When I began my post-graduate degree in psychiatry two years ago I had imagined I would be sitting with a stethoscope around my neck behind a desk with the patient on the other side explaining psychiatric complaints to me calmly while I listened to them gently and wrote down prescriptions. Instead, as soon as I began my first year post-doc, in my routine duties dealing with drug addiction patients — interviewing, examining and counselling them — I found myself interacting with patients who were aggressive, impulsive, abusive and sometimes looked as if they would crush every bone in my body when they thought that I was not giving them the attention they demanded.
De-addiction involves substituting opioid and non-opioid medicines to the addict. Patients complain, demand higher doses, some of them aggressively so. This is all part of the withdrawal symptoms, an inevitable part of the de-addiction process, and it can lead to violent behaviour. I was still a newbie when three patients attacked me and my colleagues while we were on our routine ward round. The police personnel on duty intervened and saved us. But in doing so, one of the policemen sustained an injury and needed stitches on his hand. The three patients who attacked us ran away from the de-addiction centre. An FIR was launched and later I was summoned by the court to give evidence — an altogether new experience for me that filled me with fear and thrill, all at once.
The patients and their respective histories have never failed to astonish me — how could a 12-year-old boy get hooked to alcohol and weed, and then, in a relatively short span of time, shift to other severe types of addiction such as heroin? I became aware of terms such as smack, bhukki, afeem, chitta, neela (capsules), panni (snorting), foil (drug user’s paraphernalia), teeke (injections) and several other vernacular terms used to denote different types of drugs and their method of administration.
The life stories of addicts revolve around their friends, broken love affairs, sexual encounters with a neighbour or a prostitute or a married woman to whom the patients attributed the reason for their addiction problems either partially or completely.
There have been disheartening moments as well, especially when someone young died due to an overdose. Once we received a 19-year old patient in an unconscious condition at 5.00 am. He had a history of taking an injectible drug. He had taken the drug a few hours before the incident, and before my colleagues and I could do any resuscitation, the patient expired.
The patients are mostly always in denial about accepting they have a problem. Another big issue is how to deal with the family members of the addicts and clarifying the misconceptions they have about addiction. First off, they have to be told addiction is a disease and not a voluntary habit. Second, they believe alcohol and smoking are not addictions, and it is only heroin that is problematic. This, too, is untrue. It is because of these myths that we find family members, especially mothers and wives, try to sneak in tobacco pouches for the patient. Family members say: “Doctor saab, ehda heroin da ilaaj kar do; sharab di sanu koi tension nai”. Busting these myths is a daunting task by itself.
Considering the extent to which drug addiction has spread in the state, law enforcement and policymakers should go all out to deal with the problem. Perhaps they should rope in local communities, through panchayats and NGOs, apart from support from the local police.
As doctors, we have also noticed an alarming spike in Hepatitis C, Hepatitis B and AIDS among addicts. Needle sharing among drug addicts is the chief culprit.
On the brighter side, I have seen patients getting treated, finding new jobs and mending their broken families. This is what keeps doctors like me going.
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