1. Dr.Anil Batta,J Biosci Tech, Vol 2 (3),2011, 305-311
DETECTION OF ADDICTION IN MEDICAL
PROFESSIONALS—AN EYE OPENER
Dr.Anil Batta
Associate Professor, Dep’t of Medical Biochemistry, Baba Farid Univ. of Health Sciences
Faridkot Punjab India
Abstract:
The medical professionals are vulnerable to substances of abuse/addiction due to
their ready accessibility to the substances of abuse. Of particular concern is the
finding of a lack of gender differences in problematic drinking with the pattern of
female addicts drinking rates for women approximating that of men by the end of
medical school. There is higher percentage use of alcohol, tranquillizers and Key words:
narcotics among medical students. Majority of the substance-abusing doctors are Narcotics,
graduates, belong to medicine specialty (21%) and majority of them prescribe tranquilizer,
drugs to themselves (37%). Medical student abuse is the major risk factors. medical professionals,
Despite paucity of studies in Indian population, substance use is reported between PGIMER, CHD
32.5% to as high as 81.2% among medical students, interns and house physicians.
In spite of the treatment dilemmas, the physicians do respond favorably to
treatment. These findings have implications in planning preventive and
interventional strategies for this professional group. This study explores the
attitudes and perceptions of medical students concerning patients with addictions
and policy issues related to drugs. Over 100 students from PGIMER students
responded to an anonymous survey concerning their experience and training
regarding addictions, and their level of support or opposition for various drug
policy approaches. Quantitative and qualitative epidemiological investigation of
substance use within a student population was seen during their mandatory
preventive health visit at the OPD medical facility. The purpose of this study was
to assess the prevalence of psychotropic (Narcotics) & tranquilizers drug
consumption by students undergoing medical courses of Post Graduate Institute of
Medical Education & Research, Chandigarh India to verify aspects related to those
addictions. Among psychotropic drugs, Narcotics & other psychotropic drugs like
dextropropoxyphenes, morphine, pethidine & tranquilizers were more frequently
used by the students. It was found to be 45.2% and 55.3% respectively.
1. INTRODUCTION environmental stress all can be factors. Peer
pressure can lead to drug use or abuse, but at
Physical addiction that gets (progressively) least half of those who become addicted
worse, but it’s a sort of emotional crisis that have depression, attention deficit disorder
is being pushed away. My belief is it's a post traumatic stress disorder, or another
spiritual crisis that is being batted away by mental health problem. Children that grow
taking drugs. And the trouble is, the more up in an environment of illicit drug
drugs you give an addict, the more drugs an abuse may first see their parents using drugs.
addict needs. Drug abuse can lead to drug This may put them at a higher risk for
dependence or addiction. Medico’s who use developing an addiction later in life for both
drugs for pain relief may become dependent, environmental and genetic reasons.
although this is rare in those who don't have
a history of addiction. The exact cause of People who are more likely to abuse or
drug abuse and dependence is not known. become dependent on drugs include those
However, a person's genes, the action of the who:-
drug, peer pressure, emotional 1. Have depression, bipolar disorder,
distress, anxiety neurosis and anxiety disorders, and schizophrenia
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2. Dr.Anil Batta,J Biosci Tech, Vol 2 (3),2011, 305-311
2. Have easy access to drugs drug source; uses drugs to "fix" negative
3. Have low self-esteem, or problems with feelings; begins to stay away from friends
relationships and family; may change friends to those
4. Live a stressful lifestyle, economic or who are regular users; shows increased
emotional tolerance and ability to "handle" the drug.
5. Live in a culture where there is a high
social acceptance of drug use Daily preoccupation - the user loses any
motivation; does not care about school and
Commonly abused substances include: work; has obvious behavior changes;
Opiates and narcotics are powerful thinking about drug use is more important
painkillers that cause drowsiness (sedation) than all other interests, including
and sometimes feelings of euphoria. These relationships; the user becomes secretive;
include heroin, opium, codeine, meperidine may begin dealing drugs to help support
(Demerol), hydroxymorphone (Dilaudid), habit; use of other, harder drugs may
and oxycodone (Oxycontin). increase; legal problems may increase.
Central nervous system (CNS) stimulants Dependence - cannot face daily life without
Include amphetamines, cocaine, drugs; denies problem; physical condition
dextroamphetamine, methamphetamine, and gets worse; loss of "control" over use; may
methylphenidate (Ritalin). These drugs have become suicidal; financial and legal
a stimulating effect, and people can start problems get worse; may have broken ties
needing higher amounts of these drugs to with family members or friends.
feel the same effect (tolerance).
