Against drugs, setting the wheels in motion

Aban Usmani
For three hours every morning, the team on the mobile van attends to opioid addicts in Delhi s Seemapuri. (Express photo by Aban Usmani)

Behind the rear wall of the government dispensary in Delhi s Old Seemapuri area, an ambulance arrives at the parking slot around 9 am. Its occupants step out, unnoticed amid the bustle of the busy street leading to Seemapuri Chowk. They spread out chairs and place a water cooler on top of one.

The vehicle is a mobile deaddiction van service, launched for opioid addicts in the Capital on March 26 by the National Drug Dependence Treatment Centre (NDDTC) of the All India Institute of Medical Sciences (Ghaziabad). The van offers methadone doses to those struggling with withdrawal symptoms or cravings, while ensuring there is no euphoria so that the user can lead a normal life.

While similar services have been launched in countries such as the US, China, Portugal, Spain, Canada and Netherlands, this is the first such initiative in India.

Aarti Mathews, a senior nursing officer, sits next to the dispensing window inside the air- conditioned van with a list of registered patients from the Northeast Delhi neighbourhood. We also have other prescription drugs such as Buprenorphine and Diazepam, depending on the need of the patients, she says. The van stays in Seemapuri for nearly three hours every day, from 8.30 am to 11.30 am.

Soon, a Suzuki Dzire halts near the van, and a burly man in his 50s approaches the ambulance window. Mathews hands him a small dose of liquid methadone in a plastic cup. He dilutes it with water from the cooler and gulps down the concoction. In my 30s, when I was a truck driver, someone introduced me to afeem. Over the next few months, I was chewing the small black ball everywhere. I spent so much money to get my daily fix, he says.

He began deaddiction therapy three years ago. I drive only in the NCR region now. It was difficult to find (the drug). Also, I would have fights at home every day. A neighbour told me about the therapy and I joined this programme at the deaddiction clinic in Sunder Nagri. The doctor has asked me to see him after six weeks, he says.

The van in Seemapuri is an extension of the AIIMS methadone maintenance centre in Sunder Nagri, less than 2 km away.

It s 9.45 am, and some of the shops near the van have rolled up their shutters. A group of four men, seemingly intoxicated, are standing behind the van, jeering at what they call a useless effort . The guard accompanying the van members, Dushyant Kumar Sharma, has been trying to convince the men to join. Bhala ho jayega tera (You will be cured), Sharma tells one of the men, a construction worker in his early 20s, who is hooked to inhalants.
I started sniffing glue at the age of 16 while working at a footwear manufacturing unit. For two-and-a-half months, I got myself treated at a clinic… Anyways, the services being offered at the van are for other addictions, he tells Sharma, crumpling the paper with the address of the main AIIMS centre in Ghaziabad that was handed over to him.

This is today s generation, a visibly disappointed Sharma says, as another youngster walks in, tattoos on his neck, his hands in the pockets of his torn jeans. A Class 9 dropout, the 20-year-old gets a 12 ml dose of methadone.

I started smoking smack at the age of 13. I stole money to get my daily fix. Police caught me and beat me up too. But I couldn t give up my addiction, he says.

Five months ago, after being nudged by a friend, he enrolled for treatment. I have been getting construction work daily now, he says.

The biggest hurdle in the treatment process is that society does not see addiction as a disease but a crime, says Mathews. Agrees a 27-year-old furniture shop owner who has been waiting for his friends to come to the van. They fear the neighbours will see them. They want to get their dose but now I think they are going to miss it and smoke smack instead. There are so many dealers in Kasturba Nagar and Nand Nagar. Most of the unemployed youths here in Seemapuri are hooked, says the father of an 18-month-old son, who enrolled for treatment to get back to a healthy, functional life .

I also missed my dose at the Sunder Nagri centre, but this van is accessible and now I can get my dose daily, he says.

Rupam, 25, the helper at the van, says nearly 20-25 people have been taking the dose every day. The number, however, is minuscule when compared to the extent of India s opioid problem. As per a 2019 report on the magnitude of substance abuse in India commissioned by the Ministry of Social Justice and Empowerment, nearly 2.26 crore people in the country use opioids. The most common opioid is heroin (1.14 per cent of the population), followed by pharmaceutical opioids (0.96 per cent) and opium (0.52 per cent).

However, some claim that methadone treatment is as good as addiction as it makes patients dependent on the drug. Dr Ravindra Rao, associate professor and in-charge of the methadone maintenance centre at Sunder Nagri, disagrees. Addiction is not merely about physical dependence. It s behavioural, psychological, it s a vicious cycle that goes on and on. All sense of social obligation is lost… A medical dose is different. We gradually decrease the dose over time to ensure there is no withdrawal, he says, adding, Repair takes time, generally two-three years. It can take longer for some depending on the damage caused by the opioid.

Rao believes involving the community can help in tackling the problem; top down approaches can be problematic . He adds, Many opioid users could not come to the clinic. So we decided to launch the mobile van service in Seemapuri after speaking to locals.

Dr Rakesh K Chadda, Chief of the NDDTC, says that while methadone has become available in India only recently, internationally it has been available for more than 40 years. In India, because of the risk of persion to the illicit market, its availability has been restricted, he says.

However, it is not just the black market which the authorities have been apprehensive of. Extra care is taken to ensure there is no leakage or abuse of methadone at the clinics too. Mathews says the internal mobile app helps the staff ensure the dose is right and there is no duplication.

While a precursor to opioid substitution therapy (OST) dates back to the colonial era in India, when users could get registered and buy their fixed dose from a licensed shop, it was only in 1989 at the AIIMS centre that the first government intervention for OST happened post Independence with Buprenorphine. Three decades later, there are still many loopholes in India s OST policy, or the lack of it. Unlike the AIIMS clinics that cater to all kinds of opioid users, most other OST centres are sponsored by the National Aids Control Organisation under which only injecting drug users can benefit from public health funding.

Dr Chadda feels the results of the AIIMS methadone programme have been positive and comparable to the studies from the Western countries , adding that they plan to use the same van to expand the mobile service to more areas in the vicinity.

Counselling and other services are available for patients only at the main NDDTC in Ghaziabad and its clinics in Trilokpuri, Sunder Nagri, and Kotla Mubarakpur.

As the sun peaks, the staff puts the plastic chairs back into the van. An old man, in his 70s, spreads out footwear for sale on a plastic sheet nearby. Je dispensary mein ek hi badhiya ambulance hai (The clinic has only one good ambulance), he quips, on the van s unusually regular appearance, oblivious to why.