Drug User's Condition in Tamil Nadu

[Guest guest]

Dear Forum,

This mail is to bring it to the notice regarding the situaiton of the Drug users

community in Chennai.

This community is very marginalised and also hidden due to stigma &

discrimination and the drug user community is facing major challenges.

As per the sentinel survey done by TNSAC, the prevalence rate is 30% to 35% of

them are infected by HIV/AIDS.Apart from HIV/AIDS the prevalence rate for HEP

" C " is 90-95%.Now the challenge is there is no facilities for screening for HEP

" C " before starting ART. Due to this the clients are getting worse and also

facing death.

In few months there are few clients how passed away after starting ART and being

a current user or shifting to alcohol leads adverse reaction. As chennai drug

users network would like to give a voice for our communities.If the screening is

done it will be easy to fix the regiment of ART. There are lot of difficulties

in starting ART for a chemical dependent having sufficient clean time due to

Orphan.Where will these people get support.

Secondly the current user's are very less then why 4 intervention among IDU in

Tamilnadu. Secondly the care component for this communities is inadequate. In

some of the NGO, people those are in alcohol is also shown as current injection

users.

Is there any guide line or protocol to start ART for drug using community? We

feel NACO,SACS & all NGO & CBO's to think and act for the betterment of this

communities. Every one give a voice so that it will benefit the people.

Regards

Chennai injection drug users network

Elango Kumar

e-mail: <chennai_idun@...>

[Guest guest]

Dear Forum

Re: /message/9023

This is in response to the mail send by Mr. Elango stating the plight of Drug

Users in Chennai. I would like to bring to your kind notice that we work with

the Injecting Drug Using populations in Delhi and the North East and have come

across thousands of individuals testing positive for HIV & Hepatitis C/B.

Now understanding the nature of drug use, there are programmes that cater to the

medical needs of this community. Such as Sahara, Sharan, EHA, SPYM etc.

In our experience working in this field for a very long time, we have to say

this that any IDU requiring immediate ART can be put on this medicine regimen

regardless of having a co-infection of Hep C / B. The need is ART and that is

available in the free government rollout scheme.

There could be many reasons of people dying after initiating ART in normal cases

also. Yes, drug or alcohol use needs a break in those initial stages but if that

individual is on a Buprenorphine substitution then he can sustain his ART. (I

personally know many who are currently on ART and are using drug and alcohol

also).

There is no such guideline or protocol for initiating ART for the drug users

community. It is a medical need and the doctor is the best person who can

recommend it.

Best Regards

Sahara

Francis ph - francjoseph@...

Mustafa Ali - sahara.ejaf@...

[Guest guest]

Dear Friends,

Re: /message/9023

The response from Mr.Francis was welcomed for the mail from Mr.Elango and

Mr.kumar, at the same time the experience is the best teacher.

I thank them for this response. But there is lot of difference  in each states

and mode of drugs used. The Buprenorphine substitution is not the ultimate

solution.

If you are going to take alcohol along with Opioid Substitution Therapy (OST)

with Buprenorphine & ART there is  adverse reaction and the adherence towards

the treatment is lost due the addiction.

Also the OST program trend is to just to show the target only. The primary

problem is not addressed and care component like de-addiction and rehabilitation

is lacking.

I can prove there is 40 % in total abstinences with the support of NA & AA

program.

In this  processes different component  and choice to be given to drug users.

The guide line is to made and then see the result. Without guideline and

protocol how it is going to help MO.

Secondly in my experience an ex-IDU those are in alternate  drugs like alcohol

and Marijuana are started OST.

In what way this OST is helping these community. Many of them finding difficulty

to come out of OST and asking help for de-addiction or rehab but do we have

these facilities.

A comprehensive care component  with NSEP, OST,DE-Addiction and long term

rehabilitations has to mainstreamed.

Just NSEP and OST alone is not going to help the current user until they come of

total abstinence even for people those are HIV and HEP " C " .

Just for the sake for funding some of them showing the paper work and getting

the grant where does the funding goes?

without experience in the field of addiction how they are selected for the

project?

All community from drug user and ex user join hand to give a voice.

Regards

Varadhan

e-mail: <knsvaradhan2001@...>

[Guest guest]

Re: Drug User's Condition in Tamil Nadu

 

Dear FORUM,

 

/message/9059

This is in response to the mail sent by Mr.Varadhan on the issues of drug users

conditions in Tamil Nadu. I would like to clarify his doubts on the OST, NSEP,

Detoxification and other related issues.

 

I am Dharmaraj Gasper  from Hopers Foundation, a Chennai based   CBO. I am the

president of the organization and I am working in the field of Drug use/HIV for

more than 10 years.

I have discussed with my peers about their opinion on the postings of Mr. Elango

and Mr. Varadhan. There were mixed reactions among the community. Many of the

statements in the posting are not true with the IDU community.

I got mails from  many individuals from all over India and we discussed about

these posts.

  

In his posting Mr. Varadhan stated that there is lot of difference  in each

states and mode of drugs used. The Buprenorphine substitution is not the

ultimate solution.

