I am Prashant Sharma, a drug user, a social worker and an activist. I am also a former board member of Indian Drug Users’ Forum, a forum which is the voice of drug users’ across India and the forum promotes and advocate for the meaningful involvement of the people who use drugs in all level of program and policy development. At present I am a Coordinator of Sikkim Drug Users’ Forum and we are working in all the four districts of Sikkim for the health and rights of the people who uses drugs.
Since 2005 I have been working in the field of harm reduction, “Harm Reduction is a practical approach and ideas to reduce the harm being caused by the drugs and also a movement for social justice that builds in, belief in, and respect for, the rights of the people who use drugs”. As an activist and a drug user, my prime focus is to fight for the health and the rights of the people who use drugs, and also change the narrative which is built upon on drugs use and drug users in society, which are completely baseless that drug users are criminal, bad people, monsters etc. The truth is, drug users are as normal as anybody but due to the punitive drug laws and drug policies and the baseless narrative on drug use, drug users has been made as criminals, bad people and monsters.
For example, today in our society if something bad incidents like (fights, vandalism, accident, robbery or any small petty crimes) happen or occur in some corners, most of the people without any proper information or idea will presume that it must have been done by some drug users, this is because of wrong narrative or wrong information that has been passed on to the people on drug use and drug users for many years, nevertheless it can be completely the opposite also. My point is, such act can be committed by anyone but due to the wrong narrative of drug users, it has made people to think that way.
I along with my colleague have been demanding and advocating the State and Central Government for Hep C and Hep B test and treatment since last four years, but the State Government nor the Central Government took the matter very seriously until many lost their lives due to Hep B and Hep C that India committed to eliminate viral Hepatitis by 2030 and thus Ministry of Health launched the National Viral Hepatitis control Program on 28th July 2018 however till date the implementation of the program have not reached the people.
Today the drug laws has been implemented and brought into the society and this is what has happened since then;
1. Drug users are unnecessarily criminalized, incarcerated, harassed and punished just because they chose to use drugs.
2. Many families have lost their loved ones and dear ones due to overdose wherein their lives could have been saved.
3. Due to the criminalization, drug users could not have access to health services and many are now living with HIV, TB, Hep C and dying from these diseases.
4. Prevents drug users for seeking support.
5. Prevents drug users from education or terminates drug users from education.
6. Fear of arrest drives drug users underground, away for life saving services.
7. Prevents drug users from employment or terminates drug users from jobs.
8. Destroys young people’s lives with criminal records.
9. Encourages small street crimes.
10. Prevents Effective drug education on prevention, treatment and care.
Sikkim Drug Users’ Forum (SDUF) was formed in 13th Dec 2015 and got it registered in 2019. It took us nearly three to four years to get it registered. One can understand or perceive the denial and reluctance from the government officials to get it registered. However, we pursued with grit and finally we got it done. I am also a part of Hepatitis Coalition of the Sikkim (HepCoS) that was also formed in the year 2015. The main objectives of the organisation is to fight or demand for the health and rights of the people who uses drugs in every level, if I am to elaborate what are the health and rights of the people who uses drugs, they are;
1. To enable and empower people who uses drugs legally or deemed illegal to survive, thrive and exert our voices to have meaningful inputs in all decisions that ultimately affect our lives.
2. To enhance a better understanding of the experiences of people who uses drugs, and particularly of the destructive impact of current drug policies and drug law affecting drug users, as well as our non-using fellow-citizens.
3. To use our own experience, skills and knowledge to train and educate others, particularly our peers and fellow-citizens concerned with drug dependency, HIV/AIDS, Viral Hepatitis and TB in the community.
4. To advocate for access to all the tools available to reduce the harm that people who uses drugs, face in their day-to-day lives, including, Drug Treatment, appropriate medical care for substance dependency.
5. To establish our right on evidence-based and objective information about drugs, and how to protect ourselves against the potential negative impact of drug use and advocate for a comprehensive health and social services, safe, affordable, supportive avenues for livelihood opportunities
6. To scale up access to treatment and care for drug users’, alcoholics, people living with HIV/AIDS, Viral Hepatitis and TB.
