The crackdown on drug peddlers in Punjab has raised another gargantuan problem in the region and that is rehabilitation of the drug abusers. The state government opened 10 new Drug De-addiction Centers (DDC) in the district linking them to the community health centers to fight this problem, but rehabilitation centers are still not in place.
Dr Aman Sood, Psychiatrist at the Civil Hospital Jalandhar said, "The state government came up with the idea of opening at least one rehabilitation center per district in the state. Work is being carried out in this field and it will take few months to start the facilities as it requires special staffs and recruitments are still going on."
Only 20% success rate in rehabilitation of addicts
Currently the government medical facilities are screening drug addicts and admitting them for detoxification program. Under this program an addict is identified and the nature of substance being abused by that person is confirmed. Readymade kits are available for carrying out tests to confirm the nature of abuse.
During the detoxification program the patients are admitted in the hospital and administered medicine to cure them of the withdrawal symptoms. The patients are admitted for a period of around 20 to 30 days depending on the degree and nature of abuse. Ideally after the detoxification program, a patient should be kept for six months to one year at a rehabilitation center but due to lack of such facilities, patients are discharged.
"As there is little or no rehabilitation centers in place there is an 80% chance of relapse. Only 20% cases of drug de-addiction are successful and lot of work is still to be carried out in this field to curb the drug menace in the society," said Dr Sood.
Changing nature of drugs and substance among abusers
A study done by the Post Graduate Institute and Medical Education and Research, Chandigarh over three decade tracing the changing nature of drugs and substance abusers among addicts points out that opium and its extracts commonly abused by the addicts in the region has been replaced by prescription opiods.
According to the study the proportion of subjects using natural opioids decreased over the three decades, with a concomitant emergence and increase of newer prescription opioids, such as buprenorphine, codeine and dextropropoxyphene. Polysubstance dependence increased significantly over the decades and quite recently even cocaine addiction has been reported at many DDCs.
The problem of genuine and fake addicts
A staff working with the psychiatry OPD in the civil hospital and assisting patients at the Opiod Substitution Center here on condition of anonymity said that there are many patients who get admitted for detoxification program more than once.
Dr Sood and other doctors at the psychiatry department confirmed this trend and said that drug-addicts get hooked to drugs administered to them for curing their withdrawal symptoms. A look at the log book of the OPD at the civil hospital also confirms the trend. There are patients who frequent the centers to get free medication as a substitute to the substance they are abusing.
We carry out a thorough screening before admitting a patient for the detoxification program, but the center is over burdened with only one psychiatrist and an assistant to take care of all the patients. Due to high in-flux of patients there have been incident when a person has faked as an addict just to supply drugs within the center. At times I also have to work as a security guard to keep such anti-social elements at bay, said Dr Sood.
There are 34 psychiatrists in the state health services of Punjab and out of these only 20 psychiatrists are Master Trainer in Drug Abuse Prevention from National Drug Dependence Treatment Center, AIIMS New Delhi. On the other hand drug addiction in the state has reached epidemic proportions and extra support is needed to curb the problem and in that case with work only being done on files will be of no help for the drug-abusers.
The sordid tale of the addict
Mahesh (name changed) an opium (Dodda) abuser, who visited the psychiatry OPD on Monday said, "I have been admitted twice for the detoxification program here at the civil hospital. Once I am discharged from the hospital I get hooked to the drugs. It is difficult to stay clean (sufi) when abuse is rampant among your peers."
He is not the only case, there are many abusers who return to the hospitals just to get the drugs which helped them curb the withdrawal symptoms. Despite regular requests made by the hospitals authorities to bring a care-taker like parent, wife or a local guardian along with them, most drug-addicts visits such facilities alone just to procure the medicines.
Pharmacists at the civil hospital and in the city have also received patients who willfully ask the doctor to prescribe buprenorphine and later try to tamper with the dosage mentioned in the prescription. Dr Sood also confirmed the trend.
Thinning crowd at the Drug De-Addiction Centers
A look at the log books kept at various government drug de-addiction centers and the OPD register of the civil hospital suggests that there was a surge in number of patients coming for de-addiction treatment in the month of March and April, 2014. Around 150 patients visited the psychiatry OPD on a daily basis to seek medical help for drug de-addiction during this time.
However, around 20 patients seek treatment currently and among them many are fakes and few are relapse cases. The decreasing trends also suggest that due to recurrent relapses many patients are not willing to seek medical treatment. On the other hand relapse in addicts has raised the demand of drugs and supply lines are recapitulating.
Most of the addicts who visited the civil hospital Jalandhar over a period of one week said that drugs are easily available, just one should have the right purchasing power.
Taking a note of the degree as to which drug addiction percolated into the state's social milieu, it is need of the hour to adequately equip the DDCs to deal with different type of drug abuse, rather than just operating as centers where addicts are kept till their urge for drugs depletes, because once such addicts are discharged from a de-addiction center there is a high chance of relapse among them.