Why is alcohol excluded and opium included in NDPS act, 1985?

Abstract

Byline: Saddichha. Sahoo, N. Manjunatha, Baxi. Sinha, C.R.J. Khess The Problem Different forms of alcohol have been used in various human societies at least since the beginning of recorded history. As part of the contemporary dynamic of globalization, there has also been an increased use of drugs, which has now reached mammoth proportions. The use of both licit drugs such as alcohol and tobacco and illicit drugs such as cannabis, cocaine and opioids has been acknowledged to have multiple consequences to health, society and economy. According to estimates made by the World Health Report,[sup] [1] at least ten thousand million people throughout the world regularly use alcohol and about 13.5 million people use opioids. In India too, the problem is slowly increasing and it is estimated that 75 million people are alcohol users and nearly three million are opioid users, of which a majority require medical treatment and rehabilitation.[sup] [2] A number of other psychoactive substances are being added daily to the present list of psychotropic substances. The entire issue is complex and multifaceted requiring both health measures and efforts to control trafficking / smuggling and manufacture of these drugs. There is a need for the reduction in the demand of drugs of addiction, both legal and illegal, which may otherwise lead to numerous health, family and societal consequences. To combat this, the Government of India formulated the Narcotic Drugs and Psychotropic Substances (NDPS) Act, 1985,[sup] [3] which provides the current framework for drug abuse control and sale in this country. Essentially, the Act deals with supply reduction activities of psychotropic substances namely, cannabis, cocaine and opium. However, the absence of alcohol in the list of psychotropic substances is surprising given the fact that mental health professionals consider alcohol to be a psychoactive substance leading to various social, legal, economic and medical complications ranging from gastritis to withdrawal seizures and delirium tremens.[sup] [4] The Reasons The reasons for not including alcohol in the NDPS Act are many, the important ones being (a) prevailing social acceptance even for frequent self-induced intoxication;[sup] [5] (b) the high revenues earned by the Government on the sale of alcoholic beverages; (c) prevalence of illicit and locally brewed undistilled forms of alcohol is very high in society and (d) there may be differences in the clinical course of alcohol dependence contrary to other drugs like opium which have been included in NDPS. The last reason is what can be corrected through systematic clinical studies, which have not been conducted until now. The Solution Our study We therefore aimed at evaluating the reasons for inclusion of opium and exclusion of alcohol from NDPS by comparing and contrasting the course of dependence for both substances. We recruited consecutively admitted patients of ≥18 years of age for treatment of dependence in our Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, India with International Classification of Diseases-10-Diagnostic criteria for research (ICD-10-DCR) diagnosis of alcohol dependence syndrome or opioid dependence syndrome and obtained their written informed consent. We excluded other comorbid psychiatric disorders, substance dependence or general medical conditions requiring additional treatment. We administered the SSAGA-II[sup] [6] (Semi-Structured Assessment for the Genetics of Alcoholism-II) test to all our subjects after detoxification. SSAGA II is a poly-diagnostic instrument, which was designed to assess the physical, psychological and social manifestations (in other words, in terms of the criteria of ICD-10-DCR dependence). After the interview, data was transferred to the ICD-10 tally sheets of the respective alcohol or opioid sections of SSAGA-II. We considered the earliest age of any items of respective criteria of ICD-10-DCR dependence which was taken as the age of first onset of respective criteria of dependence. …