Rising incidence of seizure of narcotics, psychotropic substances, and precursors in North-eastern states in the recent period has sounded the alarm bell that the region has become major trafficking route. A report titled "Magnitude of Substance Use in India, 2019" holds out a mirror to the societies and enforcement agencies in the region that the actual situation is more alarming than perceived. The Ministry of Social Justice and Empowerment brought out this report in collaboration with the National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi. It is based on findings of the National Survey on Extent and Pattern of Substance Use in India involving interviews of more than five lakh individuals across the country. The survey reveals that Manipur and Nagaland figure among the top ten states of the country with people who inject drugs (PWID) and of the estimated 8.5 lakh PWIDs in the country. Manipur accounted for 33,344 followed by Nagaland with 33,888. The figures for other six states in the region are: Assam -17466, Mizoram-28288, Tripura-11544, Meghalaya-11,420, Arunachal Pradesh-8580 and Sikkim-4336. "Almost half (46%) of PWID report injecting heroin predominantly, while the same proportion (46%) report using injectable pharmaceutical opioids. Only a miniscule proportion report injecting sedatives (exclusively) or ketamine," the report states. Majority of PWID report injecting frequently (Daily – 49%; 4-6 times per week – 18%). A substantial proportion of PWID report other risky injecting practices. About half report reusing their needles and syringes and about 27% report sharing their needles and syringes with their peers in past 12 months. About a third report experiencing vein-related complications and 28% experienced ulcer or abscess at the injecting sites. These findings of the survey also tell us about the picture in the region. Mizoram, Nagaland, Arunachal Pradesh, Sikkim, Manipur along with Punjab, Haryana and Delhi are the top states in terms of percentage of population affected by the problem of harmful or dependent use of opium. Of the three types of opioids use- opium, heroin and pharmaceutical opioids, heroin has the highest prevalence in the country. The States with highest prevalence of non-medical, non-prescription use sedatives are Sikkim, Nagaland, Manipur, and Mizoram. At the national level about 1.18 crore people are users of non-medical, non-prescription sedatives. The survey found that Manipur figures among the states with sizable population of Amphetamine Type Stimulants (ATS) and recorded about 1.3 lakh ATS users. Maharashtra tops the list with 5.3 lakh ATS users followed by Telangana, Uttar Pradesh-1.7 lakh, Punjab -1.6 lakh and Delhi with about estimated one lakh ATS users. Assam figures among top ten states with people who need help for cannabis related problems and accounted for 1.9 lakh such individuals in 2018. Union Home Minister Amit Shah while reviewing the drug situation at the 68th Plenary session of the North Eastern Council held on 8-9 September 2019 called for making the Northeast drug free by 2022. Shah also directed the Chief Secretaries and police chiefs in the region to draw up an action plan, to achieve the target. With only two years left to the meet the target deadline, the states in the region need to draw up comprehensive action plans at the state level and also at the regional level for coordinated actions on ground. However, the magnitude of the substance abuse in the region and in the country has affected huge population and therefore, mere seizure of illicit substance and drug traffickers is not going to address the problem. Drug controlling actions need to be backed up by programmes aimed at social inclusion of the users and gradually encouraging them to take part in development activities so that they do not feel excluded. The government agencies need to work in close collaboration with the community leaders to find out organic approaches to raise awareness against substance abuse and help those affected in rehabilitation. One of the key recommendations made in the Report is that the prevention strategies need to address risk factors like biological processes, personality traits, mental health disorders, family and attempt to enhance the 'protective factors' like psychological and emotional well-being, family attachment, affiliation to schools and communities. Stating that peer involvement plays an important role in influencing the risk of initiation of substance use, peer-led interventions, aimed at promotion of healthier lifestyle are also recommended in the report. Socio-economic support system has to be built for those rehabilitated so that they do not fall prey to the traffickers again due to stigmatization and lack of economic opportunities. Mental healthcare plays a critical role in preventing harmful dependence on substances and therefore should be a focus area of the action plans. The challenges are huge and will require cooperation and coordinated action by all stakeholders in the region. The states need to act fast before it is too late.