dependence to opioids can lead to increased rates of morbidity and mortality secondary to different infections , and it can also increase the criminal consequences for the individual using the substance as well .
heroin users are also at high risk for abusing other substances including benzodiazepines , alcohol and cocaine . according to world
report-2013 published by united nations office on drug and crime ( unodc ) , about 16.5 million , or 0.4% of world adult population ( 15 - 64 years of age ) , used illicit opioids in year 2011 .
illicit drug use in india is also quite serious , with a population of over 1 billion people ; millions of victims of different kinds of drug abuse are estimated .
although opioid - dependence has become one of the most prevalent psychiatric illnesses during recent years , but very few studies have looked into the profiles of opioid - dependent patients in this part of the world . geographical location of jammu and kashmir is such that the transit of drugs is possible across the state .
prevailing turmoil has worsened the drug scenario , and over the past few years opiate preparations including that of heroin have become most serious problem in kashmir . in comparison to 9.5%
use of opiate based preparations during 1980 in kashmir it had increased to 73% ( out of the total addicts ) , in 2002 and is worse now .
the present study was undertaken to determine the socio - demographic profile and pattern of opioid - dependence in patients attending the de - addiction centre in a tertiary care hospital in srinagar , kashmir .
the reason to start substance abuse and the motivation for seeking treatment was also taken into consideration during the trial .
it is a cross - sectional target population based study that was conducted at de - addiction centre of institute of mental health and neurosciences , government medical college , srinagar , between march 2013 to august 2014 .
two hundred treatment seeking subjects , fulfilling american psychiatric association 's diagnostic and statistical manual of mental disorders - iv - tr criteria for opioid - dependence were included in the study .
all the participants were required to sign a written informed consent approved by the institutional ethical committee before being registered .
participants having evidence of a serious psychiatric or medical illness and those using substances of abuse other than opioids were excluded from the study . psychiatric interview and medical history taking
was performed by the consultant psychiatrist at the start of study and subjects were interviewed as per self - designed semi - structured proforma .
questionnaire recorded information on age , gender , marital status , status of education and pattern of substance abuse .
armonk , ny , usa : ibm corp . ) the mean and standard deviation are presented for continuous variable .
the number and percentage of subjects practicing a particular conduct are presented for categorical variables .
armonk , ny , usa : ibm corp . ) the mean and standard deviation are presented for continuous variable .
the number and percentage of subjects practicing a particular conduct are presented for categorical variables .
the majority of the participants ( 86% ) were literate and among them 52% were undergraduates and 40% were middle class passed .
considering the employment status most of the participants ( 64% ) were employed ( mostly running their own private business ) .
large percentage ( 66% ) of our subjects were unmarried , which can be because of their young age .
the majority of the participants ( 75% ) were of young age group ( 20 - 30 years ) and the mean age of subjects was 27.6 years [ table 1 ] . considering the duration of abuse , majority of the studied participants ( 55% ) were abusing the drugs for <3 years followed by 30% of the abusers who were using the opioids for 3 - 6 years [ figure 1 ] .
oral route was the most common route ( 35% ) of drug administration followed by chasing ( 13% ) and intravenous ( 11% ) routes . a good percentage ( 41% ) of subjects used more than one route of drug administration [ table 2 ] .
sociodemographic variables of the study population ( n=200 ) number of years of opioid abuse of studied population routes of administration of abused drugs ( n=200 ) considering the type of abused opioid , diverted pharmaceutical products were the main source of opioid abuse in our studied population and more than half of them used to abuse more than one drug at a time [ table 3 ] .
the present study revealed that 50% of subjects had started to take opioid substances under the influence of their friends who were already taking these substances ( peer pressure ) .
experimentation / pleasure as the reason for substance initiation was reported by 30% of patients and in 20% of cases it was the use of prescriptional opioids which led to opioid addiction in them . the desire to return to normal life
the other two reasons for seeking treatment were the occurrence of subsequent health issues secondary to opioid addiction ( 17% ) and loss of self - respect of the abusing person ( 13% ) .
it has been observed that mostly persons of young age group are involved in drug abuse because it is the most vulnerable age for it . in the present study ,
the average age of subjects was 27.64  4.60 years , which indicates that relatively young age group is involved in opioid addiction here also .
a community study of drug abusers in kashmir carried out by margoob and dutta reported that most of the abusers were < 42 years of age .
similarly nigam et al . in their study on indian population reported the mean age of substance abuse as 28.7  7.2 years in their subjects and in a study conducted by kalra and bansal , mean age for starting of drug use was found to be 25.46  7.613 years .
so it can be said that the most productive years of life are wasted due to substance abuse . considering gender proportion , out of total study sample
, we had only one ( 0.5% ) female patient who was abusing tramadol that too was secondary to prescriptional misuse .
low turnover of female respondents for the treatment of any substance abuse is observed in several studies .
the majority of participants in our study were literate ( 86% ) , self or government employed ( 64% ) , and unmarried ( 66% ) . since the present study was carried out on urban population and majority of our subjects were belonging to relatively young age group , this may justify the higher percentage of literacy , employment and unmarried status of the subjects .
similar results were reported by ziaddini et al . in their study on iranian population , who reported that 67.9% of their subjects were employed , and 52% were unmarried and nigam et al . who reported that 91.7% of the subjects were employed , and 86.1% had education below 10 years .
as per the latest report released by unodc , although the use of opiates has remained constant over the years , but use of opioids including diverted pharmaceuticals has increased over the last few years . in the present study , also it was found that spasmoproxyvan was the most common substance to be consumed by our patients ( 17% ) , followed by heroin ( 13% ) .
