essay on drugs in punjab

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• Indian J Med Res
• v.149(4); 2019 Apr

Prevalence of substance use disorders in Punjab: Findings from National Mental Health Survey

B.s. chavan.

1 Department of Psychiatry, Government Medical College & Hospital, Chandigarh, India

3 Department of Psychiatry, Government Medical College & Rajindra Hospital, Patiala, India

Subhash Das

2 Department of Community Medicine, Government Medical College & Hospital, Chandigarh, India

Arvind Anniappan Banavaram

4 Department of Epidemiology, Centre for Public Health, National Institute of Mental Health & Neuro Sciences, Bengaluru, India

Background & objectives:

Substance use disorders are a major public health concern in Punjab. However, reliable estimates of prevalence of substance use disorders are not available for the State. The present study reports estimates of prevalence of substance use disorders in Punjab, conducted as part of National Mental Health Survey, India.

Using multistage stratified random cluster sampling, 2895 individuals from 719 households of 60 clusters (from 4 districts of Punjab) were interviewed. Mini International Neuropsychiatric Interview and Fagerstrom nicotine dependence scale were used to assess substance use disorders.

The sample comprised almost equal numbers of males and females. Nearly 80 per cent had less than or equal to high school education, and 70 per cent were married. The weighted prevalence of alcohol and other substance use disorders was 7.9 and 2.48 per cent, respectively. The prevalence of tobacco dependence was 5.5 per cent; 35 per cent households had one person with substance use disorder. The prevalence was highest in the productive age group (30-39 yr), urban metro and less educated persons. The prevalence of alcohol and other substance use disorders was much higher in Punjab as compared to other States where survey was done. Tobacco dependence was lowest in Punjab. Majority (87%) of the persons with substance use disorders did not suffer from any other mental disorder. Treatment gap was 80 per cent.

Interpretation & conclusions:

Punjab has a high burden of substance use disorders. The estimates will help clinicians and policymakers to plan the strategies against the menace of substance use disorders effectively.

Globally, alcohol use was the 7 th leading risk factor for deaths and disability adjusted life years (DALYs) in 2016, accounting for 2.2 per cent and 6.8 per cent of age standardized female and male deaths, respectively 1 . According to the WHO, 2.1 per cent persons in India above 15 yr have alcohol dependence (3.8% among males and 0.4% among females) 2 . Substance use disorders cause tremendous burden on the individual, family and community as a whole. These have become a major public health concern in Punjab (a north Indian State), and the situation is likely to worsen in the absence of appropriate interventions 3 .

Reliable estimates of prevalence of substance use disorders are not available for Punjab. A previous survey rated Punjab as a region with high opiate use 4 . In the last three decades, several studies on the prevalence of substance use have been carried out in Punjab 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 . However, the majority of these studies had methodological limitations in terms of that these were carried out at single site 7 , 13 , single district 8 , 12 , 13 or only in border villages 6 , 9 , 10 . These studies differ in terms of sample sizes, methodology, case definition and screening/diagnostic instrument used which inhibit extrapolation of their results to other States 5 , 6 , 7 , 8 , 9 , 10 , 11 . As part of National Family Health Survey in Punjab, information on alcohol and tobacco use is available. However, data on their harmful use/dependence and other substances of abuse are not available 14 .

Studies on the prevalence of substance use disorders are lacking at the national level also 15 . An earlier meta-analysis of 13 epidemiological studies reported that only five studies assessed alcohol/drug addiction and the prevalence of alcohol/drug addiction was 6.9 per cent 16 . Only a few studies have been conducted in other parts of India 17 , 18 , 19 , 20 . However, findings from other States cannot be generalized to Punjab because substance use is affected by multiple socio-cultural and environmental factors, which are important in initiation, maintenance and treatment of substance use disorders. The present survey was a part of the National Mental Health Survey (NMHS) 21 , 22 conducted in 12 States of India including Punjab. The major aim was to obtain estimates of prevalence of mental and substance use disorders and provide information to plan and develop mental health services.

Material & Methods

This study was conducted by the department of Psychiatry, Government Medical College and Hospital (GMCH), Chandigarh, and coordinated by National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India. This multisite cross-sectional study was conducted in four randomly selected districts of the State during October 2015 - March 2016. Since the survey in Punjab was part of the NMHS, the sample size for the State was calculated by the coordinating centre (NIMHANS) based on the results of the pilot study conducted in Kolar district of Karnataka 21 , 22 . Consequently, at the prevalence rate of any mental morbidity of 7.5 per cent, absolute precision of two per cent, 95 per cent confidence level, design effect of three and non-response rate of 30 per cent, the estimated sample size was 2857 rounded off to 3000.

The study was approved by the Institutional Ethics Committee of NIMHANS, Bengaluru (the coordinating centre for NMHS), and further by the ethics committee of GMCH, Chandigarh (responsible for conducting the survey in Punjab). The details of the survey procedure were explained to all the participants before the interview. Written informed consent was obtained from each interviewed individual.

Study design : The overall study design ( Fig. 1 ) was multistage, stratified, random cluster sampling technique with random selection based on probability proportion to size at each stage. To have representative sample, the number of clusters chosen was in proportion to rural, urban metro and urban non-metro population in the State as per the Census 2011 23 . The districts, community development blocks and households were the primary, secondary and final sampling units, respectively. Individuals within the identified households were the units of analysis. Since there is a close relation of mental disorders with socio-economic status, all the districts of Punjab were stratified on the basis of district-level poverty estimates into three strata. One district was randomly selected from each stratum, and two community development blocks/ taluks were selected from each district. From each tehsil/taluk , nine clusters (6 rural and 3 urban non-metro) were randomly selected. The three districts randomly selected using this technique were Faridkot, Moga and Patiala. Since there was no urban metro area within the selected districts, six urban metro clusters were selected from Ludhiana. Within the clusters, households were selected by systematic random sampling following random selection of the first household.

Study design for National Mental Health Survey (NMHS) in Punjab.

In addition to the household survey, exploratory focussed group discussions (FGDs) were conducted to understand the community perceptions regarding substance use disorders. Five FGDs each were conducted among general public and healthcare professionals in the community.

Selection of respondents : After locating the household for survey, a responsible respondent (a responsible respondent was an adult of the household, preferably but not necessarily head of the household who was aware of all the other members) was identified and a list of all members was made. All members above 18 yr were eligible and needed to be interviewed in each family. When the eligible respondent was available, interview was conducted. In case an individual was not available, two more visits were planned. The individual was declared as a non-responder if he/she was not available even after three visits.

Exclusion criteria : Family members staying away from the household due to any reason were excluded. Abandoned non-residential buildings, uninhabited houses, commercial establishments, temporary settlements, hostels and postgraduate accommodations were also excluded. Refusal to give consent and be interviewed was other exclusion criteria.

Study instruments

General information and socio-demographic details : The socio-demographic information (relation to the head of family, age, gender, education, occupation, income and marital status) of each family member was collected. Cluster type (rural, urban, urban-metro) and income of the family were also recorded.

Mini International Neuropsychiatric Interview version 6 (MINI) : Mini International Neuropsychiatric Interview version 6 (MINI) 24 is a structured diagnostic interview schedule for screening and diagnosing mental disorders. It comprises closed-ended questions and provides International Classification of Diseases-10 (ICD-10) compatible diagnosis of mental illnesses and substance use disorders (dependence and harmful use) with reference to alcohol and illicit drugs. MINI does not assess current or ever use of substances, and the focus is to identify individuals with substance use disorders who are in need of treatment interventions. Individuals who are either dependent or having harmful use of alcohol or illicit drugs (such as opioids, cannabinoids, sedatives, hypnotics, hallucinogens and solvents) are considered to have 'alcohol use disorder' or 'other substance use disorder', respectively. MINI does not include questions regarding tobacco use.

Fagerstrom nicotine dependence scale (FNDS) : The tool to assess tobacco dependence was an expansion and adaptation of Fagerstrom nicotine dependence scale (FNDS) 25 . All the questions of the scale and its scoring system were retained and were used to identify nicotine dependence among tobacco users (smoking and smokeless) 22 . A few questions were added to categorize tobacco users. Individuals found to have dependence on this scale were termed to have 'tobacco use disorder' which was further categorized as mild, moderate and significant dependence. The category of 'any substance use disorder' included individuals who were positive for either 'alcohol use disorder' or 'tobacco use disorder' or 'other substance use disorder'.

Treatment gap : The Pathways Interview Schedule of the WHO 26 was adapted for the survey to study health-seeking patterns and treatment gap. It was applied on persons identified to be suffering from substance use disorders on MINI and FNDS 21 . Treatment gap is defined as percentage of persons who have a disorder but are not taking treatment.

Translation of the instruments : All the study instruments were reviewed for their appropriateness and translated to Punjabi language. They were reviewed by the individual State collaborators and back-translated to English, checked for discrepancy in wording and phrases to ensure that the differences between the original and back-translated version were not significant. The study instruments were loaded onto handheld device (Dell Venue 8 Pro 5000 Series 32 GB Windows 8.1, Dell Inc., Texas, United States) and were subsequently used for data collection.

Quality assurance : The investigators from Punjab State team received four days of intensive training on various aspects of the survey from the coordinating centre (NIMHANS). The field data collectors (FDCs) were also extensively trained for two months before the data collection started.

