Drug addiction is a global problem. Arguably it is one of the most serious issues facing society. Its effects are multi pronged and devastating on the user. It affects his physical and mental health, splits families due to distrust and breaks down parent-child relationships and aggravates economic burdens. If not rehabilitated, drug addicts could take to the streets to join the underworld.
Despite these dangerous repercussions, illicit drug vendors continue their flourishing trade with impunity. They thrive by stalking the most vulnerable segments of society: Children, of their future potential
It is not surprising that this year’s theme for International Day Against Drug Abuse & Illicit Trafficking which falls on June 26 has chosen to focus its collective attention on how drug abuse impacts on children and youth at a time when the likelihood of a healthy safe future for them, grows bleaker by the day.
To find out more on why young people are increasingly becoming addicted to drug abuse, and the impact it has on their health, as well as recent interventions by the state, the Sunday Observer spoke to the former chairman of the National Dangerous Drugs Control Board and Emeritus Prof Colombo University, and Senior Prof of Forensic Medicine General Sir John Kotelawala Defence University, Prof Ravindra Fernando.
Excerpts from the interview:
Q. The theme for this year’s International Day against Drug Abuse and Illicit trafficking ( June 26) is “Listen first – Listening to children and youth is the first step to help them grow healthy and safe “. Why is this theme significant for global focus this time around?
A. The theme “LISTEN FIRST - Listening to children and youth is the first step to help them grow healthy and safe” is the United Nations Office on Drugs and Crime (UNODC) initiative to increase support for prevention of drug use that is based on science, and is thus an effective investment in the well-being of children and youth, their families and communities. Drug abuse affects not only the person who abuses drugs but his/her whole family and society.
Q. The UN General Assembly, in a policy document in 2009 to counter the world drug problem recommended several areas of action including youth, children, women and communities . What is Sri Lanka’s stand on this?
A. Sri Lanka has taken steps to counter the drug problem by various educational and community programmes in the last decade. Countrywide school programmes to educate children on the harmful effects of drug abuse are held and teachers are also trained in some programmes.
Q. What are the most commonly used non medicinal drugs in Sri Lanka? Cannabis? Heroin? Injectables?
A. It is estimated that Sri Lanka has about 200,000 cannabis addicts and about 50,000 heroin addicts, Fortunately, less than 1% of the addicts use injectable heroin.
Q. How are they usually taken?
A. Drugs can be taken into the body in several ways. Oral ingestion (swallowing), inhalation (breathing in) or smoking, injection into the veins (shooting up) , and depositing onto the mucosa (moist skin) of the mouth or nose (snorting) are the methods used by drug addicts. In Sri Lanka, both heroin and cannabis are inhaled.
Q. Why do they use them? Who are most at risk ( Age wise, gender wise and occupation wise?).
A. People abuse drugs for different reasons. The most common reason is to “get high.” Adolescents can become involved in experimentation with drugs. Fortunately, only a small percentage become drug abusers. The desire to “get high” can be for many reasons. Pressures of coping with school, work, or family tensions and underlying disease such as depression can lead to addiction. Young males are mostly at risk.
Q. Is it correct that in Sri Lanka, painkillers like paracetamol and some cough mixtures are also used to induce effects similar to that of taking drugs? Have any studies been done on this? Have you any statistics?
A. Paracetamol is not an addictive drug. We had experienced the abuse of a certain cough syrup a few years ago. The sale of Corex branded medicine variants were banned following eleven deaths, reported of people who abused it. The Cosmetic Devices and Drug Advisory Committee in April 2013 also took several steps to prevent illicit drugs.
The first was to restrict the sale of all tablets and syrups containing codeine, dextromethorphan, pholcodeine and dihydrocodeine to Osusala outlets with immediate effect. The committee allowed a period of three months, from April 18, for private pharmacies to sell existing stocks of tablets and syrups containing ephedrine or pseudoephedrine, currently available in the market. All market authorization holders of the above products had to adopt a mechanism to remove remaining stocks .
Q. What are the health impacts of taking drugs on the human body?
A. The main problem is the physical and psychological dependence. Most drugs abused are cerebral depressants. Drugs like cannabis causes euphoria, ‘high’ feeling, pleasurable state of relaxation, enhancement of sensory experiences, impaired performance, sleepiness, confusion and hallucinations.
Q. Alcohol?
A. Alcohol, is the most abused substance. It affects the liver, heart, pancreas, stomach and the brain. Chronic alcoholism can cause loss of appetite, social problems and sexual impotence. Alcoholics are more prone to be victims of accidents, suicide and homicide.
Amphetamine abuse can cause a feeling of well-being, euphoria, loss of appetite, sweating, increased heart rate and blood pressure, and bizarre, erratic and violent behaviour.
Heroin causes a sense of well-being, euphoria, contentment, detachment from emotional/physical distress and pain relief. It can cause drowsiness, lack of concentration, respiratory depression and even death.
Addiction to heroin causes serious withdrawal symptoms when heroin is not present in blood. Addicts experience anxiety, restlessness, sweating, yawning, runny nose, watering of the eyes, diarrhoea, incontinence of urine, abdominal pains, muscle cramps, hallucinations and delusions.
They die prematurely from acute heroin overdose, inhalation of vomit, acute ulcerative endocarditis, broncho pneumonia and hepatitis. They are more likely to meet with accidents and commit suicide. Hallucinogens such as LSD, psilocybin, can cause altered state of consciousness and auditory/visual perceptions.
