A Narrative Review of Global Perspective on Illicit Drug Utilization and Substance Use Disorders

Abstract

Drug addiction and abuse are major public health issues across the globe that impact millions of people. Substance abuse and dependence seem to have been relatively high among university students and laborers and comparatively low among school students. Drugs used by the person for nonintended reasons, mainly for their psychoactive effects termed as drug abuse. Continued use of alcohol, illegal drugs, or prescription or over-the-counter medications harms health, employment, family, and law. When it comes to illicit substance usage, possession, and trafficking, every nation has its unique set of laws. The frequency of lifetime drug usage in 2015 was 5%, according to the most current World Drug Report. There is reason to be concerned about the high rates of drug and alcohol addiction among youths because of the substantial problems that have been linked to such use, including higher rates of aggression, suicidal attempts, etc., In this narrative review, we have focused on illicit drugs, substance use, its negative impacts among youths and its prevalence among youths nationally and internationally, and also some prevention strategies to control substance use.

INTRODUCTION

Addiction to drugs, whether legal or illegal, is a serious social health issue that affects millions of individuals throughout the world. The societal costs of drug addiction include those to society's health (including the expenses of drug prevention and treatment, medical care, and hospitals), safety, the environment, and workers' productivity.[¹] More than half of the evidence submitted to a crime laboratory is related to drugs, and the laboratory's drug department is often the largest in terms of space, forensic scientists, equipment, and case submissions. This situation has persisted well for over half a century. The government has been fighting the drug problem for nearly a century now on many fronts, including helping other countries crack down on drug production and cultivation, intercepting drug shipments from other countries, cracking down on drug production and sales within the countries, and implementing youth and adult drug abuse prevention programs. Unfortunately, the effectiveness of these procedures has been inadequate over time, and in fact, only a small proportion of international drug shipments are captured at borders. The misuse of several drug classes is now greater than ever in the United States, where drug usage has not decreased. Even Indian Justice Department officials have recently acknowledged that the alleged “war on drugs” has mostly failed and needs to be scaled down.[²]

Drugs and the laws

The Opium Act of 1857, which went into effect to control the cultivation of opium poppy and the manufacture of opium, was one of the former major Acts that the Government of India consolidated to exercise strict control over narcotic drugs and psychotropic substances (NDPS) in India as specified by the United Nations conventions. The import and export of opium and poppy heads were controlled by the Indian government.[³] The Opium Act was passed by colonial India in the hopes of lowering opium usage. According to the new law, only Chinese and Indian opium consumers are allowed to buy opium, and Burmese opium users are categorically forbidden from doing so. Shanghai and Tientsin serve as refineries for most of the illicit heroin brought into the United States from China. The North-East Indian province of Assam has outlawed the growing of opium.

The Indian Parliament replaced the Opium Act of 1857, the Opium Act of 1878, and the Dangerous Drugs Act of 1930 with the more comprehensive Psychotropic Substances and Narcotic Drugs Act of 1985.

In India, the Psychotropic Substance and Narcotic Drugs Act of 1985 provides the legal foundation for drug policing. The Opium Act of 1857, the Opium Act of 1878, and the Dangerous Drugs Act of 1930 are all combined into one Act, which replaces the former primary Act. The NDPS Act also includes clauses intended to carry out India's commitments under several international conventions. The Act underwent some substantial revisions in 1989 to provide provisions for the seizure of assets obtained by drug trafficking and for the regulation of the substance and materials used in the production of psychotropic substances and narcotic drugs. The Government of India issued the N. D. P. D (Regulation of Controlled Substances) Order in 1993 to give effect to the statutory provisions relating to these substances.[⁴] This order control regulates and monitors the manufacture, import, distribution, export, transportation, etc. of any substances that the Government may designate as controlled substances under the Act.

