Drug abuse and its impact on Bangladesh

This study investigates drug abuse and its impact on Bangladesh and aims to identify the family-related and social reasons for being addicted, and the causes and effects of drug abuse. A descriptive crosssectional study was conducted in assessing the causes and consequence of its impact in Bangladesh using purposeful sampling for sample collection, involving recent graduates from different public and private university, civil servants, and civil society members. Findings revealed that drug abuse is multidimensional, and should be addressed accordingly. Many of the addicts view the rehabilitation procedures and costs introduced by the Narcotics Department as high and cumbersome. Many people, especially the youths are eager to get rid of drugs, but unfortunately can hardly find any way out. The addicts, while talking with the investigators, sought treatment to wipe out the negative effects of the drugs. Thus, the government should involve both the family and society which are the two most effective institutions to prevent drug addiction within the drug policy covering both the preventive and curative issues. These two institutions side by side with the government and nongovernmental efforts can play vital role in drug demand reduction, and preventing drug abuse in the country. Also, urgent major policy and institutional reforms involving all the concerned bodies is needed for effective response to combat drug abuse in the country.


INTRODUCTION
Drug abuse directly influences the economic and social aspects of a country.In Bangladesh, it is a growing challenge in Bangladesh, with most of them being young, between the ages of 18 and 30 years, and are from all strata of the society.Many epidemiological surveys carried out in the Bangladesh shows that the country is going to be transformed into a potential user of drugs with the rapid increase in the number of addicts.For the safety of our people and the society from this deadly game, illicit drug transportation must be controlled immediately.
Bangladesh is situated in the crucial point between the 'golden triangle' (Mayanmar, Thailand and Laos) and the 'golden crescent' (Pakistan, Afghanistan and Iran) in terms of geographical location.Also, it is surrounded by the major drug producing countries of Asia, many of *Corresponding author.E-mail: hossainfaruque@hotmail.com, mfhossain@aiub.edu.Tel: +88 01759316682.
Authors agree that this article remain permanently open access under the terms of the Creative Commons Attribution License 4.0 International License which are strengthening their narcotics legislation and stepping up enforcement measures.Bangladesh with its easy land, sea, and air access is becoming a major transit point.Traffickers who supply drugs in the markets of Northern America, Africa, and Europe are routing their shipments through Dhaka, Chittagong, Comilla, Khulna and other routes in Bangladesh (SAARC Forum, 1995;Rahman et al., 2000 a, b;Ahmad, 2001;Sani, 2010;The Daily Star, 2013;Shemul, 2017).It is believed that with the increasing quantity of the wares more and more people are likely to get involved in drug business.In this way, it ultimately contributes to the number of drug abusers as well.
Bangladesh is a land surrounded by India from three corners.The Northern and Eastern sides are surrounded with hills and mountains.And the Western corner is mainly plain land.The hilly regions are suitable for illicit drug trafficking.The traffickers can easily hide themselves in these hilly forests, and transfer the drugs safely.In Bangladesh there are many border-crossing points from where every day millions of cash are being exchanged for drugs (Rahman, 1999;Ahmed, 2001;Burt, 2002;Shazzad et al., 2013).
Narcotic abuse is a serious, but treatable disorder.When the problem is not treated, people who abuse narcotics usually suffer significant mental and physical problem.The sooner treatment begins, the more favorable the outcome.If anyone suspects he has a problem with narcotic abuse, he should contact a doctor immediately (Rahman, 1990;Henry, 1999).
Drugs are any chemical agent that affects the function of living things.Some, including antibiotics, stimulants, tranquilizers, antidepressants, analgesics, narcotics, and hormones, have generalized effects.Others, including laxatives, heart stimulants, anticoagulants, diuretics, and antihistamines, act on specific systems.Vaccines are sometimes considered drugs.Drugs may protect against attacking organisms (by killing them, stopping them from reproducing, or blocking their effects on the host) substitute for a missing or defective substance in the body, or interrupt an abnormal process.A drug must bind with receptors in or on cells, and cannot work if the inhalation, rectally, or through the skin.The oldest existing catalogue of drugs is a stone tablet from ancient Babylonia (c.1700 BC); the modern drug era began when antibiotics were discovered in 1928.Synthetic versions of natural drugs led to design of drugs based on chemical structure.Drugs must not only be effective but safe; side effects can range from minor to dangerous (Rahman, 1990;Henry, 1999;World Bank, 2001;Sani, 2010, Shazzad et al., 2013;DNC, 2013).
