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Finding the Right Antidote to Substance Use

Finding the Right Antidote to Substance Use

Opinion

Here’s Why Compassion, Not Criminalisation, Works

Let’s play a game! I’ll say something and you reply with the first word that comes to your mind?

“Drugs.”

Your response could be either “Rhea Chakraborty” or “Bollywood.” If not, congratulations – you have successfully escaped the madness that has characterised mainstream media’s preoccupation with the late actor Sushant Singh Rajput’s suicide since June.

With primetime news channel debates and social media influencers screaming for “Justice for Sushant,” the case investigation went haphazardly from focusing on the film industry’s nepotism to targeting Sushant’s girlfriend, 28-year-old actress Rhea, especially in relation to a new-found drug angle.

Today, Rhea is in judicial custody after being arrested by the Narcotics Control Bureau (NCB); she has been charged under several sections of the Narcotics Drugs and Psychotropic Substances (NDPS) Act. This includes procurement, usage and transportation of cannabis (or marijuana), which Sushant apparently consumed on a regular basis.

Fun Facts Infographic, Sept 2020 (Tarini Mehta for StoriesAsia)

Her investigation is yet to be complete. However, a vicious media trial and brutal public vilification not only ensured she was the prime accused, but have also prematurely declared her “guilty,” “murderous,” and “evil.”

Rhea is not the only casualty in this whole fiasco. The case and public response to it has revealed as well as reinforced the stigma attached to and resultant discrimination against substance users in our society. By trending #ArrestRheaChakraborty on Twitter and sensationalising this angle of the case, a huge disservice has been done to the move to see drug addiction as a health issue that needs to be treated with compassion and empathy, as opposed to a criminal activity.

India’s Drug Laws Need Reform

The main law, the NDPS Act (1985), makes use and consumption of narcotic drugs or psychotropic substances a criminal offence. This is in addition to drug cultivation, production, peddling, and so on. No distinction is made between possession of drugs for personal consumption and possession for resale. Of course, when the amounts involved are small and less than commercial quantity, the punishments prescribed are far less severe than for commercial quantities. Under Section 64A of the law, “addicts” charged with offences involving small quantities can also become immune from prosecution if they voluntarily undergo medical treatment from a hospital/institution recognised by the government/local authority. It’s a whole other story that not all drug users are addicted or need medical treatment.

Simply by making drug consumption a criminal offence, this law contributes heavily to creating an image of drug users, including those suffering from substance use disorder, as criminals and “bad” people. This adversely impacts their ability to access the treatment, empathy and acceptance they require.

A 2019 report on substance use in India, published by the Ministry of Social Justice and Empowerment (MoSJE), recommends creating a conducive legal and policy environment to help control the drug problem. Disproportionate reliance on supply-reduction approaches, which aim to curtail the availability of drugs, needs to be reduced as it doesn’t appear to be very effective, the report recommends, adding that there needs to be greater focus on taking steps to minimise stigma and discrimination against drug users. It further suggests that health and welfare systems must be provided to those affected by substance use, instead of subjecting them to the criminal justice system. Criminalisation, it says, only enhances stigma and isolation.

Incarcerating drug users may not bode well for their required rehabilitation. It may actually make them more prone to relapses and subsequent drug use. A document on drug users in prison by the United Nations Office on Drugs and Crime notes that “the percentage of individuals reporting problematic substance misuse is comparatively higher in prison than in the community.”

The MoSJE report also suggests adoption of the harm-reduction approach on a large scale to deal with substance use. The harm-reduction philosophy sees minimising the risks and harms associated with drug use as its objective, as opposed to complete abstinence which is not always possible. The potential harms of drug use are reduced through various health and social services, which can include creating awareness on safer drug use, overdose prevention, employment initiatives, and provision of psychosocial support. This philosophy is built on the foundation of human rights and social justice.

Different Approaches to Addiction Recovery and Treatment. (Tarini Mehta for StoriesAsia)

Sahara Aalhad – Leading by Example

“We’ve been using harm reduction as a strategy for comprehensive intervention in substance use,” said Elizabeth Selhore, co-founder of Pune-based non-governmental organisation, Sahara Aalhad. “We employ a non-judgemental, non-moralistic approach, and believe in supporting rather than punishing.”

Sahara works to empower vulnerable and at-risk communities, especially those affected by HIV/AIDS and substance use, in order to reintegrate them into mainstream society.

Started in 1978 as a therapeutic community, it is known for its unique humane response to drug use and its early adoption of varied treatment techniques. “I come from a family of drug users, and back then people just didn’t know where to go. There was no drug awareness, no counselling – they would just either give that barbaric electric shock treatment or lock people up in a mental institution where, in fact, their mental health would get worse. My husband and I started a rehabilitation centre, and initially we employed an abstinence model because we hadn’t heard of anything else. Then, when we got trained in harm reduction, our minds opened up to the different options that should be available,” Selhore explained.

These different options that they went on to implement included group therapies and opioid substitution therapy in which an alternative ingestible medicine is prescribed to stabilise those dependent on opioids and reduce the risk of HIV infection. They also focused on counselling, street plays, sports and creating a normal routine that began with meditation in the morning. Interestingly, a monthly Coffee Night, during which everyone comes together for music, dancing and dinner, was institutionalised too.

