DRUG ABUSE IN SRI LANKA:

Facing the challenge

Excerpts from the Deshamanya Prof. Nandadasa Kodagoda Memorial Oration delivered by Prof. Ravindra Fernando

When I joined the Faculty of Medicine in 1971, I had a chance to meet him as I was closely associated with the activities of Buddhist Brotherhood with Professor Kodagoda. I learned Forensic Medicine from him in the third and fourth years. Six months after my internship I had the privilege of joining Professor Kodagoda’s Department as a lecturer in 1977 and for the next twenty years he was my respected professional colleague.

Today to honour Professor Nandadasa Kodagoda I selected a topic that was very close to his heart, “Drug Abuse in Sri Lanka – Its Past, Present and the Future”

A drug is a substance when taken into the living organism can modify one or more of its functions. Drug abuse may be considered as the use of a drug, usually by self-administration, in a way different from the approved medical or social patterns in a given culture.

Drug dependence is a state characterized by an overpowering desire or need (compulsion) to continue taking the drug and to obtain it by any means. It is sometimes accompanied by physical dependence and the resulting state is detrimental not only to him, but also to the society.

Addiction is characterized by behavioural and other responses that always include a compulsion to take the drug on a continuous or periodic basis in order to experience its psychic effects (psychic dependence) and sometimes to avoid the discomfort of its absence (physical dependence).

Substances 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.

There are many addictive or dependence producing drugs. They include:

Alcohol

Alcohol has been produced by humans over 12000 years! Alcohol causes impaired judgment, decreased inhibitions, coma and even death. Effects vary according to body size, amount consumed, time frame of consumption, previous use and pre-existing illnesses. Consumption of alcohol with certain drugs like barbiturates and diazepam can be fatal.

Alcohol causes physical and psychological dependence. 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.

Barbiturates

Barbiturates are depressants of the brain. It can cause relief of tension, mental stress and anxiety with positive feelings of pleasure, calmness, and relaxation. Abusers show loss of motor coordination, decreased self-control, slurred speech, impaired judgment, confusion and drowsiness. Overdose can cause coma, respiratory failure and death.

Amphetamine, methamphetamine (Ecstasy) and anti-obesity drugs

Amphetamines have medical uses for attention deficit disorders, narcolepsy and appetite suppressant (slimming pills). Abuse can cause feeling of well-being, euphoria, increased alertness and energy, improvement of performance, loss of appetite, sweating, dilated pupils, increased heart rate and blood pressure and bizarre, erratic and violent behaviour.

3,4-methylenedioxymethamphetamine (MDMA), also known as Ecstasy, increases all pleasurable sensations. Users have 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 damage and liver damage. Ecstasy is popular among participants of discos in night clubs and users have died suddenly in night clubs.

Cannabis or marijuana or ganja

Cannabis is obtained from the plant of the genus Cannabis, which has 60 cannabinoids.

Cannabis is the only drug that grows in Sri Lanka. It is grown illicitly, mostly in the dry zones of the country (in the Eastern and Southern provinces). The estimated land area under cannabis cultivation is nearly 500 hectares.

Cannabis without the narcotic content is used in the manufacture of Ayurveda (indigenous) medical preparations. The Ayurveda medical practitioners and the Ayurveda Drugs Corporation are the largest consumers of it. 205 kg of cannabis were used for Ayurveda medicinal purposes in 2009. The Ayurveda Drugs Corporation used cannabis mostly for the production of drugs such as madana modakaya and buddharaja kalkaya.

Cannabis causes euphoria, ‘high’ feeling, pleasurable state of relaxation, enhancement of sensory experiences, increased appetite, impaired performance, sleepiness, confusion and hallucinations.

Cocaine

Cocaine, which is obtained from the plant of genus Erythroxylon coca, is available as a paste, or ‘Crack’ - hard white rocks or flaky material. Cocaine is smoked, sniffed or injected.

It causes euphoria and alertness and postpones hunger and fatigue. Loss of appetite, violent behaviour, hallucinations and paranoid psychosis are the harmful effects of cocaine. It increases the temperature, heart rate and the blood pressure.

Cocaine abuse leads to perforated nasal septum, keratitis of the eyes, dental erosions, fits, heart muscle disease, coronary artery disease, liver disease, brain hemorrhages and sudden cardiac death

Hallucinogens (LSD or Lysergic acid diethylamide, certain mushrooms)

Hallucinogens such as LSD, mescaline (peyote cactus), psilocybin, a mushroom, cause altered state of consciousness and auditory/visual perceptions

Khat type

These are derivatives of the plant Catha edulis.

