Knowledge, attitudes, & practices on substance use among adolescents in Nepal: research & recommendations

Abstract

Introduction: In this report, substance use refers to the use of addictive and harmful substances such as cannabis, opioids, amphetamines, and other stimulants1. Harmful substance use includes any pattern of consumption, whether occasional or regular, that leads to physical, mental, or social harm. This includes commonly used substances like alcohol, tobacco, and other illicit substances2. According to the 2024 UNODC report, more than 275 million people globally are engaged in substance use, with over 39 million suffering from related disorders. Cannabis was the most used drug in 2022, with around 200 million users. Despite having fewer users (60 million), opioids were responsible for 68% of the 180,000 drug-related deaths in 2021 and over half of the years of healthy life lost due to early death or disability. The rising prevalence of substance use among adolescents has become a pressing global public health concern. According to the World Health Organization (2024), more than 25% of individuals aged 15–19 consume alcohol, 10% of those aged 13–15 use tobacco, and approximately 4.7% of adolescents aged 15–16 have experimented with cannabis. Similar trends are emerging across South Asia, where substance use is increasingly linked to factors such as poverty, limited access to quality education and healthcare, peer influence, and exposure to domestic violence3. In 2020, the Ministry of Home Affairs, with technical assistance from the Central Bureau of Statistics (CBS) and expert oversight from national steering and technical committees, conducted the third Nepal Drug Users Survey. The objective was to analyze substance use patterns, high-risk behaviors, and demographic profiles in order to support the development of informed, evidence-based policies and intervention strategies. The survey estimated that there are 130,424 individuals in Nepal who use hard drugs (excluding alcohol and tobacco) with a staggering 93.3% of users being male and only 6.7% female. Adolescents represented a significant portion of this group, with 19% falling between the ages of 15 and 19. Cannabis emerged as the most commonly used substance (84.7%), followed by tranquilizers (73.1%) and opiates (46.8%). The findings also revealed cannabis as the most frequently initiated and most consistently used substance across a user’s lifetime. The survey further highlighted that the initiation of substance use often begins during adolescence. Among respondents who never smoked cigarettes, 55.6% reported starting between the ages of 15 and 19. Similarly, 71.4% of alcohol users had their first drink within the same age range. In terms of regional prevalence, the highest concentration of adolescent substance users was recorded in Sudurpashchim Province (19.2%), followed by Madhesh Province (14.4%)4. Complementing these findings, the National Mental Health Survey 2020 reported that 4.2% of the general population experienced alcohol use addiction within the past 12 months. Other substance use (excluding nicotine) prevalence was found 0.2% in the general population, while it was 0.6% among adolescents aged 13 to 175. Additionally, a cross-sectional study conducted in western Nepal among 460 students aged 15 to 19 years revealed that 27.4% had used at least one psychoactive substance. Among them, tobacco was the most common (59.3%), followed closely by cannabis (55.6%)6.