Owing to the rapidly changing trends of the complex problem of drug abuse and its complications among Lankan youth, which are, however, mostly underreported, treatment and rehabilitation may be interfered with by the punitive approach of the legal system due to the fear and reluctance to provide accurate information regarding drug abuse and the lack of co-operation with the relevant authorities including the Police, Judicial Medical Officers (JMOs) and the Government Analyst's Department which additionally require technological assistance and infrastructure development in order to handle such emerging challenges.

These observations were made in a story based on case reports titled “Changing patterns in the types and methods of the abuse of illegal drugs in Sri Lanka: A study based on five recent case series” which was authored by S. Raveendran (attached to the Office of the JMO of the Colombo South Teaching Hospital, Kalubowila) and S.R. Hulathduwa (attached to the Sri Jayewardenepura University's Medical Sciences Faculty's Forensic Medicine Department) and published in the Ninth Volume's First Issue of the Medico-Legal Journal of Sri Lanka in June 2021.

Case report

First incident  

A 15-year-old schoolgirl recovered from a suicide attempt of injecting Brasso (a commercial preparation of strong mineral acids used for polishing brass objects) into the cubital fossa (an area of transition between the arm and the forearm and is located in a depression on the anterior surface of the elbow joint) following an argument with her parents when the parents had imposed restrictions on her social behaviour after they had got to know that she is addicted to illicit drugs and that she maintains casual relationships with boys. One of the girl's friends, another girl of the same age, sustained a fracture after a fall from a height in suicidal intention when her parents inquired from her regarding her drug seeking behaviour. Four more girls from the same group threatened their parents that they too will jump off a high-rise building if the parents attempt to restrain their social behaviour. All six were taking illicit drugs and dating boys during school hours. With the involvement of the medico-legal system, all of them were successfully rehabilitated and kept under constant surveillance with the help of the Probation Services, with no interruption to their school education.

Second incident 

A 12-year-old parentless boy from a sub-optimal socio-economic background was produced for a medico-legal examination following an attempt of sexual assault upon an eight-year-old girl. He had also been suspected of several petty crimes and robberies. He was not schooling and was living with his drug addict grandmother. The boy too was addicted to illicit drugs. The guardianship was shifted and the child was sent to a rehabilitation centre under the supervision of the Probation Services.

Third incident 

A 19-year-old boy who came to Colombo for higher studies from a remote, rural area was found dead on the beach after a beach party with multiple superficial injuries. The party had been organised through Facebook and the organisers could not be traced as the corresponding internet page had been deleted. The toxicological analysis of the post-mortem blood and urine revealed multi drug abuse including heroin, cannabis, amphetamines, and ethyl alcohol (ethanol is a volatile, flammable, colourless liquid with a characteristic wine like odour and pungent taste, and is a psychoactive drug).

Fourth incident 

A total of 113 suspects including 27 girls and nine minors (below 18 years) were produced for a medico-legal examination for illicit drug use, from an illegally organised Facebook party held in a private residence taken for one night’s hire. The majority were young adults below 24 years while 18 were still schooling and 42 had just finished their General Certificate of Education Advanced Level Examination. Among the suspects were four women of the 35 to 45 years age range who, upon questioning, admitted that they were invited by the organisers free of charge to provide sexual services. They also admitted that though they are not commercial sex workers in the sense of street prostitutes, they have been participating in beach parties and Facebook parties of this nature for the last two years. A total of 38 were positive for 3,4-Methylenedioxymethamphetamine (MDMA/Ecstasy – psycho-stimulant, and psychedelic drug of the amphetamine family) and methamphetamine. Varying numbers were positive for alcohol, cannabis, and heroin either in combination or alone. A total of 93 of the participants claimed that it was their first experience of attending a party of this nature while the remaining 20 admitted that they are used to attending such parties for casual sex, drugs and fun.

Fifth incident 

A total of 78 suspects were produced by the Police under circumstances similar to the above fourth incident but from a different location around one month after the fourth incident. The party was organised via social media in a covered up playground in a relatively less populated area in the suburbs of Colombo. A total of 11 were less than 18 years and 22 were females. The majority were below 24 years. Most were positive for 3,4-Methylenedioxyamphetamine and methamphetamine. The majority were positive for ethyl alcohol. A minority of 13 were positive for cannabis and opioids. Some claimed that they also had used Gaba/Taba (the street name for Pregabalin which is an anticonvulsant, analgesic and anxiolytic medication). Upon questioning, two middle aged females, and one young-adult male (a cross dresser) admitted that they were commercial sex workers. Two young females were pregnant and four others had evidence of sexually transmissible infections (STIs) and they claimed that they were not aware of their state of pregnancy and the STIs at the time of examination.

All these cases were examined in a single tertiary care centre within a year’s duration. Several such similar instances had been reported from elsewhere within Colombo and other major cities of the island and had been managed by the Consultant JMOs of the respective centres and/or the University Forensic Units. This increasing tendency of substance abuse by the younger age groups was already highlighted in the Statistical Analysis Annual Reports of 2018 and 2019 released by the NDDCB. The true incidence may be higher than reported. Underreporting is common due to the difficulties in tracing such discreet parties, the maintenance of professional secrecy by health care workers, the lack of uniformity in data analysis, practical difficulties in the qualitative and quantitative chemical analysis of substances and the legal barriers faced by the law enforcement agencies.