Offering afeem as hospitality has a long history in some communities. Many people take it occasionally without realising its addictive potential.
Opium is a narcotic; possession and use outside medical licensing are offences under India's NDPS Act.
Key concepts
- Repeated use leads to tolerance and physical dependence
- Older adults given afeem for pain are at particular risk
- Communities are increasingly choosing tea and sweets for manuhar
Symptoms and signs
- Feeling unwell, yawning, body ache if the usual dose is missed
- Needing afeem to start the day or work
- Constipation, drowsiness, reduced appetite
Causes
- Social expectation to accept manuhar
- Belief that afeem gives strength or relieves pain
- Opioid effects on the brain's reward system
Risk factors
- Frequent gatherings and family use
- Chronic pain, arthritis, sleep problems
- Combining with alcohol
Evidence-based management
- Politely decline; offer tea, sweets or dry fruits instead
- For dependence: supervised withdrawal or substitution therapy
- Treat pain and sleep problems with safe alternatives
- Family and community support for change
When to seek professional help
- Daily use or withdrawal symptoms
- Older family member dependent on afeem
- Extreme drowsiness or slow breathing — emergency
Frequently asked questions
Is a small amount at a wedding harmful?
Any opioid use carries risk, especially with alcohol or in older adults, and repeated occasions can lead to dependence.
How do I refuse without offending elders?
A respectful 'my doctor has advised against it' is widely accepted.
Medical references
Guidelines and official sources used for this article.
- Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence. World Health Organization, 2009.
- The Narcotic Drugs and Psychotropic Substances Act, 1985. Government of India.
- Magnitude of Substance Use in India. Ministry of Social Justice & Empowerment and NDDTC, AIIMS New Delhi, 2019.
- Author
- Dr. Kuldeep Budania, MBBS, MD Psychiatry
- Medical reviewer
- Dr. Kuldeep Budania, MD Psychiatry
- Last reviewed
This article is for general information and is not a substitute for personal medical advice.
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