A drug is a substance which may have medicinal, intoxicating, performance enhancing or other effects when taken or put into a human body or the body of another animal, and is not considered a food or exclusively a food.What is considered a drug rather than a food varies between cultures and distinctions between drugs and foods, and between the kinds of drugs enshrined in laws which may vary between jurisdictions and aim to restrict or prevent the drug usage.
Even within a jurisdiction, however, the status of a substance may be uncertain or contested with respect to both whether it is a drug and how it should be classified if at all.There is no single, precise definition, as there are different meanings in drug control law, government regulations, medicine, and colloquial usage.
In pharmacology, drug is "a chemical substance used in the treatment, cure, prevention, or diagnosis of disease or used to otherwise enhance physical or mental wellbeing."Drugs may be prescribed for a limited duration, or on a regular basis for chronic disorders.Recreational drugs are chemical substances that affect the central nervous system, such as opioids or hallucinogens.They may be used for perceived beneficial effects on perception, consciousness, personality, and behavior.Some drugs can cause addiction and/or habituation.Drugs are usually distinguished from endogenous biochemicals by being introduced from outside the organism.For example, insulin is a hormone that is synthesized in the body; it is called a hormone when it is synthesized by the pancreas inside the body, but if it is introduced into the body from outside, it is called a drug.Many natural substances, such as beers, wines, and psychoactive mushrooms, blur the line between food and recreational drugs, as when ingested they affect the functioning of both mind and body, and some substances normally considered drugs such as Dimethyltryptamine (DMT) are produced by the human body in trace amounts.
In the United States, it has since become associated with opioids, commonly morphine and heroin and their derivatives, such as hydrocodone.The term is, today, imprecisely defined and typically has negative connotations.When used in a legal context in the U.S., a narcotic drug is simply one that is totally prohibited, or one that is used in violation of strict governmental regulation, such as heroin or morphine.From a pharmacological standpoint, it is not a useful term, as it is given by the fact that spirit and wine are classified differently due to their intoxicating power; while the narcotic principle to opium and tobacco imparts commensurate properties.
In popular language, alcohol is classed among the stimulants; and opium and tobacco among the narcotics; which are substances whose ultimate effect upon the animal system is to produce torpor and insensibility; but taken in small quantities they are at first exhilarate.And since alcohol does the same, most medical writers, at the present day, classified it among the narcotics.Statutory classification of a drug as a narcotic often increases the penalties for violation of drug control statutes.For example, although federal law classifies both cocaine and amphetamines as "Schedule II" drugs, the penalty for possession of cocaine is greater than the penalty for possession of amphetamines because cocaine, unlike amphetamines, is classified as a narcotic (Tau and Nicholas, 2015).
However, Bangladesh has become a highly risky country for sustainable development due to the increase of drug users, with most of them being the youths.So, anti-drug issues are the important challenges for the betterment of Bangladesh.To ensure better and a new generation, the stake holders of the country should act immediately to eliminate drug use and addiction.Therefore, this study has been undertaken with the following objectives: 1.To identify the family-related and social reasons for being addicted; 2. To find out the causes and effects of drug abuse; 3. To find out the ways and alternatives in coming back from addiction to normality.

Research design
A descriptive cross-sectional study was conducted in assessing the causes and consequence (impact) of drug abuse in Bangladesh.The participants were those who met the criteria needed, completed the structured questionnaire provided.

Study area and period
The study was conducted all over the country for a period of April 2015 to August 2016 (Figure 1).

Study population
The target populations of the study were Drug Addicted, Personnel of Narcotics Department and civil society members all over Bangladesh.

Selection criteria
Inclusion criteria: Respondents were those who volunteered, and were willing to participate in the study.Exclusion criteria: Respondents were those absent during data collection.

Sampling method
The sample was selected through purposive manner.For the study, we interviewed three types of concern-Recent graduates-40 from different (public or private) university of Bangladesh (as perspective candidates of civil service); Civil Servants-40 (fresh civil servants, mid-level civil servants and ex.civil servants who works/worked in Bangladesh) and Civil Society members-20 (who created awareness within the society and people respect them for their knowledge and social responsibilities in Bangladesh).

