International Day against drug abuse and illicit trafficking: Combating addiction in COVID times!

Dr Mona Nongmeikapam
Dating back in history, the United Nations on the 7th December 1987 had decided to observe 26th June each year as the International Day against Drug Abuse and Illicit Trafficking to strengthen action and cooperation for achieving an international society free of drug abuse. For the past 33 years various organizations all over the world have been observing this day to raise awareness against the global pandemic that has been terrorising our homes and the society at large since time immemorial. The theme for the 2020 ”Better Knowledge for Better Care” emphasizes the need for better understanding of the world drug problem and how better knowledge will foster greater international cooperation for countering its impact on health, governance and security.
The theme is especially apt during these Covid times when there has been a noted rise in the number as well as the severity of alcohol dependence and other substance abuse as an unintended consequence of the lockdown. The COVID-19 pandemic requires novel treatment and prevention strategies to adapt for the impact of the pandemic and hence posed major challenges for healthcare providers and authorities worldwide. Individuals with substance use disorders have an additional risk for contamination due to multiple factors—clinical, psychological and psychosocial. Moreover, social and economic burden, uncertainty and restrictions brought about by the pandemic has brought about a dramatic rise in anxiety and other psychological distress universally, pushing many an individual to seek solace in these harmful substances. Many patients report a relapse after a considerable period of abstinence or a drastic increase in their routine quantity of use. What these individuals fail to realise is that rather than allay their symptoms, substance use has a negative effect on both clinical and psychological conditions. Severity of COVID-19 is associated with chronic respiratory diseases, Diabetes, hypertension and immunosuppression and increases the lethality risk. Persons with substance use are already a risk group and hence could suffer major impacts as they have been previously associated with all these conditions. Some studies reveal that tobacco and alcohol consumption aggravate the flu. Another additional risk is poly-substance abuse, that is using two or more substances in combination. Elderly patients who are already a vulnerable age group need to exercise even more caution. There is also another factor of being more vulnerable to complications of substance use. For instance chronic respiratory diseases have an increased risk of overdose mortality due to opioids, a substance that can depress breathing. Even mild symptoms of COVID-19 can be a threat this population.
Drug use can increase the risks of corona virus infection and vice versa.  Social distance, isolation or quarantine are measures to help prevent corona virus transmission. But these strategies have been associated with negative emotions like irritability, anxiety, fear, sadness, anger or boredom which may in turn trigger relapse, even in those long-term abstainers, or intensify drug consumption. Withdrawal symptoms could drive individuals to go outside for drugs throwing all caution with the wind. Medical assistance for these symptoms in turn is limited as most of our limited medical efforts are geared towards the COVID-19 pandemic. Even in the case of hospitalization, it may be difficult to maintain voluntary stay, generating more stress to healthcare workers, already overburdened because of the pandemic. Social distancing in most addiction treatment facilities is a huge challenge and highly questionable predisposing addicts, their families and healthcare professionals vulnerable to the deadly pandemic. Having looked at the scary picture, let us educate ourselves about substance abuse because prevention is always better than cure, especially during the current times.
Common substances of abuse:
·Nicotine — cigarettes, cigars, chewing tobacco, and snuff
·Cannabinoids — Marijuana, hashish, hash oil, and edible cannabinoids
·Opioids — Heroin, methadone, buprenorphine, etc.
·Depressants — Benzodiazepines and Barbiturates
·Stimulants — Cocaine, amphetamine, methamphetamine, methylphenidate and atomoxetine
·Hallucinogens — LSD, mescaline, and MDMA (e.g., Ecstasy)
Signs of dependence:
1.    Using larger amounts or longer than intended
2.    Not able to cut down
3.    Spending a lot of time in use or procuring the substance
4.    Continuing to use despite problems faced socially or in their personal lives
5.    Giving up on important activities
6.    Continuing use despite of danger
7.    Continuing use despite physical or psychological health problems arising from use
8.    Need to increase the quantity used
9.    Withdrawal symptoms like tremors, restlessness, sleeplessness, confusion or seizures.
Binge use: Many of our patients insist that they do not drink daily and hence their drinking is not an issue. One important and very prevalent type of alcohol misuse is binge drinking which is equally hazardous. Binge drinking for men is drinking 5 or more standard alcoholic drinks in one sitting (a few hours). For women, it is drinking 4 or more standard alcoholic drinks in one sitting (4).
Cautions to be exercised:
1.    Health care professionals need to be aware of the risks and challenges they will meet during and after the COVID-19 outbreak.
2.    Addiction care must be reinforced, instead of postponed, in order to avoid complications that can arise from both and to prevent the transmission of corona virus.
3.    Professionals dealing with COVID-19, on the other hand, should consider complications of substance use during treatment.
4.    Telemedicine should be considered for mild dependence cases and PPEs must be available for those working in the street level.
5.    Addiction treatment facilities must adhere to preventive measures, such as quarantine for recently admitted patients and minimal distance between beds, and, for this purpose, special guidance by public health officials should be available. These efforts could help not only individuals with dependence, but also in the control of the pandemic and benefit the society at large.
6.    As for Illicit drug trafficking, it can only be stopped if we the people learn to say “No”.
These are challenging times and we need all our senses together to combat this killer disease and judiciously use our health care resources. Nothing seems more apt than the catchy phrase “Be smart, don’t start!” And if already in the grip of substance abuse, seeking help pronto is the only way out. As it is said, a stitch in time saves nine.
We at the IPS Manipur State Branch raise a toast to your self-restraint, good health and long life!

About the author : Member, Indian Psychiatric Society- Manipur State Branch and Consultant Psychiatrist, Shija Hospitals and Research Institute, Imphal, Manipur. The author can be reached at: [email protected]