A robust three-tier field-level, State-level and national-level monitoring mechanism was put in place for smooth conduct of the survey and for ensuring quality of the data collected. Field-level monitoring included daily monitoring by a field study coordinator. Weekly and monthly review meetings (over phone, on site, video conferencing) were conducted by the investigators to assess the quality of data collected and to provide refresher training as and when needed. Five per cent re-interviews were also conducted together by the study investigators and FDC supervisor, and Cohen's kappa was used to measure the reliability of diagnosis by measuring the agreement between the interviews and re-interviews. The overall agreement between the interviews and re-interviews was found to be fair (kappa 0.4). However, it must be noted here that this agreement was for overall mental morbidity and not exclusively for substance use disorder, and therefore, several factors such as variations in the time gap between interviews and re-interviews (it should be noted here that common mental disorders were more prevalent in the study population, and hence, time gap between interview and re-interview was important), nature and severity of the disorders under consideration, recall bias, problems with repeated interviewing (fatigability, loss of interest, forgetting, rumination bias) especially associated with mental health surveys influenced the kappa value.

Statistical analysis : The data collected by the State team were sent to the coordinating centre (NIMHANS) for error checks and cleaning the data. The final edited data set was used for analysis. The present survey employed multistage stratified random cluster sampling technique, and therefore, to increase the representativeness of the sample by neutralizing/adjusting the sampled data for unequal probabilities of selection and accommodating differential non-response rates, sampling weights were used. Design weights were calculated by considering the probability of selection of districts, taluks and the individual non-response rate. Data were summarized as frequencies and proportions. All estimates are presented with 95 per cent confidence intervals. Multiple logistic regression analysis was conducted to identify factors independently associated with substance use disorders. Data analysis was undertaken using the software package 'SPSS version 22' (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.USA).

The survey was carried out in 60 clusters where 3158 eligible members above 18 yr of age were enlisted, and of them, 2895 could be interviewed (response rate 91.7%) in 719 households (response rate 99.4%). Of the 2895 persons, there were 1464 (50.56%) males and 1431 (49.43%) females and more than 30 per cent respondents were between 18 and 29 yr of age. Nearly 60 per cent individuals were residing in the rural areas, 80 per cent had less than or equal to high school education and 70 per cent were married.

Of the 719 households interviewed, 34.91 per cent households (251 of 719) had at least one person suffering from any substance use disorder. The number of households with at least one person suffering from other substance use disorder, alcohol use disorder and tobacco use disorder was 63 (8.76%), 176 (24.47%) and 127 (17.66%), respectively.

The weighted prevalence of alcohol use disorders was 7.90 per cent and of other (illicit) substance use disorders was 2.48 per cent. The prevalence of tobacco use disorder was 5.50 per cent. The weighted prevalence of any substance use disorder (defined as an individual positive for either of the 3 categories) was 11.3 per cent ( Table I ). Among 7.9 per cent persons with alcohol use disorders, the prevalence of alcohol dependence was 4.8 per cent and harmful use was 3.1 per cent. Similarly, the prevalence of dependence to other (illicit) substances was 1.9 per cent and harmful use of other substances was 0.6 per cent. The prevalence of current tobacco use was 6.5 per cent and 2.0 per cent persons had significant dependence and 3.5 per cent had low-to-moderate dependence. The prevalence of any substance use disorders was much higher in Punjab as compared to the combined prevalence in all 12 States (4.65%) 21 . The prevalence of other (illicit) substance use disorders was highest in Punjab (weighted prevalence in all 12 States combined was 0.57%) while that of alcohol use disorders was second only to Madhya Pradesh (10.3%) 21 . The prevalence of tobacco use disorders was lowest in Punjab (weighted prevalence of all 12 States combined was 20.89%) and highest in Rajasthan (38.3%) 21 . The prevalence of alcohol use disorder was highest among persons aged 30-39 yr followed by persons aged 60 yr and above. The prevalence of other (illicit) substance use disorders was highest among persons aged 30-39 yr followed by 18-29 yr and lowest among persons aged more than 60 yr. Thus, age group of 30-39 yr (most productive age group) bore the maximum brunt of substance use disorders in Punjab ( Fig. 2 ). The prevalence of alcohol, tobacco and other (illicit) substance use disorders was highest among persons residing in the urban metro areas ( Fig. 3 ), among persons who had completed primary- and secondary-level education (as compared to persons with higher education) and among working persons as compared to those who were not working. The prevalence of alcohol use disorder and tobacco dependence was highest among married persons whereas other (illicit) substance use disorders were highest among divorced/widowed/separated. In the multiple logistic regression analysis, risk of any substance use disorder, alcohol use disorder, tobacco use disorder and other substance use disorder was significantly higher among males compared to females. The risk of alcohol use disorder was two times higher among married individuals as compared to never married individuals [odds ratio (OR) 2.18]. Among residents of urban metro areas, the risk of tobacco use disorder was nearly two times higher (OR 1.87) when compared to those residing in rural areas. Elderly persons (OR 0.37) and those having secondary education and above had lower risk of tobacco use disorder. The risk of other (illicit) substance use disorders was three times higher (OR 3.47) among widowed/divorced/separated individuals when compared to never married subjects.

Prevalence of substance use disorders by socio-demographic characteristics (%) (weighted prevalence was used)

CI, confidence interval

Age-wise distribution of prevalence (weighted prevalence in %) of substance use disorders.

Place of residence-wise distribution of prevalence (weighted prevalence in %) of substance use disorders.

Only 86 of 2895 persons interviewed reported using 'other (illicit) substances' which included opioids, cannabinoids and benzodiazepines. Of the 86 individuals, nearly 3/4 th (73.3%) reported use of only one drug. Of these 86 individuals, 67 (unweighted prevalence 2.3%) were opioid users and 11 (unweighted prevalence 0.4%) were cannabis users. Among opioid users, 18 reported use of only opium and 36 reported use of opioids other than opium. Only three persons reported use of heroin; 87 per cent persons with substance use disorders did not suffer from any other mental disorders. The most common mental disorder among persons with substance use disorders was depression (5.7%), followed by neurotic and stress-related disorders (2.2%) and schizophrenia and other psychotic disorders (1.8%).

The treatment gap for substance use disorders in the study population was 80.9 per cent. It was 81.4 per cent for alcohol, 96.9 per cent for tobacco and 60.0 per cent for other substance use disorders. The treatment gap for alcohol and other substance use disorders was highest among persons aged 50-59 yr. For alcohol use disorder, treatment gap was highest among persons residing in rural areas followed by persons residing in urban non-metro and lowest in urban metro areas. However, the treatment gap for tobacco and other (illicit) substances was highest among urban metro areas followed by rural and urban non-metro areas ( Table II ).

Treatment gap for substance use disorder by age group and place of residence (%)

Overall, in the State of Punjab, an estimated 10, 80, 974 (as of 2016) individuals above 18 yr of age were in need of de-addiction services with about 7.5 and 2.3 lakh individuals suffering from alcohol use disorder and other (illicit) substance use disorder, respectively 21 , 22 . As per the ICD 10 27 , the diagnosis of harmful use requires that actual damage should have been caused to the mental or physical health of the user. Of the 7.9 per cent persons with alcohol use disorder, approximately 40 per cent (3.1% of total) had harmful use. Previous studies from Punjab have reported current use of alcohol in the range of 19-58 per cent 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 . However, these studies lacked generalizability because they had variable methodology, sample size, study instruments and case definition and most were single site studies 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 . Most of these studies reported only current or ever use of alcohol (limited clinical utility) without information on dependence and/or harmful use.

The current study reported a high prevalence of other (illegal) substance use disorders including opiates, cannabis and other drugs. Hence, early identification and treatment of persons with other (illegal) substance use disorders should be a priority area for the government and health professionals 28 . The prevalence of tobacco use was lowest in Punjab (5.5% in Punjab vs. 20.89% in the 12 States) 21 . A previous study from Punjab has noted that religious affiliation was one of the most common reasons for achieving abstinence by persons with substance abuse 11 . In an indoor detoxification camps in the community, it was noticed that none of the patients smoked during the camp as these camps were held inside the premises of Gurudwara 29 .

Nearly 35 per cent of the households in Punjab have at least one person with substance use disorder. A previous survey of 1276 households found that the nearly 80 per cent households had one user 6 . However, this study was done in border districts only 6 with trafficking of drugs from the neighbouring countries. The present findings reflected households having persons with problematic substance use disorders (rather than use) and they needed urgent interventions and de-addiction services.

In our study, the prevalence of alcohol use disorder and other substance use disorders was relatively high in the productive population (30-39 yr). This along with a huge treatment gap (81.4% for alcohol use disorder, 96.9% for tobacco use disorder and 60% for other substance use disorders) of substance use disorder observed in the study population may have significant economic impact at the household and societal level. The treatment gap for other substances (mainly opioids), though high, was lesser than alcohol and tobacco. The possible reason for higher treatment gap among persons aged 50-59 yr could be because family and society were more concerned about the health problems among the younger generation, including substance use disorders 30 . Mental health service utilization rates were found to be lower among elderly than other age groups 31 . Higher treatment gap in rural areas may be because health services including mental health and de-addiction services in our country are concentrated mainly in the urban areas 32 . Distance to care, limited or lack of available resources may also lead to higher treatment gap in rural areas. It has also been identified that rural residents have a high need for care threshold before they seek care 33 .

