Distressed Sisters - The Continued Rise of Drug  Addiction in North-East India

By Dr Debanjan Banerjee, Geriatric Psychiatrist & Dr Mayank Rai, Psychiatrist

Edited by Didhiti Ghosh, Bureau Chief (Kolkata), IOP

- Doctor, please help save my life! I don’t want to die!

- Well, I am here for you! Tell me how I can help!

- One of my friends – Doctor - just died from a heroin overdose. I don’t want to end up like him. Please, help me, I am addicted too!

- Let us help you in any possible way we can! Please relax! You are not going to die!

Bangalore / Kolkata, June 28, 2019: Mental health professionals in several parts of India might have handled these kinds of cases and conversations once in a while, but this is a type of happening that occurs with irrefutable and alarming regularity in the geographically ‘beautiful’ North-East India. The patient being referred above was a 17-year-old adolescent and the friend of his who died of an overdose was another 19-year-old boy. He had later told the treating team that the deaths of young adolescents due to drug overdose was not ‘unheard of’ in his fraternity. In fact, adolescents of barely 16-18 years of age will be presenting to the clinics with already 5-6 years of drug use, frequently in a heavy pattern.

Early use of drugs not only causes more damage to the brain but also increases the vulnerability to various mental disorders, leading to a wide array of social and familial problems. The commonest drugs of use in this area are tobacco, heroin (injectables), cannabis, alcohol, the street drugs (LSD, amphetamine, etc), sedatives and glue-sniffing (solvents).

The youth determines a country’s workforce being economically productive age-group. It has been repeatedly insisted by the International Labour Organization (ILO) that youth well-being and employment serve as standard matrices for a country’s annual income.  With that in the background, in any other part of the world, increasing loss of young adolescents to a cause like substance use, who are otherwise medically healthy, would raise quite an uproar but for some concerning reason that has not quite been the case in the NE.

Numerous discussion and policies have been drafted, which are unfortunately restricted to papers and to add to the sad state, the people there have either made peace with their helplessness or have accepted that they are living in plain denial.

The NE part of the country (comprising of the seven sister-states viz. Assam, Tripura, Manipur, Mizoram, Meghalaya, Sikkim and Arunachal Pradesh) is known for its spectacular natural habitats and breath-taking landscapes. In recent times these sister-states (especially Manipur, Mizoram and Arunachal Pradesh) have been marred by news of recurring ethnic clashes, insurmountable episodes of various insurgencies, poverty and lastly this ever-growing colossus of drug abuse. Drug abuse and addiction, in fact, form a major part o recreation and economy in this part of the land.

The NE states of Tripura and Arunachal Pradesh are amongst the heaviest users of alcohol in the country according to percentages. Also, going by recent use (as per the National Mental Health Survey, 2015-16 conducted by the National Institute of Mental Health and Neurosciences, Bangalore) the top five heaviest users of heroin are the states from NE India. The 5 states of NE yet again comprise the leading ones in terms of current sedative/hypnotic use.

The states of Manipur and Arunachal Pradesh are the leading states in use of amphetamine-type substances (street drugs like LSD) in the country. In numbers, the people who inject drugs in the NE states alone are 149,866 out of total 854,296 known users, which is almost 17.54%. Contrary to this, the total population of NE India is about 46 million people according to the 2011 census which is only about 3.7% of the total population of the country.

The present data is from a recent national survey done by the National Drug Dependence and Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi in 2019. Comparing this data to the earlier surveys by NDDTC (2009), the Narcotics Control Bureau (2011) and the NMHS (2015) it was found that the overall drug-use has increased by 30% over last 10 years, with 60% of this increase alone being in the 13-20 years age group. Also, the women: men ratio of drug use is significantly higher in Tripura, Mizoram and Meghalaya.

The prevalence of HIV/AIDS in India is unsurprisingly highest in NE states, with Manipur, Mizoram and Nagaland leading the counts. The injection drug abuse has a direct correlation with the incidence of HIV and Hepatitis-C (both being illnesses transmitted by sharing contaminated needles), especially among women and adolescents. The screening and early detection for these illnesses are poor leading to high morbidity and deaths. De-addiction facilities being poorly accessible in these areas add to the burden, worsening the overall quality of life.

