Substance abuse leads to organ and brain damage | Sunday Observer

Substance abuse leads to organ and brain damage

5 May, 2019
The young are mostly at risk because they like to experiment with drugs
The young are mostly at risk because they like to experiment with drugs

Amid coping with victims of the horrendous Easter bomb blasts that tore apart the country, health authorities are also continuing their battle against an emerging problem with equally deadly fallouts- namely, the widespread use of illegal drugs. Ironically, like the radicalized youth who triggered the bomb attacks, the drug mafia’s most vulnerable target are the youth- those in their early twenties and thirties whose potential to live healthy lives has been robbed by their first cigarette or drug injection.

The Sunday Observer spoke to Emeritus Prof of Forensic Medicine and Toxicology, University of Colombo and Senior Prof of Forensic Medicine, General Sir John Kotelawala Defence University and former Chairman of the National Dangerous Drugs Control Board (NDDCB) Dr Ravindra Fernando to learn the reason for this dangerous trend and what steps have been initiated to halt it.

Excerpts …

Q. Whether it be drugs, smoking or the internet, being addicted to any of these is now considered a health risk. Why?

A. People with addiction lose control over their actions. They crave and seek out drugs no matter what the cost - even at the risk of damaging friendships, hurting family or losing jobs. Addiction is a long-lasting and complex brain disease. Current treatments can help people control their addictions. But even for those who have successfully quit, there is always a risk of the addiction returning, which is called relapse.

Q. Since we are now seeing a rise in the number of drug addicts globally and in Sri Lanka what do you consider as the most significant health impacts of substance addiction?

A. People with addictions often have one or more associated health issues, which could include lung or heart disease, stroke, cancer, or mental health conditions. Imaging scans, chest X-rays, and blood tests often show damaging effects of long term drug use throughout the body. Drug use can also increase the risk of contracting infections. Human immunodeficiency virus (HIV) and hepatitis C (a serious liver disease) can occur from sharing injection equipment and from impaired judgment leading to unsafe sexual activity. Infection of the heart and its valves (endocarditis) and skin infection (cellulitis) can occur after exposure to bacteria by injection.

Q. What are the recognizable effects of abuse?

A. Acute effects of abuse include sedation, drowsiness, feelings of well-being, lowered inhibitions, slurred speech, poor concentration, confusion, dizziness, impaired coordination and memory. Barbiturates can cause euphoria, unusual excitement, fever, irritability.

Q. Apart from addiction to illicit drugs, people are also addicted to abuse of medicinal and prescription drugs. Your comments?

A. Commonly misused prescription drugs include barbiturates, benzodiazepines and sleep medications, opioid and morphine-based pain relievers, amphetamines medications and dextromethorphan found in cough syrups to which people can become addicted.

Q. Who are most at risk?

A. The young are mostly at risk because they like to experiment with drugs.

Q. What are the specific body organs that are affected by the commonly used illegal drugs?

A. It depends on the drug but some can affect all organs of the body. For example, cocaine can affect the heart muscle. Cocaine leads to perforated nasal septum, keratitis of the eyes, dental erosions, fits, coronary artery disease, liver disease, brain hemorrhages and sudden cardiac death.

Q. How early do they appear?

A. Adverse effects can appear within hours.

Q. Does the health status of the person ingesting them count?

A. Yes. A healthy person will tolerate drugs better.

Q. Those with dental cavities and bad gums – are they more vulnerable to adverse effects from drug abuse?

A. Yes. Dry mouth increases acid in the mouth and leads to rotting enamel. Acid reflux, which also rots enamel and hurts soft tissue. Ulcers or sores in the mouth that can become infected. Nutritional deficiencies can damage teeth and gums . Poor dental health is associated with methamphetamine, meth or ‘Ice’ use. It is called meth mouth, as this drug rots teeth very quickly.

Meth causes blood vessels to shrivel and die, causing problems in the gums. Meth also makes the mouth dry out, and without saliva, other acids in the mouth wear away enamel. Since the drug is a stimulant, it causes people who take it to grind their teeth due to stress. People who struggle with meth addiction also crave for sugary foods and drink, which can damage oral hygiene.

