1. King Edward Medical University, Mayo Hospital, Lahore, Pakistan; maheerjamil@gmail.com
2. King Edward Medical University, Mayo Hospital, Lahore, Pakistan; mubasharanwar@gmail.com
3. King Edward Medical University, Mayo Hospital, Lahore, Pakistan; jaweriaawan@gmail.com
4. King Edward Medical University, Mayo Hospital, Lahore, Pakistan; alamnailacut@gmail.com

*             Correspondence:  maheerjamil@gmail.com

Keywords: initiatives, prevention, management, psychoactive drug, Asian undergraduates

1. INTRODUCTION

Addiction to drugs and other illicit substances endangers individuals across all age groups, educational backgrounds, and geographic locations.  Students, out of all those at risk, are disproportionately more likely to become victims of addiction and abuse because of their immaturity, young age, ease of access, pressure to perform well in school, social isolation, and, in certain situations, lack of parental supervision. According to research, between 20 and 40 percent of students globally are thought to take drugs [1]. A psychoactive substance is one that, when used, modifies emotion, behaviour, consciousness, and thought processes in addition to altering brain function.  Anything from basic caffeine or painkillers to opioids, sedative hypnotics, cannabis, and cocaine could be the cause [2]. Those who use these psychoactive substances run the risk of developing a habit. The issue arises first from usage, then from abuse, and finally from dependence.  Dependency is the necessity to consume a dose in order to feel well, whereas substance abuse is when a dose is taken in excess of what is considered moderate intake [3]. In addition to putting their lives in jeopardy, the abuse or dependence liability is a result of their subpar academic achievement. Many initiatives have been launched around the world to reduce student substance usage. Programmes that seemed to concentrate on improving social skills, understanding the causes of drug use, minimising its negative impacts, and adopting healthier practices were discovered to be more successful [4].  Certain Asian regions have seen the development and institutionalisation of programmes aimed at boosting health and primary prevention of substance use. 1989 was designated as the SAARC Year for combatting drug abuse, a decision made in 1988 during the fourth SAARC summit in Islamabad [5].  The DAPC provided financing to SAATH, a Nepalese non-governmental organisation, in 2012 so that it could conduct drug prevention programmes for schoolchildren in Nepal [6]. To raise awareness, interactive sessions with students were planned, and theatrical productions, songs, and quizzes were employed. Programmes for school awareness and teacher preparation were held in Pakistan in May 2016.  The objectives were to teach pupils about drug addiction, career counselling, and the installation of essential skills for surviving in a cutthroat setting [7]. In a similar vein, the SHIELDS programme in Malaysia seeks to raise students’ understanding and tolerance of drug abuse [8]. The International campus of Business, Agriculture, and Technology (IUBAT) in Bangladesh, in collaboration with the Lion Club of Dhaka Oasis, organised a drug awareness session for the campus’s professors and students in November 2017. Free medical camp tests were given to over 500 students who attended the lecture [9]. Numerous initiatives have been created to discourage drug usage among students, yet a sizable part of them still do so. As a result, there is a need to raise awareness of the detrimental impact that these drugs have on students’ physical and mental health. Larger study projects ought to be started in order to determine the most effective way to handle it. The purpose of this study is to examine and evaluate the different programmes that have been implemented across Asia to stop students from using drugs and other illegal substances so that more effective preventative measures can be put in place to save the future of numerous countries.