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The question obviously arises as to why the NE is so vulnerable to this burgeoning calamity. There are quite a few putative explanations for this. This part of the country is located in the vicinity of the infamous ‘Golden Triangle’ made by the bordering countries of Burma, Laos and Thailand gaining notoriety for its unregulated and highly concentrated opium production. The porous borders of India adjoining Burma historically allow for an easy illicit route of drug trafficking, with the surrounding states being the most affected. The roots of ethnic insurgency and drug trafficking are to some extent intertwined below the surface as the proceeds from the contraband sales allegedly go into procurements of armaments by the insurgents. Another often cited reason is the lack of proper awareness and growing unemployment for the people, especially the youth in this region. These states which score high on natural beauty ironically perform miserably in the technological and industrial growth which leaves even those with higher education with little or no viable remunerative options. The same coupled with local political unrest and the resulting accrued frustrations over the course of successive generations have left the people out in cold to fend for themselves.

The locals blame it on the so-called ‘step-motherly treatment’ by the Central Government meted out to the NE states since independence, which has left the whole population disenchanted and falling in a repetitive loop of despair and gloom. Claims of autonomy and independence in lifestyle, culture and governance add to this frustration. These chronically disavowed people then inevitably fall prey to the temporary but ‘addictive high’ of the illegal substances. The selling and distribution of these illicit drugs are the only means of financial gains for some of the population fuelling the promise of a better future in waiting. The relative failure of the political and bureaucratic system to rein in the drug behemoth is a massive cause for concern. Going back and forth between the ineffectual structural support system and drugs is psychologically viewed as a ‘desperate look for help’ to gain self-identity and autonomy.

As mental health professionals and doctors, we have no right to judge the Government, we are guided by it. Through various years, the Government has tried and evolved multiple solutions to curb the drug abuse problem of the NE Region. The Narcotic Drugs and Psychotropic Substances (NDPS) Act, 1985 had been a strong move in this regard, later amended thrice in 1988, 2001 and 2014. It not only provides clear guidance and restriction of drug distribution and trafficking but also lays down punishments for possession and illicit use of substances.

The Narcotics Control Bureau is active and the use of cannabis and alcohol in the NE has actually reduced over the years. But unfortunately, it has given rise to injectable substance use and street-drugs abuse which have a high toll on mental health, social conditions and also the average life-span. Consequently, the NMHS survey (2015-16) shows an increase in mental disorders like schizophrenia, depression and also suicides in the NE Region. The policies are yet far from implementation in these areas and are more focussed on ‘reduction in use’ rather than ‘reduction in demand’.

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Human behaviour is complex and as long as religious conservatism, tribalism and civil insurgence hit these areas, there will be ‘increasing demand’ to seek this ‘artificially high’. The mirage of self-satisfaction and pleasure sought out of this drug abuse only leads to a vicious cycle leading eventually to the dangerous point of ‘no-return’. This needs a ‘softer’ approach by increasing awareness, the involvement of media and NGOs, setting up de-addiction and counselling centres, early screening for substance use and HIV as well as school-sensitization programs and separate health-care facilities for women. District and grass-root level health workers and nurses need to be trained in detecting the earliest complications of drug-use and be aware of the common drugs used in the area. There need to be more health-centres equipped and trained in drug-abuse detection, treatment and de-addiction facilities.

Needless to say, administrative attention to sister-states plays an important role in curbing the problem of drug use. Policy makers need to cater to the local cultural and ethnic needs. The optimistic facts are that the GOI has its best intentions for reforms and the native population is seeking help more often. Apex institutions like AIIMS and NIMHANS are collaborating with the regional centres like Regional Institute of Medical Sciences (RIMS), Imphal to hand-hold for support in these areas. A recent study from NDDTC, 2017 shows that the locals identify the following factors as pathways to drug-abuse: social exclusion, violence, children’s welfare, and financial difficulties.

The seven sister-states form our history and heritage and it is our collective responsibility to keep them in a drug-free and shining state of mental and social health.

Image Courtesy: Quartz, Al Jazeera, IBTimes

(Dr Debanjan Banerjee is a Geriatric Psychiatrist at NIMHANS, Bangalore. E-mail: dr.djan88@gmail.com | Dr Mayank Rai is a Resident of Psychiatry at the Regional Institute of Medical Sciences, Imphal. E-mail: rai.mayank0@gmail.com).

(Editor Didhiti Ghosh is an India Columnist at La Agencia Mundial de Prensa, and is the Bureau Chief of Indian Observer Post based in Kolkata. She is a Guest Faculty of the Centre for Linguistics, Maulana Abul Kalam Azad University of Technology, WB. E-mail: didhiti.24@gmail.com | LinkedIn: https://bit.ly/2H6gNAv).