The Narcotics Drugs and Psychotropic Substances Act is currently in force and serves as a comprehensive code for the control and regulation of NDPS as well as for the control of specific chemicals, also referred to as precursors, which can be used to illicitly produce NDPS. It also serves as a tool for the investigation and forfeiture of assets with a drug-related history. The Preventing Illegal Traffic in NDPS Act of 1988 defined the requirements for detention to be employed in preventing illegal traffic in narcotic drugs, psychotropic substances, and associated goods.[⁵⁶⁷⁸]

India has signed and ratified the 1961 Single Convention on Narcotic Drugs, the 1971 Convention on Psychotropic Substances, and the 1988 Convention against Illicit Traffic in NDPS and has enacted the NDPS Act, of 1985. After the “grace period” for eliminating the nonmedical use of cannabis and opium established by the 1961 Convention had expired, domestic regulations were enacted only in the 1980s.[⁹] The NDPS Act, 1985 was swiftly approved by the Indian Parliament, using its authority to establish laws for the nation to follow “any treaty, accord, convention, or decision taken at an international conference.” The Opium Acts and the Dangerous Drugs Act were repealed and replaced with the NDPS Act on November 14, 1985. However, the 1940 Drugs and Cosmetics Act, 1940, still holds.

According to the official record, the NDPS Act was passed to reinforce regulations over psychotropic drugs, increase enforcement capabilities, and provide suitable consequences for drug trafficking. In 1989, 2001, and most recently in 2014, the Act was revised.

Misused drugs or illegal drugs refer to both drugs that are legally manufactured but are abused and drugs that are created solely for abuse. Many of them fall under the category of “Controlled Substances” in the United States, which refers to their inclusion in the Controlled Substances Act, a section of the Federal Code (Act 21 United States C. 812).

Illicit drug and its classification

A drug is any substance administered to a person or, in some cases, another animal, to alter the organism's normal physiological or psychological functioning for therapeutic purposes. This substance may be natural or synthetic. Most medications are created lawfully by pharmaceutical companies and are prescribed for diseases, injuries, or other health issues. Most often, people utilize and take these medications as prescribed. However, sometimes they produce delightful side effects, leading to their use for reasons other than those for which they were designed.[^9101112]

When individuals use drugs for reasons other than those for which they were designed, most often for their psychoactive effects, this is known as drug abuse. There are legal prescription drugs and chemicals that are made and used only for their psychoactive effects. Many of these drugs are obtained from natural sources, mostly plants, or are manufactured from naturally existing substances. Others are entirely manufactured substances. There is a wide variety of terminology used to describe pharmaceuticals that have been abused all over the world.

Classification

1. Natural occurring drugs-These chemicals are present in plants in nature. A portion of the plant is consumed, and the user then extracts and uses the medicine. Some instances are:
• Marijuana-Marijuana is smoked by drying and puffing on the leaves
• Psilocybin mushrooms-They contain the hallucinogens psilocybin and psilocin, which produce them (hallucinogen) when they are consumed
• Peyote cactus-The buttons on the peyote cactus are consumed. They have psychedelic mescaline in them.
2. Extracts of plants. These are obtained from plants and consumed as naturally occurring compounds. Some instances are:
• Cocaine-Cocaine originates from the coca plant, whereas opium poppies are the source of morphine and codeine.
3. Semi-synthetic-Chemically, these chemicals are generated from a material that occurs in nature. Some instances are:
• Heroin-Heroin, which is derived from morphine
• Lysergic acid diethylamide (LSD)-LSD is a drug made from lysergic acid.
4. Synthetic-These materials are entirely synthetic.
• Phencyclidine (PCP)
• Amphetamines
• Oxycodone
• Barbiturates.

Marijuana is the illegal substance that is used most often. Additionally, this covers the use of legal chemicals in dangerous ways, such as solvent inhalation and improper prescription of sedatives, mild tranquilizers, and anabolic steroids. Illegal drug use, despite its low incidence, has the potential to negatively affect young people's health and social development. Due to the %possibility of HIV, hepatitis, and other infectious illnesses spreading among intravenous illegal drug users, public health methods to decrease the negative health and social impacts associated with illicit drug use are especially crucial. Increases in the use of most illegal substances by adolescents have been a global phenomenon since 1990 in several countries, despite a fall in frequency during the 1980s.[^13141516]

PREVALENCE OF MAJOR LICIT AND ILLICIT DRUGS AMONG YOUTH

India is not an exception when it comes to the global public health issue which is substance usage, both legal and illegal. The frequency of lifetime drug usage in 2015 was 5%, according to the most current World Drug Report. Disorders related to drug usage were 0.6% prevalent. Nearly 29.5 million individuals worldwide have drug use disorders in absolute terms. In recent years, several studies on college students and medical students were carried out to ascertain the frequency of drug use and its pattern. Intriguingly, the same percentage (0.6%) of Indians with drug use problems were recorded in the country's most recent National Mental Health Survey (NMHS).[¹⁷] India, which is home to around 18% of the world's population, is a diversified nation in terms of its culture, economy, and sociopolitical system. All of these might affect drug usage among the general population. The frequency of drug use disorders varied significantly between the states, as predicted, according to the NMHS. Punjab had the greatest incidence of drug use disorders (2.5%), whereas Kerala and Gujarat had a frequency of just 0.1%. Being a household survey, the NMHS was likely to underestimate drug use problems, which represent a “hidden population” that is difficult to reach using conventional home survey techniques because of stigma and displacement. However, it is interesting that Punjab has a startlingly high frequency of drug use problems.[¹⁸]