Symptoms
Central nervous system depressants include 1. Some of the symptoms and behaviors of
alcohol, barbiturates (amobarbital, drug dependence include:
pentobarbital, secobarbital), 2. Confusion
benzodiazepines (Valium, Ativan, Xanax), 3. Continuing to use drugs even when
chloral hydrate, and paraldehyde. These health, work, or family are being
substances produce a sedative and anxiety- harmed
reducing effect, which can lead to 4. Episodes of violence
dependence. 5. Hostility when confronted about drug
dependence
Hallucinogens include LSD, mescaline, 6. Lack of control over drug abuse - being
psilocybin ("mushrooms"), and unable to stop or reduce alcohol intake
phencyclidine (PCP or "angel dust"). They 7. Making excuses to use drugs
can cause people to see things that aren't 8. Missing work or school, or a decrease
there (hallucinations) and can lead to in performance
psychological dependence. 9. Need for daily or regular drug use to
function
Experimental use - typically involves 10. Neglecting to eat
peers, done for recreational use; the user 11. Not caring for physical appearance
may enjoy defying parents or other authority 12. No longer taking part in activities
figures. because of drug abuse
Regular use - the user misses more and 13. Secretive behavior to hide drug use
more school or work; worries about losing 14. Using drugs even when alone
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3. Dr.Anil Batta,J Biosci Tech, Vol 2 (3),2011, 305-311
Opiates and narcotics are usually in the 2.1. Processing of sample
urine 12 to 36 hours after the last use, To 20 cc. of urine add conc. Hcl was used so
depending on the amount used and how as to get pH between 3 & 4. Reflux the
often the drug was used. contents in a flask, burner & condenser for 1
½ an hour. Allow this to cool down for
CNS stimulants such as cocaine can be about an hour.
found in urine for 1 to 12 days, again
depending on how often the drug was used. 2.2. Extraction Procedure
Refluxed urine is thoroughly washed with
CNS depressants such as Valium and Xanax 20 cc. Hexane. Then add sodium carbonate
are found up to 7 days after the last day of to get alkaline pH (8--9). Drug is extracted
use, mostly depending on the substance used from urine with chloroform & propyl
and how quickly the body removes it (its alcohol ratio of 4/1. Total volume of the
half-life). extraction mixture is 100 ml. Transfer the
Most hallucinogens also can be found in the contents in a separating funnel & collect the
urine up to 7 days after the last use. lowermost layer in a neat & dry beaker.
However, evidence of marijuana can be Evaporate the contents so that only residue
found for up to 28 days after its last use in is left.
regular users.
2.3. Spotting of Extracted Drug
2. METHOD Dried residue obtained in a beaker is
dissolved in a drop of methanol. This is
This study was carried out with students of spotted on mica plate so that difference
all years of the medical course invited to between the two is not >1/2 cm. & distance
participate anonymously by answering a from bottom is 2 cm. Along with the sample
self-applied questioaire. It was based upon the known sample is also spotted acting as
the World Health Organization's Guidelines standard of the drug.
for Student Substance Use Survey and
included 25 questions about drug addiction. 2.4. Development of spotted plate:
To carry out a quantitative and qualitative Put the spotted plates in the jar & left
epidemiological investigation of substance mobile phase to run up to 15 cm. mark. Take
use within a student population was seen out the plates & put them in oven for 5
during their preventive health visit at the minutes at about 100’C.
PGIMER medical facility.
2.5. Separating the plates
Cool the plate & spray this with spraying
Thin Layer chromatography is a method in
reagent Iodoplatinic acid. (made with the
which mobile phase moves by capillary
help of 1N Hcl, Potassium iodide & platonic
action across a uniform thin layer of finely
chloride). Alternately a UV lamp is much
divided stationary phase bonded on to plate.
better device. But for this we need labeled
Drugs when applied to the plate &
Silica to quote the glass plate.
developed with the mobile phase, they move
across the plate at different rates & hence
2.6. Detection of Drug
separated. Keeping in view cost effective
Locate the drug positive samples & compare
and reasonably accurate method of TLC was
them with morphine standard which was
used.
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4. Dr.Anil Batta,J Biosci Tech, Vol 2 (3),2011, 305-311
spotted along with the samples. Depending 6. Adequate protection staff so as to keep
on Rf value we can isolate & identify drugs checks on any suicidal or homicidal
like Morphine, codein, papavarine & other tendency.
narcotics. Similarly by changing the mobile 7. Patients were given analgesics,
phase or solvent system & spraying reagent tranquilizer, Vitamins & mineral as drug.
with dye or /UV apparatus we can isolate &
identify other drugs of abuse. 3. RESULTS
2.7. MATERIAL A total of 100 students took part in the
survey with a response rate of approximately
The present study was undertaken in one 50%. Preliminary results relating to a
hundred students studying in various courses subsample of this study are presented here
of all years in PGIMER, Chandigarh (n = 100, mean age 20 years, 56% women).
