The Tribune, Chandigarh, India

PUNJAB
A drugged state
Dr Rajeev Gupta

DRUG abuse is becoming a serious problem in Punjab. Thanks to the easy availability of various addictive substances and inadequate control, drug abuse has assumed an alarming proportion both in the urban and rural areas. Fast-growing unemployment in rural Punjab and the outgoing personality of the average Punjabi have given a boost to the problem. Many research workers, social scientists and religious organisations have been regularly pointing towards the rising incidence of alcohol and drug abuse.

Various epidemiological and clinical reports from Patiala, Ludhiana, Amritsar, Bathinda and Chandigarh have consistently pointed to the fast-rising incidence of drug and alcohol abuse among the youth and other segments of the population.

In this article I have made an attempt to highlight the commonly misused drugs and addictive substances. The purpose is to increase the awareness of the problem among the readers of The Tribune, which has launched a systematic war on the menace.

Opium: The use of opium has a very long history in Punjab. The drug has been traditionally linked with agricultural work. The use of opium increases during the harvesting months when farmers are required to do more strenuous manual work. Once harvesting is over, many selective users of opium discontinue the use. But some of the seasonal users get hooked on to it. An average boy in Punjab has hardly any love left for manual work. Field work and manual labour are being done by migrant labourers. The son of the soil has all the leisure time at his disposal and addiction is becoming his favourite pastime. It is commonly shared knowledge that some migrants are also gradually getting hooked on to opium or dry leaves of opium flowers called "bhuki".

Alcohol: Alcohol consumption has shown a considerable rise over the last couple of years. There is hardly any social function which is considered complete without a liberal supply of alcohol. The per capita alcohol consumption in Punjab is considered one of the highest in the world. Unfortunately, today the tendency towards alcohol consumption has percolated down to the youth and even teenagers are seen celebrating various occasions with beer and champagne. The media has played an avoidable role in encouraging the use of alcohol among the youth.

Today most of the alcohol-users are introduced to hard liquor at a much earlier age which gives them a long-span of alcohol consumption. they are at a much higher risk of developing various psychological and physical complications.

Alcohol is becoming an important cause of disease and death in the state of Punjab. Family and social violence has been attributed to alcohol. Many regular users of alcohol become highly irritable or explosive. Liquor acts like a depressant for the central nervous system and removes social inhibitions. Under the effect of alcohol, one may do certain undesirable acts which one may never do without it.

Alcohol is becoming responsible for quite a number of serious psychological problems like depression, behavioural abnormalities, paranoid states and physical illnesses like hepatitis, gastritis, pancreatitis, epilepsy dementia and neuropathy. It has also been documented that the regular use of alcohol raises one's blood pressure. And it is being blamed as an important cause of road accidents.

Smack, also called "brown sugar", is a byproduct of heroin synthesis. Smack addiction is one of the worst forms of drug abuse. The number of smack addicts is gradually increasing in Punjab's urban and rural population. Most of the addicts are young. They are below 30 years of age. College and university students are becoming smack victims.

Smack addiction is quite expensive and in order to maintain the habit, a good number of the habitual users gradually become criminals. Many people become victims of the violence of the addicts. A stereotyped smack addict is physically malnourished and he is a mental wreck. Invariably, he is unemployed, a social, temperamental and unpredictable in his behaviour.

Gradually, smack addicts cease to be governed by their own conscience, social norms and the accepted ethos. For them smack is the source of ultimate bliss and they can do anything or go to any extent to procure it.

The misuse of cough syrups, pain-killers, sleeping pills, anti-anxiety drugs, anti-diarrhoeal drugs and narcotic injections is an alarming factor.

It is no longer a secret that there is a gross misuse of these drugs by the people in the state. Much of the misuse is because of the non-medicinal purpose and sale without a prescription.

The easy availability of such drugs in every nook and corner of the state has made the situation worse. Codeine in cough syrups has become popular among students. Dextropropxyphene containing pain-killer preparations like Proxyvon, Sudhinol and Parvon are now common trade names. These are being widely misused by students and young people in general. The labour class too has taken to it.

