India: Opioid Substitution Treatment gives "new life" to drug users - a visit to Drug Treatment Centres in Delhi
"I have been dependent on heroin for the last 18 years. My wife does not accept me and my drug addiction pushed me into a web of criminal activities. I have been imprisoned a few times and could not hold a job, until I came to this methadone maintenance treatment (MMT) clinic. My life has changed. I am more in control now and for the last three weeks, I haven't used any drugs. I am now working and I feel much better." - Jameer*, drug user at MMT clinic
Forty-year-old Jameer has been visiting the newly established MMT centre nested in the heart of Sunder Nagri in Delhi. As we walk into the centre, there is a row of drug users waiting to be attended to by the staff. As they wait, an 18-year-old boy is at the nurse's station taking his daily dose of methadone. Methadone is a synthetic opioid, which when administered under medical supervision is very effective in drug dependence treatment, HIV and hepatitis C prevention. Scientific evidence suggests that substitution treatment with methadone can help reduce criminality, infectious diseases and drug related deaths as well as improve the physical, psychological and social well-being of dependent users.
Drug users coming to the centre for the first time are screened by a trained doctor and assessed for their suitability for treatment. Once approved, they are enrolled at the centre and are dispensed methadone daily. The MMT centre has a full time doctor, a nurse and a social worker. Open seven days a week, the centre is also equipped with basic surgical supplies for abscess management among injecting drug users.
The MMT centre at Sunder Nagri partners with a local NGO to widen its reach and provide a comprehensive range of treatment services to drug users. The field staff at the NGO helps in recruiting drug users for the centre and also provides services like the Needle and Syringe Exchange Program. The NGO also helps with follow-ups in the field.
Apart from methadone, buprenorphine is another commonly used drug for opioid substitution treatment (OST). A five minute walk from the MMT centre leads us to a community health centre where drug users have been administered buprenorphine for the past five years. Drug users are sublingually administered powdered buprenorphine tablets at the health centre. They are then observed by a nurse until the powder fully dissolves. Within 5-7 minutes the procedure is complete and the drug user is free to continue his daily activities. The centre maintains detailed records of medication administered to drug users and has many success stories to its name.
Ram Lal*, who has been on buprenorphine for the past five years, shared his story with us.
"I had been smoking and injecting heroin for 30 years. I used to inject multiple times a day and I spiraled into deterioration. I wasn't able to get married and wasn't even allowed inside people's houses. I was served food at the door and was shunned by my community. To be able to afford my daily dose of heroin, I started pick-pocketing in local buses and I landed in prison. I have been on buprenorphine for the past five years and four years ago I quit drugs. This treatment gave me a new life and now I am employed as a guard at the clinic." - Ram Lal*, injecting drug user on opioid substitution treatment (buprenorphine)
These OST centres are managed by the National Drug Dependence Treatment Centre, AIIMS in Ghaziabad. A walk through the sprawling compound sees us to the centre which was established at its current location in April 2003. The 50 bed hospital admits drug users with all kinds of drug abuse disorders. The hospital pharmacy gives out free medication once it is prescribed to the drug user by the doctor on duty. The centre is equipped with a highly advanced laboratory that conducts blood and urine analysis of drug addicts. Tests confirm the drug user's dependence on drugs and also check for drug associated damage to the liver, kidney and heart.
Tucked away in a quiet corner is the day care centre at the hospital. This day care centre houses drug users who prefer spending their day watching television and playing board games with other recovering users. Here, they also engage in activities like candle making and pottery. Drug users at the day care are able to establish a support group and are thus, less likely to go back to drug abuse.
HE Mr Juan Alfredo Pinto, Ambassador of Colombia to India together with UNODC undertook a visit to the NDDTC to learn about Government-led drug treatment centres in India. During his visit, he interacted with Dr. Ray, Professor and Chief, National Drug Dependence Treatment Centre, staff and drug users and expressed that he had learnt a lot and wished to share this knowledge and expertise with counterparts in Colombia.
UNODC would like to thank Dr Rajat Ray and the staff at the NDDTC.
The NDDTC is funded by the Ministry of Health and Family Welfare, Government of India. Some of its activities are supported by UNODC through its regional project "Prevention of Transmission of HIV among Drug Users in SAARC Countries" (Project RAS/H13), with the financial support of DFID and GIZ.
*Names changed to protect the identity of the drug users.