Opiates derived from the plant Papaver somniferum have many alkaloids including morphine. Heroin is a substance synthesized from morphine. Opium is used in the Ayurveda (indigenous) medical pharmacopeia and the government makes it available to Ayurveda Medical Practitioners through Government Hospitals.

Among the heroin users in Sri Lanka, inhalation (‘Chase the dragon’) is the preferred mode of administration. Diazepam, lactose, sucrose, acetaminophen and caffeine are the commonly used adulterants of heroin.

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.

In Sri Lanka heroin is inhaled. This is much less harmful than intravenous injection. Intravenous drug addicts are more prone to get infections.

They die prematurely from acute heroin overdose, inhalation of vomit, acute ulcerative endocarditis, bronchopneumonia and hepatitis. They are more likely meet with accidents and commit suicide.

Volatile solvents

The deliberate inhalation of volatile solvents and aerosols is an increasing problem worldwide. The ready availability, minimal cost and rapid mood-altering features of volatile solvents make these psychoactive substances particularly attractive to young people. Yet, there are clear dangers: Volatile solvents produce effects similar to anaesthetics, and can result in death following acute intoxication. Some volatile solvent users become dependent and develop chronic and disabling problems. Contrary to popular belief, the use of volatile solvents is not solely a problem of deviant groups.

Pharmaceuticals such as benzodiazepines and new psychoactive substances

Some new psychoactive substances are piperazines, arylamines, tryptamines synthetic cathinones

In Sri Lanka, major illicit drugs used today are cannabis and heroin.

Cannabis is the most widely?produced and consumed illicit substance in Sri Lanka.??The present trends indicate the incidence abuse of cannabis has become a serious problem in Sri Lankan society. A significant increase is reported of in the Kerala variety of Cannabis smuggled from India. Heroin is the second largest?and the most commonly consumed opiate in Sri Lanka. Heroin has become a major health and social problem in the country. Based on heroin seizures, the estimated street level supply of heroin in Sri Lanka is estimated to be nearly 800 Kg per annum.??

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.

Pharmaceutical drug abuse has recently gained popularity in Sri Lanka and is becoming a major health concern. Pharmaceutical Drug Abuse can be defined as taking of prescription drugs, whether obtained by prescription or otherwise, other than in the manner or for the reasons or time period prescribed, or by a person for whom the drug was not prescribed.??

The real scale of the problem is unknown, due partly to lack of data on the non-medical use of prescription drugs, and partly to the existence of many gaps in the monitoring of their legal use for medical purposes as prescribed by healthcare professionals??

Sri Lanka is a signatory to three United Nations Conventions and has established a legal frame in consonance with these conventions. They are Single Convention on Narcotic Drugs (1961), Convention on Psychotropic Substances (1971) and United Nations Convention?against Illicit Traffic in Narcotic Drugs and Psychotropic Substances (1988).?

*The latest Legislations pertaining to regulation of Pharmaceutical Drugs is the National?Medicines?Regulatory?Act (No. 5 of 2015). This act provides for the establishment of a regulatory Authority to be known as the National Medicines Regulatory Authority, which shall be responsible for the regulation and control of registration, licensing, manufacture, importation, and all other aspects pertaining to?medicines, medical devices, borderline products and for the conducting of clinical trials?in a manner compatible with the National Medicines Policy.?

*Possible solutions and recommendations?are strengthening the Information Reporting System already established at the National Dangerous Drugs Control Board (NDDCB) for collecting basic?epidemiological data on pharmaceutical drug abuse, on a continuing basis, regarding the extent and patterns of non-medical use of prescription drugs, their consequences and their diversion. Establishment of an electronic reporting system will be a further useful step.?

“The overall goal of the Government of the Democratic Socialist Republic of Sri Lanka in relation to the problem of drug abuse is to reduce supply and use to the barest minimum while working towards its total elimination from the society hopefully by the year 2020.”??

This goal will be pursued relentlessly by: Drug law enforcement agencies

Government*agencies directly involved in drug demand reduction

Agencies which have potential for contributing to the end objective

Non- Governmental Organizations

Private sector agencies

The National Policy for the Prevention and Control of Drug Abuse in Sri Lanka?includes “Effective Enforcement of Law against, production, smuggling, trafficking and use of illicit drugs”, “Effective monitoring of imports, export, distribution of drugs and precursor chemicals under control”, “Preventing?the use of drugs reducing the adverse consequences of drug abuse” and “Supporting regional and international initiatives related to combating narcotics.

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