The misuse of common tranquillisers and sleeping pills like nitraazepam (Nitra, Nitravet), and diazepam (Calmpose, Paxum) lorazepam (Larpose, Ativan), alprozalam (Alprax, Restyl, Trika) and injections of buprenorphine (Norphine) and pentazocine (Fortwin) is spreading in an epidemic manner. Many people from cities, including business executives, businessmen, housewives and working women are getting hooked. Most of the regular "users" start the medicines after medical advice. There have been innumerable cases where people have started taking the drugs for medical reasons but continued to do self-medication without any necessity later. Unfortunately, because of complete ignorance about the side-effects, the misuse of the drugs is going on completely unchecked. In the absence of adequate education and control, there is no hope of the disaster getting arrested.

Cannabis: Cannabis preparations like bhang and ganja are becoming prevalent in the poorer sections of society. Because of the low cost many young boys resort to their use. Though traditionally the use of cannabis has social sanction in many societies, in Punjab the plant grows wild and its availability is no problem. Acute intoxication, followed by violent and paranoid reactions, is well known after cannabis intake. The chronic use of cannabis is known to cause personality problems, lack of motivation, apathy towards work and life and depression.

Tobacco: The regular use of pan masala and zarda is well-known among migrants from UP and Bihar. The habit is getting gradually imbibed by Punjabis. One can judge this from the recent multiplication of pan shops in the state. The regular use of pan masala is highly hazardous. It is responsible for the rising incidence of gum diseases and mouth cancer.

Note: It is heartening to note that many social and religious institutions have taken a serious note of the problem of drug addiction and sincere efforts are being made by many individuals and organisations to improve the situation.

The author is a consultant psychiatrist and de-addiction specialist based at Manas in Tagore Nagar, Ludhiana. (Phones 472822 and 472899). He is a Visiting Professor of Psychiatry at Guru Ram Das Medical College, Amritsar.

HEALTH BULLETIN
Isapgol: tummy-tender
Dr R. Vatsyayan, Ayurvedacharya

ISAPGOL is a familiar name to individuals who are constipated. Though ancient ayurvedic texts give no reference of it, only a few treatises of late origin mention ashwagol in Sanskrit. But it is believed that isapgol is indigenous to India and was used as medicine in olden days. Books of the Unani system of medicine give a detailed study of this herb. It was only in the middle of the nineteenth century that isapgol (Plantago ovata) was admitted to the Indian pharmacopoeia and at present this country is the largest producer of this herb. A major part of the crop is exported to America. Seeds of isapgol constitute the drug.

The medicinal properties of isapgol are primarily due to the large amount of mucilage and albuminous matter present in it. The seeds are sweet in taste and have cold and astringent action. They act as a soothing agent for the intestinal mucosa and their mucilage binds and increases the mass of the stool to facilitate its smooth passing. Nowadays, isapgol husk is more used than the whole seed. White in colour and almost devoid of any particular taste, the husk has the same properties as the seeds.

Isapgol husk is a popular remedy for constipation, diarrhoea and dysentery, whether acute or chronic. The large amount of the mucilage, which is present in the husk, is not acted upon by digestive enzymes and, therefore, passes through the small and large intestines unchanged. Fluids and gases present in intestines are also absorbed by this gel.

Isapgol husk is the drug of choice in the management of occasional or chronic and habitual constipation. For this purpose, one or two teaspoonfuls of the husk can be taken at bedtime with warm milk. In diarrhoea it can be taken with any sharbat or lime water whereas in Irritable Bowel Syndrome, when the patient is preoccupied with the thought of incomplete evacuation, taking two teaspoonfuls of the husk of isapgol every morning, mixed with a little curd, is of great help. Acting as a stool regulariser, it also benefits the patients of specific and non-specific colitis and other diseases of the ano-rectal track like piles, fissures etc. Surprisingly, the latest research has shown that isapgol also has cholesterol-lowering properties.

Practitioners of Unani medicine prescribe poultices made of crushed isapgol seeds, vinegar and sesame oil in arthritic conditions. The application of isapgol gel is also advised in dry eczema and other allergic skin disorders. There are a lot of brands available in the market where isapgol has been mixed with other herbs and effervascents. But to reduce the frequency of the stool or in the case of mild or occasional constipation (in both conditions) it is better to use only pure and uncrushed isapgol husk. However, to combat severe constipation, it can be mixed with other herbal laxatives. Occasionally, adding a teaspoonful of almond oil in two gm of Isapgol husk and taking it with warm milk works well in stubborn constipation.

