Academic journal article Indian Journal of Psychiatry

Pattern and Prevalence of Substance Use and Dependence in the Union Territory of Chandigarh: Results of a Rapid Assessment Survey

Academic journal article Indian Journal of Psychiatry

Pattern and Prevalence of Substance Use and Dependence in the Union Territory of Chandigarh: Results of a Rapid Assessment Survey

Article excerpt

Byline: Ajit. Avasthi, Debasish. Basu, B. Subodh, Pramod. Gupta, Nidhi. Malhotra, Poonam. Rani, Sunil. Sharma

Background: Substance misuse is a matter of major public health concern in India. House-to-house survey, though an appealing method to generate population-level estimates, has limitations for estimating prevalence rates of use of illicit and rare substances. Materials and Methods: In this rapid assessment survey (RAS), respondent-driven sampling was used to recruit substance-using individuals from the field. Size of the substance-using population was estimated using the 'benchmark-multiplier' method. This figure was then projected to the entire population of the Union Territory (U.T) of Chandigarh. Focused group discussions were used to study the perceptions and views of the substance users regarding various aspects of substance use. Results: Prevalence of any substance dependence in the U.T of Chandigarh was estimated to be 4.65%. Dependence rates on opioids, cannabinoids, and sedative hypnotics were found to be 1.53%, 0.52%, and 0.015%, respectively. Prevalence of injectable opioids was calculated to be 0.91%. Injectable buprenorphine was the most commonly used opioid, followed by bhukhi/doda/opium and heroin. A huge gap was found between the prevalence rates of substance-using population and those seeking treatment. Conclusion: RAS can be a useful method to determine the prevalence of illicit and rare substances. Our survey shows that the use of substance including that of opioids is highly prevalent in the U.T of Chandigarh. The findings of this survey can have implications for policymaking.

Introduction

Substance misuse is a matter of major public health concern in India. Many regional surveys have been carried out in India till date to study the prevalence of substance use employing house-to-house survey technique.[1] Few such surveys have also been carried out in the Union Territory (U.T.) of Chandigarh. The first house-to-house survey carried out in Chandigarh in 1980 focused only on alcohol use and reported the rates of the same to be 27.7%.[2] Another survey using the similar technique was carried out in rural areas and urban slums of Chandigarh in 2007 and reported the prevalence of substance dependence to be 6.88%.[3]

More recently, we conducted a house-to-house survey in the U.T. of Chandigarh.[4] It was found that while 6.72% and 3.34% respondents reported ever use of alcohol and tobacco, respectively, use of opioids and sedative hypnotics was reported by only 0.17% and 0.04% respondents, and none reported the use of cannabinoids, inhalants, or stimulants. Thus, it was realized that though a door-to-door survey is an appealing method to study the prevalence of less stigmatized substances such as tobacco and alcohol, but for illicit drugs such as opioids, this method is not likely to achieve much because of severe underreporting and different sample characteristics. Further, many pockets of high and especially illicit drug use remain out of access by this methodology (e.g., homeless, street children, those not on the public census from which the sampling frame is created, and those in prisons). Thus, this approach, while essential to generate general-population level data, must be supplemented with other, more targeted but less generalizable, strategies such as rapid assessment survey (RAS) methods and indirect data collection methods. RASs have been used in the recent past in and around Chandigarh for the estimation of size of substance users. One of these surveys was carried out in Punjab, Haryana, and Chandigarh and focused on injectable drug use.[5] The more recent one was the Punjab Opioid Dependence Survey which looked at the prevalence of opioid dependence in Punjab.[6] Given the obvious concerns regarding reports of a rise in opioid and injectable drug use in this geographic area, it is understandable that these have been the focus of recent RAS surveys. However, the use of a few other psychoactive substances such as inhalants, sedatives, cannabinoids, and stimulants may also be underreported in household surveys, meriting indirect techniques for correct estimates of prevalence rates of these substances. …

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