One of India's northern states, Punjab, shares its international border with Pakistan (which in turn shares its border with Afghanistan, which continues to be the world's greatest producer of illegal natural opiates), as well as its national borders with Himachal Pradesh, Rajasthan, and Haryana. In this context, the Punjab Opioid Dependence Survey was accomplished in 2014. According to this study, the prevalence of current opioid dependency is 0.84%, which is higher than the NMHS's estimate for the prevalence of drug use disorders in India. These investigations used various approaches. Although the NMHS is a home survey, Punjab Opioid Dependence Survey used Respondent Driven Sampling to get estimates from the “hidden population” of opioid-dependent people who are difficult for normal population-based surveys to reach.[¹⁹²⁰] Table 1 represents the percentage of drug consumption in various India states.

Table 1: Drugs consumption in different states[²¹]

Drug testing among athletes

Only organized, competitive sports normally subject athletes to drug testing. Organizations like the National Collegiate Athletic Association and its member schools have implemented widespread drug testing procedures with strict consequences for those who fail the tests.[^22232425]

Under the auspices of the World Anti-Doping Agency and equivalent national organizations, consistent anti-doping procedures apply to elite athletes participating at international and national levels. The World Anti-Doping Agency is an independent global organization responsible for publishing the World Anti-Doping Code, a set of principles and guidelines for anti-doping programs in all sports and all nations. The initial version of the Code was approved in 2003, with implementation beginning in 2004.[⁸] Various anti-doping organizations, such as the International Paralympic Committee, the International Olympic Committee, major event organizations, international sports federations (such as the International Cycling Union), and national anti-doping organizations, are tasked with implementing, adopting, or enforcing anti-doping rules within their respective spheres of authority, and the Code lays out specific rules and principles for them to follow.[^26272829]

Every year or so, WADA updates and releases a new version of its list of prohibited drugs. There are certain banned drugs and procedures that are always illegal (in and out of competition) due to the possibility of enhancing performance in future contests or the possibility of masking, and there are other banned substances and methods that are only prohibited during competition. These substances are often utilized by various athletic populations. Table 2 depicts a few of them. These substances also have typical sign and symptoms, which are shown in Table 3.

Table 2: Rates of substance abuse among diverse demographics of athletes, according to many recent study studies

Table 3: Common signs and symptoms of substance relatively commonly used by athletes

The World Anti-Doping Agency is also a pioneer in creating the biological passport idea for athletes. In 2009, WADA implemented regulations on athletes' use of biological passports. The core tenet of the athlete's biological passport is based on the monitoring of selected parameters over time that indirectly exposes the impact of doping as an alternative to the standard way of direct detection of doping by analytical procedures. The suspension of competitors by their federations after health tests revealed excessive hemoglobin levels during the 2006 Olympic Winter Games sparked renewed interest in this idea. The purpose of an athlete's passport is to document a person's first hormone and blood level readings so that any subsequent fluctuations may be detected and addressed. A positive result from a diagnostic test would need an abnormally large deviation from the subject's previously established norm. This method is designed to prevent athletes from receiving false-positive test results due to high levels of endogenous chemicals that occur naturally, while also detecting individuals who are trying to cheat by utilizing such substances.

Substance abuse in other industries

According to Bacharach et al.,[³⁰] managerial control, workplace culture, stress levels, and the implementation of regulations all have an impact on how much alcohol is consumed by employees. As employees learn from their peers what constitutes good drinking behaviour, workplace culture was considered as a decisive factor. These presumptions may often develop into societal expectations, which put pressure on employees to comply. Additionally, industry-and job-specific workplace characteristics that contribute to drug usage may provide problems for productivity. Regarding disparities across industries, employees in the hospitality sector have been recognised as a high-risk category with relation to drug use at work.[³¹] Other high-risk categories for drug use have been found in studies to include those working in the arts and leisure as well as the construction sector.[³²] Peer pressure was cited by Du Plessis and Corney[³³] as a key contributor to the rise in drug usage in the construction sector. As many individuals engage in after-work socialising with coworkers, which may include drinking and other activities, it is plausible that peer pressure from coworkers may have an impact on drug usage. In other words, spending time with coworkers who often use drugs may increase someone's likelihood of using drugs themselves.