Although they do not run a rehabilitation centre, they have a care home where drug users who need help are brought in and detoxed. Nobody is locked in and they have the option to walk out, but people stay of their own volition.

They are engaged in some kind of work as per their interests and skill set. Selhore elaborated, “We try to build up their strengths according to their interests because most drug users have very low self-esteem and this can cause quick relapses. We help those who haven’t completely abstained manage their drug use so they can take it one day at a time and at least go to work and come back.” Most prefer to work within the organisation itself because they do not have any family support or financial backing to survive in the outside world where they are stigmatised.

“Everyone helps and encourages each other since they can all identify with the struggle. We are a peer-led organisation so most of our staff too is from a drug-using background; they serve as an example to other drug users that it’s doable. Many who cleaned out at Sahara have gone on to start their own rehab centres and help others.”

‘I Became Human Again’

Raju Kakade works in the accounts and administration departments at Sahara. He also actively campaigns for the rights of drug users. When he entered Sahara 13 years ago at the age of 27, he did not have any vocational skills or government documents. Instead, he carried with him the baggage of more than 10 years of drug use.

“I started taking drugs at the age of 15. There were many reasons – my friend circle, loneliness, family tension, being away from home. I used to consume marijuana initially, then later got addicted to brown sugar (heroin). I was quite troubled, and one day I attempted suicide by overdosing. It didn’t work though, and I went into a coma for a few days. When I came out of it, I had lost my memory. I couldn’t even remember who I was. That was when my friends, somehow, managed to drop me at Sahara’s rehabilitation centre in Pimpri, Pune. Gradually, with treatment, my memory began to come back. It took me seven to eight years to get okay,” he narrated.

At Sahara, there is an understanding that those with substance use disorder cannot suddenly stop taking the drug and that making someone quit forcefully is not the best way. 

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“In the end, your life is in your hands and you’ve to decide for yourself,” Raju explained. “Here nobody forces you to do or not do something; they only guide you.” They focus on counselling, doctor-prescribed medication to tackle withdrawal, and educating people through targeted interventions about not sharing and reusing needles/syringes to prevent the spread of illnesses like HIV and Hepatitis B.

Raju, too, was treated in this way. The counselling began to have a noticeable positive impact on his behaviour, and he engaged himself in tasks such as housekeeping and painting at the centre. He also learnt how to drive, read and write, and operate a computer. Once he had completely quit drugs, he became a salaried employee at Sahara.

“The special thing about Sahara is that nobody is big or small here. Everybody is human and everybody gets an opportunity to reform. I became human again here. Earlier, I was even involved in gundagardi (hooliganism), which is why I didn’t have any government documents. It is here that I got my government IDs made. I also reconnected with my family recently on Facebook. They didn’t know where I was for 25 years, but now I meet them once or twice a month and stay in touch over the phone.”

The feeling of community and family that Raju found at Sahara is what made him start enjoying life again. “Once you’ve seen this life, you don’t feel like going back to that world of drugs where nobody cares for you. You’ll be lying on the road unconscious, and no one even asks; so many of my friends have died in accidents. There’s a really huge difference between that life and this one.”

Lessons to Learn

Raju’s inspiring story of recovery and the Sahara model, more generally, make it adequately clear that a holistic and comprehensive approach comprising different kinds of treatments that are all grounded in compassion and human dignity is what is needed to reduce the suffering caused by substance use in our society.

Substance use disorder is mostly a mental health problem and hence, quality mental healthcare, along with drug detoxification, needs to be accessible and available. We need more affordable or free-of-cost rehabilitation centres, especially in states where drug use is higher, and these must be monitored to ensure those being treated are not abusedunder the guise of “punishment.” Harm-reduction strategy, including creating awareness about safety, should be widely implemented and scaled up. And individual case management, to the extent possible, should be put into practice because experiences and trauma of drug users vary widely on the basis of their socioeconomic situation. Poor people are far more likely, for example, to suffer stigmatisation and be labelled “drug addicts” and “criminals” because they are dependent on others or crime to sustain their habit.

Although aided by NGOs and private centres, the government needs to be the main provider of these public healthcare services. Section 7 of the NDPS Act creates the provision for a National Fund for Control of Drug Abuse to meet the expenditure incurred for combating illicit traffic of drugs, controlling and preventing drug abuse, and rehabilitating those who suffer from substance-use disorder. As per the Act, an annual report of the activities financed needs to be published in the Official Gazette at the end of every financial year. 

2018 press release states that Rajnath Singh, the then Union Home Minister, referred to the constitution of this fund, but I was unable to locate any report detailing the Fund’s expenditures. In any case, resources need to be channelised to make these healthcare services available, rather than spending so much time, energy and money on subjecting consumers of small amounts of drugs to the criminal justice system. 

This, as Selhore said, is just a “bandaid solution,” and a silly one at that.

If we really want to solve this country’s drug problem, we are going to have to look beyond just supply and demand reduction, and humanely address the needs of those caught in between.


Disclaimer: 
The opinions expressed within this article are the personal opinions of the author. The facts and opinions appearing in the article do not reflect the views of StoriesAsia and StoriesAsia does not assume any responsibility or liability for the same.

StoriesAsia, a collective of independent journalists from 16 South Asian and Southeast Asian countries, seeks to replace the present-day parade of faceless numbers with humanising narrative nonfiction – a largely ignored journalistic genre in the region.

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