Sample size estimation
Calculation of sample size was done using the following formula: Islam and Hossain 145 Here, n = the desired sample size z = standard normal deviation, usually set 1 .96,which corresponds to 95% CL Since there is no ready reference on the political polarization, we can assume p = 10% to be adequate.So, p-10%= 0.1, Q = (l-p) = (1-0.1)=0.9 d= Degree of precision and in this study, it will set at 5% So, sample size n = (1.96) 2 x (0.1) (0.9) 7 (.05) 2 = 138.29 Due to allocation of data collection time, the feasible sample size was 100.

Research instruments
For collection of primary data, a structured questionnaire was developed based on the research objectives.Pre-testing of the questionnaire was done on similar types of community.After the pre-testing, revision of the items and questions was formulated based on the findings.

Methods of data collection
Data were collected through face to face interview.

Data processing and management plan
The completed questionnaires were collected and checked for completeness and clarity of information.The data from all the completed questionnaires were analyzed by SPSS software.

Data presentation
Descriptive statistics was presented with frequency tables.The association was illustrated with cross tables and test statistics was added in the foot notes of the tables.Bar and pie charts was generated to illustrate descriptive statistics.

Ethical considerations
All ethical issues related to research was addressed according to the guidelines of research ethical review of American World University.Permission from American World University was obtained as pre-requisite.Informed consent was taken before the 'interview.Respondents' had rights to refuse and withdraw from the study, any time was accepted.Confidentiality of the respondents was maintained.Questionnaire and inform consent form was translated into local language (Bengali).

Age
The average age of the drug users was 36.09years, and standard deviation (SD) was 0±9.161 years.It was found that the highest respondents (drug users) rate age was 30 to 40 (43.0%)years.The average age of the personnel of Narcotics Department was 39.16 years, and standard deviation (SD) was 0±06.717 years and the highest respondents' rate age was 30 to 40 (56.0%)years.The average age of the civil society members was 50.78 years, and standard deviation (SD) was 0±8.360 years.It was found that the highest respondent's rate age was 50 to 60 (44.0%) years (Table 1).

Gender
Table 2 shows that 85.0% of the drug users were male, and 15.0% were female.On the other hand, 90.0% personnel of Narcotics Department were male, and 10.0% were female.In the civil society members, 92.0% were male, and 08.0% were female.

Family
Table 3 shows that among the respondents, 90.0% recent drug users were nuclear family and only 10.0% were joint family.In the personnel of Narcotics Department, 60.0% were joint and 40% were nuclear family.On the other hand, 58.0% civil society members were joint and 42% were nuclear family.

Narcotics personnel's education
Figure 3 shows that educational qualification of the personnel of Narcotics Department was more than half of the personnel of Narcotics Department [29 (58.0%)] are graduates, 12 (24%) are master post graduate and 9 (18.0%) are under graduate.

Drug users' profession
Figure 4 shows the profession of the drug users, it was found that about half of the drug user's profession are into business [46 (46.0%)], 28 (28.0%) were service, and 26 (26.0%) were student.

Education of civil society members
Figure 5 shows that educational qualification of civil society members, it was found that more than half of the civil society members were graduate [27 (54.0%)] and 18 (36.0%)were master/postgraduate and 5 (10.0%) were undergraduate.It was found out that more than half of the civil society members profession were civil service servant [26 (52%)] and 24 (48.0%) were into business (Table 4).

Addiction in which drug
Table 5 shows that out of 100 drug users, regarding addiction in which drug/s, which was multiple response question, the results revealed the drug user's addiction in phencidyl drug (94%), addiction in ganja (cannabis) (82%), and addiction in pethedine (79%) drug, half of the drug users addiction in heroin (52%), one fifth of the drug users addiction in yabba (ATS) (23%), and few of the drug users addiction in lupijesic (9%).

Drug users for being addiction to drugs
The results revealed that all of the drug users addiction to drugs was unemployment problem/economic insolvency

Addiction in which drug
Table 5 shows that out of 100 drug users, regarding addiction in which drug/s, which was multiple response question, the results revealed the drug user's addiction in phencidyl drug (94%), addiction in ganja (cannabis) (82%), and addiction in pethedine (79%) drug, half of the drug users addiction in heroin (52%), one fifth of the drug users addiction in yabba (ATS) (23%), and few of the drug users addiction in lupijesic (9%).

