Two weeks back, this column carried a piece entitled “Hooch Victims: Not Just Numbers!” about death of over 40 people after drinking illicit liquor. A bigger hooch tragedy last week killed over 150 tea garden workers and over 300 hospitalized for critical care in Assam’s Golaghat. A friend asked why such frequent occurrence of hooch tragedies and deaths of poor and marginalized people and why no action is being taken to prevent such tragedies. Familiar with the problem of addiction in the country, he wondered why the government was more concerned about drug addiction and not on alcohol addiction. It took some time to explain to him how the two problems were being handled by two separate ministries of the government of India-Ministry of Social Justice and Empowerment for drugs and the Ministry of Health and Family Welfare for alcohol.
Last week on 19th February, the Prime Minister through a video address launched a campaign for Drug Free India at an event at Guru Jhambeshwar University in Hisar in Haryana. This shows the concern of the central government about the major national problem of drug addiction. It is worth reproducing what the PM said about addiction. Quoting WHO estimates, he pointed out that over three crore people around the world are suffering from drug addiction.”In addition to the terrible problems and destruction of families due to substance abuse, narcotics trade is one of the biggest sources of income for terrorists and anti national elements and the money sourced by these elements through drug trade is used to destabilize the nation.”
Urging the young generation to support and help those reeling from drug addiction, he said that, ”only through conversation , counselling and continued love and support we can bring those under addiction to the path of rehabilitation”. He also highlighted the National Action Plan for Drug Demand Reduction initiated in 2018 which focuses on “awareness generation, capacity building, rehabilitation and specific intervention in vulnerable areas to ensure drug demand reduction by 2023”.
Incidentally, in December 2017 the Ministry of Social Justice and Empowerment had informed a Supreme Court Bench headed by Chief Justice Dipak Misra that the government would formulate an action plan for combating drug abuse. The apex court had also asked the Ministry in December 2016 while deciding a P I L by Nobel laureate Kailash Sathyarthi’s NGO to formulate within six months the national action plan to curb rising substance abuse cases among schoolchildren and had also ordered a national survey to gauge the extent of the menace. It may be added that the P I L had pointed out that the national capital alone has approximately one lakh street children and substance abuse is reported as a major health problem among these children.
In its affidavit the Ministry had said that it had assigned the National Drug Dependence Treatment Centre under All India Institute of Medical Sciences to conduct a national survey on the extent and pattern of substance use.
A combination of two data collection approaches was employed; firstly a Household Sample Survey [HSS] was conducted among a representative sample of the 10-75 years old population of all the states and UTs of the country. During HHS 200,111 households were visited in 186 districts of the country and a total of 473,569 individuals were interviewed. Secondly a Respondent Driven Sampling [RDS] survey was conducted covering 135 districts and 72,642 people suffering from dependence on illicit drugs. The report is intended to provide a framework to planners and policy makers, researchers and academicians and would help further in finalizing the National Action Plan for drug demand reduction formulated by the Ministry of Social Justice and Empowerment for the period 2018- 25.
It is understood that though the draft National Action Plan for drug demand reduction has been finalized, it seems the draft demand reduction policy has been withdrawn. The country has to wait for a multi-pronged strategy –involving prevention education, de-addiction and rehabilitation of affected individuals and their families and at work place.
However, with the policy for drug demand reduction yet to be finalized, the Ministry of Social Justice and Empowerment, has now brought out a document on the “Magnitude of Substance Use in India” by the National Drug Dependence Treatment Center, All India Institute of Medical Sciences. In the absence of a comprehensive policy, this document seems to be an apology. Cannabis in the form of bhang consumed during festivals like Holi is legal but derivatives like ganja or hashish are banned substances. According to the report the prevalence of cannabis use [ charas/ganja] is the highest in Sikkim at 7.3 % followed by Nagaland 4.7% while the all India average is 2.8%. The prevalence of Opioid [derivatives from opium] groups of substances which include opium, heroin [also street drugs like brown sugar/smack] and pharmaceutical opioids is 2.06%. Uttar Pradesh, Punjab and Haryana lead in the number of opioid users. There are also a variety of pharmaceutical sedatives. The survey reveals that 1.08 % people are sedative users. In terms of sheer numbers it works out to 1.18 crore people!