Majority of the individuals (87%) with substance use disorders did not suffer from any other co-morbid mental disorder. In previous Indian studies, 26-71 per cent patients with substance use disorders were found to suffer from co-morbid depressive disorders and 10-45 per cent from anxiety disorders. However, these studies were conducted on treatment seeking population 34 . Hence, patients with substance use disorders need to be actively screened for psychiatric disorders for timely diagnosis and management of co-morbid conditions, especially depression.

The study has several strengths: robust methodology, use of valid study instruments translated to Punjabi language, extensive training of data collectors, quality assurance at each level, use of hand held devices for data collection and good response rate. However, despite robust methodology and standard tools, there were some limitations. Due to stigma and many other reasons, under-reporting of substance use disorder could not be ruled out (which is a limitation of all population-based studies). Further, the study did not assess the factors responsible for initiation and maintenance of substance use disorders as this was beyond the scope of the present study. Finally, though validated study instruments were used, the Punjabi version of the same was not previously validated.

In conclusion, the data showed that Punjab had a high burden of alcohol and other (illegal) substance use disorders. Although the above figures were likely to be an underestimate, these were still alarming. Substance use disorders are associated with multiple medical, social, legal, family and marital issues thus causing a huge burden to the individual, family and society. Multipronged and integrated efforts are required to tackle the menace of substance use disorders in Punjab. There is an urgent need to create awareness regarding effective treatment for substance use disorders among the general community.

Acknowledgment

The data used for analysis in this publication are from the National Mental Health Survey (NMHS) of India. As part of NMHS, survey in the State of Punjab was conducted by the departments of Psychiatry and Community Medicine, Government Medical College, Chandigarh and coordinated by National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru. Authors acknowledge the NIMHANS, and its NMHS team, National Technical Advisory Group and National Expert Panel for technical support.

Financial support and sponsorship: The authors acknowledge theMinistry of Health & Family Welfare, Government of India, New Delhi, for financial support.

Conflicts of Interest: None.

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Indian State Finds Itself in Tight Grip of Addiction

By Jim Yardley

• April 18, 2012

KAZIKOT VILLAGE, India — In this village not far from the Pakistani border, the wheat harvest is only days away. Water buffaloes are resting in the shade. Farmers are preparing their fields. And drug addicts like Pargat Singh are crouched in the shadows, injecting themselves with cocktails of synthetic drugs.

Last Thursday, just after 11 a.m., Mr. Singh followed another man into a dark corner of a decrepit building favored by the roughly 50 addicts in this village. Cracked prescription bottles littered the ground. The other man jabbed a syringe into his arm and injected a blend of prescription drugs that delivers a six-hour high.

“Save some for me,” said Mr. Singh, who is H.I.V. positive and stricken with tuberculosis. He told a photographer: “Shoot my picture. Make me famous.”

Throughout the border state of Punjab, whether in villages or cities, drugs have become a scourge. Opium is prevalent, refined as heroin or other illegal substances. Schoolboys sometimes eat small black balls of opium paste, with tea, before classes. Synthetic drugs are popular among those too poor to afford heroin.

The scale of the problem, if impossible to quantify precisely, is undeniably immense and worrisome. India has one of the world’s youngest populations, a factor that is expected to power future economic growth, yet Punjab is already a reminder of the demographic risks of a glut of young people. An overwhelming majority of addicts are between the ages of 15 and 35, according to one study, with many of them unemployed and frustrated by unmet expectations.

For the Punjab government, the problem is hardly unknown. Private drug treatment centers, some run by quacks, have proliferated across the state, and treatment wards in government hospitals have seen a surge in patients. Three years ago, a state health official warned in a court affidavit that Punjab risked losing a whole generation to drugs. Roughly 60 percent of all illicit drugs confiscated in India are seized in Punjab.

Yet when Punjab held state elections this year, the candidates rarely spoke about drug abuse. In fact, India’s Election Commission said that some political workers were actually giving away drugs to try to buy votes. More than 110 pounds of heroin and hundreds of thousands of bottles of bootleg liquor were seized in raids. During the elections, party workers in some districts distributed coupons that voters could redeem at pharmacies, activists said.

“We have encountered the problem of liquor during elections in almost all states,” S. Y. Quaraishi, India’s chief election commissioner, told reporters. “But drug abuse is unique only to Punjab. This is really of concern.”

Punjab’s reluctance to treat the drug situation as a full-blown crisis is partly because the state government itself is dependent on revenue from alcohol sales. Roughly 8,000 government liquor stores operate in Punjab, charging a tax on every bottle — an excise that represents one of the government’s largest sources of revenue. India’s comptroller found that liquor consumption per person in Punjab rose 59 percent between 2005 and 2010.

“We are promoting addiction in our state,” said Dr. Manjit Singh Randhawa, the city of Amritsar’s civil surgeon, a job akin to chief medical officer. “I’m getting calls from people saying they have lost their children, they have lost their breadwinners. In every village, people are falling prey to this drug abuse.”

Ranvinder Singh Sandhu, a sociologist in Amritsar, surveyed 600 drug addicts in rural and urban areas of Punjab and found that they were usually young, poor and unemployed. He said that most villages did not have health clinics but did have three or four drugstores, which often made sizable profits selling pills and other synthetic drugs to addicts who cannot afford heroin.

Mr. Sandhu said he had completed his study six years ago, at the request of Punjab’s governor, yet had never been contacted by any state official about the findings. “The state is not conceiving it as a social problem,” he said. “They are conceiving it as a personal problem.”

Opium has a long history in Punjab, and was commonly and legally consumed here before India and Pakistan gained independence in 1947. Today, Punjab is a primary gateway for opiates smuggled into India from Pakistan and Afghanistan. Opium is also grown legally in India for medicinal purposes, and some of the crop arrives in Punjab on the black market.

The problem is prevalent in middle-class enclaves, where some users are hooked on heroin. One impoverished neighborhood of Amritsar, called Maqboolpura, is known as the Village of Widows — because so many young men have died of drug abuse.

“Drugs are available everywhere,” said Ajit Singh, who has spent 13 years running a school for poor children affected by drug abuse. Of the school’s 656 students, roughly 70 percent have lost a parent to drugs. One girl, a fifth grader, lost five uncles and her father to drug-related deaths.

In Kazikot Village, about a two-hour drive from Amritsar, a local nongovernmental organization tries to prevent the spread of H.I.V. by regularly distributing clean syringes to addicts. The group’s workers say there are 48 hard-core addicts in the village (out of more than 2,000 people) but that many other people use drugs. Government officials have sponsored “camps” here, with health officials providing antidrug information or trying to persuade addicts to undergo treatment — neither of which, villagers say, has been successful.

“Everybody knows about it,” said Hira Singh, a local shopkeeper. “But nobody does anything to stop it.”

Mr. Singh, the H.I.V.-positive addict, lives at his parents’ home with his younger brother and his sister. He started using drugs at age 15, and then quit school. He worked for several years pulling a rickshaw, got married and had a daughter. Later, his wife gave premature birth to twin sons, who died. Unable to abide her husband’s drug use, his wife left him and their daughter, Harpreet, 3.

“He steals things from the house,” said Seema Kaur, his sister. “Sometimes, he steals money.”

Mr. Singh, now 29, said he had tried many times to quit using drugs, but the urge was too strong. Because of his tuberculosis, he said, he is careful not to get to close to his daughter. “I play with her from a distance,” he said. “I try not to hug her, so that she doesn’t get infected.”

He added: “My future is finished. I am basically dead now.”

Hari Kumar contributed reporting from Kazikot Village, and Nikhila Gill from New Delhi.

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'I am healing': Recovering drug addicts in Punjab given a lifeline at treatment centre

Indian state has been plagued by drug abuse for decades.

On the courtyard of a drug rehabilitation centre in Kapurthala in India 's Punjab state, K sits on a raised platform, poignantly looking at the dozens of marks on her arms.

Each one is a reminder of brutal drug abuse .

She counts the number of days on her fingers. It is another month before she goes home.

The 22 year old is one of three women among the 33 people receiving treatment for drug addiction at Navjeevan Kendra, a rehabilitation centre at a government-run hospital in the city.

It is her third stay at the centre.

“It has been two months and I am healing both mentally and physically and ready for a new life. I am hopeful that I can start afresh and never have to come back,” K, who does not want to be identified due to fear of social stigma, told The National .

“It is difficult to quit drugs. Every time I come here, I vow to never touch drugs but I fail. This time, I am determined to not do it again."

She is among 700,000 drug users in the state, according to government data. On average three addicts die each day.

Punjab, bordering Pakistan, is a major international transit route for drugs from Afghanistan and over the years has also become a major consumer base itself.

Drugs 'sold like candies'

Drug abuse is believed to have started in earnest in the state in the 1960s when gold smuggling was replaced by narcotics.

Punjab is plagued by drugs, mostly three opium derivatives – raw opium, poppy husk and heroin – while over-the-counter medication and a variety of synthetic drugs are also rife.