7. To identify and advocate major stakeholders and allies to support, HIV/Viral Hepatitis/TB/Drug Dependency programs and protects the rights of drug users.
8. To provide better health services by extending care to drug users and its related disease like HIV/AIDS/Viral Hepatitis/TB etc.
9. To lobby for government legislative and commitment to protect the rights of drug users, alcoholic, and people living with HIV/AIDS (PLWHA), TB and viral Hepatitis.
10. To work in close collaborations with the state and national agencies interested in promoting the cause and welfare of drug users, alcoholics, PLWHA/Viral Hepatitis/TB.
11. To provide support, strengthen, and establish to establish local (DLNs) in the state and Network with regional, national, and international networks by ensuring active participation of drug users at every level of decision-making.
12. To create awareness among the people regarding the damage caused by using drugs and alcohol, the after- effect of dependency and alcoholism and drug dependency related problems.
13. To promote social acceptance and provide opportunities of networking to the drug users
14. To promote social acceptance of the drug users and to end social stigma and discrimination.
I always believe that as a responsible citizen I have a moral responsibility to work for my peers and fellow citizens. Today in my state (Sikkim), we lack strong civil society and that is one of the reasons why we formed the organization that will work as a civil society. I along with my colleagues have been demanding and advocating for Hep C &Hep B test and treatment, robust TB program, scaling up harm reduction program, decriminalization of drug use, drug law reform and other preventative measure to protect lives. However the system (Government) is very slow and not progressive. At times it is very hard for us as activist to demand or advocate the system (Government) which works like sloth, unnecessary bureaucracy and also insensitive towards the issues that we are advocating for. However when we see our peers and fellow citizen dying and suffering because of the negligence and denial from the service provider, poor system or poor mechanism, it made us realize that we need to do something to make people or the system (Government) accountable for their actions.
Activists are seen as threat or assume that we are against the government or person responsible for specific task. I would like to clear the blurred clouds notion that we are not against anyone but we are here to play the very important role as a responsible citizen of the society. We are the fifth pillar of the society building.
I always remember the words of Martin Luther King Jr. that “the SILENCE of good people is more dangerous than the brutality of bad people”.
You have talked about the prevailing high suicidal rate among the MDRTB patients and others in the state. In your opinion, what measures need to be done?
On one hand the government encourages to produce more babies by promising to provide some financial benefits, but on the other hand, people are committing suicide and the government has not taken up suicide as a serious threat and does nothing about it.
Sikkim has the highest number of MDRTB cases and many of the MDRTB patients are committing suicide. Those who are still surviving could be saved if there is a proper implementation of the program, however due to lack of developing better program, it is failing to save lives. As the State Government has committed to end TB by 2022 and Centre by 2025, let us be positive that many will get assistance.
Health is never given a priority by the State Government or the Central Government and high suicide rate is obvious. In my state, no investment (R&D) has been made so far to study the cause of the suicide and has not developed any program to prevent it. A program needs to be developed so as to help people from committing suicide.
For example, MDRTB patients need more care and support, young lives need more tolerant and compassionate family, teachers, friends and society, any kind of services or benefits to reach to the people but not the people to reach for the services/benefits, equality and equity in every section of the society, building better support system to the marginalized community, building better living condition and prioritizing mental health aspects. These are few examples that can be seen from the surface level, but there may be more rooted issues attached to the suicide. To establish robust and effective intervention through political will, committed health workers and necessary funding is essential.
There are few steps that the Government can take up;
1. Invest in research and development (R&D) to develop and design program.
2. Consult/Engage people who have survived from suicide, to develop suicide prevention plan and program,
3. Training for service provider on suicide prevention,
4. Awareness generation program, developing IEC,
5. Follow-up and reporting mechanism to establish evidence based services or redesigning program.
The tempo of depression, drug and alcohol use rate among the youth is highly alarming. According to you, what preventive measures need to be undertaken?
