dangerous Drugs Control Board, Prof Ravindra Fernando, to give us more insight into this growing public health menace.
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Q. The National Drugs Eradication Week was recently launched by President Maithripala Sirisena followed by an innovative schools program which saw thousands of schoolchildren taking the drug eradication oath. The President was quoted as saying schoolchildren were the best messengers to take the drug eradication message to society and should thus be actively engaged in this program. Do you agree?
A. Yes, I agree that children can be the best messengers to take the drug eradication message to society, and they should be actively engaged within schools for this program.
Q. But these children are still immature, mentally and emotionally. Can they cope with this flood of new information on drugs? What is your experience on this?
A. It is important that information on drugs should be given to children carefully so that they can understand it without creating a curiosity to experiment with drugs. The programs should be well-planned and executed.
Q. The drug menace has been around for a long time in the country. At present how many officially reported drug addicts do we have countrywide?
A. As drug addiction is a process that happens secretly, it is difficult to estimate the exact number of addicts. The National Dangerous Drugs Control Board estimates that there are about 50,000 heroin addicts and 200,000 cannabis (Ganja) addicts in Sri Lanka. However, some institutions and individuals believe the actual number is much higher. Cannabis or ganja is the most commonly used narcotic in Sri Lanka.
The Poisons, Opium and Dangerous Drugs Ordinance of 1935 criminalized cannabis. An amendment in the law allowed ayurvedic physicians to obtain opium and cannabis for the manufacture of their medicinal preparations.
The Ayurvedic Drugs Corporation (Ministry of Health) is the only legal source for cannabis in the island, and it mostly obtains the drug from police raids on illegal shipments. The only practitioners who are legally allowed to sell the drug are Ayurvedic physicians. It is estimated that there are around 16,000 Ayurvedic practitioners.
Heroin addiction is a new phenomenon in Sri Lanka. The records of the University Psychiatry Unit, Colombo, showed that the first two Sri Lankans for heroin addiction were hospitalized in the Unit in 1982.
Other drugs abused are Ecstasy or methamphetamine, which is known as a ‘disco drug’ or ‘party drug’ and cocaine.
Q. ‘Death penalty for drug traffickers’ - will it solve the issue?
A. No. I do not think death penalty will solve the issue. As of today, 142 countries have abolished the death penalty in law or practice. Sri Lanka carried out its last execution in 1976. There is no evidence that death penalty has a deterrent effect on crime.
Sri Lanka has been a leader in the region, with an enviable record of shunning this cruel and inhuman punishment at a time when many other countries persisted with it.
Q. How does substance abuse affect the human body?
A. Different drugs affect the body in different ways. In addition to heroin, cannabis, amphetamine and cocaine, other drugs or substances that affect the body include alcohol, barbiturates, hallucinogens like LSD, and drugs like benzodiazepines and tobacco products. For example, heroin causes a sense of well being, euphoria, contentment, detachment from emotional or physical distress and pain relief.
Q. Do these impacts vary from person to person as well as other factors?
A. Yes, some of the effects vary from person to person.
Q. If taken over a long period what are the health consequences?
A. Health effects also depend on the drug. For example, cannabis causes impaired performance, sleepiness, confusion and hallucinations.
Heroin causes drowsiness, lack of concentration, respiratory depression and even death. It causes euphoria and alertness and postpones hunger and fatigue.
Loss of appetite, violent behaviour, hallucinations and paranoid psychosis are the harmful effects of cocaine. It increases the temperature, heart rate and blood pressure.
Cocaine abuse leads to fits, heart muscle disease, coronary artery disease, liver disease, brain hemorrhages and sudden cardiac death.
Q. Are they permanent? Or can they be reversed?
A. Some health consequences improve if a person stops taking a drug.
Q. What about pregnant women who smoke, drink and take drugs? Can this affect the foetus they are carrying?
A. Yes, definitely. For example, ‘Fetal alcohol syndrome’ is a condition in a child that results from heavy alcohol exposure during the mother’s pregnancy. It causes brain damage and growth problems.
The problems vary from child to child, but defects caused by fetal alcohol syndrome are not reversible. There is no amount of alcohol that’s known to be safe to consume during pregnancy. If a mother drinks during pregnancy, she places her baby at risk of fetal alcohol syndrome.
The child will have poor coordination or balance, intellectual disability, learning disorders, delayed development, poor memory, trouble with attention and rapidly changing moods
Q. If treated early can a drug addict be cured completely?
A. Yes, but with difficulty.
Q. Initial symptoms to look out for in someone taking narcotics?
A. Sometimes it is difficult to distinguish normal teenage moodiness or behaviour from signs of drug use. Possible indications include, problems at school or work, such as frequently missing school or work, a sudden disinterest in school activities or work, or a drop in grades or work performance.
There can be lack of energy and motivation, weight loss or gain, red eyes, lack of interest in clothing, grooming or looks, efforts to bar family members from entering his or her room or being secretive about where he or she goes with friends; or drastic changes in behaviour and in relationships with family and friends, sudden requests for money without a reasonable explanation or discovery that money is missing or has been stolen or that items have disappeared from home, indicating that they are being sold to support drug use.
Q. Age of high risk groups?
A. Teenagers and young adults.
Q. How are drug abusers usually treated?
A. Treatment is difficult. Detoxification is normally the first step in treatment. This involves clearing the abused drug from the body and limiting withdrawal reactions. In many cases, a treatment clinic will use medications to reduce unpleasant withdrawal symptoms. If a person is addicted to more than one substance, they would often need medications to reduce withdrawal symptoms for each one.
Counselling and behavioural therapies are the next step. Therapy might be one-to-one or a group session. It is usually intensive at the outset of treatment with the number of sessions gradually reducing over time as symptoms improve.
Q. Are there adverse side effects from this treatment? If so what are they?
A. There are no adverse effects.
Q If the addict is suffering from a pre-existing illness at the time he is being treated can it compound his health issues?
A. Yes. Drug addicts can suffer from malnutrition and infections which need specific therapy.
Q. I understand rehabilitation is part of the treatment program. What is involved in this procedure?
A. Counselling and behavioural therapies are useful for the rehabilitation of a drug addict.
Q. Cannabis is now being grown legally in certain parts of the US and some Western countries. What are the side effects of medicinal cannabis?
A. Medicinal cannabis used in Ayurveda has no harmful effects. However, Marijuana has both short-and long-term effects on the brain. Short-term effects include altered senses, changes in mood, difficulty in thinking and problem-solving, impaired memory, hallucinations and delusions.
Functional and structural changes in the brains of marijuana smokers have been demonstrated.
For example, adults who smoked marijuana regularly during adolescence have decreased functional connectivity in brain regions important for learning, memory, executive functioning, and processing of habits and routines, which might be responsible for impairments such as lowered IQ.
Cannabis affects brain development. Regular cannabis use, particularly, when started in adolescence, is associated with addiction, lasting cognitive impairment (e.g., lower IQ), poor educational outcome, diminished life satisfaction and achievement, and increased risk of psychotic disorders.
Q. Your message to parents and teachers of schoolchildren?
A. Make children aware of the harmful effects of addictive drugs. Advise them not to experiment with them so as to protect themselves from adverse health impacts.