Most users live in rural areas where families are reportedly involved in the business of selling drugs but there is a growing clientele among youth in rich urban classes.

The ease of availability and growing unemployment in the state are factors in the epidemic.

Heroin is the most widely used drug, but with one gram costing between 5,000 and 7,000 rupees ($66 to $84), many users turn to cheaper versions that sell for one third of the price.

K was barely 15 when her neighbourhood friend introduced her to heroin. Before she knew it, she was addicted.

She said she has spent about half a million rupees on drugs, all from her late father’s pension money stolen from her mother over the years.

“The first time I did it, I felt good, really good. Once I got hooked, it was not possible for me to stop,” she said.

In the seven years since her addiction began, she has married – her husband is also an addict, she said – and lost her mother to a heart attack. She also lost a newborn child because of complications relating to her addiction.

“My life completely changed after I became an addict. I couldn’t study or work. My mother died of a heart attack after she saw a video of me begging for drugs on social media. My siblings abandoned me,” she said.

“I got married but my husband physically abused me. I lost my daughter within a month of birth because I was taking drugs during pregnancy. The problems in my life kept pushing me to drugs.

"Drugs are sold like candies here."

Failure to stop rise in drug abuse

More drug rehabilitation centres are being created in the state to help wean addicts off drugs, but successive state governments have largely failed to arrest the rise in numbers of drug users despite the grim statistics and the menace becoming a major political and policy issue in Punjab.

There are more than 200 outdoor opioid assisted treatment (OOAT) clinics in the state, run by the government.

Punjab Chief Minister Bhagwant Mann has vowed to wipe out the problem.

His government has decriminalised drug abuse, with addicts and those caught with narcotics being sent to drug centres instead of prison.

But recovering addicts blame a nexus between traffickers and authorities for the persistent menace.

“Drugs are easily available in every street and corner,” a 35-year-old male inpatient, who has been undergoing treatment at the centre for the past six months, told The National .

"Wherever we go, we see people are doing it. Neighbours, friends, we go for work, our colleagues do it and push us. Police know this very well."

The father of two sons worked as a welder but spent all his earnings on heroin. His addiction started in 2012 and since then, he has been to the centre six times.

“I have tried to quit it but every time I go back, my friends push me to do it. It is available for anywhere from 300 rupees to 700 rupees for 10 grams," he said.

“It is the government’s responsibility to stop the availability. The whole youth in the state has been destroyed because of it."

Social revolution

Dr Sandeep Bhola, deputy medical commissioner and consultant psychiatrist at the hospital, said successive governments have brought programmes and treatment but until now social stigma and lack of awareness about chronic drug abuse has largely hampered efforts.

“Each government has started different modalities like rehabilitation centres and OOAT clinics and awareness programmes. The main issue is the lack of co-ordination and involvement from the civil society, patients, religious leaders and families. It is still a stigma and there is lack of guidance to youth,” Dr Bhola said.

Singers in Punjab have been accused of glorifying drug abuse by frequently using words such as "chitta" to describe cocaine and other drugs.

Dr Bhola said influences on young minds further aggravates the problem.

“The adolescents follow celebrities who are glorifying drugs. They should rather be songs or videos to encourage the youth to seek treatment,” he said.

Dr Bhola called Mr Mann’s announcement “encouraging” but said change must come from the society.

“The problem is so deep that it will take time," he said. "Creating awareness is not a one-day phenomenon. There needs to be a revolution from within the society. We should not only look at supply of drugs, but also the rooting out the demand, it is interconnected."

Table of Contents

Drug abuse in Punjab

Tags: GS Paper 1 Indian Society

Context: Punjab Chief Minister Bhagwant Mann led a large prayer gathering of schoolchildren, in which they pledged to reject the scourge of drugs.

• Punjab continues to grapple with the menace that has plagued it for over a decade. Seasoned police officers describe it as narco-terrorism, propagated by an unfriendly neighbour.
• The Director-General of Police regularly updates the public on drug seizures, citing an alarming annual tally of 12,000 to 14,000 cases filed under the NDPS Act, alongside a record seizure of 1,100 kg of heroin in 2023.
• Drug overdose deaths continue — as per the government’s own report, 266 persons have died of drugs between April 2020 and March 2023.
• Earlier it was also reported that the problem of drug abuse is likely to explode in the next decade as the usage in now reaching the adolescents. It was also observed that impact of drug abuse has increased both in rural and Urban India.
• There has been also an increase in drug-abuse particularly post the corona pandemic.

What is Drug or Substance Addiction?

Drug addiction occurs when its abuse affects a person’s work and normal family life. It creates a ripple effect in the lives of the user and his immediate circle of family, friends, co-workers, neighbours and acquaintances. 

Why Punjab remains a problem?

Geographic Location:

The state’s vulnerable geography makes it a hotspot for smuggling of heroin and other opioids across the border.

Declining Agricultural Wealth

Agriculture, which brought the state its wealth, is stagnating and with little industrialisation there is high unemployment present today in Punjab, which makes it a ideal breeding ground for drug industry to make inroads.

Reminiscent of Khalistan movement

In the 1980s, Punjab was in the grip of a violent separatist militancy which has now ebbed but has left its scars. Though Punjab got rid of the secessionist movement only for it to be replaced with narcotics-terrorism thus highlighting the linkages between organised crime and terrorism.

Functional challenges

The small quantity of the drugs seized by the police are clubbed under personal consumption and not as aggregators or peddlers, and this lapse is being utilised by the drug cartels which now engage small time and part time drug peddlers not only making it difficult for police to crack but also multiplying the spread.

Ludhiana as the Drug capital

As Drug usage is also directly proportional to availability of money, Ludhiana being a business hub and with the large population has led to its emergence as Drug capital in Punjab. 

Further the presence of strong diaspora abroad and the remittances contributed by them increases the paying capacity of people also in rural areas.

REASONS FOR DRUG ABUSE IN INDIA

GEOGRAPHIC LOCATION: India is located between the Golden Crescent (IRAN, PAKISTAN and AFGHANISTAN)  and the Golden Triangle (Myanmar, Laos, Thailand and Vietnam) which are the largest opium producing region globally.

LOW INCOME GROUP: Population belonging to the lower strata of the society are particularly exposed to drug abuse in India, and use these as a form of relaxation agent.

SOCIETAL PRESSURE: Most of the youth who get addicted to drug abuse is due to the fact that they start it under the peer pressure or even due to the isolation suffered at the adolescent level at the hands of parents and friends. Apart from this performance pressure, growing emptiness and changing socio-economic conditions are having a toll on the age group.

HEALTH CONDITIONS: It can also be due to mental health disorders such as anxiety and depression or even due to the high levels of stress.

POOR LAW ENFORCEMENT: Corruption among the local enforcement agencies (police) and the loopholes at the border levels have been successfully exploited by the drug cartels. There is also a shortage of staff and equipment to tackle the illicit traffic of drugs.

CURRENT ECONOMIC DOWNTURN: The economic downturn due to covid pandemic and the global recession that is following will certainly increase the trend of drug abuse in India.

GLAMOURISATION:

There has been also glamourisation of intoxication and addictive substance via social media and OTT platforms through web series. 

Steps taken by Punjab to counter

• Many villages have formed their own anti-drug committees .
• Some police districts have introduced gully cricke t, while others have instructed constables to mentor addicts.
• Police personnel’s are also harnessing the power of social media , with district police chiefs often leading these initiatives.
• The prayer gathering at the Golden Temple was an attempt in this direction such that the tenets of religion can be also utilised as a tool of moral suasion.

  Indian Government Efforts To Fight Drug Abuse

• Narcotics Control Bureau (NCB ): NCB is primary agency responsible for curbing trade in illicit drugs & precursor chemicals. NCB shares intelligence with other agencies like Directorate of Revenue Intelligence (DRI), Central Board of Excise and Customs (CBEC), and Central Reserve Police Force (CRPF) for better coordination. 
• NCB also take required actions to control drug trafficking under the Narcotics Drugs and Psychotropic Substances Act of 1985. India has entered into 26 bilateral agreements to tackle the threat of drug trade.
• Narco-Coordination Centre was established in 2016.
•  A mechanism under the NCB which was restructured in 2019 into a four-tier district-level scheme.
• Seizure Information Management System (SIMS ) was also launched in 2019 under Narcotics Drugs and Psychotropic Substances Act, for better coordination of all drug law enforcement agencies.
• Constitution of National Fund for Control of Drug Abuse
• Project SUNRISE was launched specially for the Northeast region to tackle rising HIV prevalence, especially among the people injecting drugs.
• NASHA MUKT BHARAT campaign was also launched.
• India’s NCB works with several international agencies like SAARC Drug Offences Monitoring Desk, BRICS, Colombo Plan Drug Advisory Program, ASEAN Senior Officials on Drug Matters, BIMSTEC, United Nations Office on Drugs and Crime (UNODC), and International Narcotics Control Board (INCB), among others, to combat the illicit trade of drugs.
• India is also a signatory to UN Convention on NARCOTIC DRUGS (1961), UN Convention on PSYCHOTROPIC Substances (1971), UN Convention on TRANSNATIONAL ORGANIZED CRIME.

