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Indian Journal for the Practising Doctor

Vol. 5, No. 5 (2008-11 - 2008-12)


ISSN : 0973-516X

Vo.l V No. 5 (November-December) 2008

IJPD 2008; V (5):
(Listed in Index Copernicus)
(A bimonthly journal for doctors working in peripheries)

National Advisory Board

  • Dr J S Bajaj
  • Dr S N Ahmedshah
  • Lt Gen (Dr) J R Bhardwaj
  • Dr R K Srivastava
  • Dr Shiv Lal
  • Dr Deoki Nandan
  • Dr D Nagaraja
  • Dr Upinder Kaul
  • Dr K Srinath Reddy


Dr Muzaffar Ahmad, MD, FACP, FAMS
Muzaffar.hakim (at)

Executive Editor

Dr Bashir Gaash, MD, PhD, DCH
gaasgb-10 (at)

Associate Editor


Editorial correspondence: P. O. Box: 673 (GPO), Srinagar, Kmr.
ijpdindia (at)
ijpdindia (at)
Fax: 91-194-2430581


Substance abuse is one of the leading social and economic problems facing the modern world. There are indications that approximately 40 crore (400 million) people across the globe may be abusing some or the other drug. This implies 40 crore families fighting the drug abuse menace.

These families are full of economic worries and socioculturally maladapted, because of poverty, stigma or disease. The money and energy that could be utilized for constructive purposes (adequate food, good education, standard housing) is wasted in drug abuse and its biomedical, economic and sociolegal consequences.

What keeps the drug menace alive and flourishing is ‘demand and supply’. Circumstances which create demand may be modifiable or non-modifiable. Some factors are so intertwined that oversimplifications just don’t work. Children of an affluent family may be drawn to drugs basically because their busy parents had no time for them. But then they can afford it because of their huge pocket allowances. Their sustainable habit makes demand perpetual, and this should be met by suppliers. The poor, starving rickshawala of Delhi slum is hooked to alcohol in a way that he may be toiling hard under the scorching sun merely to raise funds for his desi booze. The drug provides energy to face the next day. Prima facie no apparent reason can be discerned in many cases.

Huge sums of money are involved in drug trade. Globally the trade is now at least 800 billion US dollars a year. Drug lords in many countries can install their own regimes, or oust the undesirable ones. One drug lord in Columbia whose son had been captured by the US antidrug agencies offered to settle the entire debt of his country in exchange for his son!

A kilogram of heroin that costs a few thousands in Afghanistan begets at least one crore in the West. Profits are so enormous that people will be tempted to take risks. A person who wants to be rich overnight has only two viable options left: drugs or arms. The former seems to be less risky, since antidrug agencies may be as involved in the trade as those who are labelled as traffickers and peddlers. Since all seem to benefit, all are equally involved. In many regions, even governments are involved directly or indirectly. In many places, rival forces may equally encourage cultivation, processing and trafficking of drugs, getting a cut from the proceeds to buy men and ammunition.

Oversimplification of the epidemiology of drug abuse has not yielded the desired results. Drug abuse is a social, cultural, legal and economic problem, and thus can not be curbed by simple measures like legislation, punitive action or social ostracization. Globally, almost all countries are baffled how to tackle this menace. Countries that had opted for severe penalties (USA, Iran) have begun to go softer. On the contrary, Netherlands and Scandinavian countries which had been very lenient have begun to question their strategies.

In conservative societies, substance abuse is a taboo and women generally inferior citizens. Therefore it is not hard to envisage the plight of a woman drug abuser in traditional societies. There is no doubt that, in majority of studies, men have far outnumbered women in drug abuse. This is because women try to resist drugs much more vigorously than men. And when a woman falls pray to drugs, it implies much more than merely her vulnerability. It calls for an indepth scrutiny of the circumstances prevailing in family, community and society .

In Kashmir, rural women used to puff at the hookah and no one would object. This was done to get solace after a very hectic day that would start at 5 am when they would head for the forest to fetch twigs and finish at 9 pm when they would fall dead tired. Modernization and education have raised expectations; changes are occurring where a woman enjoying the hookah is being looked down upon, while a cigarette smoking woman may be labelled modern and progressive. The difference remains, however; hookah had an implied social sanction and was used in the family—the woman would not be tempted to go for harder drugs. The cigarette-smoking 21st Century-woman may have to smoke outside her family, with peers and friends, and thus could fall a prey to harder stuffs. In situations as complex and complicated as drug abuse such subtle intricacies have to be considered since these are so trivial-looking as to escape attention.

It should be borne in mind that while the anti-drug agencies and volunteers are busy introducing new approaches to curb drug trafficking and abuse, drug mafias will be busy devising new strategies to expand their market. Previously adolescents were targeted for initiation because of their gullibility and inexperience. Now mafias want to catch them still younger. In Chennai, bhang-laden toffees made a roaring news recently. In Kashmir where 35 kg of charas was seized in downtown Srinagar this year, the arrested peddler confessed that they were making small cannabis-laden toffees meant for school children. Certainly something to ponder!

December 2008
Bashir Gaash

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