By Dwip Rachchh
There seems to be a tacit agreement that the drug problem in Punjab has turned into a full-blown crisis. The 2015 Punjab Opioid Dependency (POD) Survey, conducted by AIIMS, roughly put the number of Opioid dependants at 232,856. It estimated the total number of opioid users to be around 860,000. Most of these users were male and in the age group of 18-35.
The primary response to this has been increased policing and emphasising on inpatient de-addiction centres. The National Crimes Records Bureau indicates increased year on year drug related arrests. The Health and Family Welfare minister has inaugurated new hospitals/de-addiction centres. However, those arrested are mostly drug users. This does nothing to curb the supply or disincentivise drug trade. The scant hospitals/de-addiction centres cannot keep up with the burgeoning demand. According to the same survey, only 8% of the dependant individuals had access to de-addiction centres.
Switzerland grappled with the same problem in the 70’s. Their success in solving this crisis has garnered appreciation among drug policy practitioners globally. While Punjab and Switzerland cannot be held in the same stead socio-economically, the Swiss response and methodology can certainly shed light on what Punjab is doing wrong.
Drawing parallels: Punjab and Switzerland
With the rise of the counter-culture movement in Europe, Switzerland experienced a drastic increase in drug use. The earliest onset of heroin can be traced back to the 70’s, assisted partially by the transit points at the US military bases in neighbouring Italy. The next two decades witnessed a consistent increase the in user base. At its peak, thousands would descend onto the Platzspitz Park, a small spit of land between two rivers, to consume narcotics. A survey conducted in this park in 1990 showed a user base ranging from young people to older working and professional adults. This lead to unwanted externalities like increased rate of HIV and low-level crimes. As of 1988-89, half of all new cases of HIV transmission were linked to the injection of drugs.
Several parallels can be drawn with the Swiss situation of the 80’s and 90’s. Punjab, too, is grappling with an opioid crisis partly fuelled by heroin from external sources. This epidemic also has mostly afflicted men ranging from 18-year-olds to middle-aged working professionals. HIV transmission is very common among drug users. Drug-related crimes are on the rise. The situation has steadily declined despite sustained efforts to prevent a situation like this.
Commonality in the initial approach
What makes this comparison interesting is the commonality in the initial efforts and its results therein. The Swiss believed that the solution lay in increased policing and harsher sentencing for drug users. The federal drug law of 1975 defined rigorous criminal sanctions on drug use and sale. This resulted in a significant increase in the arrests of drug users and sellers by the police. The law further promoted an abstinence-only approach. Public health measures like distribution of clean syringes and prescription of methadone to curb heroin users were made more onerous. It was believed that such methods would legitimise drug use and encourage more people to try drugs. Many health and social professionals emphasised that traditional methods of drug dependency treatment were obsolete. This approach did little to stem the growth of drug use in the country.
Those familiar with Punjab’s story can draw parallels between the two cases. The National Policy on Narcotics Drugs and Psychotropic Substances presumes that “If any NGO or person is allowed to promote harm reduction, then there is a greater risk of it being used as a cover to actually push drugs or promote them”. Such myopic and outdated policy stances cost Switzerland dearly in the 80’s, and continue to plague Punjab till date. According to the same POD survey, 80% of the surveyed users tried to quit but received little help. In-patient care, which is the mainstay of the current policy was made available to only 8% of the users (many of whom relapsed). Lack of sterile syringes has led to an increase in transmitted diseases, particularly HIV. All evidence points towards the failure of the current system in rehabilitating drug users and ensuring their health and wellbeing.
Dealing with drugs: The Swiss way
The new Swiss model of drug prevention was based on four pillars. These were: Prevention of drug use, Therapy for drug dependence, Harm reduction, and Law enforcement. While prevention and policing are common to most systems, therapy for dependence and harm reduction is what makes this policy stand out.
One of the first steps while helping drug users is to decriminalise small quantities of drugs. This helps distinguish drug dealers from users. This also ensures that those in need of help are diverted to medical centres instead of prisons. Drug users are more likely to come forward to receive help if it is guaranteed that they will not be prosecuted. Further, countering drug dependence is a multi-step process that cannot be straitjacketed into inpatient care.
Another signature initiative of the Swiss policy was to introduce Heroin Assisted Treatment (HAT) for addicts. This process would ensure that the addicts were given access to clean heroin and under medical supervision. It ensured that over time, these doses could be stabilised and gradually reduced to wean people off heroin. After studying the effects of rigorous implementation, researchers were able to establish that HAT does not initiate heroin use among non-users. There is a serious improvement in the health and well-being of the addicts and it is effective in helping people wean off heroin in the long term. These findings were later endorsed by a WHO report in 1999. The Swiss model was quick in recognising that the emphasis on inpatient care was not enough to treat the prevailing drug dependence in the country. Punjab is hard pressed to provide inpatient care to all of its drug dependants. It must consider outpatient care for them which would involve similar programs along with counselling and necessary training. This would ensure better utilisation of the meagre resources at hand.
Another irreplaceable aspect of an effective drug policy is harm reduction. Motivated Swiss medical and social practitioners were able to convince the government and the general citizenry about the benefits of harm reduction. Harm reduction techniques like providing clean syringes and raising awareness about safe drug use helped Switzerland transition from having one of the highest cases of HIV transmission in Europe to one of the lowest. Eradicating or controlling drug dependence is a long process. To ensure the health and well-being of users while they consume drugs is the duty of the state. As mentioned earlier, India’s national policy believes that setting up of injection rooms for safe consumption or provide clean syringes is akin to encouraging drug use. Not only is this theory outdated, but there also exists empirical evidence that refutes this claim. Currently, all major European countries consider harm reduction to be a human right, and have made provisions of injection rooms and needle exchange programs.
Recognising the results, and the problem
The success of the Swiss policy can be gauged by the following numbers. The number of new heroin users dropped from 850 in 1990 to 150 in 2002. Between 1991 and 2004, drug-related deaths decreased by more than 50%. The country witnessed a 90% reduction in crimes committed by drug users. Moreover, the country with the highest rates of HIV transmission in Western Europe is now among the lowest. The way to achieve this favourable outcome is by recognising that the current policies are flawed and making an effort to change them. Central to this is acknowledging that drug dependence is a health issue and not criminal deviance. It is also important to recognise that a drug user is a person who is entitled to all human rights; primarily health, well-being, and dignity.
Dwip Rachchh is an Associate Fellow at Observer Research Foundation Mumbai where he works on issues of law and policy.