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The Problem of Drug Abuse in Punjab: A Study

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LLM Student at Rajiv Gandhi National University of Law, India

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India is trapped in a never-ending spiral of drug usage, with the population of addicts increasing by the day. In Punjab, The epidemic of drug addiction among young people has reached alarming proportions. Drug addiction is being fueled by changing cultural standards, growing economic hardship, and decreasing social relationships. This paper has analyzed the causative factors that are exacerbating the drug abuse in Punjab, ranging from peer pressure unemployment to easy availability and porous borders. The paper further discussed the new and emerging trends on drug abuse in the state, such as the role played by the women in the trafficking of drugs and how they are used by male drug peddlers to mask their illicit drug trafficking, the implications of Covid Pandemic on the magnitude of substance abuse, how it helped the administration in bringing people closer to de-addiction centres. The paper that over-the-counter drugs medicines facilitate speedier and less expensive access to healthcare; yet, their abuse and negative health impacts raised concern in the contemporary society, the loopholes in the law regulating the over-the-counter drugs have been investigated by the paper and found that a family carrying bottles of Codeine cough syrup or a pharmacist selling Tramadol without first checking for medical prescriptions is the current reality in Punjab, and even in India as a whole. This study has found that The situation is extremely serious in Punjab. It is critical that government take notice of it. To conclude, the drug menace is likely to endanger the social, economic and political systems in the country in the near future, unless we start making all-out efforts immediately to control it with a firm political resolve, community involvement, and immediate legislative and executive interventions.

• Drugs Abuse in Punjab
• Narco Terrorism
• Substance Abuse Punjab.

Research Paper

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International Journal of Law Management and Humanities, Volume 5, Issue 1, Page 826 - 844

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OPINION: How to face Punjab’s drug problem

Over-reliance on law enforcement is not just ineffective; it may be counterproductive

The drug problem in Punjab is serious. In terms of proportion of people affected by drug addiction (or ‘substance use disorders’ which is the more correct term), Punjab figures among top states in the country for almost all the categories of drugs.

Among various drug categories, the most serious problem for Punjab (and indeed for India) is the category of opioid drugs. Opioids are substances which have action similar to that of opium on the body, even though not all opioids are derived from opium (some are synthetically prepared as well). Among opioids, it is the heroin which is most addictive. Addiction to opium is associated with high risk of devastation and death. 

India is a legally opium cultivating country with an established (socio-culturally accepted) practice of use of opium and other low potency opioid products. However, it is heroin that is used by a far higher number of people, as noted in the report, Magnitude of substance use in India (Ministry of Social Justice and Empowerment and All India Institute of Medical Sciences, 2019).

The data shows that the highest rates of opioid addiction in India are in states that are located along the known international heroin trafficking routes (those in the northeast and in the northwest). Thus, it seems that excessive control on legal opium cultivation, and on availability of low-potency opium products like doda or bhukki (poppy husk), has been followed by a higher demand for internationally trafficked heroin in India.

Dealing with the problems of drug addiction requires a judicious combination of three types of strategies—drug supply reduction, drug demand reduction and harm reduction. Unfortunately, almost everywhere in the world the knee-jerk (and populist) response to drug problems is that of supply control. Using brute force, the authorities (erroneously) believe that it will be possible to clamp down on drug availability. 

Over-reliance on drug law enforcement is just not ineffective; it may in fact be counterproductive. As long as there is demand for drugs, the supply would continue (and a relatively less harmful drug will often be replaced by a more harmful drug).

Many countries have realised this and have taken demand reduction and harm reduction approaches along with supply reduction.

Demand reduction constitutes two broad sets of measures—those aimed at prevention of drug use and those aimed at treatment of drug use disorders. Harm reduction essentially means that reducing harms of drug use (such as death or spread of serious infections like HIV) is much more important than insistence on complete cessation of drugs use. Thus, supplying clean needles and syringes to people who use drugs or educating them on how to minimise the risk is an effective harm reduction approach employed in many parts of the world, including India.

In 2015, the report of Punjab Opioid Dependence Survey was released. In that report—looking at the high prevalence of opioid dependence in the state—we recommended a judicious combination of supply reduction, demand reduction and harm reduction. More specifically, as the treatment strategy for opioid dependence, we recommended not relying only on the conventional approach of inpatient or residential treatment in the de-addiction or rehabilitation centres (which was then, the predominant approach in Punjab). 

Since opioid dependence is a chronic, relapsing non-communicable disease (just like hypertension or diabetes or depression), it requires a long-term medical and psychosocial treatment at the outpatient level (not just a few weeks stay in a restrictive setting).

Fortunately, over the years, we have seen the recommendation being followed in Punjab. The Outpatient Opioid Assisted treatment (OOAT) programme is the largest programme of its kind for any state of the country, delivering treatment to lakhs of patients. Indeed, many other states which are facing the opioid dependence epidemic need to develop and implement similar, state-specific treatment programmes which are based on scientific evidence of effectiveness.

The National Drug Dependence Treatment Centre at AIIMS has been proud to provide its assistance to Punjab over many years now in the form of research, guidance, mentoring and hand-holding to enhance the capacity of health systems and the treatment professionals in the state to respond effectively to the challenge posed by drug addiction.

Dr Ambekar is professor at the National Drug Dependence Treatment Centre and department of psychiatry at AIIMS, Delhi.

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Explained: What are Punjab government’s anti-drug initiatives?

Under the buddy programme, 9.51 lakh groups in various educational institutions have been formed and more than 43.5 lakh students have enrolled as buddies..

After a Covid-induced break and months ahead of assembly elections, the Punjab government is set to revive its two flagship initiatives — the Buddy, and Drug Abuse Prevention Officers (DAPOs) programmes — to check drug abuse in the state. Punjab Chief Minister Captain Amarinder Singh would soon hold video conference sessions with participants of the programmes. Also on anvil is imparting training to master trainers and wall paintings on ill effects of drugs to take the initiatives further.

What is a Buddy programme and how many have enrolled for it?

“The Buddy programme is aimed at identifying vulnerable adolescents to prevent them from falling into the trap of drugs. It is basically focused on early identification,” said Dr Ranbir Singh Rana, consultant psychiatrist and technical advisor to the anti-drug Special Task Force.

Under the programme, Buddy groups have been formed in educational institutions – both government and private. Generally, a Buddy group comprises five classmates, selected by a teacher, who has been named as senior buddy. The role of a buddy, as per the programme, is to identify signs of drug/intoxicant use, regularly discuss positive activities, assist in co-curricular activities and discuss harmful effects of drugs from time to time.

The focus of the Buddy programme is also to verify if drug use is reported, and also to communicate with the child, collect maximum details, try to find out history and source of drug use, counsel as a guide, inform the school principal and contact parents. The programme envisages that members of buddy groups should not be sarcastic, accusatory, hostile and biased.

Under the programme, 9.51 lakh groups in various educational institutions have been formed and more than 43.5 lakh students have enrolled as buddies.

What is DAPOs’ programme?

Under this programme, a drug abuse prevention officer is supposed to raise awareness and identify users, high-risk people and vulnerable sections. DAPOs’ role includes motivating drug users and their families to avail of treatment facilities, facilitate treatment and do counselling. DAPOs are entrusted with a locality/cluster of houses which will be his/her core jurisdictional area. However, a DAPO may spread the message against drugs in society at large irrespective of his/her allotted jurisdictional area.

DAPOs have been categorised into two – official volunteer (OV) and citizen volunteer (CV). The roles and responsibilities of both are, however, same. An official volunteer is one who works under the Punjab government or any of its undertakings. A citizen volunteer should be above 18 years of age. The assignment is honorary.

As per the recent data, 6.28 lakh drug abuse prevention officers (DAPO) have already contacted over 11.33 lakh people to make them aware of ill effects of drugs and provided literature on the subject. According to Dr Rana, the DAPOs have contributed a lot in bringing patients to Outpatient Opioid Assisted Therapy (OOAT) centres.

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What has been the scale of the drug problem in Punjab? 

During the previous Akali Dal government, 55,117 persons were arrested under NDPS cases and 1,683 kg of heroin recovered during the 51-month period. For the corresponding period under the current Congress rule, 60,025 arrests were made and 2,089 kg of heroin was recovered, registering an increase of 8.9 per cent and 24.1 per net, respectively.

As per the official figures, as many as 46,746 cases under NDPS Act were registered by the district police, State Special Operations Cell (SSOC) and Government Railway Police in the 51-month-period between January 1, 2013 to March 31, 2017. In the current Congress rule, for the similar number of months, 46,273 cases were registered between April 1, 2017 to June 30, 2021 by the same agencies.

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Act tough on illegal flow of liquor, cash, drug smuggling: eci tells punjab dcs, cps, ssps.

