alexa Epidemiology of Substance Abuse in Bangladesh: A Narrative Review

ISSN: 2471-271X

Journal of Mental Disorders and Treatment

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Epidemiology of Substance Abuse in Bangladesh: A Narrative Review

Mohit Kamal1*, Huq N2, Mali B3, Akter H3 and Arafat SMY4
1Department of Psychotherapy, National Institute of Mental Health, Dhaka, Bangladesh
2School of Public Health, Independent University, Bangladesh
3Department of Nursing, Bangabandhu Sheikh Mujib Medical University, Bangladesh
4Department of Psychiatry, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
*Corresponding Author: Mohit Kamal, Professor and Head of Psychotherapy, National Institute of Mental Health, Dhaka, Bangladesh, Tel: +8801711832955, Email: [email protected]

Received Date: Jul 13, 2018 / Accepted Date: Jul 16, 2018 / Published Date: Aug 10, 2018

Abstract

Background: Substance abuse is an important public health and social problem in Bangladesh. The menace of substance has been increasing day by day in the country.
Objectives: This review was aimed to look into the epidemiology of substance abuse in Bangladesh based on recent literatures.
Methods: Search was done in PubMed, PubMed Central, Google Scholar, and Bangla JOL with searching keywords till March 2018. After considering inclusion and exclusion criteria total 15 articles were selected for review.
Results: From the pooled data the review revealed majority of the respondents were less than 30 years of age, 94.17% were male, 62.90% were unmarried, 94.17% from urban background, and 19.66% were businessman. Peer pressure was found as the commonest risk factors (54.69%) followed by anger or impulse issues (41.87%) and availability of drugs (41.17%) were considerable risk factors. Heroin was found as a first choice of drug followed by yaba and cannabis.
Conclusion: This review revealed early adulthood was more risky years, males are mostly affected by drugs, peer pressure was most significant influencing risk factor and heroin is the mostly expected drug in Bangladesh.

Keywords: Substance abuse; Bangladesh; Drug abuse; Epidemiology; Heroin; Yaba; Demography

Introduction

Substance abuse is recognized as an important public health and social problem in Bangladesh [1,2]. The incidence of drug abuse has been increasing day by day in a developing country like Bangladesh [2]. Drug addiction hampers the mental well-being of an individual as well as it causes lots of physical complications [2]. In terms of geographical location Bangladesh is situated in the central point of the world's biggest growing narcotics zone: the 'golden crescent' (Afghanistan, Pakistan, and Iran) and the 'golden triangle' (Myanmar, Laos, and Thailand). So, the country has become a major transit point for drug dealers [3]. They are routing their shipments through this country to the markets of other parts of the world including Europe, Africa and America. Besides this, India, which is an important producer of opium and other substances located around Bangladesh. Though there was no available exact estimation of substance abusers in Bangladesh, on the basis of different and statistics, it can be estimated that the number may be more than 6 million and these people spend over 70 million BDT every day on illegal narcotics [3]. The major illicit drugs available in Bangladesh are opium derivatives (heroin, pethidine), cannabis (marijuana, ganja, chorosh, bhang, hashish), stimulants (yaba, cocaine), sleeping pills, cough syrup (phensidyl, dexpotent etc.) and few others [1,4]. The problem is increasing day by day and threatening the nation. Males are being affected by drugs more than the females [1] and early adulthood is the vulnerable age for abusing drugs. Preferable drugs are heroin, yaba, cannabis, followed by few others. However, it is under studied in the country. No nation-wide prevalence study has been published yet. There is dearth of epidemiological research on drug abuse. We aimed to look into the epidemiology of drug use in Bangladesh based on the existing literature.

Methods

For selecting article search was done in electronic data bases (PubMed, PubMed Central, Google Scholar & Bangla JOL) with searching key words till March 2018. Initial screening was done by analyzing the titles, then abstract was reviewed and finally full articles were downloaded and studied. After exclusion of duplication, screening, finally selection was done on basis of inclusion and exclusion criteria and finally 15 articles were selected for review.

Searching words

Substance abuse in Bangladesh, drugs in Bangladesh, drug abuse in Bangladesh, yaba in Bangladesh, addiction in Bangladesh, cannabis in Bangladesh, substance use disorder in Bangladesh, substance related disorder in Bangladesh, prevalence of substance use/related disorder in Bangladesh, demography of substance users in Bangladesh

Inclusion criteria

1. Full downloadable original articles in pdf form

2. Articles regarding substance abuse in Bangladesh

3. English language.

Exclusion criteria

1. Review articles

2. Articles of single substances

3. Article of suicide outside the Bangladesh demography.

Variables: Age, sex, occupation, status, residence, marital status, choice of drug, route of drug, identifiable risk factors, reason for relapse, and sources of money, were considered as the variables of the study.