Given the impact that drug use may have on one's ability to make decisions both during and after usage, the favourable associations seen in the construction sector are particularly concerning. A possible contributing factor to the rise in drug usage in the construction sector, according to Biggs and Williamson, is the employee's incapacity to handle the lifestyle that results from project-to-project, nomadic labour.[³⁴]

Part of the reason for the high probability of drug use among certain segments of the agricultural business was self-esteem problems brought on by a sense of undervaluation as a result of the absence of suitable career options and proper training.[³⁵]

NARCOTICS AND PSYCHOTROPIC DRUGS AND THEIR ILLICIT USE

The NDPS Act makes it illegal to cultivate, produce, possess, sell, buy, trade, import, export, use, and consume narcotic narcotics and psychotropic substances unless they are used for legally permitted medicinal and scientific reasons. Both planning and trying to conduct some crimes are prohibited. Criminal conspiracy and aiding and abetting are accessory offenses that carry the same penalties as the primary offense.

The act covers three broad classes of substances

• Narcotics, or drugs controlled under the 1961 Convention
• Psychotropic drugs, those governed by the 1971 Convention, as well as other psychoactive compounds, including ketamine, have not yet been assigned a specific classification by international agreements
• ”Controlled substances,” which include precursor compounds like acetic anhydride, ephedrine, and pseudoephedrine, are utilized to produce narcotic medications or psychoactive substances.

Narcotic drugs and their prevalence

Cannabis

The illegal substance used most often in the EU is cannabis. Around 1% of European individuals (aged 15–64) are thought to use cannabis daily or almost daily. Sixty percentage of them are between the ages of 15 and 34. The percentage of people who have used cannabis at least once in their lifetimes varies greatly throughout the EU Member States, from over 40% in France, 30% in Denmark, and <0% in several Eastern European nations (Bulgaria, Hungary, and Romania). According to a poll conducted by the European Monitoring Centre for Drugs and Drug Addiction in 2016, 16.6 million young Europeans (aged 15–34, or 13% of this age group) reported using cannabis in the previous year. Only a few EU Member States provide survey data on medium-and long-term trends in young people's cannabis usage in the previous year (15–34 years).

According to surveys, the prevalence of cannabis has decreased or remained consistent over the last 10 years in nations with relatively high prevalence levels like Germany, Spain, and the United Kingdom, however, it has increased since 2010 in France. Teenagers utilize the substance for several purposes, such as experimenting, mood-enhancing, social-enhancing, and adhering to peer pressure. The major goal of the European School Survey Project on Alcohol and Other Drugs is to gather comparable information on drug use among 15–16-year-old European students to track trends both within and across nations. The most common illegal substance used by 15–16-year-old school kids, according to the most recent ESPAD data, was cannabis.[³⁶]

Coca

Cocaine is derived from the leaves of the Erythoxylon coca plant, which is native only to the Andean foothills of the Amazon rainforest in South America. There is evidence of the use of coca leaves by indigenous people as early as the year 500 Anno Domini. Throughout Peru, coca plants were planted widely 500 years later. Domestically produced cocaine is made from coca leaves and shipped to the US and other nations. Cocaine was quite well-liked in the US as a recreational drug at the turn of the 20^th century. There were several items on the market that included cocaine. might consume them by drinking, inhaling, or injecting them.

The Pure Food and Drugs Act of 1906 and the Harrison Act of 1914 significantly reduced cocaine usage and tightened control over the substance. Cocaine usage decreased in the 1930s as amphetamines became more accessible, but then it increased once again in the 1970s when amphetamines were rigorously regulated. For a very long time, people thought cocaine wasn't a physiologically addictive substance. The introduction of crack, a crystalline form of cocaine, has altered this attitude. Since crack can be smoked and has a lower melting point than powdered cocaine, it has gained popularity. As a result, crack's effects are significantly amplified, and the body can absorb it more readily. Crack cocaine may result in physical addiction when smoked.

