Correlates of opium use: retrospective analysis of a survey of tribal communities in Arunachal Pradesh, India

The harmful effects of addictive substances have been widely documented [1‐4]. Opium intake and opium dependence cause major damage to health, increase the risk of cancer, and can lead to injury, obesity, and a poor quality of life [3‐7]. The consumption of opium results in substantial morbidity and mortality [1, 3‐8]. Despite these adverse effects on health, opium continues to be consumed by various means (e.g., smoking, drinking and swallowing) in many parts of the world, including in Southeast Asian countries [9‐11]. Though non-medical use of all intoxicating substances is prohibited in India, opium has been reported to be used in many Indian States, such as Arunachal Pradesh, Assam and Rajasthan [3, 10‐13]. In Arunachal Pradesh, opium has been traditionally used medically among the tribal community for insomnia, pain, diarrhea, physical and mental stress, etc. It is also used socially on various celebratory occasions, such as births, marriages and festivals [10, 12].

Arunachal Pradesh is the largest state in Northeast India, and shares long international borders with China and Myanmar. Drug trafficking across the border in this region has been a major problem because of the close proximity of Myanmar, which is notorious for bulk production and nodal distribution of opium and its derivatives [9, 14‐17]. Evidence of opium use in Arunachal Pradesh has been reported previously [10, 12], but there is a need for an in-depth analysis of existing data to understand the differentials and determinants of opium use in the population. Therefore, the present study aimed to assess the prevalence of opium use among different tribes in Arunachal Pradesh and to examine the sociodemographic factors associated with opium use.

The general profile of the respondents, including demographics, education, occupation, and religion is presented in Table 1. More than 50% of respondents were illiterate, 45% were self-employed (mainly farming), and the majority of unemployed respondents were women, usually working as housewives. The prevalence of opium use was recorded as 10.6% among men and 2.1% among women (p < 0.01). As opium use among women was low, the prevalence of opium use in each of the tribes by age, education, occupation, marital status, religion and family size is presented only for male respondents in Table 2. Opium use among men in different tribes was 23.9% in Singpho, 28.4% in Khamti, 8.6% in Tutsa and 7.8% in Tangsa. Opium use was higher in older age groups and in men with a low education level. The prevalence of opium use was high among those of Buddhist (19.2%) or Indigenous (16.9%) religions (Table 2). The sociodemographic factors associated with the prevalence of opium use were similar in all tribes.

Multivariate logistic regression was used to examine the association of prevalence of opium use among male and female respondents of all tribes with age, occupation, marital status, religion, ethnicity and family size (Table 3). Among men, the MRR for opium use was significantly higher in older age groups (3.9 for 35–54 years and 5.7 for ≥ 55 years) with reference to the 15–34-year age group. MRR was also significantly higher for employed (4.1) and self-employed (8.7) male opium users than unemployed males, indicating the greater likelihood of opium use among those who had a source of income. Opium use was also significantly higher in married men (3.2) and widowers (5.4). Compared with Christians, MRR was significantly higher in Indigenous (8.3), Hindu (3.3) and Buddhist (2.8) religions. The MRR of opium use was significantly higher in Singpho and Khamti tribes (4.2 and 6.6, respectively) compared with the Tangsa tribe. The effect of education and household size on opium use was found weak in men and also in women. Among women, opium use was significantly higher in Singpho (13.2%) and Khamti (3.4%) tribes compared with the others. It was also higher among Buddhists (6.9%), with significantly higher MRR (10.1) compared with Hindus. However, none of the Christian women was recorded as an opium user. Opium use was higher among illiterate (2.6%) than literate women (0.8%), but the MRR was not significant. Opium use among older women (≥ 55 years) was also high (5.6%) with reference to the youngest age group (15–34 years) and the MRR was significant (4.3).

