Drug Abuse Pattern and Risk Taking Behaviors among Drug Abusers in Dharan , Nepal

Background: Drug abuse is a serious and global health problem, causing significant morbidity, mortality, and adverse social and economic effects. The deleterious consequences of drug abuse are related not only to drugs themselves but also to the related risk taking behaviors, particularly sexual and injecting behaviors which can lead to other major health problems such as HIV/AIDS and Hepatitis B. Objectives: This study describes the pattern of drugs of abuse, sex-related behaviors, and injecting practices among drug abusers in Dharan municipality, Eastern Nepal. Methods: A total of 291 drug abusers were interviewed using friendship snowball sampling method with personal and household contacts. Results: The average age at drug initiation was 17.1 years. Marijuana appeared to be the major gateway substance in more than half of the respondents. Age group, caste/ethnicity and occupation were significant associates with injecting practice. More than 22% of intravenous drug abusers were injecting through dangerous routes, such as femoral and neck veins. Half of the drug abusers who visited commercial sex workers did not use condom. Almost half of respondents had never been tested for HIV. Conclusions: To tackle this situation, there is an urgent need for intervention programs, including harm reduction strategies to address these high risk behaviors and practices. Central Niraula et al. (2015) Email: J Subst Abuse Alcohol 3(4): 1040 (2015) 2/6 Sexual risk-taking behaviors are common among drug abusers, who often have multiple sex partners, including Commercial Sex Workers (CSWs). Male drug abusers do not regularly use condoms [7], greatly increasing the chances of disease transmission. National Institute on Drug Abuse (NIDA) [8] reports that drug addiction treatment is effective. Scientifically based treatments typically reduce drug abuse by 40 % to 60 %. These rates are not ideal, of course, but they are comparable to compliance rates seen with treatments for other chronic diseases such as asthma, hypertension, and diabetes. Moreover, treatment markedly reduces undesirable consequences of drug abuse and addictionsuch as unemployment, criminal activity, and HIV/AIDS and other infectious diseases-whether or not patients achieve complete abstinence. Unfortunately, many members of the public still mistakenly doubt that treatment can help someone overcome addiction, perhaps because-as Principles explains-recovery from addiction can be a long-term process and frequently requires multiple episodes of treatment. Research has shown that every $1 invested in treatment saves $4 to $7 in costs related to drug abuse. In Nepal, estimated HIV prevalence among injecting drug users (IDUs) was 38.4% overall and 68% in Kathmandu [9]. In the Eastern Terai (the lower plains region of Nepal), 35% male IDUs tested HIV positive in 2004 [10]. The number of IDUs is increasing all over Nepal. The problem is more prevalent among the adolescent age group [6]. This study describes the pattern of drugs of abuse, sexual behaviors and injecting practices among drug abusers in Dharan, Eastern Nepal. Drug abuse can apply to the harmful use of both licit and illicit substances and drug abuse patterns are different from place to place. In this Nepal-based study, drug abuse refers only illicit substances, excluding alcohol and tobacco, as both alcohol and tobacco have legal status in Nepalese law [11]. This study addresses both oral and injecting drugs along with its associated factors. MATERIALS AND METHODS Nepal is a landlocked country bordered by India and China covering an area of 147,181 square kilometers; it has a population of greater than 23 million [12]. Dharan municipality is situated in the Eastern Development region at the foothills of the Himalayas. A total of 291 drug abusers between the ages 15 to 40 years were identified within the Dharan Municipality in 2007 using a) friendship snowball sampling method and b) through identification by a random sample of non-drug abusers who identified potential drug abuse cases. Case/control definition Cases were defined as persons, between 15 and 40 years of age, who were screened using the CAGE [13] scale and found to meet the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-IV) criteria for drug abuse [14]. Sampling: Potential case identification was carried out using two methods. First, using snowball sampling, five exdrug abusers, four drop-in-center in-charges and four outreach workers from 19 wards of Dharan were contacted and initially identified sixteen drug abusers who were found to meet DSMIV criteria for drug abuse. Each of these cases was also asked to name a friend who might be a drug abuser (a potential case). These individuals were interviewed (with consent), and in turn were asked to identify other drug abusers. All (except 5 who were under severe influence of drugs) agreed to participate in the interview. A total of 150 cases were selected using this snowball sampling method. A second set of 141 drug abusers was identified using a random sampling methodology. First, 158 households from 19 wards of Dharan municipality were selected using stratified random sampling with proportional allocation method. A randomly selected occupant aged 15 to 40 years in each household (without history of drug abuse) was asked to list friends who they believed were drug abusers. One person from the list was randomly selected as a potential case. The sample size calculation, reliability and validity of the instruments used for interview have been described elsewhere [6]. Investigator took the interview under the guidance of a psychiatrist. The average time for interview was half an hour for each participant.