Addiction is a medical disorder that affects the brain and causes changes in an individual’s behavior, and it is a problem that affects a large number of people around the globe, with youth being particularly susceptible to the scourge. Broadly speaking, illicit drugs, tobacco, and alcohol are substances that may cause addiction. The National Institute of Drug Abuse, Bethesda, U.S.A., defines addiction as “a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences. It is considered a brain disorder, because it involves functional changes to brain circuits involved in reward, stress, and self-control, and those changes may last a long time after a person has stopped taking drugs.” (https://urlzs.com/zhSr8)
Generally, the chance of developing an addiction depends on the number of risk factors involved, and similarly, certain protective factors reduce the risk. The risk factors include aggressive attitude as a child, lack of proper supervision by parents, less developed social skills, tendency to experiment with drugs, relatively easy drug availability (especially around the school premises), poverty in the community, etc. Protective factors include a well-balanced temperament, good parental supervision, supportive relationships, good school grades, disciplined school environment, and positive community, etc. Naturally occurring opiates (plant alkaloids originating from the opium poppy), along with synthetic and semi-synthetic opioids, are considered to be narcotic drugs. They can be either legally prescribed or illicit substances. Thus the use of the word, narcotic drugs, is most often associated with opioid drugs, which the U.S. Drug Enforcement Administration (DEA) defines as drugs that relieve pain and dull the senses.
Besides reducing pain perception in the CNS, opioids also produce euphoric effects, thus leading to their abuse and making them very addictive. As per the American Society of Addiction Medicine (ASAM), almost 300 million opioid drugs were prescribedin 2015 worldwide, of which 80% were in the U.S.A., where over 60% of overdose deaths were due to an opioid drug. The Center for Disease Control estimates that there are about 90 opioid-related overdose deaths daily in the U.S.A. The most commonly used narcotics and opioid drugs are opium, heroin, morphine, codeine, hydromorphone, oxycodone, fentanyl, and carfentanil. (The Big List of Narcotic Drugs, Reviewed by Scot Thomas, M.D., https://urlzs.com/zh5vv).
The Scenario in Nepal
Coming to Nepal, cannabis, which is found growing wild in the high hills and cultivated in the southern part of the country (illegally), has been used traditionally for ages, either as powder (ganja), base (bhang), or resin (hashish). Nepal does not manufacture heroin, and does not produce any precursors scheduled in the 1988 UN Convention. Opium and its derivatives (brown sugar and white heroin), as well as banned pharmaceutical products, are smuggled in mostly from India. Modern drug abuse in Nepal began from the 1960s, which increased in succeeding decades, and substance abuse, too, expanded from mostly cannabis to synthetic opiates and sedatives. Likewise, modes of administration changed, as well, from smoking and ingestion to injection. Besides alcohol and tobacco, cannabis, nitrazepam tablets, cough syrups containing codeine, heroin (mostly smoked), and buprenorphine injections were the major drugs of abuse. (UNODC South Asia Regional Profile 15 Sept 2005, https://urlzs.com/jGn4L)
The Government of Nepal Central Bureau of Statistics conducted a nationwide “Current Hard Drug Users survey 2013” from August 2012 to March 2013, in which hard drugs included synthetic opiates and chemical substances treated as illicit drugs (morphine, buprenorphine,
propoxyphene, heroin, LSD, cocaine, etc.). Inhalers of adhesive substances (e.g. dendrite) were also regarded to be drug users. According to the survey, there were 91,534 drug users in 2069 (2012), as compared to 46,309 in 2063 (2006). Cannabis, tranquilizers, and opiates were the most popular drugs used, and males constituted 93.1% of the users, with 6.9% being female. Kathmandu Valley had the highest number of drug users (36,998). Among the total users, 57% were IDUs (injecting drug users). (Survey Report on Current Hard Drug Users in Nepal – 2069, http://old.moha.gov.np/uploads/documentFiles/drug%20survey_20140202035708.pdf)
Current rehabilitation center admission trends show that, generally, grade 11 to bachelor's degree level students between 15 to 30 years constitute almost 75% of the drug users admitted, and 6-7% are girls. About 300 rehab centers are running across the country, but only about 104 such centers are registered with the Narcotic Drugs Control Division. (My Republica, February 11, 2017, https://urlzs.com/6ZZYq). According to the executive director of Narconon Nepal, as stated in a report in another national daily, dated May 7, 2019, the number of addicts in Nepal currently totals about 150,000, with 64% being young people, and with 900-1200 of these addicts being street children of Kathmandu, who inhale glue fumes. (The Himalayan Times, May 7, 2019, https://urlzs.com/YDpf3)
While rehab centers are doing their best to cure addicts and return them to society as responsible citizens, Nepal Police, through its Narcotics Control Bureau (NCB), is ever vigilant to this deadly menace that is no less than a scourge to the country. Established as the Narcotics Drug Control Law Enforcement Unit in 1992, which was upgraded to the NCB in 2012, it is governed by the Narcotic Drug Control Act (NDC Act) 1976. It has nine satellite stations spread across the country, mainly at major border check points, including at Tribhuvan International Airport, Kathmandu. (https://ncb.nepalpolice.gov.np/)
According to WHO’s World Drug Report 2018.
- In 2016, about 275 million people around the world were estimated to have used illicit drugs (cannabis, cocaine, opioids, amphetamines, etc.).
- With 192 million users, cannabis was the most commonly used illicit drug.
- The number of users with drug use disorders was about 31 million.
- Almost 11 million used illicit drugs in the form of injection, and of this, around 1.3 million had HIV, 5.5 million had hepatitis C, and around 1 million had both.
- In 2015, there were around 450,000 deaths due to drug use disorders, of which. about 167,750 were directly due to overdose, while the rest were due to HIV and hepatitis C.
- Opioids were responsible for almost 76% of the deaths due to drug use disorders.
- Every year, about 3.3 million deaths are attributed to the harmful use of alcohol (a psychoactive substance with dependence-producing properties).