Daily reports of new hauls of illegal drugs entering the country and making their way to schools and youth hostels in tantalising packages and wrappings to lure young people to experiment with them and become addicted to them is a disturbing trend, raising concerns among health officials.
The Sunday Observer spoke to Emeritus Prof of Forensic Medicine and Toxicology, University of Colombo Dr Ravindra Fernando a long campaigner against drug abuse, to find out what drives people to use drugs and their harmful impact on the human body.
Q. Recent reports reveal illegal substances entering the country and several hundreds of persons being caught red handed. The problem has escalated in the past few months and especially spiked after the curfew was imposed following the Covid-19 outbreak. Your comments.
Dr Ravindra Fernando
A. Yes, the Police and the Security forces have detected large scale drug smuggling recently. In March, the Navy seized two foreign trawlers with 400kg heroin (worth $33 million) and 100kg crystal methamphetamine near Colombo. In April, the Navy seized $65 million worth crystal methamphetamine and ketamine in the country’s biggest drugs bust. The Navy found 605 kilograms of crystal meth, also known as Ice, and 579 kilograms of ketamine. This is the first time we found ketamine. The street value of all these drugs is very high driving dependents to the underworld of crime.
Q. Tell us what the commonest additive drugs used in Sri Lanka are.
A. The commonest addictive or dependence producing drugs are Alcohol and Tobacco, both are legal. Other common drugs are amphetamine, methamphetamine (Ecstasy) and Ice, Cannabis or ganja or marijuana and Heroin. Cocaine and Benzodiazepines and similar drugs. Other addictive drugs include barbiturates, Hallucinogens (Lysergic acid diethylamide – LSD, certain mushrooms), Khat type, and Volatile solvents.
Q. Today we have new drugs such as Ice that have become very popular among the elitist groups. As not many people know what it is tell us what it is.
A. Ice, along with speed and base, is a form of the potent stimulant drug methamphetamine, mentioned earlier. Also referred to as ‘shabu’, crystal, crystal meth or d-meth, Ice is the purest and most potent form of methamphetamine. It comes as a powder or crystals that are usually snorted, injected or smoked. About half of those who use methamphetamines say they prefer to take Ice.
How quickly you feel the effect of methamphetamine depends on the form, the route of administration and how much of it one uses. Mostly people smoke, inject or swallow a pill, and sometimes dissolve it in alcohol or water and drink it. Methamphetamine psychosis typically involves feeling overly suspicious, having strange beliefs about things that are not plausible, or hearing and seeing things that are not there.
Q. Signs to look out for in a user?
A. If one smokes it, it has an immediate high, just in a couple of minutes. If ingested its effects are felt in about 20 minutes. The immediate effects from ICE are intense pleasure and clarity. Users say they have lots of energy and can think clearly, feel like they can make good decisions, and plan effectively.
This is because methamphetamine dramatically increases the levels of the hormone dopamine – by up to 1,000 times the normal level – much more than any other pleasure seeking activity or drug. Physical effects include dilated pupils, an increased heart and breathing rate, a reduced appetite and an increased sex drive.
Q. What are the commonest drugs used in Sri Lanka? Explain what adverse health impacts each of them has on regular users.
A. The commonest addictive drug is cannabis. Marijuana refers to the dried leaves, flowers, stems, and seeds from the Cannabis sativa or Cannabis indica plant. The plant contains the mind-altering chemical tetrahydrocannabinol (THC) and other similar compounds. Cannabis is the only drug that grows in Sri Lanka. It is grown illicitly, mostly in the dry zones of the country (in the Eastern and Southern provinces). The estimated land area under cannabis cultivation is nearly 500 hectares.
Cannabis causes euphoria, ‘high’ feeling, pleasurable state of relaxation, enhancement of sensory experiences, increased appetite, impaired performance, sleepiness, confusion and hallucinations.
Opiates derived from the plant Papaver somniferum have many alkaloids including morphine. Heroin is a substance synthesized from morphine. Among the heroin users inhalation (‘chase the dragon’) is the preferred mode of administration. Diazepam, lactose, sucrose, acetaminophen and caffeine are the commonly used adulterants of heroin. Heroin causes a sense of wellbeing, euphoria, contentment, detachment from emotional/physical distress and pain relief. It can cause drowsiness, lack of concentration, respiratory depression and even death.
Addiction to heroin causes serious withdrawal symptoms when heroin is not present in blood. Addicts experience anxiety, restlessness, sweating, yawning, runny nose, watering of the eyes, diarrhoea, incontinence of urine, abdominal pains, muscle cramps, hallucinations and delusions.
In Sri Lanka heroin is inhaled. This is much less harmful than intravenous injection. Intravenous drug addicts are more prone to get infections. They die prematurely from acute heroin overdose, inhalation of vomit, acute ulcerative endocarditis, bronchopneumonia and hepatitis. They are more likely meet with accidents and commit suicide.
