Drug users during the times of COVID-19 pandemic in Manipur

Gay Thongamba
The present condition of the nation is in a total lock down due to the wide spread of pandemic COVID- 19 (coronavirus). One of the main reasons of the current lock down is to mitigate and minimise the spread by staying at home with minimal mobility, as realistic as possible.
In this present scenario, it is of utmost importance to note that some of the people may be more at risk than others. This may be because of their profession, life style, their behaviour, geographical and present location,they are in or may be in unavoidable circumstances. By profession, we should not forget the bank officials. I remember someone in a WhatsApp group reminding me that bankers are never thanked for the risk they put themselves in, at this critical juncture. I take this opportunity to thank everyone who is leading from the front, doctors to vegetable vendors and garbage cleaners, who are giving us all hope that “We shall overcome”. A song which is becoming more and more meaningful and relevant as our days pass quarantined.
All of the State’s population, not only in Manipur, but even neighbouring states and the entire country could be at great risk. The limited accessibility and availability of things people desire, especially who are engaged in drug-use, are at a heightened risk, simply for the reason that a drug user is likely to take extreme measures (step out of home) to obtain their daily dose (or any other preferred substance of use) from wherever or whatever source available. Following this, they may indulge in behaviour which may put themselves and others (including their families) in great risk of COVID–19 transmission. It is important to note here that many of the drug users are married, have children and live in localities which are community based, where the chances of spread could be high, if adequate precautions are not taken into consideration.
I am not here for a debate whether the daily wage earner who may have nothing to eat in times to come (loss of income opportunity) and may succumb to unlawful activities, in order to contain their hunger; are at greater risk or not. I am simply saying besides hunger, there are risk-taking behaviours, which we may witness more during the lock-down.
Our state Manipur, which has a population of about 2,855,794(Census 2011), harbours a sizeable proportion of drug and substance users. Manipur has an estimated 34,344 population of People Who Inject Drugs (Magnitude of Substance Use in India, 2019 MSJE). It is important to note that this estimated number did not take into account alcohol and other mode of drug use such as Oral Drug use, Cannabis, inhalants or the popular WY. The estimated number will rise much higher if these mentioned modes of use are taken into consideration. It is pertinent to conclude here that a large section of the population is into alcohol and drug use.
Besides the issue of estimated number (how many), it is evident that not only the parents but community leaders and Law enforcement agencies have to play a role in ensuring the safety of the Drug Users community, during the times of COVID – 19 pandemic. For some, the best remedy may be ‘to confine these people and put them away from everyone else”, but we know better that this is neither feasible nor practical.
There are civil societies, networks and organisations in the state of Manipur dedicated purely and selflessly worked with the drug user’s community for more than decades. Their experience and intervention at this period will be critical.  I have deliberately tried to refrain myself from naming these organisations, however, I could not help mentioning organisation such as SASO, CoNE, MNP+, Kripa Society, USER Manipur, CARE Foundation and Dedicated People Union.I am also optimistic that there are community leaders and experts in the state will lead the cause.
Besides, there are more than 80 Drug Rehabilitation Centres in the states (about 20 are Government funded; private or self-funded stand at 60 approximately). We can still debate one day whether the existence of large number of Drug Rehabilitation Centres should be seen as liability or an asset. While the State should think of strategies for containment of COVID-19 in general population at large, a special focus should be on making sure that the drug-deaddiction and rehabilitation centres are well equipped and functional, especially under these extraordinary situations. De-addiction centres and rehabilitation centres in the State should refrain from taking measures like immediate discharge of clients, as it is in such a situation that more support should be extended to the community.
As per CoNE (an organisation working with Drug Users);maximum of the private rehabilitation centre has a client-load ranging from 40-60 individuals, exceedingly even 100 individuals mark in a few centres. It is fair to assume/estimate that there are thousands of drug users in the rehabilitation centres of the state, currently. An immediate shut down of all drug rehabilitation centre may put the state into big risk, as far as the transmission of COVID–19 is concerned. Many of the individuals who are currently under drug use treatment are likely to start drug use again, if such shut down take place. Evidence suggests that a high proportion of the rehabilitated drug and alcohol users’ relapse.  In such a situation, it will put the state into a tremendous pressure to contain the drug user’s population off the street and local hotspots.
Taking the present unprecedented situation and the above background into account, strict directives from the concern department will go a long way in maintaining a safe environment. The following are some of the suggestions which may help mitigate the concerns:
1.    Initiate supply of basic Personal protection equipment to the existing rehabilitation centres across the State.  Mask and hand sanitizers (small carriable) should be provided to the Drug Users in and of the street.
2.    Directives and strictures should be given to the Rehabilitation Centre to refrain from new admissions, with immediate effect and with punishment in case of violation. This measure will not only help in keeping both the food stocks and basic medicines in ample supply, but also not overcrowd the functioning institutions and keeping the clients safe from the virus.
3.    The institutions should enforce hand wash and other safety precautions among the clients and the staff members. Any essential trip made outside the facility needs to be dealt with carefully, for example, there should be provision of hand washing at the gate of the facility and anyone entering the premises (including staff) of the rehabilitation centre should abide by the basic prevention guidelines. Further, the mobility of the residential staff should be restricted.
4.    Visits, Discharges and parents meeting (face to face) should not be entertained at all in the Rehabilitation centres. No visitors should be allowed to enter the premises of the rehabilitation centre. Any discussion or meeting with the parents/visitors which need to be done should be conducted either by phone or outside the campus or premises of the rehabilitation centre. Personal protective measures: promoting proper hand hygiene and risk reduction practices such as, coughing and sneezing in your elbow. Also ensuring bathrooms are stocked with soap and drying materials for hand washing.
5.    Family of clients at the rehabilitation centres should be notified and updated about their ward and the stock condition at the centre, on a regular basis, through phone calls and SMS.
6.    If in case certain rehabilitation facilities may temporarily close down, essentially due to lack of external support and depleting supplies of essential food items (rice, pulses, oil, milk, sugar, vegetables, etc), cooking gas/firewood, water supply, medicines, the parents and guardians of the clients should be notified in advance about the closure of the facility. The concern government department and different organisation working in the area of Drug Use should extend support, so that that the rehabilitation centre does not closed down.
7.    A task force to enforce and ensure all safety precautions amongst the current drug users’ population (including the ones in the rehabilitation centre), should be formed at the earliest. This initiation can be taken up by the community leaders with the concerned government department. The task force should include (but not limited to) community and local leaders, stake holders, NGOs and people of imminent importance including current practitioners in the field of Drug use and Rehabilitation.
8.    Identify places such as large schools and colleges (or any other) to create detoxification, treatment and isolation facilities at the large scale for current drug users who are at risk. The task force should advocate with the concerned government department to establish detoxification, treatment and isolation facilities for current Drug users at the earliest.
The author is Chief Functionary, Makers Foundation, IPA Ibungo Drug De-Addiction & Rehabilitation Centre, Manipur
(Endorsed by Manipur Network of Positive People (MNP+), Social Awareness Service Organisation (SASO), Community Network for Empowerment (CoNE), USER Manipur, Dedicated People Union (DPU), Kripa Society & Care Foundation Manipur)