The survey by the National Drug Dependence Treatment Center gives details about alcohol use and addiction. Prevalence of alcohol use in the country is 14.6 %. This means alcohol is a much larger issue than drugs, though alcohol itself is legal and a regulated substance. The emphasis of the document seems to be on treatment rather than on prevention. The absence of a comprehensive alcohol policy is a gaping gap. No wonder our commitment to WHO to reduce alcohol use by 10% seems under achieved. In this context it is worth quoting one of the editorials of ‘Niramaya’, the NCD newsletter of the Ministry of Health and Family Welfare which deals with alcohol addiction, a major NCD or Non communicable Diseases. ”In 2011, the UN High-level Meeting on NCDs identified alcohol as one of the four major risk factors for NCDs. The 66th World Health Assembly [WHA] followed up on the Political Declaration adopted at the highest level meeting by endorsing the WHO Global Action Plan for the prevention and control of NCDs 2013-2020. This action plan reinforces the implementation of the Global strategy to reduce the harmful use of alcohol. The Global monitoring framework includes 25 indicators and a set of nine voluntary global targets. One of these targets is at least 10% relative reduction in the harmful use of alcohol by 2025. India has become the first country to adopt a national framework for prevention and control of NCDs, setting a target of 10% reduction of alcohol use by 2025”. With reports that liquor sales rose by 10% in 2018, it is to be seen how we will ensure 10% relative reduction in the harmful use of alcohol!
Alcohol use and dependence of alcohol are major problems that affect almost all sections of society. The poorer and marginalized sections of the society are more severely affected as poverty and alcohol mix well and the entire family is affected if the man of the house becomes an alcohol dependent. Poverty, deprivation, domestic violence, spurt in NCDs and neglect of children are some of the major effects on an alcohol dependent’s family. Easy availability and social acceptance of alcohol as a legal celebratory drink and the exorbitant price of foreign and Indian Made Foreign Liquor [IMFL] force the poor to go for much cheaper illicit liquor or hooch which are dangerous. The recent death of over 150 tea garden workers drinking spurious liquor illustrates the magnitude of illicit liquor.
Addiction to substances is a psycho -social, physical and spiritual problem. According to Suneel Vatsyayan, a long time friend and associate, a leading prevention expert and Chairman Nada India with very vast experience in alcohol and drug prevention has given many practical suggestions linking it to Sustainable Development Goals [SDGs] of the United Nations. “In July 2016 the Prime Minister had constituted a Group of Ministers [GoM] to examine National Drug Demand Reduction Policy prepared by the Ministry of Social Justice and Empowerment. This shows the government’s commitment to deal effectively with drug demand reduction in India. He had also mentioned about the problem of drug addiction in the first edition of “Man ki Baat”.
The policy examined by the GoM will also help create the required enabling environments to achieve the goal - ”Ensure healthy lives and promote well being for all at all ages.” under Sustainable Development Goals. India has committed to implement the 2030 agenda and achieve its 17 goals, says Vatsyayan. He further calls for integrating drug demand reduction in medical training and lauds the GoM’s proposal for the accreditation of de addiction centers, both private and government run ‘to ensure standardization in rehabilitation by building a skilled cadre of peer educators, rehabilitation social workers psychologists and strengthen the frontline health workforce in the country. This will help in mainstreaming thousands of peer led drug rehabilitation centers across the country. These drug free peer educators can contribute in reducing drug demand substantially as they connect directly at individual and community levels and no measure of technical knowledge can replace the insight of the lived experience. There is need for strengthening patients and create a people centered health care system in and around drug rehabilitation centers. This is vital for a drug free and healthy India”.