Opium

Opium poppy plant, opium poppy straw, opium poppy juice, opium poppy juice mixture, formulations with 0.2% morphine, and derivatives like morphine, heroin, and codeine.

Psychotropic drugs

Greek words for soul and turning, respectively, are psycho and trope. Any carpet that has an odd affinity towards or impacts on the psyche (mind-altering). Psychotropic drugs include:

• Depressants-Depressants are medications that slow down the brain's processing speed, leading to a state of peace and contentment. In the form of sedatives, they are used to help people relax and drift off to sleep. Some examples are barbiturates, mild tranquilizers, and opiate analgesics
• Hypnotics-Hypnotics, like depressants, influence the central nervous system and produce drowsiness. Substances such as barbiturates, methaqualone, and chloral hydrate are all examples of hypnotic medications
• Stimulants-Stimulants are medicines that increase brain activity. Illicit therapeutic applications of several stimulants include the treatment of depression and the management of weight gain caused by overeating (psychostimulant). Both amphetamines and cocaine work by stimulating the central nervous system
• Hallucinogens-Hallucinogens are medications that alter one's state of mind and one's perceptions in various ways, from sensory illusions to full-blown hallucinations. Drugs like LSD, PCP, and psilocybin fall within this group.

SUBSTANCE USE DISORDERS

Substance use disorders are characterised by chronic alcohol and/or drug abuse which results in clinically substantial impairment. This impairment caused by continuous substance use may manifest in a variety of ways, including health issues, incapacity, and the inability to fulfil key duties at school, work, or home. It also has repercussions for individuals, groups, and the larger society.

Physical health

Some of how drug misuse may negatively affect a teen's health include accidental injuries (such as those sustained in vehicle accidents), physical impairments, illnesses, and even death from overdose. An excessive number of young people who use alcohol and other drugs are at higher danger of dying prematurely through suicide, violence, accidents, and diseases.

Emergency room visits for substance abuse have been on the rise, as reported by the Drug Abuse Warning Network study. This research was conducted in a nationally representative sample of hospitals throughout the United States. There was a 17% rise from 1993 to 1994 in the number of 12–17-year-olds who presented to emergency rooms due to drug use, according to estimates based on preliminary data. This rise was higher than that seen in any of the older age groups studied. Young people (12–17) had a 50% rise in marijuana/hashish-related ER visits between 1993 and 1994. In 1993, 91 teenagers died as a direct result of drug usage.[³⁷]

Mental health

Substance misuse in adolescents is often linked to a variety of mental health issues, including but not limited to clinical depression, developmental delays, apathy, withdrawal, and other psychosocial dysfunctions. Young individuals who misuse drugs have a much higher incidence of clinical depression, suicidal thoughts and behaviour, personality disorders, and committed suicide compared to their counterparts who do not engage in substance abuse. Among young people, marijuana use is quite common; this usage has been found to impair short-term memory, learning, and psychomotor abilities. One's drive and psychological/emotional growth might be impacted as well.

Social and economic consequences

Substance abuse among adolescents has substantial implications for both society and the family's finances. The causes of these problems are the increased costs associated with supporting adolescents who are unable to support themselves, the increased demand for medical and other treatment services for these youth, as well as the increased financial losses and emotional distress experienced by victims of alcohol and drug-related crimes.[³⁸]

Academics

Dropping out of school, poor academic performance and increased absenteeism have all been connected to adolescent drug use. Teenage drug use has been associated with a lack of academic motivation and an increase in absenteeism, according to research cited by Hawkins et al. Adolescents who drink or use drugs may have cognitive and behavioral problems that make it difficult for them to learn and disrupt their classmates' capacity to do so as well.[³⁹⁴⁰]

PREVENTING SUBSTANCE ABUSE AND HARM

The given Figure 1 describes different prevention strategies for controlling the substance abuse alongwith some measures which can help reducing the scenario of substance abuse.[^414243444546]

Figure 1: Prevention strategies for substance abuse

TREATMENT OF SUBSTANCE USE AND SUBSTANCE DEPENDENCE

Motivational enhancement therapy

Based on the trans-theoretical framework of change and the social learning theory, Motivational enhancement therapy (MET) aims to promote clients' intrinsic motivation for behavioral change via client-centered care. Problematic drinking and alcohol-related harm prevention do not seem to be affected by MET. Treatment for any kind of substance abuse results in minor, but statistically significant decreases in total substance use in youth, according to controlled research. With the cigarette data removed, however, the average effect size was rather tiny, with considerable uncertainty. Abstinence from ecstasy and cocaine was not found to be different in a randomized controlled trial with youn-g stimulant users compared to a control group that received just information on the effects and health hazards of stimulants.[⁴⁷⁴⁸]