2. MATERIALS AND METHODS

Systematic reviews are publications that summarise data and highlight the significance of findings by incorporating material from multiple research articles on a particular topic. They can be used as guidelines in medical practice and are a great method to stay informed about new discoveries. The review was conducted using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Online resources and electronic databases including Google Scholar, Pubmed, PakMediNet, and others were used in this study. Multiple terms, such as “drugs,” “psychoactive substances,” “smoking,” “alcohol,” “caffeine,” “opioids,” “pain-killers,” “drug abuse,” “cigarette,” and “addiction,” were modified utilising Boolean and wildcard operators in each database. Only English-language articles were included in the search.Our evaluation comprised reviews, descriptive studies, cross-sectional studies, and cohort studies. Only articles written in English or translated into English will be included, as there is an English language requirement for inclusion. Articles that were readily accessible online were included in this review.  Articles addressing psychoactive substance use, prevention, and reduction programmes among Asian university students were found to share titles, intentions, and content. We removed articles whose titles did not make sense in light of our findings.  A number of study design papers—such as case reports, editorial reviews, interventional studies, correspondence, and grey literature—were excluded. We excluded from our review any articles that were published in languages other than English and that did not have an English translation. A database search produced 102 articles in the first instance.  There were 54 papers left for two researchers to review after duplicates were removed. The researchers first looked over the abstracts and titles before making the exclusions based on the previously established standards. After reading all of the remaining publications, a third researcher reconciled any discrepancies. Eleven papers that passed the full-text screening process and were deemed eligible for inclusion were used to extract data. Figure 1 shows the study selection procedure. The writers (KI, MM, MA, KZ, JT) extracted data independently about the quantity, characteristics, and sources of evidence from the included publications.  The following details are included: author, year, nation, sample cohort, sample size, age, study chronology, scales/instrument, diagnostic method or screening tool utilised, measuring the psychoactive substances, use, and preventive and reduction programmes among Asian university students. The same authors chose which data to review and vetted any full-length articles.

3. RESULTS AND DISCUSSION

The many study designs, include narrative, cross-sectional, descriptive, and theme evaluations. There were 19 to 52,874 students in the sample. The publications assessed student substance use prevalence, trends, contributing variables, and outcomes in addition to preventative and reduction initiatives.  Among the substances were glue sniffing, alcohol, cannabis, benzodiazepines, tobacco, areca nut, and opioids. The changes in the use of psychoactive substances by Asian college students are covered in this review. This systematic study gave us information about the usage of a range of substances by Asian university students, including alcohol, tobacco, and cannabis. A study carried out in Nagpur, India in 2019 found that university students were using areca nuts more frequently due to a lack of knowledge about the potential negative effects.  An analogous study was carried out in Pakistan, demonstrating the higher incidence of alcohol and tobacco use among Lahore medical students. This underscores the greater need to develop efficient strategies for the reduction of psychoactive substances. One more cross-sectional study examined the use of e-cigarettes among Chinese university students. The study’s conclusions emphasised the urgent need for appropriate awareness campaigns to stop students from abusing psychoactive substances in large quantities. Important sociodemographic characteristics of opioid users were also shown, along with a comparison to heroin users. The risk factors connected to drug usage are highlighted in a different study done in 2021. Three categories—”individual, family, and community”—were used in this systematic review to summarise the factors that have contributed to the rising drug prevalence. The aforementioned studies urge the development of customized interventions, the implementation of effective awareness campaigns, and the creation of regulatory reforms to reduce the hazards associated with the use of psychoactive substances and to support the health and wellbeing of Asian university students. Our review’s objective was to evaluate the use of psychoactive substances by Asian college students as well as any prevention or reduction initiatives. We looked at a variety of psychoactive substances, including cannabis, alcohol, tobacco, and areca nuts. Similar to other regions, drug use among college students is a serious problem throughout Asia that is mostly unreported.  Finding out how common it is and what influences students’ inclination to abuse psychoactive substances was the aim of this study. Two examples of psychoactive substances that can be abused or utilised dangerously are alcohol and illicit drugs. Numerous studies have shown that the overproduction of certain feel-good hormones by the brain in response to particular substances is what causes drug addiction. Drug abuse acts as a “escape mechanism” and a source of amusement and satisfaction for the majority of people. Environmental characteristics that were found to be statistically associated with substance usage included living arrangements, substance abusers in the family, siblings, close friends, friends who insisted on substance use, and substance abusers in the community, particularly parents [18].  Adolescent drug use was also found to be strongly correlated with a history of abuse, particularly in females.  There is, however, currently minimal evidence linking substance usage to maltreatment. The study’s conclusions suggest that youth with negative personality traits should get ongoing supervision, health education, motivation, therapy, and emotional support because these characteristics have an impact on teen drug use in the areas of the individual, family, and community. Individual risk factors included unfavourable personality traits including high impulsivity, rebelliousness, difficulty managing emotions, and alexithymia, as well as past histories of substance abuse and addiction, attitude, and perspective.

