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 Table of Contents  
BRIEF RESEARCH COMMUNICATION
Year : 2021  |  Volume : 7  |  Issue : 1  |  Page : 61-65

Opioid dependence growing concern: A profile of a tertiary care hospital in North India


1 State Drug Dependence and Treatment Centre, Institute of Mental Health, Rohtak, Haryana, India
2 Department of Psychiatric, Social Work, Institute of Mental Health, UHS, Rohtak, Haryana, India

Date of Submission21-Mar-2021
Date of Acceptance17-Apr-2021
Date of Web Publication18-Jul-2021

Correspondence Address:
Dr. Bhupendra Singh
Institute of Mental Health, UHS, Rohtak, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjp.tjp_1_21

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  Abstract 


Background: It is well-known that opioids are one of the world's most challenging substances which are growing rapidly. India too has a considerable problem of opioid use. State Drug Dependence and Treatment Center, Rohtak is only center in Haryana proving treatment with opioid substitution therapy.
Aim: The present study was aimed to draw a profile of the patients attending this treatment facility.
Methods: It was a retrospective secondary data-based study for the year 2018–2019. All the data records were reviewed and tabulated for the interpretation.
Results: The present study found that maximum (46%) of the participants were from the age group of 20–29, almost males married and unmarried both were seeking treatment, 70% of them were educated at least up to secondary slandered but maximum (42%) were unemployed. Age of initiation was vary from 10 to 29 years and 74.2% were reported addiction of heroin. Chasing was the most popular method of consumption followed by oral and intravenous. Support from family was reflected in the referrals, and it can be considered as good for the better outcome and reduction of relapse.
Conclusion: Opioid use is growing among adult males that need immediate attention of care.

Keywords: Comorbid mental illness, injectible drug user, opioid dependence


How to cite this article:
Rathee S, Kumar V, Singh B, Gupta R. Opioid dependence growing concern: A profile of a tertiary care hospital in North India. Telangana J Psychiatry 2021;7:61-5

How to cite this URL:
Rathee S, Kumar V, Singh B, Gupta R. Opioid dependence growing concern: A profile of a tertiary care hospital in North India. Telangana J Psychiatry [serial online] 2021 [cited 2021 Dec 2];7:61-5. Available from: http://www.:tjpipstsb.org/text.asp?2021/7/1/61/321760




  Introduction Top


Opioid dependence is the major public health problem in India. Continuous use of opioids leads to syndrome of opioid dependence. It is estimated that a total of 2.3 crore users, 77 lakh of them are problem users and 28 lakh are dependent for opioid. About 0.70% of Indians (approximately 77 lakh people) are estimated to need help for their opioid use problems. A far higher proportion of Heroin users are dependent on opioids when compared with users of other opioids such as Opium and Pharmaceutical Opioids.[1] Globally, approximately 269 million people (or 5.3% of the global population aged 15–64 years) used drugs at least once in 2018. Among them, about 58 million people used opioids. About 35.6 million people suffered from drug use disorders in 2018.[2]

Estimates on the prevalence of drug abuse in India through a national household survey have reported a prevalence of opium use at 0.6% ever and with a prevalence of heroin use at both as high as 0.4% during the past 30 days, never use and in the last 30 days, as 0.2%.[3] In India, according to National Family Health Survey 3, alcohol (21.4%) was primary substance used followed by cannabis (3.0%) and opioid (0.7%), correspondingly.[4] In the last three decades, the Ministry of Social Justice and Empowerment has conducted two nationwide drug surveys those published in 2004 and 2019.[5] The results of these surveys suggest that drug use continues unabated in India. Opioid use has amplified magnitude from 2 million to more than 22 million. More horrifically, heroin has been found most commonly used natural (poppy and poppy husk) ill-treated opioid.

