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Wednesday 22, January 2020
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Curb drug abuse with focus on public health

GRAPPLING with drug abuse, countries are realising that the only way to progress is to focus on people rather than drugs.

Upneet Lalli
Dy Director, Institute of Correctional Administration, Chandigarh

GRAPPLING with drug abuse, countries are realising that the only way to progress is to focus on people rather than drugs. As per the UNODC (United Nations Office on Drugs and Crime) World Drug Report-2017, around 2.95 crore people or 0.6 per cent of the global adult population suffers from drug use disorders, including dependence. Around 20 per cent of the world’s prison population takes drugs, compared to an estimated 5.3 per cent in the community. As Punjab confronts a growing epidemic of drug and substance abuse, policy-makers, law enforcers and public health officials need to pay heed to the International Guidelines on Human Rights and Drug Policy (2019). These introduce a comprehensive catalogue of human rights standards.

India needs to learn lessons from other countries which have dealt with drug abuse. Policy-making requires a clear understanding of whether, how and to what degree imprisonment for drug offences affects the nature and extent of the drug problem. A ‘zero tolerance and deterrence’ approach hasn’t worked. The US could not win the war against drugs, launched in 1971 by then President Richard Nixon. It was extended by then President Ronald Reagan to the demand side; during his rule, the Crime Bill led to a crackdown on addicts. The stiffer prison terms did not curb drug abuse. Today, the US has 655 prisoners per 100,000 of the general population, among the highest in the world. The disastrous consequences of the war on drugs are persisting in countries like the Philippines.

In 2001, Portugal became the first country to decriminalise the possession and consumption of all illegal substances, including heroin and cocaine. Portugal did not legalise drug use, but made the purchase or possession of small quantities — up to 10-day supply and administrative supply — a public health intervention. A person caught with a personal supply is given a warning, or has to pay a small fine, or is told to appear before a local ‘Dissuasion Commission’ hearing in an informal meeting. There he is informed about treatment, harm reduction and available support services. Drug-related HIV infections have dropped to 95 per cent, and heroin users are down from 1 lakh to 25,000.

The results of a survey conducted by AIIMS in 2018 reveal that Punjab had one of the highest prevalence of substance abuse across drug categories, with 10.9 lakh sedative users and 27,000 cocaine users. The Punjab and Haryana High Court has directed the state government to establish rehabilitation centres in each prison of the state and passed a slew of directions to tackle the drug menace. The strategy has to be based not only on supply reduction, but also on demand and harm reduction.

The Global Prison Trends Report-2018 revealed that harsh criminal justice responses are responsible for prison overcrowding. About 70 per cent of the undertrials in Punjab are booked under the NDPS Act. According to available UN data, 83 per cent of the drug offences that are recorded by criminal justice systems are possession offences. A study done by Vidhi Centre for legal policy (2018) found that strict liability provisions have led to high convictions under the NDPS Act in Punjab. The data suggests that 70-90 per cent of the total drug cases are intermediate quantity cases. It is seen that around three-fourths of those sentenced under the Act are lower-level actors such as couriers and mules. The public safety impact of incapacitating these offenders is nullified because they are quickly replaced. While Sections 27, 39 and 64A of the Act provides an option to the courts and the prosecution to send those caught with small amounts for treatment in rehabilitation centres, these are rarely used. There is a need to sensitise them about this provision. Further, policemen also need to be sensitised so that they can identify and differentiate between a drug user-turned-peddler and drug dealers, who are professional criminals. Better investigation skills, financial probe and freezing of assets of drug traffickers require greater attention.

The drug problem in society gets reflected in prisons. Prisons are ‘secure’ establishments, and drug and mobile phones inside jails raise serious questions about safety and security. Prisoners in any country will try to get drugs inside. When one route is closed, another will be found. Tablets, opium, smack etc. are routinely recovered from inmates. The inside economy operates due to the demand from consumers and innovative suppliers. Addressing the availability of drugs in prisons requires constant vigilance and prompt action through a comprehensive supply reduction strategy. 

There are drug users and suppliers in the captive market. The addicted prisoners undergoing withdrawal symptoms are easy to spot. There are some prisoners with prior drug problems, while some have committed an offence to fund their drug use — they normally start as juveniles. There are other prisoners who have been involved in criminal activity which brings them into contact with drugs. Some develop drug problems in prison. With no purposeful activity, and addicts as co-inmates, it is easy to succumb. There are some whose families have rejected them, and drug use becomes a coping mechanism. I have come across women inmates who have desired treatment.

Mental health assessment becomes important to identify such at-risk prisoners. In the draft Prison Act 2016 that I had submitted to the Punjab Government, mandatory drug testing and treatment had been provided. The Act is yet to be implemented, even as Outpatient Opioid Assisted Treatment (OOAT) centres have been established in eight central prisons of the state through the Department of Health and Family Welfare for the treatment of prisoners. 

Rarely does the prison environment fully prepare inmates for life after release. Addiction treatment must have a strong component of learning how to cope with the stressors and triggers that addicts will face once they are back in their familiar environment. Prisons don’t have programmes that facilitate this. Skill development of inmates is essential for proper time management and reintegration. Only when addict prisoners stop thinking of drugs will they start seeking work and have better chances of recovery. Post-release follow-up is important, as there is extreme vulnerability following release and re-entry into community. There is a risk of overdose, frequently due to their relapse into heroin use and reduced tolerance to opioids. Peer-led interventions can be useful. 

Prisons provide an opportunity to promote public health through working with prison staff and prisoners and also the outside community. An effective response to drug abuse requires law enforcement to curtail trafficking; treatment to reduce dependency and recidivism; and alternative sentencing for non-violent drug offenders. The criminal justice and treatment systems need to engage the communities to optimise resources that benefit health, safety and well-being of the individuals and society.

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