Drug users for being addiction to drugs
The results revealed that all of the drug users addiction to drugs was unemployment problem/economic insolvency (100%), encouragement from friends/peer pressure (100%), mental stress due to family problem/frustration from family matters (100%), all most all of the drug users addiction to drugs was easy access to drugs (88%) and to get immediate relief from tension (78%), only few of the drug users addiction to drugs was surrounding atmosphere (10%) and curiosity (17%, Table 6).

Drug users source of money
Table 7 shows that out of 100 drug users, regarding the source of money for buying drugs, being a multiple response question, the results revealed that all of the drug users source of money for buying drugs was loan from friends, family members (100.0%),all most all of the drug users source of money for buying drugs was collected through criminal activities like hijacking, extortion etc (80.0%), more than half of the drug users source of money for buying drugs came from pocket money (68.0%) and from their own income (30.0%).

Drug users by the collect drugs
Table 8 shows that out of 100 drug users, regarding where they get their drugs the collect their drugs, the results revealed that all of the drug users collect their drugs from a house close to the border area (100%), all most all of the drug users collect their drugs from specific seller in the locality (77%) and from spot beside lanes/roads (75%), more than half of the drug users collect their drugs from drug smugglers in town (55%) and few of the drug users collect their drugs from drug smugglers in border crossing points (29%).

Physical and mental effects of drug users
Table 9 shows that out of 100 drug users, regarding feeling of physical and mental effects after drug addiction, the results revealed that all of the drug users feeling after drug addiction was sense of perception doesn't work (100.0%),feeling dizziness until taking drugs (100.0%) and decreased working capability and stability (100.0%),all of the drug users feeling after drug addiction was lack of discipline in daily life (80.0%),few of the drug users feeling after drug addiction was insomnia(20.0%),hallucination syndromes (20.0%), sexual problem (15.0%) and physical impatience (10.0%), increased head-ache (10.0%), and abnormal behavior (10.0%).

Treatment for get rid of drug addiction
Table 10 shows that out of 40 recent graduate's/respondent's, regarding if they have taken any treatments in order to get rid of drug addiction, the results revealed that all most all of the drug users did not take any treatment in order to get rid of drug addiction (79%), and less than one third of the drug users took treatment for get rid of drug addiction (21%).

Personnel of Narcotics Department for being addiction to drugs
Table 11 shows that out of 50 personnel of Narcotics Department, regarding the reasons for being addicted to drugs, which was multiple response question, the results revealed that more than half of the personnel of Narcotics Department reasons for being addicted to drugs was easy access to drug (52.0%), and mental stress due to family problem/frustration from family matters(56.0%),more than one third of the personnel of Narcotics Department reasons for being addicted to drugs was unemployment problem/economic insolvency (38.0%), encouragement from friends/peer pressure (34.0%) and to get immediate relief from tension (38.0%),only few of the personnel of Narcotics Department reasons for being addicted to drugs was estranged in love (18.0%) and surrounding atmosphere (10.0%).

Personnel of Narcotics Department by the negative effects due to drug addiction
Table 12 shows that out of 50 personnel of narcotics department, regarding the negative effects due to drug addiction, which was multiple response question, the results revealed that most of the personnel of Narcotics Department negative effects to drug addiction was decreased working capability and stability (72.0%) and physical impatience (70.0%), more than half of the personnel of Narcotics Department negative effects to drug addiction was feeling dizziness until taking drugs (52.0%), abnormal behavior (44.0%), sexual problem (40.0%), few of the personnel of Narcotics Department

Personnel of Narcotics Department by the causes to change drugs
Table 13 shows that out of the 50 personnel of Narcotics Department, regarding the cause to change drugs one after another by the addiction, which was multiple response question, the results revealed that more than half of the personnel of Narcotics Department knew the cause to change drugs one after another by the addiction was lower cost (50%) and adventure in tasting different drugs (50%), one third of the personnel of Narcotics Department knew the cause to change drugs one after another by the addiction was a tendency to increase the desired effect of drug (32%) and easy access to other drugs (30%), a psychological and physical dependence on the effects of the drugs (24%), and to feel better (26%).

