The drug problem of Punjab is back in the spotlight. This time due to a massive number of addicts making beelines to Outpatient Opioid Assisted Treatment (OOAT) centres in the state due to drug supply lines getting choked when Punjab imposed a strict curfew and lockdown to fight Covid-19 pandemic. The Indian Express explains what do these new addict registrations with OOAT centres mean for Punjab’s war on drugs.
What are OOAT centres and how many new addicts have registered for treatment with them during the pandemic?
The concept to set up OOAT centres in Punjab began in October 2017. The centres were set up to administer de-addiction medicine, a combination of buprenorphine and naloxone, to the addicts registering with them. Administered in the form of a pill, the opioid assisted treatment as the name suggests is primarily for addicts who are hooked to and dependent on various opioid drugs, including heroin, poppy husk and opium. The centres were set up seven months after Punjab CM Amarinder Singh formed a Special Task Force (STF) to tackle the drug problem and take on drug mafia in the state. There are currently 199 government-run OOAT centres where medicine is given free of cost.
There are 130 private de-addiction centres which can also administer buprenorphine-naloxone tablets, charging not more than Rs 7.5 per tablet, said a senior Punjab Health official associated with de-addiction programme.
From March 23, when Punjab government imposed a strict curfew and lockdown, to June 17, when the unlock relaxations are in place, 1,29,504 new addicts enrolled in the OOAT centres. Around 1.2 lakh of them registered during the period when curfew and lockdown was strictly in place. As of June 17, the total number of addicts registered with OOAT centres is 5,44,125, meaning thereby that 23 per cent of the total enrolled in less than three months alone during the pandemic.
What is the age profile of the addicts who enrolled during Covid pandemic?
Official data compiled by the Punjab government reveals that new registrations for treatment include addicts from almost all the age groups, from aged less than 20 years to more than 80. As per the data, there are 38,152 new addicts in the age group of 30 to 39 who registered in less than three months, maximum for an age bracket.
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Also, 956 were below the age of 20 and 366 above 80. Among the new registrations, 4,585 were between 70 to 79 years of age, 11,267 between 60 to 69 years of age and 20,296 in the age bracket of 50 and 59. There are 22,909 new registrations in the age bracket of 20 to 29.
What is the district wise pattern of new addicts registering for treatment?
Punjab has 22 revenue districts and new registrations are in varying proportions for these. For instance, Bathinda district topped in fresh number of addict registrations, almost equalling the number of patients registered in OOAT centres in around two and a half years. From October 26, 2017 when OOAT centres became functional to March 22 this year, Bathinda district had 13,955 addicts registered for treatment. From March 23 to June 17, around 13,517 more addicts opted for treatment in OOAT centres. Fazilka district, which has a total 11,251 registrations, had 4,003 addicts registering with OOAT centres from March 23 to June 17, more than half of the total numbers. Ditto for Mansa district which had 8,047 registered till March 22 and 5,132 new registrations from March 23 to June 17. A number of other districts reported comparatively lesser percentage increase in the corresponding periods. From October 26, 2017 to March 22 this year, 41,4621 had registered for treatment in OOAT centres across the state.
What does increase in new registrations mean?
As per functionaries of Punjab government and anti-drug STF, this is a welcome development where such a large number of addicts registered for treatment in a short span, widening the treatment canvass. With lockdown relaxations, however, there are apprehensions that among the fresh addicts registering for treatment. there may be relapses if supply chain of illegal drugs resumes.
What is the carry home dosage from OOAT centres and the controversy about it?
During curfew/lockdown, as the movement of people was restricted, the government increased the carry home dosage of buprenorphione-naloxone tablets from a week to fourteen days and subsequently to 21 days. Later, however, amid fears of “misuse and diversion” the state government reduced the carry home dosage to a week after lockdown restrictions were eased. On ground, the medicine is being administered for five to seven days to each registered for treatment. Punjab Health Minister Balbir Singh Sidhu says that the carry home dose has been reduced so that addicts could make more visits to the OOAT centres so that they could be counselled more frequently. STF chief Additional Director General of Police Harpreet Singh Sidhu is, however, for longer duration of carry home dosage saying that “those who come to take the free medicine from OOAT clinics usually cannot afford to pay for these medicines at private centres. More frequent visits for medicine would mean that they would end up wasting a day or half which could be used for gainful employment. Calling them repeatedly for the medicine also puts a burden on doctors and other staff who are working very hard and also are already overstretched”.
What about the efficacy of buprenorphine-naloxone tablets?
Viewpoints are divergent to an extent. Some say that that since it is opioid assisted therapy, it is another form of addiction and there should be adequate checks and balances. STF chief Sidhu, however, asserts there are minimal chances of any “misuse” of buprenorphine. “Its misuse is very minimal. For instance, only the first pill will work and even if someone consumes more pills, these would have no impact due to the ‘ceiling effect’ of the medication and will not cause any harm,” said Sidhu. Dr Abhishek Ghosh, assistant professor in PGI psychiatry department and de-addiction and treatment centre, also vouches for the efficacy. “Buprenorphine does not produce a high or euphoria equivalent to other abusive drugs like heroin or other opioid drugs. It is basically a medicine which can take care of craving, withdrawal symptoms and which can also block the effects of abusive drugs. For example, if a person is on adequate dose of buprenorphine and that person relapses for heroin and even if he/she takes heroin he/she will not get high because of the heroin,” said Dr Ghosh. Dr Ghosh said that since buprenorphine was being administered in combination with naloxone, risk of abuse was very low. “There is a ceiling effect after a certain dosage,” added Dr Ghosh.
How has the drugs issue played out politically in Punjab?
Facing drug taint in the run up to 2017 Assembly elections, Shiromani Akali Dal was hit hard. SAD has since targeted Chief Minister Captain Amarinder Singh for failing to fulfil the promise to eliminate drugs in four weeks as he had declared during his campaign. Amarinder Singh says he had vowed to break the backbone of drug supply chain and those involved in drug trade and he has done that. But, minus the Covid pandemic data where around 1.3 lakh registered for treatment in OOAT centres in less than three months, it appears the drug backbone remained far from broken in the state prior to that.