ON APRIL 14, when the new government completes four weeks, statements such as it has kept its promise of ending the drug menace in the state in four weeks are likely to be made. The Special Task Force (STF), consisting of three IG-rank officers, is said to have launched a crackdown on the big drug dealers in the state. Police have been arresting street peddlers. Also, the government is likely to declare that it has broken the drug supply chain.
Twenty-five years after they broke drug cartels in Colombia, the US is still struggling with the cocaine supply chain, but even overlooking that small detail and assuming that the government’s claim is true, the challenge is really on the health front.
Doctors and psychiatrists in the state say that if the government is really sincere about dealing with the drug problem in Punjab, it must come up with a master plan that includes major interventions on the health front even as law enforcers put a squeeze on supplies. Medical professionals know better than anyone that as long as there is demand, there will be supply and, as long as there is supply, there will be demand. Dealing with it is a continuous process, not one deadlined to four weeks or eight or even 54.
“The problem with our politicians is that they talk without really knowing the problem. They make issues emotive. Diseases are not emotive issues,” a senior psychiatrist at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, told The Indian Express. “There can be many other issues which are emotive, but diseases have to be tackled in a very dispassionate and scientific manner,” he added.
In 2012, the Punjab government had roped in PGIMER doctors to chalk out a plan to address the issue through medical intervention.
The drug issue over the years, doctors believe, has been politicised so much that it has now become a social evil. “We never talk of other diseases as social evils as in the case of drugs. If we regard it as medical illness, then the role of society is to provide effective, readily available, accessible and affordable treatment to those suffering from it,” said a PGIMER doctor, who was part of the previous government’s plan to tackle the menace.
Doctors said PGIMER had submitted plans, which were implemented, resulting in the creation of a lot of infrastructure. However, the concern for doctors is that the facilities have remained unutilised.
This concern was also highlighted by a recent CAG report. According to the Punjab health department, drug de-addiction and rehabilitation infrastructure has been established at a cost of Rs 134 crore. But, all put together, only 1,835 patients have been treated at these centres so far. In March 2017 alone, only 184 patients were admitted.
Statistics also show that the number of visitors at the outpatient department in government hospitals across Punjab in the past three years has gone down, signalling that people are not coming forward for treatment. The number was the highest in 2014 when 2,89,366 patients were registered in the OPD. In 2015 and 2016, the registration went down to 1,89,242 and 1,46,401, respectively. The situation was the same in the Inpatient Department. In 2014, 8,236 patients were admitted while the numbers in 2015 and 2016 were 7,972 and 7,708 patients, respectively.
The story behind these numbers is that when the government focused on the showy business of arrests and seizures, there was pressure on supplies, which sent the prices soaring. That pushed addicts to de-addiction centres. Once the crackdown eased, they found their supplies and life went back to how it was before the arrest.
“All the noise was on the supply issue and the authorities focused on law enforcement and supply reduction. Our study showed how the problem on the treatment side remained unaddressed,” said Dr Atul Ambekar of National Drug Dependence Treatment Centre, AIIMS, New Delhi.
His study has found that Punjab has a huge opioid drug usage. “The major issue which seems not to have received adequate attention is that these people are suffering from opioid addiction and they have not received appropriate and adequate treatment,” he said.
What needs to be done for treatment? Doctors said a “stepped care approach” is needed which provides different types of treatment for various types of needs. “The most evidence-based treatment available worldwide and in the country is known as opioid substitute therapy.
There are specific mechanisms to ensure that diversion of medicines does not take place. We can try it and we can control the problem to a large extent,” said Dr Atul.
In the current scenario, Atul said, drug de-addiction centres are opened, patients are admitted for a few days “and then discharged with the belief that the disease must be cured by now”.
Dr Arun Bansal, consultant psychiatrist at the civil hospital, Fazilka, said the biggest problem right now was that there was no mechanism to keep track of an addict. “We can’t keep track of them or what has happened to them. They don’t visit us regularly. When we ask them why they cannot check into a rehabilitation centre, they say they are the breadwinners of their family and they cannot afford to lose their income,” he said earners. Do you expect them to stay away from home for three months?” said Dr Atul. “They need the kind of treatment which makes it possible for them to work.”
One of the missing links in the current approach of the government is that there is no outreach to the addicts. “This is a highly stigmatic illness. It is not a disease like toothache. They are drug users and they will hide it. They are marginalised people. To reach out to them is the responsibility of the state and society,” said the PGI doctor.
Dr Atul said addiction to opioids should be seen as a chronic non-communicable disease. “Addicts should not be seen as criminals involved in an illegal act. They are victims who need treatment,” he said. “It becomes an emotive issue because people see it as a law enforcement problem. They see it as a sign of failure of the law enforcement machinery. We need to move this discourse. If you make effective treatment services available to people, you will find a lot of people visiting hospitals,” he reasoned.
Another worry is that there is a shortage of psychiatrists and other health specialists, which could become a major obstacle in the Punjab government’s battle against drugs. Against the sanctioned posts of 63 psychiatrists in the Punjab government medical service, there are only 34 at present.
“There is a shortage of psychiatrists in the state and it needs to be dealt with by the government. The government should look into this issue,” said a psychiatrist posted in Ludhiana district, adding, “In Punjab, there are only a few seats for this programme. The government is not able to get more people because the salary is not much.”
According to the Punjab health department, they are now training medical officers to provide de-addiction service under the guidance of psychiatrists in the state.
Doctors said another issue, which needed to be taken care of, was awareness. “The government needs to address the most important issues like unemployment, provide proper recreational facilities and promote sports to channelise the energy of the youth. The government should make the youth aware of the ill-effects of drugs,” said a doctor posted in Amritsar.
Punjab health director Dr H S Bali told The Indian Express that the department would now hold awareness camps across the state so that more addicts were motivated to join the rehabilitation centres. “The activities to end the drug problem have been intensified in the state after the new government took over,” he said, adding that the department is now monitoring both government and private drug de-addiction centres in the state for their smooth functioning.
Meanwhile, doctors are worried that the four-week deadline may worsen the problem further.
“There is a medical system to tackle the disease. Let us not be emotive about it. Politicising something and making it an emotive issue aggravates the problem instead of solving it. You have started picking people and it shouldn’t go wrong in a hurry,” cautioned the PGIMER psychiatrist. “It was an overreaction in 2014 and so is now. The supply was then stopped and addicts started approaching the hospitals. There was a sudden surge then. The surge triggered the creation of infrastructure. But, the problem on the medical front was not addressed. The results are for everyone to see and there are more addicts now,” he said.
Vini Mahajan, former Punjab health secretary, who was recently shifted, agrees that the drug problem is “serious”. “…All we know is that it is a serious problem, sufficiently serious, to warrant all actions that the government can take. Action needs to be taken in a prompt manner because many stakeholders are involved. It is an issue which deserves the time and attention of the decision makers,” she said.