/   A visiting delegation of the Election Commission of India (ECI) on Wednesday asked all the Deputy Commissioners (DCs), Commissioners of Police (CPs), and Senior Superintendents of Police (SSPs) of Punjab to enhance their campaigns to prevent the smuggling of drugs, liquor, and cash into the state given the June 1 Lok Sabha elections.   ECI team, led by Deputy Election Commissioner Hirdesh Kumar, asked the officials to make all required arrangements at polling stations to ensure ease of voting to increase voter turnout in the upcoming election.   The team also told the officials to ensure adequate arrangements for central forces deputed in the State on security duty during polling.   Detailed information was sought from all the districts regarding liquor and drug seizures after the enforcement of the Model Code of Conduct. Information was also obtained about the steps taken by various districts to increase voter turnout, webcasting arrangements and make all preparations at polling stations.   Likewise, the ECI team also shared crucial suggestions and information related to the election process with all the DCs, CPs and SSPs.   Punjab CEO Sibin C assured the Commission that the Lok Sabha elections in Punjab would be conducted without any pressure and in a fair and free manner. At the same time, he assured the ECI team that all officials have been categorically directed to strictly enforce the Model Code of Conduct and various measures have been taken to curb illegal smuggling of drugs as well as liquor in Punjab.   He also said that special attention is being given this time to increase the number of model polling stations by emulating the state’s cultural themes to attract maximum voters and making entire experience of voting pleasant and enriching experience. The ECI team appreciated this initiative of the State.   The CEO added that directions have been issued to further enhance facilities at each polling station, including drinking water, adequate furniture, proper lighting, proper signage, help desks, and toilets.   Meanwhile, the ECI and CEO appreciated Malerkotla Deputy Commissioner for taking a unique initiative and designing a special application called ‘Booth Raabta’ to provide information related to elections, including the nearest police station, hospital, ambulance service, knowing your BLO, contacting school principal/building in-charge, and providing PwD voter assistance.   The ECI team also launched three books including Turnout Implementation Plan (TIP) for increasing voter turnout, meeting the target of more than 70 per cent voter turnout; Booklet on Poll preparedness along with State and District profile and Booklet on legal provisions in Elections.  

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Punjabi Essay on "Drug Addiction", “ਨਸ਼ਾ ਨਾਸ਼ ਕਰਦਾ ਹੈ ਨਾਰੀ ਦੀ ਭੂਮਿਕਾ ਪੰਜਾਬੀ ਲੇਖ”, “Say No to Drugs”, Punjabi Essay for Class 5, 6, 7, 8, 9 and 10

Essay on Drug Addiction in Punjabi Language : In this article, we are providing  ਨਸ਼ਾ ਨਾਸ਼ ਕਰਦਾ ਹੈ ਨਾਰੀ ਦੀ ਭੂਮਿਕਾ ਪੰਜਾਬੀ ਲੇਖ  for students...

ਜਿਵੇਂ ਕਿ ਕਈ ਲੋਕਾਂ ਨੂੰ ਪਤਾ ਹੈ ਕਿ ਪਿਛਲੇ ਕੁੱਝ ਸਮੇਂ ਤੋਂ ਵਿਦਿਆਰਥੀਆਂ ਵਿਚ ਨਸ਼ਿਆਂ ਦੀ ਭੈੜੀ ਆਦਤ ਲਗਾਤਾਰ ਜ਼ੋਰ ਪਕੜ ਰਹੀ ਹੈ । ਅੱਜ ਕਲ੍ਹ ਸਕੂਲਾਂ, ਕਾਲਜਾਂ ਵਿਚ ਪੜ੍ਹਦੇ ਵਿਦਿਆਰਥੀ, ਹੋਸਟਲਾਂ ਵਿਚ ਰਹਿੰਦੇ ਹੋਸਟਲਰਾਂ ਆਦਿ ਵਿਚ ਬਹੁਤ ਸਾਰੇ ਨਸ਼ਿਆਂ ਦੇ ਸ਼ਿਕਾਰ ਹਨ । ਹੋਸਟਲਾਂ ਵਿਚ ਰਹਿੰਦੇ ਵਿਦਿਆਰਥੀ ਉੱਤੇ ਤਾਂ ਨਸ਼ਿਆਂ ਦੀ ਵਰਤੋਂ ਦਾ ਇਕ ਤਰ੍ਹਾਂ ਦਾ ਭੂਤ ਹੀ ਸਵਾਰ ਹੋ ਗਿਆ ਹੈ । ਉਹ ਇਕ ਦੂਜੇ ਦੀ ਰੀਸ ਤੇ ਭੇਡ ਚਾਲ ਕਾਰਨ ਇਸ ਬੀਮਾਰੀ ਦਾ ਸ਼ਿਕਾਰ ਹੋ ਰਹੇ ਹਨ । ਹੋਸਟਲ ਦੇ ਵਿਦਿਆਰਥੀਆਂ ਕੋਲੋਂ ਸ਼ਰਾਬ, ਚਰਸ, ਗਾਂਜਾ, ਕੋਕੀਨ, ਭੰਗ, ਐਲ.ਐਮ.ਡੀ. ਦੀਆਂ ਗੋਲੀਆਂ ਆਦਿ ਕਈ ਕੁਝ ਮਿਲਦਾ । ਹੈ । ਇਹ ਆਦਰ ਮੁੰਡਿਆਂ ਵਿਚ ਹੀ ਨਹੀਂ ਸਗੋਂ ਕੁੜੀਆਂ ਵੀ ਇਸ ਦਾ ਸ਼ਿਕਾਰ ਹੁੰਦੀਆਂ ਹਨ ।

ਆਮ ਤੌਰ ਤੇ ਹੋਸਟਲ ਦੇ ਪੁਰਾਣੇ ਨਸ਼ੇਵਾਂਜ ਵਿਦਿਆਰਥੀ ਨਵੇਂ ਵਿਦਿਆਰਥੀਆਂ ਨੂੰ ਜਬਰਦਸਤੀ ਜਾਂ ਮਜ਼ਾਕੀ ਮਜ਼ਾਕ ਵਿਚ ਇਸ ਨਸ਼ੇ ਦੀ ਆਦਤ ਪਾਉਂਦੇ ਹਨ । ਸਿਗਰਟ ਅਤੇ ਸ਼ਰਾਬ ਪੀਣਾ ਉਹ ਇਕ ਸ਼ਾਨ ਮੰਨਦੇ ਹਨ । ਹੌਲੀ-ਹੌਲੀ ਉਹ ਇਹਨਾਂ ਨਸ਼ਿਆਂ ਦੀ ਆਦੀ ਹੋ ਜਾਂਦੇ ਹਨ । ਇਹਨਾਂ ਨਸ਼ੀਲੇ ਪਦਾਰਥਾਂ ਦੀ ਵਰਤੋਂ ਦਾ ਕਾਰਨ ਜਿੱਥੇ ਉਦਾਸੀਨਤਾ, ਬੇਚੈਨੀ ਅਤੇ ਮਾਨਸਿਕ ਪਰੇਸ਼ਾਨੀਆਂ ਹਨ, ਉਥੇ ਛੇੜੀ ਸੰਗਤਾਂ ਵੀ ਹੈ ।

ਨਸ਼ਿਆਂ ਦੀ ਵਰਤੋਂ ਦੀ ਬੀਮਾਰੀ ਨੌਜਵਾਨ ਵਿਦਿਆਰਥੀਆਂ ਅਤੇ ਆਉਣ ਵਾਲੀ ਪੀੜੀ ਨੂੰ ਨਕਾਰਾ ਅਤੇ ਕਮਜ਼ੋਰ ਬਣਾ ਰਹੀ ਹੈ । ਇਸਦਾ ਸੌਖਾ ਇਲਾਜ ਹੈ ਕਿ ਸਭ ਤੋਂ ਪਹਿਲਾਂ ਨਸ਼ੀਲੇ ਪਦਾਰਥਾਂ ਦੀ ਖੁੱਲੀ ਵਿਕਰੀ ਉੱਤੇ ਪਾਬੰਦੀ ਲਾਈ ਜਾਵੇ । ਜਿਹੜਾ ਵੀ ਚੋਰੀ ਛਿਪੇ ਵਿਦਿਆਰਥੀਆਂ ਨੂੰ ਨਸ਼ੀਲੀਆਂ ਵਸਤਾਂ ਦੀ ਸਪਲਾਈ ਕਰਦਾ ਹੈ, ਉਸਨੂੰ ਸਖ਼ਤ ਸਜ਼ਾ ਦਿੱਤੀ ਜਾਵੇ । ਇਨ੍ਹਾਂ ਕੁਰੀਤੀਆਂ ਦੀ ਥਾਂ ਵਿਦਿਆਰਥੀਆਂ ਵਿਚ ਵੱਖ ਵੱਖ ਢੰਗਾਂ ਦੁਆਰਾ ਮੁਕਾਬਲੇ, ਕਲਾ ਪਿਆਰ, ਸਾਹਿਤ ਸਿਰਜਣਾ ਆਦਿ ਦੀਆਂ ਰੁਚੀਆਂ ਪੈਦਾ ਕੀਤੀਆਂ ਜਾਣ ।

ਨਸ਼ੇ ਦੀ ਆਦਤ ਸਿਰਫ ਹੋਸਟਲਾਂ ਦੇ ਬੱਚਿਆਂ ਨੂੰ ਹੀ ਨਹੀਂ ਹੁੰਦੀ ਇਹ ਆਦਤ ਘਰ ਵਿਚ ਮਾਂ-ਪਿਉ ਦੇ ਪਿਆਰ ਤੋਂ ਸੱਖਣੇ ਰਹਿ ਜਾਂਦੇ ਹਨ ਜਾਂ ਘਰ ਵਿਚ ਆਪਣੀਆਂ ਜਿੰਮੇਦਾਰੀਆਂ ਪੂਰੀ ਨਾ ਕਰ ਸਕਣ ਦੀ ਹਾਲਤ ਵਿਚ ਵੀ ਉਹ ਇਸ ਨਸ਼ੇ ਦਾ ਸਹਾਰਾ ਲੈਂਦੇ ਹਨ ।