The National Mental Health Survey (2015–2016) has shown a treatment interval of >70% for drug use disorders.[6] A recent nationwide survey replicated the results, with a treatment interval of about 75% for drug use disorders. Added to that misery, only 5% of people with illicit drug use disorders received institutional care.[5]

The Ministry of Social Justice and Empowerment, Government of India, has published a report titled, “Magnitude of Substance Use in India, 2019.” Opioid use is reported in 2.1% of the country's population, with heroin use being highest at 1.14% followed by pharmaceutical opioids at 0.96% and opium at 0.52%. Dependent use is the highest among users. At present, the prevalence of opioid use in India is three times the global average. In comparison to 2004,[4] the overall use of opioids has become higher and use of heroin has surpassed opium use. There has been a rapid increase in the route of injection of heroin and synthetic opioid analgesics in India. It is estimated about 8.5 lakh people were injecting drugs. High number of people injecting drugs is estimated in Uttar Pradesh, Punjab, Delhi, Andhra Pradesh, Telangana, Haryana, Karnataka, Maharashtra, Manipur, and Nagaland. The opioid group of drugs is mainly injected by patients (heroin – 46% and pharmaceutical opioids – 46%).[5] This rapid increase in the population of injectible drug users poses new challenges in the management and care of these patients.


  Methods Top


The present study was conducted at the State Drug Dependence Treatment Center (SDDTC). At the SDDTC, most patients come by self or family referral while some are referred from other hospitals or other departments of our institute. The hospital has a dedicated center for addiction treatment with both inpatient and outpatient services. The present study is a retrospective chart review study. Case records of all patients with opioid use disorder attending the outpatient department of SDDTC in North India across 2 years (between January 2018 and December 2019) were reviewed retrospectively to study their sociodemographic and clinical profile. The information was gathered using a semi-structured pro forma and detailed case records. Age of onset, reasons of initiation of substance, family history of substance, comorbid psychiatric, and medical illness were calculated. During this period, around 2347 patients sought consultation, of whom 1078 were patients of opioid dependence (45.9%). All the patients were evaluated by the postgraduates' trainees and psychiatric residents under the supervision of consultants in the center.


  Results Top


[Table 1] shows over 1 year (January 2019–December 2019), a total of 1079 patients with opioid use disorder were included in the study. The mean age of patients was 28.53 years. Nearly half of patients (46.9%) were between 20 and 29 years of age group. Most of the patients were males (99.3%), majority (45.7%) were educated up to higher secondary and 5.7% were not formally educated. In occupation, most of the patients were unemployed (42.4%) while 30.8% were self-employed. More than half of the patients belonging from nuclear families (52.8%). Majority (58.4%) of patients were from the urban background. Majority of the patients were accompanied by their family members (56.7%) and 16.5% were brought by his family members for treatment while 70.3% were by their own initiative.
Table 1: Sociodemographic profile of the participants (n=1079

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[Table 2] reveals more than half of the patients (60.7%) started taking opioids in the age group between 20 and 29 years. Heroin use was found among 74.2% of the patients while 13.7% were using opium and 12.1% were of prescription opioid use. Among the route of administration of opioids, chasing route was the most common among the patients (42.7%) while 20.8% were taking through intravenous route history of sharing of needles and syringes were found among 4.4% of the patients.
Table 2: Pattern of opioid use

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[Table 3] explains concurrent psychiatric comorbidity was present in 6.8% among them mood disorder was found in 3.2% and psychotic disorder (1.2%). Comorbid medical illness found among 3.5% of the patients. Regarding previous treatment for substance use disorder, 25.3% took treatment from various private and government hospitals, only 6.3% of the patients were hospitalized.
Table 3: Clinical profile of the patients

