If there is any entity of the Punjab government which can be praised for making sincere efforts to reform drug addicts, it would have to be the drug de-addiction and rehabilitation programme of the state government. Available in every district, the programme endeavours to help people overcome their addiction for drugs and prevent them from substance abuse in future. 

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As per its policy, the Punjab government follows a pyramid model at three levels to offer drug de-addiction and rehabilitation services. First, the community health centre (CHC) level, where medical officers are trained to treat substance abuse on out-patient department (OPD) basis. The second level is for serious patients, who need to be admitted and treated under supervision. For such addicts, the government has opened drug de-addiction centres, with 10-20 beds, a psychiatrist posted there for OPD and in-patient based (IPD) treatment. At the tertiary level, there are five ‘model centres’ holding a capacity of 50 beds. Apart from providing OPD and IPD facilities, these model centres are involved in research and training work as well. As of now, there are a total of 31 government-run de-addiction centres in the state, out of which 26 are functional. The rest are currently under construction.

When a patient is treated at a de-addiction centre, a period of two to four weeks is required in the detoxification process. However, the role of the state health department does not conclude there. The patient also needs to be rehabilitated in order to ensure that he does not pick up the habit again. The rehabilitation phase runs for a period of three to six months, which may increase up to a year depending on the severity of the patient’s condition. The government is in the process of setting up 18 rehabilitation centres, 50-bedded each, in every district. These centres would also provide vocational training to patients to help them make a living.

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According to official figures, in November 2014, there were 18,572 OPD patients and 502 IPD patients in all government run de-addiction centres of Punjab. But keeping track of a patient’s health after he is discharged from a centre is a task unfulfilled as it lacks a proper mechanism. “If a patient does not return to the centre, we are not sure whether it is because he really quit drugs or because he has again started the habit and does not wish to come back, or whether he has gone to some other centre for treatment,” says Dr Sandeep Bhola, who heads the government-run Kapurthala de-addiction centre. He explains the constraint behind keeping a tab on patients who are discharged after treatment. “The main hurdle in following up with patients is that confidentiality of their identities needs to be maintained.”

The state government is now planning to incentivise accredited social health activists (ASHAs) and rope them in the government’s programme, to overcome this obstacle. As per the plan, medical officers in each district would provide training to ASHAs, for bringing patients to CHCs or de-addiction centres after visiting their households. ASHAs would maintain an account of the patients’ physical and mental health and inform the government, without disclosing their identities. 

Inside the centre

The Swami Vivekananda de-addiction centre in Amritsar is one of the five model centres set up by the government. Functional for the past four years, the centre receives 20-25 fresh cases of drug addiction every month and around 400 follow-up cases. Dr Shyam Sunder Deepti, member of the centre’s council, says generally the recurrence rate (patients visiting a centre again for treatment) is exceedingly high, close to 85-90 percent. “However, if the treatment is given in the right manner, the rate can reduce to 50-60 percent. For this, counselling of patients and their family members is extremely essential,” he says.

Sub-inspector Harinder Singh has been posted at the Swami Vivekananda centre since its inception. He looks after the security of the premises. Harinder easily recognises every patient who has been visiting the centre over and over again for treatment. From his experience of having observed numerous patients, Harinder feels that staying away from drugs is a daunting task. “A de-addiction centre can only treat a patient, but the initiative to quit the habit has to be taken by the patient himself. I have seen many patients returning for treatment as many as eight-nine times,” he says.

Understanding an addict and his condition, especially by family members, again plays an important role in faster recovery. After studying the behavioural pattern of parent-addict relationship, Dr Deepti says that he often finds parents being so annoyed with their children’s craving for drugs that they tell us to use whatever possible means to remove the addiction, even if it means beating them up. “But we advise parents to support their children and motivate them to lead a better life once they are discharged,” he says.

At most of the de-addiction centres in the state, buprenorphine is used in substitute therapy to treat patients. Buprenorphine is a mild drug that is given to patients as a substitute for drugs like smack or heroin. With buprenorphine, the patient does not suffer from mood swings and hallucination as in the case of other drugs. Moreover, the after-effects of hard drugs stay in the addict’s body for around four to six hours whereas the effect of buprenorphine stays for 24-36 hours, making it less harmful. Another advantage of using buprenorphine is that a patient can carry out his day-to-day work without facing any problems.

Being under the ambit of the state government, the centre provides the treatment at subsidised rates. For '250 per day, patients are provided all facilities that include their medicines, food and bed. But these provisions have been exploited by miscreants in the past. A common way of taking advantage was to pose as a drug addict at a centre, buy the medicine being sold at subsidised rates and then sell them in the open market in black at much higher rates. After this criminal activity came to the knowledge of the doctors supervising the centres, the government recently issued guidelines for de-addiction centres to prevent misuse of facilities rendered. One of them was to conduct a urine test of those who wished to avail the treatment, in order to verify the presence of drug in their body. The centres were also directed not to sell medicines lasting for more than seven days to a patient, at a time.

Yet, there lies no absolute deterrent for illegal activities to operate inside drug de-addiction centres. In his career span of four years, Harinder has caught around 200 patients trying to sneak in drugs. “All sorts of tricks are used by patients here. The most popular one is to hide drugs in undergarments. Once I had caught a patient who was carrying heroin under his fingernails,” says Harinder. In the past, patients have also cut window mesh and broken window panes to bring drugs inside the centre.

It was this notorious environment at the Swami Vivekananda centre that forced 28-year-old Paramjit Singh to seek help at another drug de-addiction centre. Paramjit, who has been taking smack and heroin for the past nine years, has been in and out of de-addiction centres a couple of times. “In Amritsar, I was unable to reform, as drugs used to enter the centre premises somehow or the other. In such a scenario, it was difficult to stay away from them,” he says. Paramjit is now admitted to the government-run drug de-addiction centre in Kapurthala. 

At the Kapurthala centre, which has 25 beds and gets around 70 new patients every month, is admitted another patient named Ravinder Singh. Abusing heroin for the last eight months, Ravinder used both foil paper and syringes for drug intake. In the former technique, heroin powder is put on a foil paper which is heated from beneath by a lighter. The fumes released are then inhaled by the user. “I told my parents about my habit a month ago and they got me admitted here. I am about to get married in two months. I cannot afford to continue my life like this after marriage,” says Ravinder, who works as a salesman at a garment shop. 

Though Punjab also has many private de-addiction centres, addicts usually share a bad experience about them due to their high fee. Dr Deepti has come across many addicts going to private centres that charge as high as '5,000-10,000 per day for the treatment, depending on the financial background of the addict. “Many are under the illusion that private centres provide better services, but after a while they all go to government centres for treatment,” says Dr Deepti.

Balwinder Singh, of a village in Tarn Taran who died over a year ago from heroin injection, had been taken to private de-addiction centres by his family members. Balwinder’s elder brother Avneet Singh took him to private centres a couple of times but ended up spending a lot of money without receiving any benefits. “The private-run centres used to charge '3,000-4,000 per week but my brother showed no signs of improvement upon returning home,” says Avneet.

Though de-addiction centres are far from being comforting places, there are some who have got attached to the place. Having interacted with hundreds of patients at the Swami Vivekananda centre, and predicted the health status of those visiting repeatedly, Harinder feels a connect with the patients and the centre. “I love my job and wish to work here till destiny decides so. Once, I was transferred to the police line while I was serving here. I requested my seniors to send me back here, as I cannot imagine working anywhere else now. Thankfully my request was accepted,” says Harinder.

yogesh@governancenow.com

Note: The names of the addicts and their relatives have been changed.

(The article appears in the April 16-30, 2015, issue)