Personnel of Narcotics Department by persons involved in drug business
Table 14 shows that out of 50 personnel of Narcotics Department, regarding the persons involved in drug business/smuggling, which was multiple response question, the results revealed that most of the of the personnel of Narcotics Department knew the persons involved in drug business/smuggling was a syndicate of smugglers (86.0%), one third of the personnel of Narcotics Department knew the persons involved in drug business/smuggling was some political leaders/so-called students leader (34.0%), and some elites in society (32.0%).

Personnel of narcotics by the key reasons for inefficiency of department
Table 15 shows that out of 50 personnel of Narcotics Department, regarding the key reasons for inefficiency of Narcotics Department, which was multiple response question, the results revealed that more than half of the

Personnel of Narcotics by the critical issues of addict patient to rehabilitate
Table 16 shows that out of 50 personnel of Narcotics Department, regarding the critical issues of narcotics addict patient to rehabilitate, which was a multiple response question, the results revealed that more than half of the of the personnel of Narcotics Department knew the critical issues of narcotics addict patient to rehabilitate was comprehensive treatment (54.0%) and cooperation of the family (54.0%),more than one third of the of the personnel of Narcotics Department knew the critical issues of narcotics addict patient to rehabilitate was post recovery professional activity (40.0%), sustainability of the recovery (38.0%),Appropriate medication (28.0%) and poor environment of the centre (38.0%).

Civil society members for being addiction to drugs
Table 17 shows that out of 50 civil society members, regarding the reasons for being addicted to drugs, which was a multiple response question, the results revealed that about all of the civil society members knew reasons for being addiction to drugs was unemployment problem/economic insolvency (94.0%) and easy access to drug (90.0%),all most all of the civil society members reasons for being addiction to drugs was encouragement from friends/peer pressure (88.0%), mental stress due to family problem/frustration from family matters(84.0%)and to get immediate relief from tension (84.0%), more than half of the civil society members knew reasons for being

Civil society members by the source of money for buying drugs
Table 18 shows that out of 50 civil society members, regarding the source of money for buying drugs, which was a multiple response question, the results revealed that all most all of the civil society members knew the source of money for buying drugs was gotten through criminal activities like hijacking, extortion etc. (88.0%) and loan from friends, family members (80.0%), half of the civil society members knew source of money for buying drugs from pocket money (62.0%) and from own income (44.0%).

Civil society members by the collect drugs
Table 19 shows that out of 50 civil society members, regarding where to get collect drugs, which was a multiple response question, the results revealed that all most all of the civil society members knew were to get drugs from either from a specific seller in the locality (86.0%), from house near border area (80.0%) and from spot beside lanes/roads (70.0%).While about half of civil society members knew were to get drugs from drug either from smugglers in town (40.0%) and from drug smugglers in border crossing points (34.0%).

Civil society members by the impact of changes behavior due to drug addiction
Table 20 shows that out of 50 civil society members, regarding the impact of changes in social behavior for increasing drug addiction, which was a multiple response question, the results revealed that all most all of the civil society members knew the impact of changes in social behavior for increasing drug addiction which was deteriorated law, order situation and respects to elder

Civil society members by the suggestions to get rid of drug addiction
Table 21 shows that out of 50 civil society members, regarding the suggestions to addicted to getting rid of drug addiction, which was a multiple response question, the results revealed that all of the civil society members knew the suggestions to get rid of drug addiction which are healthy drug free working environment (100.0%),enactment of articles on anti-drug issues in the text books and newspapers (100.0%) and media campaign against drugs (100.0%).All most all of the civil society members knew the suggestions to get rid of drug addiction which was creating more employment opportunities (88.0%) and to involve in any creative work (84.0%), while about half of the civil society members knew the suggestions to get rid of drug addiction which was to avoid mixing with bad company (40.0%)and ensuring proper treatment and rehabilitation measures (36.0%).

