How much do drug abusers pay for drugs in Bangladesh?

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Sir, Drug abuse is an alarming problem in Bangladesh where there are 1.7 million drug abusers (1). The number is increasing greatly over recent years. Among drug abusers, intravenous drug use has the potential to turn a slow HIV epidemic into an explosive and devastating one, as was observed in Thailand and northern India (2,3). Drug use shortens life expectancy, decreases productivity, increases absenteeism from workplace and schools, and is linked to higher cost of medical care, accidents, crime, and high-risk sexual behaviour (4,5). During October 1998--February 1990, we investigated the patterns of drug abuse among 196 drug abusers who had been admitted to a drug-dependence treatment centre in Dhaka, Bangladesh. We also analyzed the cost of drug abuse. Cost data were adjusted to 2003 Bangladeshi taka [2003 cost data=1999 cost data x [(1+0.05).sup.4]]. The following formula was used for calculating the daily average cost of drug per person: Cost per drug user per day=[P.sub.1][C.sub.2]+[P.sub.2][C.sub.2]+[P.sub.3][C.sub.3] + .........[P.sub.n][C.sub.n] Where P is the proportion of drug users using one particular drug, C is the cost of the drug for average daily consumption, and n is the number of drugs available and consumed by abusers. Table 1 shows the baseline characteristics, drug-use patterns, and cost of each unit of drug. Of the respondents, 93.9% were male, 64.8% were unmarried, 56.1% were either students or unemployed, 95.4% were smokers, 85.7% were influenced by friends, 64.3% were addicted to codeine-containing cough syrup, 64.3% were habituated to more than one drug, 65.8% took drugs in groups, and 63.8% had a history of unprotected sex. The mean number of drugs abused by them was 1.9, while the mean duration of addiction was 42.1 months. According to the above formula, the average per-person cost of drugs was US$ 1.9-3.1 per day or US$ 707-1,135 per year. The amount of money drug abusers spent per year (US$ 707-1,135 per person) is much higher than the per-capita income of Bangladeshi people (US$ 380 in 2001) (6). Moreover, the total amount spent by 1.7 million drug abusers in Bangladesh would be US$ 1.2-1.9 billion. This amount is extremely high if we compare it with the annual expenditure (adjusted for 2003) for healthcare (US$ 2.06 billion) (7), or drugs (US$ 0.448 billion) (8), or the allocation for development programmes in Bangladesh (US$ 3.44 billion) (9). Moreover, the actual cost of drug abuse would be far more if we include other related costs (Table 2). The main limitation of this study was that the sample of drug abusers was taken from a drug-addiction treatment centre, which covers only part of the capital city population. Therefore, our results could be different from those of actual population-based estimates. Drug abuse is a complex problem in Bangladesh. Being very close to the 'Golden Triangle' and having thousand of kilometres of common border with India, illicit drugs are easily trafficked here. Easy availability of drugs is the prime cause of the growing number of drug abusers in Bangladesh. Growing criminal activities, such as robbery, burglary, theft, mugging, extortion, forgery, family violence, sexual assault, and gang assault in Bangladesh are believed to be partly attributable to drug abuse. REFERENCES (1.) Salek SA. Role of mass media in control of drug abuse. Dhaka: Bangladesh Narcotics Control Board, Ministry of Home Affairs, Government of Bangladesh, 1999:15-20. (Occasional publication). (2.) Sarkar S, Das N, Panda S, Naik TN, Sarkar K, Singh BC et al. Rapid spread of HIV among injecting drug abusers in north-eastern states of India. Bull Narc 1993;45:91-105. (3.) Poshyachinda V. Drug injecting and HIV infection among the population of drug abusers in Asia. Bull Narc 1993;45:77-90. (4.) Burt MR. Reasons to invest in adolescents. J Adolesc Health 2002;31(Suppl 6):136-52. …