Q. Do these adverse effects occur in short term users or those who have taken them for a long time?
A. Adverse effects are found even in short term users. Serious life threatening effects are found in chronic users. For example, marijuana affects brain development. When people begin using marijuana as teenagers, the drug may impair thinking, memory, and learning functions and affect how the brain builds connections between the areas necessary for these functions.
Q Are they reversible?
A. Some effects pass off if one stops taking the drug. Others, such as cocaine abuse leading to perforated nasal septum, keratitis of the eyes, dental erosions, heart muscle disease, coronary artery disease and liver disease are sadly not reversible
A. Yes, certain conditions are curable.
Q. Does it affect one’s vision?
A. Nearly every substance of abuse can affect vision. Alcohol intoxication can cause double vision or blurry vision. Amphetamines can cause blurred vision and changes in pupil size.
The drugs can also cause rapid quivering of the pupils (nystagmus). Cigarette smoking can lead to cataracts of the crystalline lens – an area of the eye that produces one-third of the image the brain processes by focusing light onto the retina. Cocaine stimulates the brain and releases endorphins and adrenaline, and the body will react by dilating the pupils. Symptoms of overdose include hallucinations, including visual hallucinations. Heroin can cause drooping eyelids due to sleepiness. Methamphetamine intoxication causes rapid eye movements – usually about 10 times faster than average eye movement.
Q. Skin? Can some drugs cause skin rashes?
A. Drug rashes usually are caused by an allergic reaction to a drug. Typical symptoms include redness, bumps, blisters, hives, itching, and sometimes peeling, or pain.
Q. Violent unpredictable behaviour?
A. Since drug and alcohol use can weaken self-control, it’s not uncommon to see people who are under the influence engaging in behaviour they usually wouldn’t if they were sober. The effects of substance use on behaviour lead many to believe that there is a strong correlation between acts of violence and drug or alcohol use.
Q. Can taking certain of these drugs result in fatal outcomes like lung failure and ruptured blood vessels? Mention which.
A. Drug use can lead to a variety of respiratory problems. Marijuana smoking can cause respiratory problems, including chronic bronchitis. Smoking crack cocaine can cause lung damage and severe respiratory problems.
The use of heroin may cause breathing to slow, block air from entering the lungs, or make asthma symptoms worse.
Q. Will the effects be the same in older persons whose brain has already developed as in young people?
A. Chronic use of some drugs can lead to both short- and long-term changes in the brain, leading to mental health issues including paranoia, depression, anxiety, aggression, hallucinations, and other problems. Effects will be more on developing brains of young people between 18 -25 years.
Q. What drives young people to use drugs?
A. The most common reason is to ‘get high.’ The desire to ‘get high’ can be for many reasons. Pressures of coping with school, work, or family tensions and underlying disease such as depression can lead to addiction.
Q. Is there a safe dosage of illegal drugs one can take?
Q Does taking illegal drugs interfere with one’s sexual life?
A. Erectile dysfunction (ED), defined as the inability to achieve and/or maintain an erection satisfactory for the completion of sexual activity, is highly prevalent among males abusing heroin.
Q. Is there a link to illegal drugs and pre-existing diseases like diabetes, hypertension, and heart disease?
A. All illegal drugs can aggravate almost all pre-existing diseases.
Q. With the current Covid-19 pandemic can taking drugs increase susceptibility to this emerging disease?
A. Yes, drug abuse or addiction, can lead to considerable damage to the immune system. Therefore addicts may be more susceptible to Covid-19 like infections.
Q. Is taking alcohol a drug abuse?
A. Yes, alcohol is an addictive chemical.
Q. Smoking we know causes different cancers. Can breathing the same tobacco smoke affect a person in the same room?
A. Yes. Second-hand smoke has been confirmed as a cause of lung cancer. Passive smoking increases the risk of respiratory illnesses in children, including asthma, bronchitis and pneumonia
Q. Smokeless cigarettes that are now in fashion?
A. Prolonged use of smokeless tobacco products contributes to serious health issues.
These include cancer and heart disease. Some smokeless tobacco products contain 3 to 4 times more nicotine than cigarettes. These products contain substances that increase risk of oral and oropharyngeal cancer.
Q. Rehabilitation? What are the steps taken recently to rehabilitate a user?
A. Drug rehabilitation is the process of medical or psychotherapeutic treatment for dependency on psychoactive substances and drugs such as cannabis, and heroin.
The objective is to enable the patient to confront substance dependence and cease substance abuse to avoid the psychological, legal, financial, social, and physical consequences that can be caused by extreme abuse. Treatment includes medication for depression or other disorders, counselling by experts and sharing of experience with other addicts.
Q. Gaps you like to see filled in the present system?
A. Closer monitoring and studies on private rehab centres which is not available at present. According to reports other countries show excessive charging from patients, untrained counsellors, ill-treatment of patients, etc.
Q Your message to readers on minimising /preventing drug abuse?
A. We should have family, school and community based prevention programs