ਇਸ ਕੰਮ ਲਈ ਇਕੱਲੀ ਸਰਕਾਰ ਕੁਝ ਨਹੀਂ ਕਰ ਸਕਦੀ। ਮਾਪਿਆਂ ਨੂੰ ਵੀ ਇਸ ਕੰਮ ਲਈ ਹੰਭਲਾ ਮਾਰਨਾ ਪਏਗਾ । ਵਿਦਿਆਰਥੀਆਂ ਨੂੰ ਸੁਚੱਜੇ ਢੰਗ ਨਾਲ ਨਸ਼ਿਆਂ ਦੀ ਵਰਤੋਂ ਤੋਂ ਜਾਣੂ ਕਰਾਇਆ ਜਾਵੇ । ਮਾਂ ਪਿਉ ਨੂੰ ਚਾਹੀਦਾ ਹੈ ਕਿ ਉਹ ਆਪਣੇ ਬੱਚਿਆਂ ਨੂੰ ਪਿਆਰ ਨਾਲ ਧਿਆਨ ਨਾਲ ਰੱਖਣ ਉਹਨਾਂ ਦੀ ਜਰੂਰਤਾਂ ਨੂੰ ਸਮਝਣ ਤੇ ਉਹਨਾਂ ਦੀ ਜਿੰਮੇਦਾਰੀਆਂ ਨੂੰ ਪੂਰੀ ਕਰਨ ਲਈ ਉਹਨਾਂ ਨੂੰ ਤਿਆਰ ਕਰਨ । ਇਸੇ ਨਾਲ ਹੀ ਅਸੀਂ ਆਪਣੀ ਆਉਣ ਵਾਲੀਆਂ ਪੀੜੀਆਂ ਨੂੰ ਸਹੀ ਰਾਸਤਾ ਵਿਖਾ ਸਕਦੇ ਹਾਂ ਤੇ ਆਪਣੇ ਦੇਸ਼ ਨੂੰ ਚੜ੍ਹਦੀ ਕਲਾਂ ਵਿਚ ਰਖ ਸਕਦੇ ਹਾਂ ਕਿਉਂਕਿ ਅਜ ਦਾ ਨੌਜਵਾਨ ਹੀ ਸਾਡੇ ਦੇਸ਼ ਦਾ ਭਵਿੱਖ ਹੈ ।

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LS poll: Punjab police, BSF and NCB chalk out strategy to deter drug supply in border areas

J alandhar ( Punjab ) [ India ], April 4 (ANI): In order to ensure free, fair and peaceful forthcoming General Elections 2024, Special Director General of Police (Spl DGP) Law and Order Arpit Shukla on Thursday chalked out a foolproof strategy with the Border Security Force ( BSF ) to further strengthen the second line of defence and completely break the supply chain of drugs from across the border.

The Special DGP accompanied by IG Frontier Headquarters, BSF Jalandhar Dr Atul Fulzele was holding a Joint coordination meeting with the senior officers of Punjab Police, BSF , CRPF, ITBP, Narcotics Control Bureau (NCB) and other central agencies to review security arrangements at the Border and discuss issues pertaining to upcoming Parliamentary Elections 2024. Zonal Director NCB, ADGP State Armed Police (SAP) MF Farooqui, DIG Border Range Rakesh Kaushal and DIG Ferozepur Range Ranjit Singh Dhillon also attended the meeting.

Giving a call for greater synergy and teamwork between BSF and Punjab Police, Spl DGP Arpit Shukla exhorted both forces to work as one team to ensure free and fair elections in the border state.

He said that being positioned at the first line of defence, the BSF needs to be more alert to prevent smuggling and infiltration bids by militants, terrorists or smugglers. He also ordered to enhance the number of Police personnel deployed on night patrolling along the International border.

The Spl DGP advised the BSF to use drone detection technology to counter the Drone operations at Punjab borders, which have emerged as the new modus operandi to smuggle drugs from across the border. He also directed all the SSPs of border districts to conduct regular meetings with Village Level Defence Committee (VLDC) members and sensitise field staff and VLDC members to keep a strict vigil on the movement of drones.

As per the information, there were 325 drone sightings across the border in 2023, of which 118 drones were successfully recovered. Similarly, 26 drones have been recovered in 2024 so far.

Sharing details on security arrangements for the upcoming Lok Sabha Elections, Spl DGP Arpit Shukla said that security has been beefed up across the state and Punjab Police has mobilised 75 percent from district police and 50% police force from other units for deployment during elections.

He said that the Punjab Police have already laid well-coordinated strong inter-state nakas at all the sealing points of 10 border districts in the state to stop the menace of liquor and drug smuggling. The 10 inter-state border districts include Pathankot, Sri Muktsar Sahib, Fazilka, Ropar, SAS Nagar, Patiala, Sangrur, Mansa, Hoshiarpur and Bathinda.

He said that the 25 companies of Central Armed Police Forces ( CAPF ) have been deployed in vulnerable districts of the state to instil confidence among the general public as well as to dominate sensitive and hyper-sensitive areas in the state. The 25 companies include five coys of Central Reserved Police Forces (CRPF), 15 coys of Border Security Force ( BSF ) and five coys of Indo-Tibetan Border Police (ITBP). (ANI)

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Chandigarh, Apr 4 (PTI) In view of the coming Lok Sabha polls, Special Director General of Police Arpit Shukla on Thursday chalked out a strategy with the Border Security Force (BSF) to further strengthen the second line of defence and break the supply chain of drugs from across the border.

He held a joint coordination meeting with BSF Inspector General (Punjab Frontier) Atul Fulzele and senior officers of CRPF, ITBP, Narcotics Control Bureau (NCB) and other central agencies to review security arrangements in the state’s border areas and discuss matters pertaining to the parliamentary elections 2024, according to a statement.

Giving a call for greater synergy and teamwork between the BSF and Punjab Police, Shukla exhorted both forces to work as one team to ensure free and fair elections in the state.

He said being positioned at the first line of defence, the BSF needs to be more alert to prevent smuggling and infiltration bids by militants, terrorists or smugglers, the statement said.

He also ordered to increase the number of police personnel deployed on night patrolling along the International border, it added.

The Special DGP advised the BSF to use drone detection technology to counter the suspicious drone operations at Punjab borders, which have over time emerged as the modus operandi to smuggle drugs from across the Indo-Pak border, according to the statement.

He also directed all the district police chiefs of border districts to conduct regular meetings with village level defence committee (VLDC) members and sensitise field staff to keep a strict vigil on the movement of drones.

There were 325 drone sightings across the border in 2023, of which 118 drones were successfully recovered. Similarly, 26 drones have been recovered in 2024 so far, the statement said.

Sharing details on security arrangements for the coming Lok Sabha elections, Shukla said security has been beefed up across the state and Punjab Police has mobilised 75 per cent of district police and 50 per cent force from other units for deployment during elections.

He said police have already laid well-coordinated strong inter-state checkpoints at the points of 10 border districts in the state to stop the menace of liquor and drug smuggling.

The 10 inter-state border districts include Pathankot, Sri Muktsar Sahib, Fazilka, Ropar, SAS Nagar, Patiala, Sangrur, Mansa, Hoshiarpur and Bathinda.

He said 25 companies of Central Armed Police Forces (CAPF) have been deployed in vulnerable districts of the state to instil confidence among the general public as well as to dominate sensitive and hyper-sensitive areas in the state. PTI CHS RPA

This report is auto-generated from PTI news service. ThePrint holds no responsibility for its content.

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I Thought Weight-Loss Drugs Were the Answer — Until They Sent Me to the ER

Published on 4/3/2024 at 10:30 AM

"You'll be happier when you're skinnier."

These words lingered in my head as I sat on my couch at home, staring blankly at the waiting room screen on the telemedicine call. It was a lie I had believed my entire life. Soon, a physician assistant from the virtual primary care clinic joined the meeting and asked a few questions about my health history, why I wanted to lose weight, and my height and weight to calculate my BMI. Although I was fully aware that BMI is an archaic system based on white male bodies, I was still ecstatic to hear that I was considered overweight by medical standards, thus a strong candidate for a revolutionary, new weight-loss drug called tirzepatide. Sold under the brand name Mounjaro, the medication was initially used to address type 2 diabetes until it was approved for weight-loss purposes last year. After debating for months whether to sign up for another costly "medically supervised weight-loss plan," I began my treatment in February.

When I first heard about Ozempic in 2021 and Mounjaro two years later, I was completely seduced by their promises.

When I first heard about Ozempic in 2021 and Mounjaro two years later, I was completely seduced by their promises — that they would suppress my appetite by slowing down my metabolism, which would silence the persistent " food noise " in my head, as well as eliminate my tendency to overeat and give in to my intense cravings. I saw these medications blowing up on social media with celebrity success stories; they were all over the news, which framed them as " the end of obesity. " I noticed medspas and plastic surgeons around me advertising these options as miracle weight-loss drugs. Before long, consumers were able to conveniently get a prescription online.

