Punjab owes its young a chance to recover

Why in the News

More than 10 lakh people have registered at Punjab’s government de addiction clinics since the State opened them, and that figure counts only those who gave their names. What changed in Punjab is the chemistry of the supply rather than its presence, since opium and poppy husk were consumed within social boundaries for generations. Chitta, the local name for smoked or injected synthetic heroin, reaches the brain in seconds. The Outpatient Opioid Assisted Treatment (OOAT) programme can report how many crore tablets it dispensed last year and cannot report how many people recovered. The tension is between policing and treatment. Peddlers have been arrested under every government without a single trafficking network being broken, and the treatment system that would cut demand was built and then left unfunded.

What is the Outpatient Opioid Assisted Treatment programme?

1. What it does: It delivers opioid substitution treatment on an outpatient basis, so a dependent person receives a prescribed medicine at a clinic and returns home rather than occupying a bed.
2. Why substitution is used: A long acting oral opioid occupies the same brain receptor as heroin without the rapid rise that drives craving. That allows a person to function while the dependence is managed.
3. How it is delivered: The programme runs through government OOAT clinics across Punjab, with dispensing recorded centrally.
4. What it does not do by itself: Substitution manages dependence. It does not supply the counselling, follow up and employment that decide whether a person stays recovered.

Why has the chemistry of the supply changed the nature of the problem?

1. The same receptor, a different speed: Opium and heroin act on the same brain receptor. The difference between them is the speed at which each reaches it.
2. Why the rate of rise matters: Opium eaten is absorbed over hours, so the body can adjust to it. Heroin smoked or injected arrives in seconds, and it is that rate of rise that builds craving.
3. What sustained use does: When a stronger drug floods those receptors every day, the brain stops producing its own opioids. Within months the user is chasing an ordinary baseline rather than a high.
4. Why willpower is the wrong frame: Withdrawal is the loss of the ability to feel ordinary comfort. It is not a matter of discomfort or resolve.
5. What this changed in Punjab: Poppy husk was sold at the village shop and opium was taken at weddings, funerals and harvests, within recognised limits. The shift to fast acting synthetic opioids removed those limits with no change in the population’s morals.

What does the registration figure show, and what does it miss?

1. The undercount: The register counts only those who gave their names, so the dependent population is larger than the recorded number.
2. What a registration is not: A registration records an entry into treatment. It records nothing about completion, relapse or recovery.
3. The household scale: Each registration stands for a family waiting on an outcome, which makes this a demand side problem of a size no enforcement drive can absorb.
4. Why the number is the starting point: A dependent population of this size sets the staffing, dispensing and follow up load the system has to be built for.

Why can interdiction alone not close the supply?

1. The arithmetic of potency: Synthetic opioids are potent enough that a year’s worth can cross the border in a drone the size of a tiffin box, so seizure volumes cannot keep pace with supply.
2. Arrests without networks: Every government of every colour has arrested peddlers. Not one has dismantled a trafficking network.
3. Where enforcement would have to move: Effective control needs technology on the fence, detection grids, counter drone systems and forensics that trace a consignment backwards to its source.
4. The political element: Prosecution has to reach the people who protect the trade, rather than stopping at the boys who consume it.

What has gone wrong with treatment delivery?

1. Built and then starved: The OOAT programme was created with a working frame and then left without the money to run it.
2. Counting the wrong thing: The State can report the tablets dispensed. It cannot report the people recovered.
3. Diversion priced into the system: A tablet costing thirty rupees at the clinic sells for three hundred rupees outside it. That price gap is a direct measure of how little supervision is being paid for.
4. The empty posts: Punjab has a very small number of psychiatrists, and counsellors and hospital beds are similarly short, so the clinical side of the programme is understaffed.
5. The budget comparison: The entire de addiction budget is a rounding error against the State’s power subsidy bill.
6. Follow up and work: Relapse occurs around 18 months after the last dose, so follow up has to run long past discharge. A recovered person with nothing to do on a weekday afternoon is not recovered.

Challenges to Punjab’s drug de addiction response

1. Treatment capacity is concentrated in dispensing: Clinics can hand out medicine at scale without the psychiatric and counselling staff that make substitution therapy work. Eg. The National Mental Health Survey, 2015 to 2016 recorded a treatment gap above 80 percent for alcohol use disorders in India, driven by the shortage of trained personnel.
   The Fix: Fund and fill sanctioned psychiatrist and counsellor posts at OOAT clinics before dispensing capacity is expanded further.
2. Diversion of substitution medicine: Unsupervised take home dosing allows prescribed opioids to reach the illicit market, so the treatment supply becomes a source of supply. Eg. Buprenorphine formulations dispensed under opioid substitution programmes have been recovered from illicit markets in several States.
   The Fix: Require directly observed dosing at the clinic through the initial phase, and link take home doses to verified follow up attendance.
3. Border technology lags the smuggling method: Fencing and patrolling were designed against people and vehicles, not against small payload aerial delivery. Eg. The Border Security Force recovers drones along the Punjab frontier with Pakistan every year, and annual recoveries have risen rather than fallen.
   The Fix: Deploy a continuous counter drone detection and jamming grid along the Punjab border sector, in place of sighting and pursuit.
4. Prosecution stops at the consumer end: Cases cluster at small quantity possession, so the financing layer above the peddler is rarely reached. Eg. Case loads under the Narcotic Drugs and Psychotropic Substances Act, 1985 are dominated by small quantity matters rather than by commercial quantity trafficking.
   The Fix: Route every commercial quantity seizure to a parallel financial investigation, so the trafficking case and the asset case are run together.
5. Recovery has no employment endpoint: A person completing treatment returns to the same absence of work that preceded the dependence, so relapse is structurally invited. Eg. Punjab’s high rate of youth emigration reflects the shortage of local work that treatment programmes discharge people back into.
   The Fix: Attach a guaranteed skilling and placement slot to discharge from an OOAT clinic, tracked through the period in which relapse occurs.

Conclusion

Punjab has organised its response around arrest and abstinence, and neither instrument matches what the problem actually is. Dependence on fast acting opioids is a treatable clinical condition sitting on a criminal supply chain, and the clinical side has been funded as an afterthought. A state that can count tablets and cannot count recoveries has not yet settled what it is trying to achieve. The thing to watch is whether the next State Budget moves the de addiction allocation to a level comparable with the State’s other standing commitments, and whether recovery, rather than dispensing, becomes the reported statistic.

Government Initiatives for drug demand reduction

1. Nasha Mukt Bharat Abhiyaan: Launched in 2020 by the Ministry of Social Justice and Empowerment, it runs awareness, community outreach and treatment linkage in the districts identified as most affected.
2. National Action Plan for Drug Demand Reduction: The central scheme funds State run de addiction and rehabilitation centres, counselling services, community peer networks and awareness programmes.
3. MANAS helpline: The Narcotics Control Bureau operates a national toll free helpline for reporting drug trafficking and for seeking counselling and rehabilitation support.
4. National Drug Dependence Treatment Centre: Based at the All India Institute of Medical Sciences, New Delhi, it conducts national surveys of substance use and trains treatment personnel for State programmes.

Matching Previous Year Question

“[2018, GS3, 15] India’s proximity to two of the world’s biggest illicit opium-growing states has enhanced her internal security concerns. Explain the linkages between drug trafficking and other illicit activities such as gunrunning, money laundering and human trafficking. What counter-measures should be taken to prevent the same?”