Academic journal article Indian Journal of Psychiatry

Descriptive Epidemiology and High Risk Behavior of Male Prescription Opioid Abusers: Cross-Sectional Study from Sikkim, North East India

Academic journal article Indian Journal of Psychiatry

Descriptive Epidemiology and High Risk Behavior of Male Prescription Opioid Abusers: Cross-Sectional Study from Sikkim, North East India

Article excerpt

Byline: D. Datta, S. Pandey, S. Dutta, Y. Verma, Amit. Chakrabarti

Background: Sikkim is emerging as an important area for prescription opioid abuse with frequent news of seizures and arrests due to possession of prescription opioids. However, till date there is a little information on descriptive epidemiology and high risk behavior of prescription opioid abusers from Sikkim. Aims: The aim was to describe demographic (age, sex, religion, marital status, community, occupation, etc.); socioeconomic (income, education, family information etc.); and high risk behavior (e.g., injection sharing, visit to commercial sex workers [CSWs], homosexuality etc.) among treatment-seeking prescription opioid abusers in Sikkim. Materials and Methods: Epidemiological data were collected by administering predevised questionnaires from n = 223 prescription opioid abusers (main problem prescription opioids) reporting for treatment at five different drug abuse treatment centers across Sikkim. Results: The mean age of prescription opioid abusers in Sikkim was 27 years; all were male, of Nepalese ethnicity and single/never married, school dropout and/or illiterate, earning < Rs. 10,000/month with most spending almost Rs. 5000 a month on prescription opioids. Most (57.4%) prescription opioid abusers belonged to the urban community. Commonly abused prescription opioids were dextropropoxyphene and codeine. Injection sharing was more in urban areas whereas syringe exchange was observed equally among rural and urban prescription opioid abusers. Among urban injectors visits to CSWs, and multiple sex partners were also common in spite of knowledge about AIDS. Limited condom use was observed among rural respondents. Incidences of arrests, public intoxication, and violence under the influence of prescription opioids were also reported. Conclusion: Both the rural and urban areas of Sikkim show increasing rates of prescription opioid abuse among males. It is more prevalent among school dropouts and unemployed youth. Trends of injection drug use, unsafe injection, high risk behavior have also been observed.

Introduction

Sikkim, a small mountainous state in the Eastern Himalayas, observed great changes in its political and social structure; economic life; and cultural values during the past 100 years. The state borders Nepal to the West, China's Tibet Autonomous Region to the North and East, and Bhutan to the Southeast. The Indian state of West Bengal lies to the south. Sikkim with a population of 6.11 lakh [sup][1] is a multi-ethnic state, inhabited by an ethnic population of Lepchas, Bhutias and Nepalis. Lepchas are traditional inhabitants of Sikkim, whereas Bhutias and Nepalis (approximately 70% of Sikkim's population) have migrated from Tibet and Nepal, respectively. Sikkim was annexed to India as its 22[sup]nd state in 1975. As a result, a lot of migration took place from other parts of India, with the introduction of new substances of abuse including prescription opioids.

Prescription opioids are drugs that are prescribed for the management of pain mainly chronic noncancer pain. Prescription opioids are believed to be safer than illicit drugs of abuse and are also more easily available than illicit opioids like heroin. This has resulted in increases in the incidence of abuse of prescription opioids. While substantial epidemiological information on prescription opioid abuse is available globally and from India, such information is still not available from the state of Sikkim. National Household Survey on Drug and Alcohol Abuse, Government of India, observed the prevalence of opioid abuse of 0.7% after alcohol (21.4%) and cannabis (3%) among adult males.[sup][2] North Eastern India, particularly states of Manipur and Nagaland are known for problems of opioid abuse, mainly due to their proximity to the“Golden Triangle" – Myanmar, Thailand, and Cambodia.[sup][3] A cross-sectional study among 200 injecting drug users (IDUs) in Imphal, Manipur, and Dimapur, Nagaland indicated that the primary drug of abuse was injection dextropropoxyphene (spasmo proxyvon) (65. …

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