I truly believed these medications would stop my lifelong, toxic cycle of binge eating, extreme dieting, and weight cycling . As a Korean American actor, I was always told by industry professionals, friends, and family that I'd be so much prettier and more successful as a performer if I just lost some weight. Unfortunately, fatphobia is deeply ingrained in Asian culture, and it is acceptable to openly comment on others' bodies under the pretense of genuine concern and care. But the reality is that I was constantly judged, criticized, and humiliated, and somehow that always led me right back to binge eating, followed by food restrictions, calorie counting, obsessive scale monitoring, and rigorous fitness routines.

So this time, I'd become thin for good, with the help of GLP-1 agonists. I was naive enough to think all medical providers cared about me and would treat my mental and physical health holistically. During the seven-minute consultation call, my PA and I briefly discussed my intake form, and I brought up my previous experience with Ozempic — four months of relentless nausea, vomiting, diarrhea, heartburn, panic attacks, and misery — as well as my concerns about the benign nodules in my thyroid my doctor discovered during an ultrasound a few years ago (I was apprehensive after seeing the FDA warnings about GLP-1 agonists causing thyroid cancer in rodents). After hearing my history, the PA recommended Mounjaro over Ozempic, the more well-known weight-loss drug. I asked the PA how bad the side effects would be on Mounjaro and if I should worry about regaining weight once I stopped the protocol. (Two years prior, I had lost 25 pounds on Ozempic, but gained 30 within two months of discontinuing the treatment.) She convinced me that it was completely safe and said that most patients had little to no side effects. She added some may experience a bit of nausea or constipation, but assured me it wouldn't be as severe as what I had experienced on Ozempic.

Because the treatment was not covered by my insurance, I paid $607 for the initial consultation and a six-week supply of tirzepatide, plus lab fees for a comprehensive metabolic panel. When I received the medication in the mail a few days later, I immediately tore through the insulated pouch and removed the seal from the vial. I felt the cooling sensation of an alcohol wipe as I cleaned a portion of my upper thigh, then administered the first injection into my leg.

Little did I know I would end up in the emergency room four weeks later.

As soon as I started on the lowest dosage of Mounjaro, the nausea hit me. Then, more gastrointestinal issues quickly ensued, including diarrhea, constipation, painful bloating and discomfort from gas, and incessant burping. (When I say burping, I mean foul, rotten-egg burping . Yes, that's a thing.) I did not have a single bowel movement for four to five days at a time, accompanied by severe stomach cramps, lower back pain, and sleepless nights. I felt lightheaded and weak because I could barely stomach two bites of my meals without feeling incredibly stuffed. Some days, I'd realize that I had only half a banana in 24 hours, but I wouldn't feel hunger or hear my stomach growl. Still, my PA told me these symptoms were normal and would go away with time. Plus, I saw the numbers dropping on my scale, which affirmed my decision to continue my weekly injections. Just like Ozempic, Mounjaro was making me lose weight so rapidly — but by making me so ill I could barely function.

After four weeks of toughing it out, I woke up on a Sunday morning feeling dizzy and unable to stand up without assistance. It was hard for me to even speak without feeling winded. My husband pointed out that my blood sugar was likely low from essentially starving myself, so he brought me a glass of orange juice. When I got up to use the restroom, my legs gave out and I fell to the ground. After that terrifying moment of losing consciousness, I was quickly rushed to the ER, where the doctor told me to quit taking Mounjaro immediately. He explained that I wasn't obese and should not have been prescribed it in the first place. He also mentioned the alarming influx of patients coming to the ER with similar side effects on Ozempic and Mounjaro.

I was upset at myself for falling into yet another fad diet trap without carefully considering its effects on my body, and I felt taken advantage of by medical providers who had not informed me of these dangers. I nearly cried with frustration as I discarded what was remaining in my tiny bottle of Mounjaro.

Looking back, it was way too easy for me to get my hands on such a powerful drug.

Looking back, it was way too easy for me to get my hands on such a powerful drug. I was never asked any relevant questions about mental health, body image, or eating disorders. I could have simply lied about my weight just to get access to the medication. I remember how thorough and strict my doctors were when I took Accutane for my acne — the grueling monthly contracts I had to sign requiring contraception and regular blood work. The process for getting semaglutide or tirzepatide seems less regulated, and yet they have the potential to wreak so much havoc on your body. (It's also important to note that you should not get pregnant , drink alcohol , or undergo general anesthesia while on any GLP-1 agonist.) I also wonder if, like fen-phen , the "miracle" obesity treatment that was popular in the '90s, these weight-loss drugs that are trendy now will be pulled from the market eventually for some horrendous long-term side effects that we're not fully aware of yet.

In today's society, I'm constantly being told I'm not good enough. I willingly put myself through all this agony because I was fixated on fitting an unattainable and unsustainable standard of beauty. It's so not worth it. It took an expensive ER bill and a major health scare for me to learn how to be kinder to myself and appreciate my body. Now, I'm focusing on redefining what beauty and wellness is for me. I choose to love myself as I am now, not some distant future self when I'm 30 pounds thinner. It might take years to unlearn all of this internalized fatphobia, heal my relationship with food, and stop judging myself so harshly. But I vow to be patient, compassionate, and gentle with myself, while empowering others to do the same.

Helen Hyunbin Han is a South Korean immigrant and owner of two small businesses, Elevate: Modern Massage and Elevate: Pet Boutique. These ventures combine her love for guiding others in their self-care and wellness journey and elevating their furry companions' quality of life. She is passionate about AAPI issues, mental health awareness, music, movies, theater, and food.

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Prevent smuggling of drugs, cash in Punjab, says Election Commission

The Election Commission of India (ECI) on Wednesday instructed all Deputy Commissioners, Commissioners of Police, and Senior Superintendents of Police of Punjab to enhance campaigns to prevent smuggling of drugs, liquor, and cash into the state in the run-up to the Lok Sabha elections.

Chandigarh: The Election Commission of India (ECI) on Wednesday instructed all Deputy Commissioners, Commissioners of Police, and Senior Superintendents of Police of Punjab to enhance campaigns to prevent smuggling of drugs, liquor, and cash into the state in the run-up to the Lok Sabha elections.

At a meeting held here, an ECI team, led by Deputy Election Commissioner Hirdesh Kumar, asked the officials to make all required arrangements at polling stations to ensure ease of voting to increase turnout in the elections.

The ECI team also told the officials to ensure adequate arrangements for central forces deputed during the polling on June 1.

Detailed information was sought from all districts regarding liquor and drug seizures after the enforcement of the Model Code of Conduct. Information was also obtained about the steps taken by various districts to increase voter turnout, webcasting arrangements and make all preparations at polling stations.

Punjab's Chief Electoral Officer Sibin C. assured the Commission that the Lok Sabha elections would be conducted without any pressure and in a fair and free manner. He said special attention is being given this time to increase the number of model polling stations by emulating the cultural themes of the state to attract maximum voters and make the entire experience of voting a pleasant and enriching experience.

Meanwhile, the ECI and the CEO appreciated the Deputy Commissioner of Malerkotla for taking a unique initiative and designing a special application called ‘Booth Raabta’ to provide information related to elections, including the nearest police station, hospital, ambulance service, knowing your booth level officer, etc.

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Journal of Materials Chemistry B

Cancer nutritional-immunotherapy with nir-ii laser controlled atp release based on material repurposing strategy.

Enlightened by the great success of drug repurposing strategy in pharmaceutic industries, in the current study, material repurposing was proposed where the performance of carbonyl iron powder (CIP), a nutritional intervention agent of iron supplement approved by the US FDA for iron deficiency anemia in clinical was explored in anti-cancer treatment. Except for the abnormal iron metabolic characteristics of tumors that serving as potential targets for CIP-based cancer therapy under repurposing paradigm, the efficacy of CIP as catalyst in Fenton reaction, activator for dihydroartemisinin (DHA) and thus increase the chemo-sensitivity of tumors, as well as the potent agent for NIR-II photothermal therapy (PTT) was fully evaluated by an injectable alginate hydrogel form. The CIP-ALG gel could cause rapid temperature rise in the tumor site under NIR-II laser irradiation, leading to complete ablation in the primary tumor. Further on, such photothermal-ablation would lead to ATP release significantly and in the bilateral tumor model, both primary tumor ablation and inhibition of secondary tumor were observed simultaneously under synergistic tumor treatment of nutritional-photothermal therapy (NT/PTT). Material repurposing could thus be confirmed by our pioneering trial and the CIP-ALG meditated NT/PTT/immunotherapy would provide new choice of strategy for safe and efficient tumor therapy.

• This article is part of the themed collection: Journal of Materials Chemistry B HOT Papers

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J. Lu, Y. Wang, X. Gao, Y. Li, N. U. Pambe, A. Fahad, Z. Jin, Z. He, Z. Guo, W. Xie, S. Wang, X. Sun, X. Wang, J. Yu, S. Che, G. Zhang, Y. Wei and L. Zhao, J. Mater. Chem. B , 2024, Accepted Manuscript , DOI: 10.1039/D4TB00288A

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