kalra and bansal reported that out of their study population , 5% consumed tramadol , 12.5% used codeine and 9% abused spasmoproxyvan ( dextropropoxyphene 65 mg , dicyclomine 10 mg , and paracetamol 400 mg ) .
the main reason for higher proportion of our subjects consuming the diverted pharmaceutical opioids like spasmoproxyvan may be because of their easy accessibility in the black - market . in our study , most of the patients admitted that they were first provided these drugs free of cost by some of their friends , and once they became dependent on these drugs , then they had to pay for it . from the above data , it can be concluded that there is a trend towards abuse of medicinal drugs .
even among studies done in past decade , vasvani had reported increasing trend in abuse of benzodiazepines and other over the counter available drugs .
has also reported a significant increase in abuse of drugs available over the counter like that of dextropropoxyphene , diphenoxylate , codeine phosphate etc .
as per the current dams data , opium and its derivatives ( heroin , other opioids ) emerged as second preferred drug category as 40% men reported its use ( 14% each for opium and heroin and 12% for other opoids mainly spasmoproxyvan , fortwin and norphine etc . )
the average years of opioid consumption in the present study was 5.73  3.12 years .
, who carried out an epidemiology study that showed that 41.65% patients took substance for the period of more than 5 years and only 5.94% took medication for < 1-year .
reported the average years of consumption to be 4 - 5 years in their study , and in the study conducted by ziaddini et al .
, the average years of opioid use was reported as 8.0  4.20 years , the results of both of these studies are similar to our findings .
this may be justified by the fact that the diverted pharmaceutical products used by our subjects are available mainly in oral preparations .
the other common method of use was chasing , where the abusers used to put opiate powder usually heroin on a piece of aluminum foil , and then place it over burning candle and inhale the smoke produced .
the present study revealed that in 50% of the cases the opioid addiction had started secondary to peer pressure .
this can be explained by the fact that youth are mostly influenced by their peers and that the choice of friends will in part determine their social behaviors or misbehaviors .
other reason that was cited by 30% of the studied population was for experimentation / enjoyment .
other important thing which came into notice was that 20% of patients had started abusing opioid substance because they were prescribed to them by medical personal ( itrogenic cause ) , which shows that the unethical use of medication is very much contributing to increased prevalence of diverted pharmaceutical substance abuse .
a study carried out by kalra and bansal reported that 20% of their subjects started addiction for enjoyment / or experimentation , 9.5% because of peer pressure and in 9% of cases it was secondary to iatrogenic cause .
almost similar findings were seen in another study carried out in adolescents by naskar et al . in the present study
main reason given by the patients for seeking treatment was self - motivation in the majority ( 70% ) of cases .
over the years , most of these patients realized that their life has now been more of driven by the drugs .
they were totally dependent on the availability of drugs and at times they had to face embarrassment for this reason . health related issues ( 17% ) and loss of self - esteem within the society ( 13% ) were the other reasons for seeking the treatment in our studied population .
although the present study has got some important finding , but there were few limitations too . it was a monocentric study carried out in a single tertiary care hospital with small sample size .
the majority of our subjects were mainly from urban population because the de - addiction centre is located in city center . in the present study only pure opioid abusers were enrolled , and the sociodemography of other substances of abuse could not be found . therefore , there is further scope for similar kind of studies to be conducted at multicentric level involving larger proportion of the community with larger sample size .
although the present study has got some important finding , but there were few limitations too . it was a monocentric study carried out in a single tertiary care hospital with small sample size .
the majority of our subjects were mainly from urban population because the de - addiction centre is located in city center . in the present study only pure opioid abusers were enrolled , and the sociodemography of other substances of abuse could not be found . therefore , there is further scope for similar kind of studies to be conducted at multicentric level involving larger proportion of the community with larger sample size .
the findings of the present study showed that a relatively young age group is involved in opioid addiction and , therefore , many years of their productive life are lost in substance abuse .
the substance abuse is prevalent in any segment of population irrespective of educational and marital status .
we found that a good percentage of our subjects were abusing diverted pharmaceuticals . therefore controlling
the menace of opioid abuse is a multidisplinary task with law and enforcement agencies having a greater role to play , so that the illegal and unauthorized sales and distribution of prescriptional opioid drugs could be brought under control .
 background : the substances abuse has become one of the major public health problems of present society . 
 recently there has been an increase in the incidence of substance abuse including that of opioids throughout the world . 
 the proper assessment of the current trends and pattern of opioid abuse can be helpful in more effective intervention of this menace.materials and methods : to find out various socio - demographic variables and pattern of opioid abuse , a predevised questionnaire was administered to 200 opioid patients who presented to de - addiction center for treatment.results:majority of the participants ( 75% ) were of young age group ( 2030 years ) and the mean age of subjects was 27.6 years . 
 more than half of participants ( 55% ) were abusing the opioid substances for < 3 years followed by 30% of the abusers who were using the opioids for 46 years . 
 oral route was the most common route(35%)of substance administration followed by chasing(13% ) and intravenous(11% ) routes . 
 diverted pharmaceuticals emerged as one of the common substances of abuse , and peer pressure was found to be the main reason to start substance abuse.conclusion:a comprehensive preventive program targeting young adults needs to be formulated and strict laws against sales of diverted pharmaceuticals to be implemented . 
Introduction
Materials and Methods
Statistical analysis
Results
Discussion
Limitations
Conclusion