When Elixir Turns Deadly

Science and technology have been developing at an impressive rate. The invention of new drugs is one of the upsides in the medical field. As we celebrate this growth, a painful side unfolds before us in every hospital, specifically in the emergency department. A scenario that brings a cocktail of emotions ranging from sympathy to resentment. One that takes us beyond medicine, to pause and think about the complexities of lives around us. Deliberate self-harm and suicide are serious mental health concerns often stemming from emotional pain, mental illness, trauma or a sense of hopelessness, making a person take drastic steps to harm themselves with or without the intent to end life. Deliberate self-poisoning (DSP) is now commonly used in clinical and psychological contexts to distinguish poisoning from other forms of self-harm, such as cutting or burning. Among all hospital admissions related to suicide attempts, DSP is one of the leading methods used (85%–95%).1 The National Crime Records Bureau statistics show an alarming rise in suicide rates in India, reflecting a severe mental health crisis.2 As opposed to a western society, where drug overdose often paints the picture of an unfortunate addict overdosing, in India, most of the cases reported are those of medication overdose with the intent of self-harm. Some studies have shown that this act is often an attempt to escape reality due to their dire helplessness rather than an intention to end life.3 A desperate plea for help! In 2014, India amended the Narcotic Drug and Psychotropic Substances Act to provide access to opioids for pain management. However, alongside offering pain relief and improving quality of life, this has played a role in increasing the rate of misuse and addiction. The gap in E-Pharmacy regulation makes the situation even worse.4 The ease of availability has made drug overdose more common among the urban and semiurban areas in recent times: Analgesics, antidepressants, antipsychotics, and antihistamines being the most abused drugs.5 The highest prevalence is observed among individuals aged 15–29 years, where a link has also been identified between preexisting psychiatric disorders and this impulsive behavior.6 THE TRIGGERS? Mental health stigma Even in the 21st century, we are struggling to normalize treatment for mental health. Individuals are often left to deal with this alone, rather than get help, because of the stigma question “What will people say?” Social or peer pressure The pressure on today’s young generation from early academic performance to milestones such as jobs, income, and health leads to constant comparison, causing feelings of worthlessness and emptiness. Government regulatory lapse The ease with which medications can be obtained from pharmacies without even consulting a doctor, or how a 5–10-year-old prescription still gets them medications, is horrifying, and further promotes this behaviour. WHAT CAN WE DO? The road to change is a long and tedious journey. Actions such as educating society about mental health, raising awareness about and encouraging the use of available suicide helplines like iCall (a telephone and email-based counseling service by the TATA Institute of Social Sciences providing help in multiple languages between 10 am and 8 pm), or AASRA (a non-political, nonreligious charity organisation based in Mumbai working in crisis intervention and mental health), and other suicide prevention helplines, as well as implementing regulatory changes at the government level to restrict the availability of drugs, are important. We can collaborate with the implementors of the Mental Health Care Act 2017 to ensure families are involved in counseling and to provide better care and long-term support to these individuals. More research is needed to explore the nuanced aspects of drug overdoses, extending beyond medicine into the daily lives of individuals. As we are in an era of practicing preventive medicine, let us all commit to taking action, with multilevel collaboration involving healthcare providers, policymakers, and representatives of society, to better understand, address and reduce this crisis, if not fully prevent it.