Caution: An overdose of isapgol or not taking sufficient liquids with it may pose a risk of partial or complete intestinal obstruction. It should also be given with care during the active phase of rheumatoid arthritis as due to its cold effect it may aggravate the pain and stiffness of the joints.

Dr R. Vatsyayan is an ayurvedic consultant based at Sanjivani Ayurvedic Centre, Ludhiana. (Phones: 423500 and 431500. Email - sanjivni@satyam.net.in)

QUESTIONS AND ANSWERS
Problems of the prostate gland

DR S.M. Bose, Professor and Head of the Department of Surgery, PGI, Chandigarh, in consultation with Dr Uttam Kumar Mete, Assistant Professor of Urology at the PGI, answers readers' questions:

Q What is the prostate and where is it present?

A The prostate is a secondary sexual organ and is present only in males. It is located at the base of the urinary bladder and encircles the first part of the urethra. It is, therefore, apparent that any swelling of the prostate gland will lead to the obstruction to the outflow of urine.

Q Why does the prostate gland get enlarged and why is it seen only in old age?

A The enlargement of the prostate is a natural physiological process. The exact cause is not known but probably it is on account of altered hormonal balance related to old age. All persons, above the age of 50, get an enlargement of the prostate but only a few require treatment for their complaints.

Q What are the commonly seen diseases of the prostate?

A The medical problems associated with the prostate gland are: the enlargement of the gland (both cancerous and non-cancerous) and infections which can be due to common micro-organisms, tuberculosis or by sexually transmitted organisms. But of all these, the non-cancerous enlargement of the prostate is the most commonly seen problem.

Q What are the symptoms of the enlargement of the prostate?

A A patient of the enlargement of the prostate complains of an increased frequency in passing urine (more so during the night); urgency; hesitancy (taking more time to start the act of urination); progressive thinning of the urinary stream; prolonged urination time and passage of blood in urine. Many of these patients may complain of sensation of incomplete emptying of the urinary bladder and eventually may not be able to pass urine — known as retention of urine.

Q Is surgery the only treatment for the enlargement of the prostate?

A Surgery is indicated for those patients who develop recurrent episodes of retention of urine, passage of blood in urine, recurrent infection due to prostatic enlargement, associated stone formation in the bladder or renal failure due to prostatic enlargement.

A significant number of patients, who do not have the above-mentioned indications for surgery but are bothered by the symptoms can be managed by medicines.

Q What are the types of operations undertaken for prostate enlargement?

A The cases which do not respond to medical treatment or have above-mentioned indications for surgery are managed by an operation. This can be done by endoscopic surgery (transurethral resection — TUR) or open techniques. At present 90 % of the cases are dealt by TUR; it eliminates any skin incision, is associated with a fewer complications and requires shorter hospitalisation. In addition to TUR by electro-cautery, other techniques using LASER, high-intensity focused ultrasound and thermal ablation (TUNA) can be also undertaken.

Q My grandfather was diagnosed to have cancer of the prostate. How common is it?

A In males, the prostate is one of the commonly affected organs involved by cancer. It has been seen that as age advances, the incidence of cancer in prostate also increases. It has been reported that above the age of 80 years, 80% of the population has the presence of cancer in the gland although all these persons may not have obvious symptoms.

Q How can the cancer of the prostate be suspected?

A The cancer of the prostate can be suspected by a surgeon by the following signs:

(a) if the prostate gland is hard and \ or nodular on examination;

(b) if the PSA level is found to be on the higher side of the normal level; levels in the range of 4 to 10 ngm per ml are suspicious and require further investigations;

(d) fine-needle aspiration cytology confirms the diagnosis.

Q How do you manage a patient of prostate cancer?

A A patient of prostate cancer is managed by drugs (hormones), radiotherapy or by surgery. About 90% of the Indian patients come in an advanced stage of the disease when hormonal manipulation is the best choice of treatment. The retention of urine not responding to hormone therapy may require TUR.

Bony metastatic symptoms may be treated by local radiotherapy or radioactive isotope therapy.

Early-stage patients can be managed by surgery and/or radiotherapy so as to open the occluded passage in the urethra, enabling the person to pass urine.