A visit to drug de-addiction centres of Punjab reveals the scourge of sweeping substance addiction that does not discriminate between class, caste or creed, and has become an immense leveller.
The 50-bedded Vivekanand de-addiction centre of Guru Nanak Dev Hospital, Amritsar, established in 2011 as the model centre in the state, speaks volumes about the drug epidemic and the mounting pressure on the health infrastructure. In 2013 alone, more than 23,000 drug addicts got treated here.
Dr PD Garg, head of the centre, says the centre daily examines on an average 35 new patients and in the past three years, around 30 female substance abusers had visited. "Yes, we are short of staff, but not low on morale," says Dr Garg, adding that the de-addiction process of a patient may take six months to more than a year. The centre admits a patient for a maximum of 10 days; the patient has to pay Rs 250 per day for detoxification but "there are many who can't even afford Rs 2,500 for the treatment expenditure," says Ashraf, 43, a rickshaw-puller. He had visited the centre for prescription of buperinorphine tablets. Buperinorphine is used in substitution therapy in more than 70 countries, and not more than 20 tablets can be prescribed at a time, as per Dr Garg, who adds that a few addicts even take the medicine and sell it outside at enhanced rates.
The medicine should be combined with psycho-social therapy (counselling), advises Dr Garg, agreeing that there should be the facility of a rehabilitation centre with occupational therapies for such patients, which state government hospitals lack till date.
The 25-bedded de-addiction centre at Jalandhar's ESI (Employees' State Insurance) hospital also remains packed with patients. It has treated around 380 illegal drug users since April this year. The maximum patients came in May and June after the anti-drug drive started by the state police. The drive was launched after the ruling Shiromani Akali Dal (SAD) performed below par in the Lok Sabha elections, with the drug menace becoming a key poll issue in Punjab.
Accepting that numerous private de-addiction centres have mushroomed with the aim of cashing in on helpless people eager to buy hope at any cost, Manpreet Kaur, a psychologist at the Jalandhar centre, says, "There have been many relapse cases which come to us later. Many private centres even charge a minimum of Rs 15,000 and the patients are involved in mopping and cooking. They don't have qualified staff and many ex-addicts are running such centres."
Also, government de-addiction centres lack separate wards for females. Hence, the fairer sex does not come here due to the social stigma, adds Kaur.
State govt treatment
Dr D Basu, an expert member of the Punjab State Board for De-addiction and Rehabilitation, and a professor in the psychiatry department at PGIMER (Post-graduate Institute of Medical Education and Research), Chandigarh, says, "It has taken one full generation for us to reach up to this level, so it would take at least 5-6 years to control it as the state government has shown its willingness to stem the problem."
He clears that work on rehabilitation centres initially at model hospitals such as those in Amritsar, Patiala and Faridkot is progressing on a war footing and the authorities are also considering pre-fabricated structures for it. There are plans to involve Accredited Social Health Activists (ASHA) on an incentive-based system at the grassroots level to educate people.
As of now, all eight central jails have de-addiction centres, apart from 22 district hospitals in the state with a minimum of 10-bed capacity.
The PGIMER has plans to train doctors of around 130 community health centres across the state to deal with the problem at the grassroots level.
Prohibition of no use
Complete prohibition of drugs/alcohol would not help, rather it would increase organised crime, opines Dr Basu, adding that supply should be restricted and demand be controlled. "Public stigma makes it worse for the addicts. Do not criminalise or stigmatise them, it's a disease and we should bring them to the mainstream," he adds.
Common used synthetic drugs by youngsters and poor strata of society:
Calmpose, proxyvon, phensidryl, lomotil, momotil, codeine, diphenoxylate, dextropropoxyphene, pentazocine, nitrazepam
Other narcotics used in Punjab:
Heroin, smack, opium, poppy husk, charas, narcotic powder
Trembling, insomnia, body ache, loss of appetite, weight loss, sneezing
HIV, hepatitis, lung cancer, mental imbalance, impotency, liver cirrhosis, infertility
Scarcity of infrastructure, staff; Lack of patient's will, relapse due to easy availability of drugs or money minting private de-addiction centres
Tomorrow: Punjabi NRIs part of well-knit narcotics circuit
(The article is the result of ground reportage from Punjab by HT senior staffer Sanjeev Verma for his project under the Inclusive Media-UNDP Fellowship-2014)