 

We beg to disagree with this view, we feel that there is no difference in any

states and modes of drug use, however the strength and potency of the drug

differs and varies from each region.

 

Mr. Varadhan stated that " Also the OST program trend is to just to show the

target only. The primary problem is not addressed and care component like

de-addiction and rehabilitation is lacking " .

 

In our view It is not at all true, I think Mr. Vardhan have acquired some wrong

information, which I don't know from where. OST program is primarily to focus on

the drug related harm eg: HIV/AIDS, HEP C, OVER DOSE DEATHS, ABCESSES, Crime and

violence etc. the list never ends.

Through OST program the society is safe and most importantly me and you are

safe.

 

Mr. Varadhan further stated that " I can prove there is 40 % in total abstinences

with the support of NA & AA program. "

I don't know if he  can prove that there are 40% in total abstinence with the

support of NA & AA program or not , however I can tell you that there are many

individuals who have been thought the NA & AA system coming to the drop in

centres after a relapse.

And first would like to inform that NA & AA names should not be drawn to public

controversy and they have their own traditions, there is the 10th tradition in

12 step program which should be adhered at all costs.

Narcotics Anonymous or Alcoholics Anonymous has no opinion on outside issues;

hence the NA name ought never be drawn into public controversy.

 

So please understand that is also a community of people who are trying to stay

off the drug use or alcohol. So according to the tradition of these people, I

don't think these statements can possibly be discussed.

So I don't know how you are saying that you can prove that they are 40% of

abstinence population, can a mapping be done on the group you have mentioned.

I don t think so. NA/AA does not engage themselves in any research, Data

collection or mapping as to the best my knowledge.

Mr. Varadhan stated that " In this processes different component and choice to be

given to drug users. The guide line is to made and then see the result. Without

guideline and protocol how it is going to help?

 

This statement is not understandable. Please be specific, what is that going to

help mo.?

 

Mr. Varadhan further stated that " Secondly in my experience an ex-IDU those are

in alternate  drugs like alcohol and Marijuana are started OST. In what way this

OST is helping these community " .

As I have already mention earlier you will now be aware how it is helping us

(society) and the drug users.

 

You have mentioned that alcohol and marijuana abusers have started OST. I will

come to your own terms and accept the statement, I would like to inform that

alcoholics and marijuana abusers don't take OST, its reverse, People who are

taking OST are possibly consuming alcohol and/or marijuana.

This  can not be stopped at all, no matter what , there are lessons learnt all

these years from doing interventions for drug users.

I have also heard from your previous posts that 95% of the population is

infected by the deadly HEP C virus. So you have to come to conclusion that if

Alcohol is good or OST is better for the HEP C infected individual.

 

I have personally noticed that many consume alcohol. I have come across many

deaths due to Hep c and alcohol abuse among drug users.

OST does not kill the drug users with Hep c like alcohol does. Your intentions

might be good; however it is not practical for bringing such a huge population

to abstinence.

 

Imagine the number of people who are abstinent, it may few , now imagine people

who are using, there are probably 100 time or more.

You can not compare with the percentage like you have mentioned before.

 

OST is implemented by the government (NACP-III) not by any individuals.

Government have come to an understanding that OST & NSEP are the only best

solutions for countering the drug related harm all around the world. It can not

be different in Tamil Nadu.

Mr. Varadhan further stated that " Many of them finding difficulty to come out of

OST and asking help for de-addiction or rehab but do we have these facilities "

This is statement may be correct, but imagine drug users with out OST. A drug

user with out OST will be shooting drugs, sharing injecting equipment and

infecting others or getting infected.

Drug users will be using drugs which are very hard to cope with withdrawals but

OST does not induce such with drawls as any other drug compared. This is the

least and the easiest drug to quit.

So there are more chances for drug users to quit drugs if I have to converse in

your terms. Now coming out of OST is very easy, there are no facilities as you

asked however there are tapering schedules, if the drug users insist. This is

much easier than you think, so its good news for you.

Mr. Varadhan stated that " A comprehensive care component with NSEP, OST,

DE-Addiction and long term rehabilitations has to mainstreamed "

This statement is contradicting, how will you mainstream harm reduction and

abstinence based rehabilitations. Both have different purposed to serve. If at

all it is main streamed, there will be conflicts on Goals and Objectives of each

component.

So first you have to come to an understanding of the objectives of each

component. Harm reduction is for reducing harm for the society and the drug

using community.

 

Abstinence based is entirely based on the morals of the society and the

willingness of the drug using individual. We can not give rehabilitation for all

drug users but we can give Needles and syringes for each and every drug user so

as the OST.

 

Mr. Varadhan stated that " Just for the sake for funding some of them showing the

paper work and getting the grant where does the funding goes? "

For this question no one can answer because no one knows where it goes.

It is very unfortunate that some of them show paper work. But I think the NACP3

is the solution for your question. Because as CBOs, no one can lie for them

selves.

 

Mr. Varadhan stated that Without experience in the field of addiction how they

are selected for the project? All community from drug user and ex user join hand

to give a voiceâ.

 

We are ready for joining hands for the community, sort these kind of issues. You

dint mention who? don't have experience in the field of addiction.