CONCLUSIONS AND RECOMMENDATIONS
The main elements in combating drug addiction include measures to control availability and use of drugs, treatment of withdrawal symptoms, and restoration of social moral and religious values.To prevent re-addiction in patients, innovative treatment containing medical, social and religious aspects must be put in place.Easy availability of treatment will ensure the elimination of this socially and physically dreaded disease.Treatment of addiction in our country is still not in a hopeful stage.Some unqualified and unscrupulous people are engaged in making money out of this affliction with mushrooming organizations and signboards, which confuse the patients.Such institutions do not have doctors.Others falsely advertise the availability of services and doctors from abroad.Such doctors even if available cannot be very effective, unless they are truly knowledgeable about our social, cultural and economic environment.It is time that experienced and qualified doctors and health professionals should come to the aid of these addicts in our society, and to give genuine and prolonged treatment and care.
Drug abuse is a multidimensional problem, and it should be viewed from multidimensional perspective and be addressed accordingly.The government should involve both the family and society, which are two most effective institutions to prevent drug addiction within the drug policy covering both the preventive and curative issues.These two institutions side by side with the government and nongovernmental efforts can play vital role in drug demand reduction and preventing drug abuse in the country.All these urgently demand major policy and institutional reforms involving all the concerned corners for effective response to combat drug abuse in the country.During this research, it has been found that many people, especially the youths are eager to get rid of drugs.But unfortunately, they can hardly find any way out.The departments of narcotics control, police, BDR etc. either do not work or/and even somehow are related to drug smuggling/business.According to the discussion with the concerned people such as drug abusers, guardians, teachers, policemen and related persons in the drug business, behavioral modification of the abusers is not enough to check the spread of drug taking and drug trafficking.The concerned people gave the following suggestions to be free of drugs.
Concerned administration should be reshuffled.Culprits that are hidden in the police, BDR, and narcotics control department must be punished.At the same time, rewards may be declared for superior performance.It is obvious that, drugs business in the country would fall drastically if border-crossing areas can be checked properly.Leaders of social institutions like schools, colleges, clubs etc. should come forward to build resistance against drugs.
The NGOs can play a significant role in Bangladesh, especially in the awareness and rehabilitation processes.It is observed by many of the addicts that, the rehabilitation procedures and costs introduced by the Narcotics Department are high and cumbersome; however only a few NGOs are active.The addicts, while talking with the investigators, sought treatment to wipe out the negative effects of the drugs.

Figure 1 .
Figure 1.Map of the study area.

Figure 2 .
Figure 2. Distribution of the drug users by educational qualification.

Figure 3 .
Figure 3. Distribution of the personnel of narcotics by educational qualification.

Figure 4 .
Figure 4. Distribution of the civil society members by educational qualification.

Figure 5 .
Figure 5. Distribution of the drug users by their profession.

Table 1 .
Age distribution of the respondents.

Table 2 .
Gender distribution of the respondents.

Table 3 .
Family structure of the respondents.

Table 4 .
Distribution of the civil society members by their profession.

Table 5 .
Number and percent distribution of respondents by addiction in which drug/s.

Table 6 .
Drug users by reasons for being addiction to drugs.

Table 7 .
Drug users by the source of money for buying drugs.

Table 8 .
Number and percent distribution of respondents (drug users) by the collect drugs.

Table 9 .
Number and percent distribution of respondents (drug users) by feeling of physical and mental effects after drug addiction.

Table 10 .
Number and percent distribution of respondents (drug users) by taken any treatment for getting rid of drug addiction.

Table 11 .
Number and percent distribution of respondents (Personnel of Narcotics Department) by the reasons for being addicted to drugs.

Table 12 .
Number and percent distribution of respondents (Personnel of Narcotics Department) by the negative effects due to drug addiction.

Table 13 .
Personnel of Narcotics Department with the causes to change drugs.

Table 14 .
Personnel of Narcotics Department by persons involved in drug business.

Table 15 .
Number and percent distribution of respondents (personnel of Narcotics Department) by the key reasons for inefficiency of Narcotics Department.

Table 16 .
Number and percent distribution of respondents (personnel of Narcotics Department) by the critical issues of narcotics addict patient to rehabilitate.

Table 17 .
Number and percent distribution of respondents (civil society members) by the reasons for being addicted to drugs.

Table 18 .
Number and percent distribution of respondents (civil society members) by the source of money for buying drugs.

Table 19 .
Number and percent distribution of respondents (Civil society members) according to the drugs collected.

Table 20 .
Number and percent distribution of respondents (civil society members) by the impact of changes in social behavior for increasing drug addiction.

Table 21 .
Number and percent distribution of respondents (civil society members) by the suggestions to get rid of drug addiction.