Substance abuse, also known as drug abuse, refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. Drug abuse has been a serious global problem that has affected millions of people globally including Nepal. It has adversely affected urban to rural communities. Youths are more prone to substance abuse than older people because they are more likely to imitate others and are eager to try and experience new things. It impacts negatively on social, cultural, economic, academic and physiological development of their lives.

The most commonly abused drugs in Nepal are cannabis (marijuana), hashish, codeine-containing cough syrup, nitrazepam tablets, buprenorphine injections and heroin, apart from tobacco and alcohol. Although the use of drugs such as cannabis and alcohol has traditionally been part of the Nepalese spiritual and religious culture, it did not create major social problems in the past. There has been a shift in the types of drug usage from cannabis to synthetic opiates and chemical substances in the last few decades.

A change in the mode of drug usage from smoking/ingesting to injecting has become one of the major causes of HIV infection. Injecting drugs carries a high risk of infection with blood borne viruses such as HIV, hepatitis B and hepatitis C, and the sharing of contaminated needles and syringes is an important mode of transmission of those viruses. Tuberculosis, STDs, malnutrition and mental health illnesses such as depression, anxiety, and bipolar disorder are some additional health-related issues faced by drug users. These co-occurring disorders can exacerbate each other and lead to a higher burden of disease. Substance abuse increases morbidity and mortality risks for individuals, can trigger substantial suffering and lead to impairment in personal, family, social, educational, occupational or other important areas of functioning. It is associated with significant costs to society due to lost productivity, premature mortality, increased health care expenditure, and costs related to criminal justice, social welfare, violence against women and girls and other social consequences. Since substance abuse causes significant health and social problems for the abusers, their families and communities, it is considered one of the major social and public health problems in the context of Nepal. 

In Nepal, the young population engages in drug usage for various reasons, leading to tragic consequences. Peer pressure, recreation, curiosity, feeling happy, mental stress, family problems, depression, and academic problems are some of the reasons for drug usage. Increasing unemployment, lack of education, lack of awareness, broken families, crime, depression, mass media are some additional factors that contribute to an increase in the prevalence of substance abuse. Social stigma, limited access to treatment facilities, and inadequate awareness campaigns further exacerbate the problem.

Although no community in Nepal seems immune to the devastating consequences of substance abuse, the burden has significantly increased in the Terai-Madhesh region in recent decades. Foreign employment has become one of the reliable means of running the households particularly in Madhesh. According to the data maintained by the Department of Foreign Employment, youths from the districts of Madhesh Province stand on the top list in terms of seeking foreign employment. The youths of Madhesh are suffering from the growing unemployment and tough economic situation in the country. The lack of reliable employment opportunities in the country has driven many young individuals to prematurely abandon their education and to go abroad in search of work, as they view education as a pathway to nowhere. It has led to brain drain, increased school/college drop-out rate and issues related to substance abuse. The majority of youths from Madhesh go to the Gulf countries for employment and they lack formal education, specialized skills and work-related knowledge. As a result, the majority of households are left without male guardians. It causes lack of proper monitoring and care of their children. Going abroad has been taken as an important social indicator of success and affluence in the whole Nepalese society in recent years.

According to Nepal Drug Users Survey conducted by the Ministry of Home Affairs, under the Government of Nepal in the year 2076, the number of drug users was 1,30,424, with a rapid increase from 43,309 in 2063 and 91,534 in 2069, among whom 1,21,692 (93.3 percent) were male and 8,732 (6.7 percent) were female, with an average annual growth of 5.06 percent from the year 2069 to 2076 in Nepal. There were 1,00,165 (76.9 percent) drug users below the age of 30, and out of those, 69.5 percent were between the ages of 20 and 29. While in Madhesh Province, 14.8 percent of drug users were under the age of 20, compared with 7.4 percent in total. The statistics of the rising number of drug users, especially youths, are really distressing and have raised serious concern in recent years, necessitating the need to address the growing problem of substance abuse in the country. As the survey is conducted every five years in Nepal, the next survey is anticipated to show an over two-fold rise in the number of drug users.

With the increase in the drug trade and abuse, the number of deaths and various criminal activities is also growing. Drug control has become a challenge for the government of Nepal since drug abuse has become a multidimensional problem in the country. Target 3.5 of UN Sustainable Development Goal 3 sets out a commitment by governments to strengthen the prevention and treatment of substance abuse. Several other targets are also of particular relevance to drug policy-related health issues, especially target 3.3, referring to ending the AIDS epidemic and combating viral hepatitis; target 3.4, on preventing and treating non-communicable diseases and promoting mental health; target 3.8, on achieving universal health coverage; and target 3.b, with its reference to providing access to affordable essential medicines. Substance abuse on the one hand has generated challenges to achieve the national goal of constructing healthy, civilized, virtuous citizen and crime free society and on the other hand has obstructed the SDGs.

Both the concerned state and non-state actors are supposed to prioritize drug control and prevention promoting campaigns at individual, community and national levels.  An effective local or national prevention system responding to drugs, including law enforcement and supply reduction, treatment of drug use disorders, and reduction of risk associated with drug use, is required. Effective prevention contributes significantly to the positive engagement of children, youth and adults with their families, schools, workplace and community. Raising public awareness and organizing educational programs in schools and colleges about the dangers of substance abuse and its side effects is essential. The system should ensure the availability of controlled drugs for medical and scientific purposes while preventing diversion and non-medical use. 

Annually on June 26, as the International Day against Drug Abuse and Illicit Trafficking is commemorated, it is crucial to advocate for policies that prioritize prevention and evidence-based treatment, envisioning a society where every person can pursue a healthy and fulfilling life free from the grip of substance abuse.

 
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