Permission: As the data includes only online available previously published information, no formal ethical clearance was needed.

Data analysis: All selected articles were scrutinized for the variables and data were pooled to create a single source. Percentages were calculated based on summation of the total samples of the mentioned article and summation of corresponding variable frequencies. There were multiple responses and different pattern of variables in different articles. So total number of sample and total frequencies were mentioned in every variables separately.

Results

The mean age of the respondents was 28.10 years with ranges from 10-50 years. Majority of the respondents were less than 30 years of age. About 94% of the respondents were male, 63% were unmarried, 94% from urban background, 33% were unemployed and 51% were from joint family (Table 1). Peer pressure was found as the most influencing risk factors. About 55% of the respondents take substance due to peer pressure, 41% were influenced by availability of drugs, 34% took drug to get pleasure, and 27% started for their curiosity (Table 2). Heroin was the choice of drug in this review. About 67% of respondents considered heroin as their choice of drug, 44% considered yaba, and 39% considered cannabis as drugs of choice (Table 2). For abusing drugs 65.49% of the respondents arranged money from criminal activities, 64.28% from family and 33.80% from own income. Majority of the respondents (63.45%) took drug orally, 57.39% took through inhalation, and only about 9% in injectable form (Table 3). But, a substantial portion of respondents took drug in multiple routs. Moreover, abusing more than one substance is an important concern (Table 4).

Year Author City Location Sample Size Type of study Investigated issue
2014 Zaman et al. [1] Dhaka CTC 300 Cross-Sectional Psychosocial illness in detoxification center
2013 Maehira et al. [5] Dhaka Private Hospital 260 Prospective cohort Factors associated with relapse in detoxification–rehabilitation programme
2010 Roy et al. [6] Dhaka BSMMU and CTC 500 Case Control Personality Traits of Substance Users
2013 Hossain et al. [7] Dhaka CTC 1076 Cross-Sectional Sex-habit and STIs among drug abusers in Detoxification
2013 Riya et al. [8] Dhaka CTC 150 Cross-Sectional Pattern of Drug Abuse in Addiction Rehabilitation Centers
2015 Islam et al. [2] Mymensingh Private Hospital 38 Cross-Sectional Social Impact of Drug Addiction
2015 Khan [9] Munshiganj Community 182 Cross-Sectional Debunking the Drug Abuse-Crime in Urban Youths
2017 Hasam and Mushahid [10] Sylhet Private Hospital 99 Cross-Sectional-multi center Causes of Drug Addiction in Urban Life
2014 Islam et al. [11] Across Bangladesh Universities, public institutions 100 Descriptive Impact of Drug abuse
2017 Mohit et al. [3] Dhaka Private Hospital 306 Descriptive Prevalence and Patterns of Substance Abuse among Male Patients
2017 Roy and Mian [12] Sylhet Private Hospital 155 Descriptive Socio-Demographic and Clinical Profile of Substance Abusers
2017 Soron et al. [13] Dhaka NIMH and CTC 101 Descriptive Social and Family Determinants of Substance Abuse
2016 Maruf et al. [14] Dhaka Private Hospital 105 Descriptive Pattern of Substance Use in De-addiction Clinic
2018 Hossain et al. [15] Dhaka CTC 120 Descriptive Oral and Dental Diseases and Oral Hygiene Practices among Illicit Drug Abusers
2017 Ahad et al. [4] Sylhet Private Hospital 42 Descriptive Socioeconomic Status of Young Drug Addicts

Table 1: List of articles.

Demographic Variable Frequency Percentage   Total sample
Sex      
Male 856 94.17 909
Female 53 5.83 909
Marital Status      
Married 332 46.82 709
Unmarried 446 62.90 709
Divorce 28 3.94 709
Widow 2 0.97 206
 Habitat      
Urban 834 94.17 1067
Rural 233 21.84 1067
Missing 28 7.8 1067
Occupation      
Student 182 19.34 941
Unemployment 271 32.22 841
Business 185 19.66 941
Service 142 16.86 842
Driver 5 3.50 143
Cultivator 5 4.95 101
Day labor 19 10.50 181
Other 15 5.24 286
Housewife 4 3.81 105
Retired 1 0.95 105
Education      
Illiterate 61 23.55 259
Below SSC 157 24.30 646
SSC 171 22.95 745
HSC 193 19.97 966
Graduate 278 26.07 1066
Postgraduate 60 10.84 100
Type of family      
Nuclear 143 48.97 292
Joint 149 51.03 292

Table 2: Distribution of demographic variables of the respondents.