attending the OPD for a different 44% of the students consumed narcotic &
psychological problem of drug de-addiction tranquilizer at least once in their life. Other
& treatment Centre (DDTC) department of evaluated substances had a prevalence of
Psychiatry, Post graduate Institute of consumption lower than 1%. For the first
Medical Education Research, Chandigarh consumptions, a majority of students state to
(PGIMER, Chandigarh) & those who were felt "pleasant" effects: relaxation (71%) and
ailing & admitted to the ward of DDTC.All euphoria (53%). 13% state to have felt
of them were scanned thoroughly to rule out effects of anxiety or sadness. 25% admit
taking the drugs inadvertently. Age group having had difficulties of expression, 24%
was not particular & all the students doing memory deficits, 35% trouble with
all medical courses were selected. They coordination or balance and 39% difficulties
were provided a test tube for collecting a of concentration. Approximately 16% had
urine sample for detecting the drugs in urine. impressions of depersonalization and
They were guarded by watch staff so that derealization. Lastly, some experienced
they may not dodge by filling the tube with "psychotic-like" effects such as visual (10%)
a water sample. Different routine and auditory (6%) hallucinations, as well as
investigations with Liver Function Tests in referential ideas (16%), mistrust or feelings
particular were carried out. This was taken of persecution (11%). 26% of the student
into consideration as they may have been sample had felt at least one of these last four
taken raw morphine which contains Arsenic. "psychotic-like" effects. : In 2000-2006,
Following tests were carried out in routine 66.0% of male respondents and 52.0% of
in all the suspected cases:-- female respondents have reported any drug
use during their life. The analysis of
1. Serum ALT/AST/ALP/GGT. standardized data (by the place of residence)
2. Routine tests like Sugar, urea, TSP/DSP showed an increase in the prevalence of
were carried out by auto analyzer. drug use during 2006-2010.Up to 69.67 % in
3. Tests according to History of Patients. boys (P<0.05) and up to 60.60 % in girls
4. The food was provided by PGIMER, (P>0.05). Percentage of club drug users
CHD mess to rule out any foul play of increased significantly in girls (from 21.5%
sending the medicine in food. to 29.8%; P=0.040)
5. Watch & ward staff was always on alert
to rule out any back door entry of drugs
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5. Dr.Anil Batta,J Biosci Tech, Vol 2 (3),2011, 305-311
Table 1
Graduates perusing post Graduate Study-Specialty wise
Chronic Self Response rate
Specialty Mean age±SD Gross response rate
illness prescription Specialty wise
Medicine 23% 35% 25±1.9 39%
Psychiatry 39% 48% 24±2.9 48%
Surgery 25% 29% 24±3.9 29% 41%
Orthopedics 21% 15% 26±5.9 15%
Table -2
Chart showing narcotic and tranquilizer addiction (Priority wise)
Total Revealed Type of Drug & its sex wise prevalence
Professio intake of prevalence in both sexes
nal Drug Tranquilizer Narcotics Male Female
Narcot
Tranquilizer Narcotics Tranquilizer
ics
67% 52% 64% 58% 73% 32%
100 58
Table-3
Comparative Data of the last ten years
Type of drug & its Sex wise prevalence
Major %
prevalence in both
cause Addicts Male Female
sexes
Tranquilizer Narcotics Tranquilizer Narcotics
2000- Sadness/
45.4%
2006 Anxiety 67% 52% 64% 58% 73% 32%
Depression 32.5%
2007- Relaxation 59.8%
2010 60.60% 67.8% 66.43% 74.32% 32.76%
Euphoria 65.32% 69.67%
Loneliness 29.7%
Failed
love 39 %
affair
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6. Dr.Anil Batta,J Biosci Tech, Vol 2 (3),2011, 305-311
4. DISCUSSION: problematic drinking with the pattern of
female rates. Drugs were most frequently
Students were asked to take part in an used by, students living single in hostel
investigation of their substance consumption room, who live alone and do not support
and their individual experiences with themselves communication with friends who
narcotics & tranquilizers in particular. use drugs, participation in the parties where
Personality auto questionnaires were drugs are used, alcohol use, and smoking. In
performed and the psychotomimetic effects 2006 survey, more significant relationship
of narcotics & tranquilizers were between drug use and social and behavioral
investigated with substance use within a factors was observed. Several indicators of
student population seen during their drug use showed a significant increase in
mandatory preventive health visit at the drug abuse among students of medical
OPD medical facility. The use of illicit schools in North India during the period of
drugs by students and the possible 20004-2010. Multisectorial efforts and
psychological repercussions in this integrated preventive measures should be
population of young adults is an important applied for the prevention of epidemics of
public health issue. Some data in the drug use in North India & for that matter the
literature suggest a relationship between whole India. Alcohol was most used and
drugs and the occurrence of mental health was related to other drug addictions. Drugs
disorders, in particular psychotic illnesses, were most frequently used by single, male
epidemiologic surveys have shown that students, who live alone and do not support
narcotics & tranquilizers is the most themselves, communication with friends
consumed illicit drug who use drugs, participation in the parties
where drugs & alcohol are used. In 2006
Narcotic & tranquilizers consumption is
survey, more significant relationship
highly variable among different consumers.
between drug use, social and behavioral
Implications for prevention strategies are
factors was observed. Several indicators of
discussed such as educational interventions
drug use showed a significant increase in
based on recognition and motivation for
drug abuse among students of medical
change. The results are consistent with the
schools in North India during the period of
idea that the impact of tranquilizers &
2004-2010. Multisectorial efforts and
narcotics is easy we can isolate & identify
integrated preventive measures should be
other drugs of abuse.
applied for the prevention of epidemics of
As the present study was meant for drug use in North India & for that matter the
knowing the level of addiction in students of whole India.
different medical courses like Laboratory
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