As a part of Team Alliance India, ‘Substance use/drug abuse has been an oft-repeated phrase. Like any other ordinary human, I, too, had a mixed perception towards the segment, heavier on the negative side, to be honest. The Bollywood touch had all the more made the subject overwhelming over the years.
My perception slowly yet steadily changed shades from grey to clearer ones with several case studies/interactions. The eternal paradoxical question whether deviance gives way to drug abuse or vice versa – perhaps remains a mystery till date. Yet, an individual’s immediate environment and mental health go a long way to make him/her vulnerable to drug abuse.

As per the May 2022 data of the Narcotics Control Bureau (NCB), around ten crore Indians are addicted to some or the other narcotics substances. Narcotic substances range across traditional plant-based drugs such as cannabis, cocaine, and heroin to synthetic drugs such as tramadol. Heroin consumption has steadily increased the most over the years. While cannabis in the form of bhang is legal in India, its other renditions viz. ganja (marijuana) and charas (hashish) are illegal. Some pharma products too are used for their sedation effects. Trends depict that the maximum number of sedative users are in Uttar Pradesh, followed by Maharashtra, Punjab, and Andhra Pradesh. Some drug users, and unfortunately children, take the inhalational route for psychoactive drugs. There are many anecdotes derived from Alliance India’s Hridaya and HR Asia project, where under-18 adolescent boys/girls also seek HR services. The existing HR services only cater to adult people who use drugs (PWUDs). The need for age-appropriate HR services is clearly felt.

Women are affected both as partners of male substance users and as substance users themselves. The stigma around female drug addicts is much more than male drug addicts. Society perceives them as doubly deviant.

Harm Reduction (HR) programs should thus include women who use drugs, female sex partners along with Transgender people who use drugs. The HR services need to be customized as per the respective segments’ needs.

Injecting drug use has emerged as an important route of HIV transmission in India. Sharing of syringes and needles, frequency of injection, early initiation of injecting practice, inconsistent condom use and having multiple sexual partners were all commonly associated with HIV infection among HIV + PWID. The focus should be on treatment literacy on HEPC/HIV and managing side effects. This would enable PWUD to access services, tests & treatment.

Harm reduction is any behavior or strategy that helps reduce risk or harm to yourself or others. HR plays a significant role in preventing drug-related deaths and offering access to healthcare, social services, and treatment. These services decrease overdose fatalities, acute life-threatening infections related to unsterile drug injection, and chronic diseases such as HIV/HCV.

Till the time we sweep the disputed subject under the rug, there would be no concrete strategy to address it. Various remedial measures to combat substance use can be developed as a function of societal attitude and support. Besides medical intervention, empathy and support from family & friends are crucial for someone to feel secure and adhere to a consistent treatment regime.

In today’s age, we need to think twice before labeling a drug user as a culprit. In most cases, on a deeper probing, the same culprit might turn out to be a victim of circumstances. Of late, the social justice and empowerment ministry has revamped the word ‘addict’ into ‘user’ or ‘substance dependent’. Imprisonment or penalties would only mean punishing an offense. At a holistic level, rehabilitation and empathetic treatment along with counseling would address the subject from the core. Judgement and moralizing hardly work with addiction since most substance users are strong-willed. Community engagement/involvement is essential not just for implementation but also for research, M&E, and decision-making. This all the more calls for Community Led Monitoring.

Let’s understand & believe that the person is never the problem. The problem is the problem.
Mark Twain summed up the challenging dialectics of addiction : “Giving up smoking is the easiest thing in the world. I know because I’ve done it thousands of times.”

-Mou Mukherjee