Variable Frequency Percentage  Total sample
Risk factors      
Peer pressure 710 54.69 1298
Getting pleasure 155 34.06 405
Curiosity 243 27.24 892
Depression 57 19 300
Failure in love 56 11.61 482
Loneliness 12 4 300
Unemployment 141 15.87 888
Frustration 134 20.83 643
No reason 17 10.96 155
Family problem 252 34.14 738
Availability 105 41.17 255
surrounding environment 43 10.59 406
Anger/ Impulse 170 41.87 406
Financial 58 18.95 306
Relationship 52 16.99 306
Family history 27 8.82 306
Political issue 11 3.59 306
Parental separation 8 2.61 306
Death of loved ones 4 1.30 306
Prescription 3 1.93 155
Choice of drugs      
Heroin 1625 66.98 2426
Phensidyl 613 25.26 2426
Cannabis 942 38.82 2426
Sedatives 180 16.58 1085
Yaba 596 44.37 1343
Danti 30 10 300
Shisha/Hukka 24 8 300
Cough syrup 61 9.47 644
Injection 136 7.06 1926
Alcohol 303 27.72 1093
Pathedine 168 22.76 738
Morphine 12 2.63 456
Cocaine 13 2.86 453
 Reason to relapse      
Peer influence 69 18.64 370
Family-related problem 44 11.89 370
Personal problems 13 20.31 64
Drug craving, withdrawal symptoms 6 9.37 64
To enhance sexual power 2 3.12 64
Psychological 60 19.60 306
Anger/ Impose 52 16.99 306
Frustration 30 9.80 306
Loneliness 26 8.49 306
Break up 22 7.18 306
Environmental 14 4.57 306
Occasion celebration 12 3.92 306
Extra marital affair 8 2.61 306
Unemployment 7 2.28 306

Table 3: Distribution of Risk factors, drugs choice, reasons for relapse, among the respondents.

Variable Routes of drug Frequency Percentage Total sample
Oral 356 63.45 561
Inhalation 332 57.39 561
Injection 50 8.91 561
Drug abuse in lifetime
Single drug 105 35 300
Two drugs 380 27.61 1376
Three drugs 353 25.65 1376
Four drugs 322 23.40 1376
Five drugs 213 15.47 1376
Six drugs 107 7.77 1376
       

Table 4: Distribution of routes and number of drugs among the respondents.

Discussion

In this paper, epidemiology of substance addiction in Bangladesh was reviewed. About 94% of the respondents were male that signifies the gender representation of substance use in Bangladesh. Repeated studies in Bangladesh revealed that males are being addicted more than the females [4-14]. This review found unmarried (62.90%) respondents were more likely to take substances than married and others those are supported by other studies [3,10]. However, Maehira et al., found most of the respondents (59%) were divorced/separated/widower/ widow [5]. Most of the respondents (94.17%) were urban background which was found in multiple studies [3,8,12-14]. The situation can be explained by the sample distribution and place of the studies. Most of the studies were conducted in clinical settings in urban areas. As a result, such urban rural distribution was found. Study revealed almost similar distribution in regards to the educational achievements, interestingly more respondents were prevalent in graduate class (Table 2). Unemployment and businessmen were more prone for substance abuse which was found in multiple studies [2,8,10,11,13,14]. Unemployment may act as both cause or effect of substance abuse. However, none of the studies studied the relationship of unemployment and substance abuse. In other ways, Islam and Hossain, found students were more take substance than unemployment and businessman [11]. Peer pressure contributed highest as a risk factor followed by anger or impulse, availability and getting pleasure which was supported by multiple original studies [1,3,11,14,15]. Heroin as a most choice able drug of majority of the respondents followed by yaba and cannabis those are repeatedly found in other study [1,3,4,6-9,11,12,14,15]. In current scenario of the country yaba might be the most abused drug and future studies would reveal that.

Conclusion

The review revealed the recent epidemiology of substance abuse in Bangladesh. To the authors best knowledge this is the first study to explore the substance abuse in the country. Early adulthood, is risky part of life, abusers are mostly male, peer pressure is the most significant influencing risk factor and Heroin is the mostly expected drug. However, further systematic reviews would help to generalize the findings.

References

Citation: Kamal M, Huq N, Mali B, Akter H, Arafat SMY (2018) Epidemiology of Substance Abuse in Bangladesh: A Narrative Review. J Ment Disord Treat 4: 165. DOI: 10.4172/2471-271X.1000165

Copyright: © 2018 Kamal M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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