I don't know on the terms of addiction but there are many individuals very well

experienced and well versed with the drug users issues and drug use.

Thank you and regards,

D.Gasper,

President

(Hopers foundation)

67,Thiruvengadam Street

Perambur   Chennai-600011.

+919840119235

Dharmaraj Gasper

e-mail: <gussy1959@...>

[Guest guest]

Dear Forum,

Re: /message/9077

The mail from Mr.Gasper responded very well and also there are lot of mis

communication and miss concept in the content. For example in the recent

discussion with the peer group those who are in OST said that they are injecting

the tablets which is issued in drop in centre, the proof is few weeks back the

Perriamet police arrested few drug user, while arresting them they were having a

strip of " ADNOK " which is used by crushing it and mixing with water or avail and

then fixing to get the high. They say there is no Brown sugar available in

chennai.

This shows how in effective the monitoring system towards OST program,apart from

this some of the ex-user those are into alcohol and cannabis is also started OST

to just to get the high and show the numbers.

we are not against the NSEP & OST,but the linkages with de-addiction and long

term treatment facility's to be strengthened.

First of all harm reduction's goal is first step to total abstinence,then

de-addiction and rehabilitation is the second.

Chennai injection drug user's concern is to link the treatment process,OST +

NSEP + De-addiction + rehabilitation + CCC and then AA/NA/HIVA.

The statement given by Mr.gasper is not true as per CIN's experience.

There are lot of difference from north chennai and south chennai's using pattern

and also the drug used and mode of using, the current injection drug users are

very less as per our experience in the field then who is going to benefited is

it IDU or Alcoholic or the NGO or CBO?

Regards

Sasikumar & Thirumali

e-mail: <chennai_idun@...>

[Guest guest]

Dear FORUM,

 

Re: /message/9059

 

I am sorry if  this email might sound bad and you may find it attacking Mr.

Varadhan's posting.  Please do not take it that way. My apology if my email

hurts anybody's sentiment

I am sorry to say that Mr. Varadhan's view are narrow and largely based on his

personal and handful of people's expereince. He said that he is  an ex -drug

user but he  failed to recognise the needs of his fellow drug users who have

been benifitting from OST programs.

I dont know about Mr.Varadhan but i know so many people who have stopped

injecting, leading a more organised life, carrying that smile on their face as

they dont have to run around and do all sorts of crazy things to get drugs.

 

A drug user should know better than anyone what are the needs of other drug

users but you failed to do that. I know so many drug users, harm reduction

supporters, goverment officials who have been working really hard to sustain the

OST program in our country and your view is disrespeting their effort and the

good work of NACO and our goverment.

OST is also a vital component to achieve Universal access among drug use

population. Without OST a country drug use program is incomplete.

 

Mr. Varadhan said ''If you are going to take alcohol along with Opioid

Substitution Therapy (OST) with Buprenorphine & ART there is  adverse reaction

and the adherence towards the  treatment is lost due the addiction''-  What is

important is if people were not on OST they would be injecting, imagine someone

who is on alcohol and at the same injecting regularly, this increases unsafe

injection practices and leading to further HIV and Hepatitis infection.

Mr. Varadhan said''Also the OST program trend is to just to show the target

only. The primary problem is not addressed and care component like de-addiction

and rehabilitation is lacking''- Even if the OST project is about numbers if you

can get as many as injecting drug users and put them on OST you are stopping

many of them from injection and providing them the opportunity to discuss  about

their drug use issue. Is it good or bad?  For your information OST is one of the

care components for drug users.

 

Mr. Varadhan's statement ''in my experience an ex-IDU those are in alternate 

drugs like alcohol and  Marijuana are started OST''- You should thank NACO and

those NGOs for running OST programs otherwise those who have started OST after

using alocohol and Marijuana might have gone to Injection straight away and

getting infected with HIV and Hepatitis. How many are they who changed their

drugs of choice from alcohol or marijuana to OST? 1? 2? 3?. You should have done

some drug prevention awareness with them before they started OST.

Mr. Varadhan's  statement '' Many of them finding difficulty to come out of OST

and asking help for de-addiction or rehab but do we have these facilities''-

you demand for more rehab and de-addiction centres.

 

I agree with you, there is limited drug users freindly rehabs in the country.

Rehabs are expensive for many drug users. We should ask for more affordable and

user freindly rehabs run by drug users.

 

Mr. Varadhan said ''Just NSEP and OST alone is not going to help the current

user until they come of total abstinence even for people those are HIV and HEP

" C " .

 

No one says NSEP and OST are the only option, I agree other options such as

rehab should be provided if they are willing to come off totally. Here my advise

will be, in case in future if you happen to work in an OST program, be careful.

dont push them hard to stop OST and try to send them to rehab as soon as they

get into OST program, they might go back to injection.

For majority of drug users rehab is not an option for them during the earlier

period of their OST program.

 

These are some of my thoughts which came to my head when i was reading your

email. And finally if you agree that NA/AA thing ''addiction is a disease

or whatever'' then you should also agree OST is a medicine to treat that

disease.

Regards

 

 

Potsangbam

e-mail: <steven.potsangbam@...>