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  Discussion Top


The present study found those 20–29 years age groups have a maximum prevalence of opioid use disorders. High prevalence in 20–40 years' age group was reported in previous studies.[7],[8],[9] Age of the opioid users was almost similar in the current findings as found in the previous studies.[7],[10],[11],[12] Male gender found dominant[7],[13],[14],[15] in taking treatment and being diagnosed in India our findings are also supporting the same it could be understand and easily explained on two levels psychological and social. Psychological components play a vital role in help-seeking behavior for male and social aspects reduces the chances of exposure and accessibility of substance for the females. Both the components reduce the chances of addiction and treatment for the females, especially in North India. Working capabilities and financial contribution in household were also affected negatively.[7],[16] There is dearth of the factual knowledge on livelihood issues such as poor productivity nonattending the job[7] that directly and indirectly encumber the growth. Many time compromised productivity causes the challenge and increases the changes of substance use vulnerability among working age individuals. It has been reported[14],[15],[17],[18] that individuals from the urban background are more prone for the opioid dependence. Similarly, we also found the predominance of the urban population, but a previous study[7] from India reported slight rural dominance which was contrary to our findings. This flow of the urban population indicate that opioid use has increased in urban areas and it also shows that patients have turned for therapeutic management although our Institutional Mental Health and substance awareness programs are paying a very significant contribution in the locality.

Research findings show significant trudge of substance use disorder in the rural areas[7] as well as in industrial,[19] developed and developing urban areas. This is against the prejudice of the conceptual though that illicit drug use is a problem of urban and developed areas. Our findings also show very small difference between urban and rural background that is explanation of globalization and easy methods of communication and travel.

Maximum participants in our research were either unemployed or self-employed, and very few of them were employed that is contrary to previous studies from J&K and Jharkhand where more half or more participants were employed.[13],[15] Almost 10% participants were students; studies reported predominance of this group.[7] Involvement of students in opioid use should be considered as alarm that requires immediate attention with prompt and multi-level intervention.

The result indicates that mostly patients visited to drug dependence and treatment center by their own initiatives or with the family referrals findings are consistent with previous research findings.[7],[14] Family social support has been proven to reduce relapse rate in substance use disorders and significant contribution in quality of life.[20] More than half (60%) participants initiated opioid in their 20s and almost one fourth (24%) of them were started before 19 years of age. Age of initiation was found similar with previous studies as they also reported 80% cases initiated taking opioid between 10 and 29 years of age.[7],[15] Similar findings from methadone replacement therapy center were reported from West.[21]

Heroin was the drug used by 74% of our patients and 6% of them were on prescription opioids. Very similar findings were reported from previous study[7] conducted in J&K. Earlier use of heroin was lesser than combination drugs,[13],[15] but in the current study, it was found that three-fourth of the patients were using heroin and the use of other drugs is reducing. Most of the patients are intravenous drug users they are using only intravenous or combination of intravenous route with oral and/or inhalation route. A previous[7] study was also reported similar findings, but others[13] found oral use as preferred method of intake. Intravenous use of opioid gives exposure to sharing needles and syringes that multifold the chances of exposure for HIV and hepatitis B and C virus.[22]

This vulnerability of exposure and infection makes frailty quality of life and amplify morbidity and mortality in this group.[22] In our research, we found only 4.4% participants those who were shared the syringe with other users.

The current research reveals nearly 7% of the opioid users suffered with psychiatric comorbidity, which were seen very high in the previous studies around 50% 7 and high comorbidity conditions in India[15],[23] and abroad.[19],[24] Mood disorder was found as most prevalent comorbid mental health issue among the participants followed by personality disorders. Very similar findings were reported by another retrospective chart-based study.[25] Attention-deficit hyperactivity disorder (ADHD) children were likely to use illicit substance and nicotine other than alcohol they are highly prone to develop substance use disorders.[26]

The findings from opioid substitution therapy group reported that 19.4% of the patients were indicated possibility for concurrent adult ADHD symptoms.[27] Another[28] study conducted on influence of ADHD and conduct disorder on severity of opioid dependence found substantial presence of adult ADHD among the patients having methadone maintenance treatment. Furthermore, it has been found that patients are at high risk for other psychotic disorders if they who have ADHD and substance use disorder in comparison to substance use disorder.[29],[30] ADHD presence in opioid use disorder patients increases the need of early detection and management[7] to reduce the chances of developing other dependence and mental illness.