Nonetheless, it has been discovered that certain personality traits—such as optimism, high mindfulness, and social anxiety—protect against drug dependence. The study came to the conclusion that teenagers with negative personality traits should be closely watched and given health information, motivation, counselling, and emotional support because these traits are associated with high-risk behaviours like drug use. The prevalence of smoking among young people in China, including the use of water pipes, e-cigarettes, and traditional cigarettes, was examined in this study. The results showed that boys used all three products more frequently than girls, with boys reporting regular cigarette use at a rate of over half compared to just over one-third for girls. This was in line with earlier study findings [10, 11]. It was also common to use e-cigarettes and water pipes, with a sizable portion of users adding nicotine to these devices. These results support past systematic reviews and meta-analyses that found a cross-sectional association between youth use of alcohol, cannabis, e-cigarettes, and cigarettes [20].  The current review contributes to the corpus of literature by highlighting the temporal trend that youth who use e-cigarettes are more likely than youth who have never used one to start using other psychoactive substances later in life.

The review discusses how important it is to understand medical students’ attitudes towards the use of areca nuts as a means of mitigating their harmful effects. In India and other countries, areca nut is a widely used and highly addictive narcotic that is ingested in many forms and has been linked to several health problems. In India, the use of smokeless tobacco has increased within the last few decades. The use of it seems to be increasing, particularly among college students and homeless people, which makes it a severe problem. According to studies, smoking and chewing are more popular than ever and are even beginning to gain traction among youth. Cannabis was found to be the most often used illicit drug among medical students, ranging from 1.6% to 10.1%. This prevalence is consistent with the previous systematic review, which found that the frequency was 11.8%. The fact that medical UGs often consider cannabis to be a harmless substance and that it has hypnotic, anxiolytic, mood-altering, and appetite-promoting effects makes it evident why medical students use cannabis at a higher rate. Additionally, the study found that nearly half of the participants in the study were young people, and that poly tobacco use—the simultaneous use of two or more tobacco products—was becoming more and more common among this demographic. Men were more likely to use two or more medicines than women, who typically used none at all. The survey found that a significant portion of medical students (25.9%–57.4%) used substances, including alcohol, cannabis, and cigarettes (smoking and non-smoking). Medical students were less likely to smoke than the Indian community as large.  Based on an extensive analysis, 17.2% of medical students reported using tobacco products. According to a global survey of final-year medical students, medical students are not sufficiently and consistently taught about nicotine dependence and its treatment, as well as the harmful effects of smoking cigarettes, even though tobacco use is very common among them. The study’s conclusion emphasises the need for more research to determine the extent and contributing factors of substance use among medical students, as well as the necessity for consistent definitions of current substance use. Therefore, it is imperative that the curriculum include additional time for psychiatry training and instruction, including how to prevent and treat nicotine habit. However, in order to address the issue of substance abuse, it is advised that teenagers’ activities be regularly observed and monitored, that they be given access to a suitable and supportive environment, and that they be given school-, community-, and health facility-based awareness, counselling, and problem-solving approaches [12–20]. Consequently, there would be a reduction in the number of students who smoke, and better clinical care for their patients who have tobacco-related issues would be promoted. This study can have certain limitations even if it is founded on the results of a comprehensive analysis of research conducted under various conditions. First, we did not look at the severity of the psychiatric comorbidities in students who used drugs and alcohol, even though these two conditions regularly co-occur and hinder one another’s progress. Second, we only examined the prevalence and usage of psychoactive substances, despite the fact that the attitudes and comprehension of substance use among medical students were not evaluated. Third, the scope of our review was limited to Asian university students, and the extent of substance use in other populations was not evaluated. Finally, as we only included English-language articles, it’s possible that we missed some additional important details.

Figure 01: PRISMA flow diagram depicting study screening process.

4. CONCLUSIONS

In conclusion, students’ quality of life is seriously hampered by the usage of psychoactive substances.  This study highlights the need for more research to determine the extent and contributing factors of substance use among medical students, as well as the necessity for consistent definitions of current substance use.  Hence, it is imperative that the curriculum allocate additional time for psychiatry education and training, encompassing the management and prevention of nicotine addiction. Consequently, there would be a reduction in the number of students who smoke and better clinical care for their patients who have tobacco-related issues would be promoted. The results of this study could have an impact on practice and policy by helping to create treatments that teach college students how to abstain from using these substances.

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