The Surge of Stimulant Addiction in India

Illicit stimulant drugs are among some of the most addictive drugs. Cocaine and amphetamine-type stimulants (ATS) such as amphetamine, methamphetamine, and 3,4-methylenedioxymethamphetamine or ecstasy constitute some of the most commonly used stimulant drugs globally. In addition, various other amphetamine derivatives and new psychoactive substances with stimulant properties frequently emerge in illicit drug markets. These substances come in several forms and can be smoked, snorted, injected, or orally ingested. Stimulant use is linked to a variety of physical, psychological, and sociooccupational harms. Their use is associated with elevated mortality, poor mental health (substance dependence, suicidalty, psychosis, violence, and depression), increased risk of cardiovascular events, and increased incidence of HIV, hepatitis C, and sexually transmitted infections.1 The harmful effects of using stimulants are some of the most severe ones among all addictive drugs.2 In India, illicit stimulant use at one time was only sporadic. Its use was limited to metropolitan cities, where owing to the high cost of drugs, the rich clientele with high disposable income were the primary users.3 A nationwide survey conducted in 2017–2018 to assess the magnitude of substance use found the presence of past-year cocaine use among 10.7 lakh adults (males – 0.18% and females – 0.01%).4 3.2 lakh (0.03%) adults used it in harmful and dependent patterns. Maharashtra, Punjab, Rajasthan, and Karnataka were reported to have the maximum number of cocaine users. ATS was reportedly used by a smaller general population (0.18%; 19.4 lakh individuals). About 0.06% (7 lakhs) of individuals used it in harmful or dependent patterns. ATS use was more common in Maharashtra, Telangana, Uttar Pradesh, Punjab, Manipur, and Delhi.4 However, the recent substantial increase in illicit stimulant drug seizures by law enforcement agencies, a proxy indicator of stimulant drug trade and use in the country, indicates an increasing trend of stimulant drug use in India. India being situated between the two major ATS manufacturing hubs, namely Afghanistan and Myanmar, is becoming a transit point and destination for the drug consignments. In past years, the Narcotics Control Bureau, coast guard, Directorate of Revenue Intelligence, and other law enforcement agencies had ATS seizures of over a quintal from a vessel off the coast of Gujarat (221.10 kg) in January 2022, from Manipur in June 2022 (119.79 kg), from Mizoram in September 2022 (108.35 kg), from Maharashtra in October 2022 (200 kg), and from a vessel off Kerala coast in May 2023 (2526.01 kg).5 Meanwhile, many smaller seizures also happened in different states of India. In March 2024, a man with 532 g of methamphetamine was arrested from Goa.6 Likewise, methamphetamine worth Rs 5 crore, disguised as tea bags was seized from Delhi from foreign nationals.7 Furthermore, the local manufacturing of stimulants has picked pace. Many clandestine laboratories involved in the illicit manufacture of stimulants have been reported to be dismantled in India since 2014.8 Furthermore, substantial seizures (of more than 3.5 tons in methamphetamine equivalents) of precursor chemicals used in the manufacturing of ATS happened between 2017 and 2021.9 Overall, this reveals a marked increase in illicit stimulant drug-related activities in India. Addressing the surge of stimulant addiction requires concerted efforts from all stakeholders. A multifaceted approach that integrates prevention, treatment, and harm reduction efforts is needed. At the policy level, governments at the center and state are required to undertake policy initiatives aimed at regulating drug manufacturing and distribution. Furthermore, there should be enhanced cooperation among them as well as the law enforcement agencies and regulatory machinery working under them.10 This will help reduce the illicit trafficking and supply of these drugs. Prevention, treatment, and harm minimization efforts must supplement law enforcement measures. Prevention and health promotion can reduce the demand for stimulants. In addition, expanding access to addiction treatment services and implementing evidence-based interventions are essential steps toward mitigating the impact of stimulant addiction on society. Health-care providers are required to be vigilant about this emerging problem and be trained and equipped to manage it. The UNODC outlined key principles for preventing stimulant use-related issues.11 It emphasized the effectiveness of integrating ATS prevention within broader drug prevention strategies, targeting substances such as tobacco, alcohol, and cannabis. Evidence suggests that children and youth can benefit from selective prevention programs that aim to build protective factors in their lives. Accurate data including information on substance usage, community risk factors, and available resources collected from diverse sources such as law enforcement and health-care systems are essential for informed intervention planning. Furthermore, recommended was engaging the youth to improve the design and implementation of the ATS prevention plan. Comprehensive prevention plans addressing various risk factors and considering the protective factors are vital. Multicomponent initiatives are more effective than singular approaches, and long-term programs maintain impact. Coordination and collaboration between government agencies, civil society organizations, and the private sector are necessary along with sustained investment in workforce development, robust monitoring and evaluation, and research. Measures promoting nonuse can benefit many not yet exposed to ATS.11 Several challenges can be anticipated to hinder the effective management of stimulant addiction in India. These include inadequate resources, fragmented health-care systems, cultural attitudes toward substance use, and the ever-evolving nature of the drug market. Newer ways of drug trade such as the use of darknet have become increasingly common to ship synthetic stimulants to India.12 Furthermore, consumers from diverse geographies are at risk of getting exposed to stimulants because of high rates of migration (internal and external) in India.13 It needs to be seen how India deals with the rising use of illicit stimulant drugs. However, India should be prepared to deal with this problem. By understanding the underlying drivers of stimulant use, implementing evidence-based interventions, and fostering collaboration across sectors, India can confront this crisis and pave the way toward a healthier and more resilient society.