  Conclusion Top


Opioid use disorder is escalating, and use of heroin in comparison to other pharmaceutical agents is also increasing with intravenous method of intake. This study explains the preview of opioid dependence and its increasing access to the Haryana. The findings indicate western influence on this negative part of life along with the other aspects of life. The focus of management also shifted on this issue by establishing of methadone substitution clinic. It is high time to increase the number of dependence treatment centers for dealing with substance dependence and develop rehabilitation possibilities for the patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ambekar A, Agrawal A, Rao R, Mishra AK, Khandelwal SK, Chadda RK. Magnitude of Substance Use in India. New Delhi: Ministry of Social Justice and Empowerment, Government of India; 2019.  Back to cited text no. 1
    
2.
Kempen A. The world of drugs: The 2020 World Drug Report. Servamus Community Based Saf Secur Mag 2020;113:54-7.  Back to cited text no. 2
    
3.
Srivastava A, Pal HR, Dwivedi SN, Pandey A, Nath J. Prevalence of drug abuse in India through a national household survey. Int J Curr Sci 2015;15:103-3.  Back to cited text no. 3
    
4.
IIPS O. National Family Health Survey (NFHS-3), 2005-06: India. Vol. I. Mumbai: International Institute for Population Sciences. 2007.  Back to cited text no. 4
    
5.
Ray R. The Extent, Pattern and Trends of Drug Abuse in India, National Survey, Ministry of Social Justice and Empowerment, Government of India and United Nations Office On Drugs and Crime, Regional Office For South Asia. 2004.  Back to cited text no. 5
    
6.
Ambekar A, Agrawal A, Rao R, Mishra AK, Khandelwal SK. On Behalf of the Group of Investigators for the National Survey on Extent and Pattern of Substance Use in India. In: Magnitude of Substance Use in India. New Delhi: Ministry of Social Justice and Empowerment, Government of India; 2019.  Back to cited text no. 6
    
7.
Bhat BA, Dar SA, Hussain A. Sociodemographic profile, pattern of opioid use, and clinical profile in patients with opioid use disorders attending the de-addiction center of a tertiary care hospital in North India. Indian J Soc Psychiatry 2019;35:173.  Back to cited text no. 7
  [Full text]  
8.
Vasilenko SA, Evans-Polce RJ, Lanza ST. Age trends in rates of substance use disorders across ages 18-90: Differences by gender and race/ethnicity. Drug Alcohol Depend 2017;180:260-4.  Back to cited text no. 8
    
9.
Farhat S, Hussain SS, Rather YH, Hussain SK. Sociodemographic profile and pattern of opioid abuse among patients presenting to a de-addiction centre in tertiary care Hospital of Kashmir. J Basic Clin Pharm 2015;6:94-7.  Back to cited text no. 9
    
10.
Margoob MA, Dutta KS. Drug abuse in Kashmir – Experience from a psychiatric diseases hospital. Indian J Psychiatry 1993;35:163-5.  Back to cited text no. 10
[PUBMED]  [Full text]  
11.
Nigam AK, Ray R, Tripathi BM. Buprenorphine in opiate withdrawal: A comparison with clonidine. J Subst Abuse Treat 1993;10:391-4.  Back to cited text no. 11
    
12.
Kalra I, Bansal PD. Sociodemographic profile and pattern of drug abuse among patients presenting to a de-addiction centre in rural area of Punjab. Age 2012;19:38-66.  Back to cited text no. 12
    
13.
Medhi GK, Mahanta J, Adhikary R, Akoijam BS, Liegise B, Sarathy K, et al. Spatial distribution and characteristics of injecting drug users (IDU) in five Northeastern states of India. BMC Public Health 2011;11:64.  Back to cited text no. 13
    
14.
Rather YH, Bashir W, Sheikh AA, Amin M, Zahgeer YA. Socio-demographic and clinical profile of substance abusers attending a regional drug de-addiction centre in chronic conflict area: Kashmir, India. Malays J Med Sci 2013;20:31-8.  Back to cited text no. 14
    