Overall, the mean age ± SD of initiation of opium use was 23.7 ± 9.3 years, and was significantly different between male (23.2 ± 9.3 years) and female (27.0 ± 9.9 years) opium users (p < 0.01). The mean duration of opium use was 3.4 ± 0.9 years, and was almost the same for men (3.5 ± 0.9 years) and women (3.4 ± 0.9 years). The correlation between age of opium users and duration of taking opium regularly was highly significant (r = 0.485; p < 0.001). The prevalence of use of other substances among opium users was recorded as 76% for tobacco in any form (chewing or smoking or both) and 44% for alcohol (Table 1).

The present analysis showed a strong association between opium use and age, occupation, marital status, religion and ethnicity in both sexes. There was a weak association in the case of education and household size. An association of sociodemographic factors with opium and other drug use has previously been reported [9, 12, 21‐28]. The prevalence of opium use among men was significantly higher than among women, as previously reported by others [12, 13, 26, 29]. However, the prevalence was found to increase with age in both sexes. The prevalence of opium use among older age groups was significantly higher compared with younger age groups. Though opium use among younger subjects was recorded as low, most of the opium users started it at a young age as reflected by a mean age of initiation of 23.2 years in men and 27 years in women. Such findings were widely reported elsewhere [12, 13, 25, 30, 31]. It is possible that there was under reporting of opium use in young age respondents because of concerns of privacy [12, 26].

Though opium use was recorded in all the tribes, it was significantly higher among Khamti and Singpho tribes of this region, who were mostly Buddhist. Among the majority Tangsa tribal community, opium use was particularly high among those of Indigenous religion. In contrast, there was a low prevalence of opium use among Christians, indicating the influence of religion and the traditional culture of different tribes on their habit of opium use as discussed by others [12, 25, 32]. A decreasing prevalence of opium use with increasing level of education was observed, but the multivariate analysis showed that the effect of education was not significant. The lack of a major influence of education on opium use was possibly related to the strong hold of traditional beliefs and practices among tribal people. Occupation was also found to be an important correlate of opium use. Analysis revealed high opium use among employed and self-employed respondents, who had significantly higher MRRs compared with unemployed respondents. Employment status may be a proxy indicator of respondent income and their ability to afford opium. As the cost of opium is high, its affordability and the income of individual users were also important factors related to its use. An association between substance use and occupation and income has also been reported by others [10‐12, 25, 33‐35].

As mentioned earlier, only a small percentage of women (2.1%) had been using opium. As they had limited social interaction, familial influence was likely the main cause of opium use among women as in previous studies [9, 12, 22]. In contrast, previous studies showed that male opium users were mainly introduced or influenced by their friends at the initial stage of taking opium [10, 11, 23, 26]. At a later stage, they continued the habit of taking opium in their own house with the acceptance of the family. As mentioned by the family during the survey, it was accepted that they control excessive opium use and prevent social harm. However, opium use had an adverse effect on their family members, especially women or female partner. Women were initially involved in helping the men prepare the opium for smoking. Thereafter, they were encouraged to use it as a medicine for body pain and stress [10, 12]. Gradually, they were persuaded to join their husband in taking opium. Such an influence of the familial environment on substance use among the family of opioid and other illicit drug users was also reported by others [12, 25, 30].

Though the study provides useful information, it has some limitations. It was an analysis of secondary data and some categories of explanatory variables did not have an adequate number of observations to estimate the odds ratios. For instance, because of the small numbers of women in some categories, it was not possible to estimate odd ratios for the association between opium use and some independent variables.

In conclusion, the study revealed a high prevalence of opium use among tribal communities in Arunachal Pradesh, and the important correlates were age, sex, occupation and religion. It suggests the need for a large population-based survey on addictive substance use, and formulation of effective interventions to curb the practice. Tribal youths can be motivated to avoid drug use by educating them about its harmful effects, and through counseling by their youth leaders and religious heads. Overall, the study provides valuable information for future community-based studies on opium use in Arunachal Pradesh.