title: Injection drug use among children and adolescents in India: Ringing the alarm bells.
abstract: BACKGROUND
  Injection drug use (IDU) is intricately linked to preventive aspects for human immunodeficiency virus from a public health perspective. No large-scale data are yet available for injectable drug use among children and adolescents in India, apart from few anecdotal reports.
  
  
  OBJECTIVE
  The present paper reports on the profile and substance use pattern of 509 child IDU users, among a total sample of over 4000 children using substances across 100 sites from 27 states and 2 UTs in India. It was undertaken in 2012-2013 by the National Commission of Protection for Child Rights in collaboration with the National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi. For inclusion, participants had to be 18 years or less, should have used at least one other substance besides tobacco in the last 1 year, and should be living at home/street, in or out of school. Data were gathered using a 95-item semi-structured questionnaire.
  
  
  RESULTS
  A large proportion of ever users of IDU also reported use in the past year (96.5%) and past month (92.7%). Apart from IDU, tobacco, alcohol, cannabis, and pharmaceutical opioids were the most common substances of abuse in order of frequency. There was an interval of about 3 years from the initiation of tobacco to the initiation of IDU. Average age of onset for IDU was a year lesser in males than female users. The street children initiated IDU earlier than out-of-school and schoolgoing children. No quit attempt was made by more than half of the children. More than 40% had frequent familial conflicts, more than half had a familial history of substance use, and three-fourths had drug-using peers.
  
  
  CONCLUSIONS
  The paper highlights the profile and pattern of children and adolescents using IDU across many parts of India, dispelling the myth that IDU is largely an adult phenomenon in India. There is a clear need to promote different harm reduction and preventive strategies across the "hard-to-reach" younger age groups using injecting drugs.
authors.affiliation: National Drug Dependence Treatment Centre, New Delhi, India.
authors.forename: Anju
authors.initials: A
authors.lastname: Dhawan
authors.affiliation: Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Raman Deep
authors.initials: RD
authors.lastname: Pattanayak
authors.affiliation: National Drug Dependence Treatment Centre, New Delhi, India.
authors.forename: Anita
authors.initials: A
authors.lastname: Chopra
authors.affiliation: Formerly- National Commission for Protection of Child Rights, New Delhi, India.
authors.forename: Vinod Kumar
authors.initials: VK
authors.lastname: Tikoo
authors.affiliation: Society for Promotion of Youth and Masses, New Delhi, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kumar
keywords: Adolescents; India; children; injection drug use; substance use