15.
Mohanty R, Senjam G, Singh NH. Psychiatric comorbidities among opioid-dependent patients attending department of psychiatry, Regional Institute of Medical Sciences Hospital, Manipur. Indian J Soc Psychiatry 2018;34:132.  Back to cited text no. 15
  [Full text]  
16.
Rice JB, Kirson NY, Shei A, Cummings AK, Bodnar K, Birnbaum HG, et al. Estimating the costs of opioid abuse and dependence from an employer perspective: A retrospective analysis using administrative claims data. Appl Health Econ Health Policy 2014;12:435-46.  Back to cited text no. 16
    
17.
Bashir N, Sheikh AA, Bilques S, Firdosi MM. Socio-demographic correlates of substance use disorder patients seeking de-addiction services in Kashmir India – A cross sectional study. Br J Med Pract 2015;8:9-13.  Back to cited text no. 17
    
18.
Margoob M, Majid A, Dhuha M, Murtaza I, Abbas Z, Tanveer M, et al. Thin layer chromatography (TLC) in detection of current nature of drug abuse in Kashmir. JK Pract 2004;11:257-62.  Back to cited text no. 18
    
19.
Borgohain L, Phookun HR. Psychiatric comorbidity with substance abuse: A clinical study. Dysphrenia 2013;4:59-70.  Back to cited text no. 19
    
20.
Giri OP, Srivastava M, Shankar R. Quality of life and health of opioid-dependent subjects in India. J Neurosci Rural Pract 2014;5:363-8.  Back to cited text no. 20
[PUBMED]  [Full text]  
21.
Naji L, Dennis BB, Bawor M, Varenbut M, Daiter J, Plater C, et al. The association between age of onset of opioid use and comorbidity among opioid dependent patients receiving methadone maintenance therapy. Addict Sci Clin Pract 2017;12:9.  Back to cited text no. 21
    
22.
Joint United Nations Programme on HIV/AIDS (UNAIDS). The GAP Report 2014. Geneva: UNAIDS; 2014. Available from: http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2014/UNAIDS_Gap_report_en.pdf. [Last accessed on 2021 Feb 11].   Back to cited text no. 22
    
23.
Vivek K, Dalal P, Trivedi J, Pankaj K. A study of psychiatric comorbidity in opioid dependence. Delhi Psychiatry J 2010;13:86.  Back to cited text no. 23
    
24.
Brooner RK, King VL, Kidorf M, Schmidt CW Jr, Bigelow GE. Psychiatric and substance use comorbidity among treatment-seeking opioid abusers. Arch Gen Psychiatry 1997;54:71-80.  Back to cited text no. 24
    
25.
Basu D, Sarkar S, Mattoo SK. Psychiatric comorbidity in patients with substance use disorders attending an addiction treatment center in India over 11 years: Case for a specialized “dual diagnosis clinic”. J Dual Diagn 2013;9:23-9.  Back to cited text no. 25
    
26.
Lee SS, Humphreys KL, Flory K, Liu R, Glass K. Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: A meta-analytic review. Clin Psychol Rev 2011;31:328-41.  Back to cited text no. 26
    
27.
Lugoboni F, Levin FR, Pieri MC, Manfredini M, Zamboni L, Somaini L, et al. Co-occurring attention deficit hyperactivity disorder symptoms in adults affected by heroin dependence: Patients characteristics and treatment needs. Psychiatry Res 2017;250:210-6.  Back to cited text no. 27
    
28.
Carpentier PJ, van Gogh MT, Knapen LJ, Buitelaar JK, De Jong CA. Influence of attention deficit hyperactivity disorder and conduct disorder on opioid dependence severity and psychiatric comorbidity in chronic methadone-maintained patients. Eur Addict Res 2011;17:10-20.  Back to cited text no. 28
    
29.
Sobanski E. Psychiatric comorbidity in adults with attention-deficit/hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci 2006;256 Suppl 1:i26-31.  Back to cited text no. 29
    
30.
Wilens TE, Kwon A, Tanguay S, Chase R, Moore H, Faraone SV, et al. Characteristics of adults with attention deficit hyperactivity disorder plus substance use disorder: The role of psychiatric comorbidity. Am J Addict 2005;14:319-27.  Back to cited text no. 30
    



 
 
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