Substance Abuse in Punjab: Challenges and the Punjab Substance Abuse Prevention Plan

Background: The Scale of the Crisis

In late July and early August 2020, Punjab faced a tragic wake-up call with the alcohol poisoning incident that claimed at least 100 lives across Amritsar, Gurdaspur, and Tarn Taran districts. This disaster, caused by illegally-made toxic alcohol, prompted hundreds of raids and 40 arrests, exposing the dangers of unregulated alcohol markets. While Punjab has made strides in providing de-addiction services across nearly all districts, the focus on prevention has been insufficient. The absence of a robust prevention strategy has hindered efforts to curb substance abuse, underscoring the need for a comprehensive approach combining prevention, treatment, and rehabilitation.

Introduction: Understanding Substance Abuse in Punjab

Substance abuse is a pressing psychosocial issue with significant public health consequences in Punjab. The National Survey on the extent, pattern, and trends of substance abuse in India estimates 73 million drug users (including alcohol) nationwide, with 13 million dependent. In Punjab, the National Mental Health Survey (2015–2016) reports prevalence rates of 5.4% for tobacco use disorders, 7.9% for alcohol use disorders, and 2.5% for other substance use disorders. Globally, the World Drug Report (2017) highlights that 29.5 million people suffer from drug use disorders, with opioids causing 70% of the negative health impact. In Punjab, over two-thirds of victims are regular alcohol users, and 26% use illicit drugs. Notably, alcohol and drug abuse have been linked to farmer suicides in the state, which has the highest per capita alcohol consumption globally, amplifying the urgency for targeted interventions.

The Punjab Substance Abuse Prevention Plan (P-SAP)

To address this crisis, Punjab invited public health expert JS Thakur to develop the Punjab Substance Abuse Prevention Plan (P-SAP), a holistic model emphasizing health promotion and a continuum of care (prevention, treatment, and rehabilitation). The plan, crafted through situation analysis, stakeholder workshops, and consultations with key officials, focuses on supply reduction, demand reduction, and harm reduction. Below is a detailed breakdown of the plan’s key components.

Key Activities in P-SAP

Supply Reduction

• Stricter Enforcement: Disrupt the supply chain of illegal drugs and alcohol through enhanced border control measures.

• State Resource Center: Establish a State Resource Center for substance abuse within the State Health Resource Center in Punjab.

• Budget Allocation: Dedicate a fixed percentage of the state budget to prevention activities.

• Excise Policy Review: Reduce the number of alcohol shops in urban and rural areas through policy reforms.

• Increased Taxation: Impose higher value-added taxes on tobacco products to deter consumption.

• Penalties for Non-Compliance: Enforce strict punishments and fines for unlicensed alcohol vendors.

Demand Reduction

• Capacity Building: Develop resource centers to train health and non-health sector personnel.

• Social Marketing: Launch campaigns to raise awareness about substance abuse prevention.

• Sensitization Meetings: Conduct district-, block-, and village-level meetings to discuss and implement action plans.

• Strengthened De-Addiction Services: Enhance synergy between prevention and treatment services across districts.

Harm Reduction

• Integration with Existing Programs: Link with the State AIDS Control Society’s initiatives, such as harm reduction programs for injecting drug users (IDUs).

• Key Harm Reduction Steps:

  1. Encourage IDUs to use clean needles/syringes.

  2. Implement drug substitution therapy programs.

  3. Provide drug dependence treatment programs.

  4. Offer vocational training or job placement assistance.

  5. Conduct family counseling to promote acceptance and support long-term rehabilitation.

District-Level Implementation

The P-SAP is designed for scalable implementation at the district level, ensuring localized action plans that address specific community needs. District-level efforts include establishing resource centers, conducting awareness campaigns, and integrating prevention with existing de-addiction services to ensure a cohesive approach.

Cost of Implementation

The estimated cost of implementing P-SAP is INR 2.45 crores (USD 0.35 million) in the first year, with INR 2.17 crores (USD 0.31 million) annually thereafter. Key expenses include:

• Capacity Building: INR 2,50,000 in the first year.

• Implementation, Monitoring, and Evaluation: INR 2,40,000 per year.

• State Resource Center Setup: INR 50.9 lakhs (USD 0.072 million).

• Per-District Cost: INR 52,216 (USD 709.47) annually.

These investments aim to create a sustainable framework for tackling substance abuse across Punjab.

Conclusion: A Path Forward

The Punjab Substance Abuse Prevention Plan (P-SAP) represents a comprehensive and proactive approach to addressing the state’s substance abuse crisis. By integrating supply reduction, demand reduction, and harm reduction strategies, the plan tackles the issue holistically. However, its success hinges on strong political and administrative commitment, robust monitoring, and active stakeholder participation. If implemented effectively, P-SAP could serve as a model for other Indian states and low- and middle-income countries grappling with similar challenges. By prioritizing prevention alongside treatment and rehabilitation, Punjab can create a healthier, safer future for its communities.

References

• Ahuja, R. (1997). Social Problems in India (2nd ed.). Jaipur: Rawat Publications.

• Torrens, P. R., Lynch, B. S., & Bonnie, R. J. (1994). Growing up Tobacco Free: Preventing Nicotine Addiction in Children and Youths. Washington, DC: National Academies Press. Available from: https://www.ncbi.nlm.nih.gov/books/NBK236763/. [Last accessed on 2015 Dec 07].

• United Nations Office on Drugs and Crime. (2017). World Drug Report 2017. ISBN: 978-92-1-148291-1. Available from: https://www.unodc.org/wdr2017/field/Booklet_1_EXSUM.pdf. [Last accessed on 2019 May 05].

• Ministry of Health and Family Welfare, Government of India. (2016). National Mental Health Survey of India, 1-15-16: Prevalence, Patterns and Outcomes. National Institute of Mental Health and Neuro Sciences. Available from: http://indianmhs.nimhans.ac.in/Docs/Report2.pdf. [Last accessed on 2019 May 08].