Q. How can we prevent addiction?

A. Prevention is critical to reduce the harms of addiction. Childhood and adolescence are times when parents can get involved and teach their kids about a healthy lifestyle and activities that can protect against the use of drugs. Physical activity is important, as well as getting engaged in work, science projects, art, or social networks that do not promote use of drugs. Prevention programs should enhance protective factors and reduce risk factors. The risk of becoming a drug abuser involves the relationship among the number and type of risk factors (e.g. deviant attitudes and behaviours) and protective factors (e.g. parental support).

Prevention programs should address all forms of drug abuse, alone or in combination, including the underage use of legal drugs (tobacco or alcohol); the use of illegal drugs (cannabis or heroin); and the inappropriate use of legally obtained substances (inhalants), prescription medications, or over-the-counter drugs.

Prevention programs should address the type of drug abuse problem in the local community, target modifiable risk factors, and strengthen identified protective factors. Prevention programs should be tailored to address risks specific to population or audience characteristics, such as, age, gender, and ethnicity, to improve program effectiveness.

Q. Is drug addiction treatable?

A. Addiction is a treatable disorder. Research on the science of addiction and the treatment of substance use disorders has led to the development of research-based methods that help people to stop using drugs and resume productive lives, also known as being in recovery. Like other chronic diseases such as, heart disease or asthma, treatment for drug addiction usually isn’t a cure. But addiction can be managed successfully. Treatment enables people to counteract addiction’s disruptive effects on their brain and behaviour and regain control of their lives.

Q. What is the treatment procedure?

A. Treatment depends on the severity of addiction and the individual. Some people can stop cigarette smoking and alcohol use disorders on their own. More severe cases might require months or even years of treatment and follow-up, with real efforts by the individual. Researchers are evaluating experimental therapies that might enhance the effectiveness of established treatments. Mindfulness meditation and magnetic stimulation of the brain are being assessed for their ability to strengthen brain circuits that have been harmed by addiction. Scientists are also examining the potential of vaccines against nicotine, cocaine, and other drugs, which might prevent the drug from entering the brain.

Q.The Government has proposed a new rehabilitation scheme for drug addicts. Give us more details on how this operates.

A. Cabinet approval was granted in February this year to establish an authority to rehabilitate drug addicts. The proposal was put forward by the President, the details of which are not yet available.

Q. Are all drug addicts treated in the same way? Or is the treatment tailor made to each of their needs and health status?

A. There should be tailor-made treatment depending on the drug and the duration of abuse. Treatment is easy in new addicts compared to long term users. The age and health status is also important when deciding a treatment method.

Q. Are all drug addicts put into the same cells on arrival at a rehabilitation centre?

A. There are no ‘cells’ in a rehabilitation centre, they are not prisons. The patients have freedom and their only commitment is to follow the treatment program of the centre.

Q. Social media? What role does it play in promoting drug addiction?

A. It is estimated that around one-third of humans on the planet are using social media, and some of these people are displaying mal-adaptive, excessive use of these sites. A study has shown that decision making is oftentimes compromised in individuals with substance use disorders. They sometimes fail to learn from their mistakes and continue down a path of negative outcomes.

Q. How can you prevent this?

A. There should be sensible use of social media.

Q. President Sirisena has said that he would make Sri Lanka free of the drug menace within two years, with new laws and the setting up of the DOPE authority, etc. Do you think this is a realistic goal?

A. It is a difficult goal but we should try.

Q. What do you see as possible obstacles in achieving this goal?

A. The obstacles are the deficiencies in cooperation at national, international, regional and bilateral levels in drug dependence and lack of technical and financial assistance in capacity building. We must develop a good monitoring system. The gaps in legislation and regulations must be changed, and delays in the administration of justice corrected. Educating parents and teachers to detect, prevent and help drug addicts to recover is also important.

Q. Do you think that stiffer laws and penalties as well as the death penalty for drug traffickers would solve the problem?

A. Stiffer laws and quick administration of justice would help solve the problem. I do not think death penalty is a solution.

Q. Your message to the public, parents, teachers?

A. Be vigilant of the possibility of drug addiction among children and adolescents. Early detection and early treatment is the key to lower exposure of new addicts to drug abuse and to rehabilitating them.