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT's) effectiveness in treating drug use problems among young people has only been studied in a small number of cases. Some data suggest that CBT enhances abstinence from cigarettes, but only from low-quality research; other trials show CBT is effective for cannabis use disorders, and the results of two alcohol treatment trials were inconclusive. According to a study by the US Institute of Medicine published in 2015, the standard of evidence supporting psychosocial therapies for drug abuse was low.[⁴⁹⁵⁰]

Pharmacotherapy based approach

Buprenorphine, Methadone, and naltrexone-based pharmacotherapy for opioid addiction has been shown to be effective in lowering illegal opioid consumption. Opioid-dependent persons on parole, probation, or in drug courts seldom use these therapies.

Various immunotherapeutic strategies are being developed to treat drug addiction. Antibodies that attach to drugs and stop them from having rewarding effects on the brain are produced by the immune system when the immune system is stimulated by drug vaccinations. Nicotine, opioids, methamphetamine, and cocaine are now being studied drugs of abuse. Numerous potential treatments are available with immunotherapy, including overdose treatment, pharmaceutical addiction treatment, foetal protection during pregnancy, and heart and brain toxin prevention.[⁵¹]

Family-based treatments and multisystemic therapy

Some research suggests that young individuals with alcohol use disorders may be helped by family-based treatments and multisystemic therapy. However, several of these trials lacked long-term follow-up, and a control group received no treatment. Two trials found modest reductions in hazardous use and harm, but there was not enough data to make any firm conclusions regarding effectiveness. In this case, we were unable to find any evidence of tobacco-specific family interventions. Significant but modest effects on drug abuse and criminal behavior were found in an evaluation of multisystemic and family-based treatments for youth substance abuse.[⁵²⁵³]

PUBLIC HEALTH INTERVENTIONS TO PREVENT SUBSTANCE USE AMONG YOUTHS

Young people in industrialized nations have used drugs more often since 1991, with marijuana usage showing the highest increase. The totality of efforts to cut down on drug usage in communities has not been able to stop these recent upward tendencies. It is crucial to design a cohesive public health strategy to prevent and decrease the drug use. This strategy should be based on the data currently available on successful programs and take both theoretical and practical factors into account. Interventions in public health include primary prevention—preventing the beginning of drug use—and secondary prevention—decreasing the amount of substance use and abuse.[⁵⁴⁵⁵]

In general, the focus has been on preventing the start of smoking, drinking, and using illegal drugs. The theoretical components that have been proven to be most significantly connected with drug use should be the foundation for developing tailored therapies. Social factors, particularly peer pressure, play a significant role in the onset and continuation of drug use across a variety of areas. For instance, the main strategy for tobacco education in the 1970s was the creation of a school curriculum to educate and inform pupils. Compared to more current programs that focus on influencing peers and societal pressures to smoke and improving social skills to refuse offers of tobacco, these programs were largely ineffectual.[⁵⁶⁵⁷]

Between 50 and 75% of children reported decreased usage of tobacco, alcohol, and marijuana during the follow-up in the seventh grade, according to Botvin et al. By the time students graduated from high school, around 44% had cut down on their usage of cigarettes, alcohol, or marijuana, and 66% had stopped using all three. At 3 years, there was a discernible impact on knowledge and attitudes toward drug use.[⁵⁸]

CONCLUSION

Prevention of illicit drug misuse is crucial for health on a global and national scale. For the benefit of patients, treatment recommendations must be created and put into practice. Several studies concluded that the relationships between drug use and its health services, and the cost of medical care have used a community-based sample of drug users. According to the study, interactive programs emphasizing life or skill development should be adopted in schools. For prevention to be successful, national policy objectives must be set, a global information system developed, and global collaboration at all levels strengthened. Since many health-related behaviors are established in early adulthood, more research is needed to determine the obstacles and motivations to developing and sustaining routines that promote the consumption of a variety of legal and illicit substances.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Acknowledgement

We express our sincere thanks and gratitude to our Research supervisor and Principal for their valuable support.