Q. Do they carry life long scars physically, emotionally, mentally?
A. If not rehabilitated, a drug addict can become weak, undernourished and may suffer from diseases like TB. Emotionally and mentally they are not stable and are prone to self-destructive behaviours such as, self-harm by cutting their forearms.
Q. Once addicted, can a drug addict be treated? Cured? How?
A. Yes, drug addiction or dependence can be treated. Usually, residential treatment for a few months in a rehabilitation centre is useful. After the residential period, the rehabilitated addict should follow the relapse prevention programme. Parents/guardians are required to assist the addict’s rehabilitation process and help cope with uncomfortable feelings.
The residential programmes incorporate activities and experiences consistent with normal lifestyles. Daily activities include individual and group counselling sessions, educational programmes, work projects such as landscaping, creative pursuits such as pottery, welding work, carpentry and drama, stress management activities like muscle relaxation, meditation and recreation.
The National Dangerous Drugs Control Board has four residential rehabilitation centres in Thalangama, Peradeniya, Unawatuna and Nittambuwa.
Q. What are the new substances that Lankan youth are becoming addicted to and the emerging challenges we face today?
A. Easy availability of drugs is the major challenge. Despite frequent arrests smuggling continues. Data has revealed that highest numbers of drug related seizures were reported in the Western Province. In 2016, the second highest seized amount of heroin and cannabis were detected in the Southern and North Western Provinces respectively. Youth are becoming addicted to amphetamines and new psychoactive drugs.
Q. It has been charged that some of these new substances include drugs like Ecstasy. What is the health impact of this drug?
A. Ecstasy, an amphetamine derivative, also known as ‘Disco Drug’ is popular among participants of discos and night clubs in Sri Lanka. Ecstasy increases all pleasurable sensations. Users have a feeling of emotional closeness, increased physical and emotional energy, restlessness, anxiety and hallucinations. Its serious health effects are increased heart rate and blood pressure, brain and liver damage, and users can die suddenly.
Q. Is treatment the same for all drug users?
A. Treatment and rehabilitation methods have to be adjusted according to the needs of the drug user. Some may need treatment with prescribed drugs to help them with initial difficulties due to withdrawal. Others may need more time with counselling.
Q. How can we prevent drug abuse? What are the programmes as opposed to sentencing them to imprisonment, currently underway to that end globally and in Sri Lanka with special emphasis on youth and vulnerable communities?
A. Drug addicts are not criminals. They should be rehabilitated and not sent to prisons. Addiction is now considered a brain disorder characterized by compulsive engagement in rewarding stimuli despite adverse consequences. ΔFosB, a gene transcription factor, has been identified as playing a critical role in the development of an addiction. Over expression of ΔFosB in the nucleus accumbens in brain is necessary and sufficient for many of the neural adaptations seen in drug addiction. It has been implicated in addictions to alcohol, cannabinoids, cocaine, nicotine, phencyclidine, and substituted amphetamines, as well as addictions to natural rewards such as sex, exercise, and food!
Q. What are the gaps you see in the present system of preventing and treating drug addicts in Sri Lanka?
A. There is a need for more rehabilitation centres with trained staff. The government should either establish more centres or assist the private sector to start rehabilitation centres.
Q. In a recent decision the government has approved the reintegration of prisoners including drug addicts in a rehabilitative programme. Is this a good thing?
A. Yes. As I mentioned earlier, addicts must be rehabilitated, not sent to prisons.
Q. The UN has defined certain actions to be taken by member countries which include Sri Lanka, to counter drug related offences by year 2019. What are these goals? Is Sri Lanka anywhere near achieving them, especially, in keeping children safe and healthy and free from drugs?
A. On April 19, 2016, the United Nations adopted a new framework putting people at the centre of global policies on drug control, which the head of the UNODC said can help promote the “urgent, united and concerted action we need.” “Putting people first means reaffirming the cornerstone principles of the global drug control system, and the emphasis on the health and welfare of humankind that is the founding purpose of the international drug conventions,” the Executive Director of UNODC, Yury Fedotov, told delegates at the opening of the UN General Assembly Special Session on the world drug problem (UNGASS) in New York, in which I participated.
Putting people first means balanced approaches that are based on health and human rights, and promote the safety and security of our societies. It means looking to the future, and recognizing that drug policies must protect the potential of young people and foster healthy lifestyles and safe development. Sri Lanka must focus on new challenges and threats, including the emergence of new psychoactive substances and base decisions on research, data and scientific evidence. The emphasis should be on the well-being of children and youth, their families and their communities.
Q. Have you a message to parents, teachers and others dealing with youth on how this year’s theme of listening to children has a special bearing for them?
A. Evidence shows that drug use can be prevented, drug use disorders treated, drug dependence that contributes to crime can be diminished, and people with drug dependence helped and returned to productive roles in society.
Risk periods for drug abuse occur during major life transitions facing examinations and leaving school. Research shows that strengthening a child’s “protective factors” can help them deal with the social and emotional challenges of transition without resorting to drugs or alcohol.
Protective factors include a strong parent-child bond based on being a parent, creating opportunities where your child can apply his/her natural gifts, helping the child achieve academic competence, clearly stating your expectations about behaviour and consistently enforcing consequences. Parents and teachers should closely monitor the activities and behaviour of children to detect possible drug or alcohol addiction.
Q. Is there a hot line that parents can call if they suspect their child to be taking drugs?
A. The National Dangerous Drugs Control Board has a hotline to get information. The number is 1984.