Mental health is one of the biggest issue among the youngsters today. Though we have the mental health act in place and services but the program needs to be re-designed in the context of Sikkim state specifically. Socio economic and political atmosphere is different in each and every state, so also is Sikkim. Therefore each and every state needs to have a specific program in mental health, especially among the youths depending on the scenario.
When we say depression according to today’s way of life, it is more challenging. The rhythm of life has changed from values to materialistic world. We have cellphone to connect however this has made us more apart physically, we have Facebook, Intstagram, but we all are living in a virtual world, we have huge list of friends but how many of them can be counted in times of need, these are the realities of our life.
Today we do not have a personal space to connect with each other, whereas there was a time when the whole society used to be one family, but everything has changed. Today youths live in a society where one is valued for what he or she has, rather than what he or she is.
When it comes to mental health or depression, we tend to assume that it is related to drugs or alcohol but it is much beyond that. Depression can happen to anyone, anytime or at any stage. It is very much associated with disrupted relationships with partners, family and peers and also it is very much linked to unemployment, workload, social isolation, dysfunctional families etc. Depression can trigger any moment and can be lethal in the later stage if it is not addressed on time. Such experience can result in suicide, drugs, alcohol abuse, over eating, gambling, violence etc.
If we view Sikkim from remote, it may appear as one of the best state in India in terms of social, economic or politically, but if you have a deeper look, it is completely the opposite. Sikkim has the highest suicide rates, highest MDRTB cases, highest number of drugs and alcohol users, huge unemployment rates etc. How come the best state has all these big problems?
Challenges as an activist
Though I am not a physician or a psychiatrist or any expert, but as a health worker or activist, I can suggest the same steps which I have suggested earlier so as to tackle depression by the government.
When I see or experience that our health and rights are being denied or overlooked by the government, it really challenges me. Every day there is something or the other that I hear, like doctor denying to conduct operation of the patients just because he or she has Hep C virus, TB patients who committed suicide, TB patients being neglected, drug users running around the court for more than a year, drug users unnecessarily criminalized, high fees charged by the Pvt. Diagnostic Lab for testing, unnecessary bureaucracy in the government, and when I see people dying just because they could not reach the health services because of stigma and discrimination and poor health services.
We are already running projects supported by India HIV/AIDS alliance to strengthen the drug users forum. Formation of the district level drug users’ forum and goals of the project is to increase uptake of harm reduction services, building organizational capacity and advocacy. Another project is that we will receive from International network of people who use drugs (INPUD) by Dec 2019 and the goal is to build organizational financial management.
The current plan is to file PIL to the Sikkim state health department on the TB implementation program in the state, formation of district level drug users forum, organizing training on Organizational development and advocacy, organizing training on Organizational financial management, organizing state level consultation on drug law and policy, and organizing state level consultation on minimum standard of drug treatment center.
Message to the readers and youths of Northeast
Since our work is more focused on the health and rights of the people who use drugs, my message to the readers and youth is “drug use is a health issue not a criminal issue”. I agree that drugs have destroyed many lives, but bad drug laws have destroyed many more. It has been many decades that punitive law has been enforced upon drug users and it has completely failed. It is time for human rights and evidence base, scientific and holistic approach can encourage people to seek help.
I want the people who read this article to understand that drug use is not a moral issues or criminal issue. It is mistaken to assume that only bad people uses drugs, good people use drugs too. Drugs use has been polarized so much that politician contest and win elections on drug and alcohol issues. What happens after the election? Nothing happens, except the black market, criminalization, deaths and diseases. Drug free society is just an illusion and it is time to build laws and policies that will protect lives and do away with dirty politics.
Take the example of Portugal in the year 2000, one percent of the population was dependent on the drugs and had a high number of HIV and HCV and unemployment in the country and the then UN General Secretary was the President of the Portugal. He called for a meeting and asked to build a law policy that will decrease the drug use and HIV and HCV and unemployment. They introduced the policy which decriminalized the drug use and possession, built a drug treatment program, employment schemes, loans on small scale industries etc. After few years they found fifty percent reduction in drug use, infection rate of HIV and HCV drastically went down and people started working. Why can’t the policy maker apply the same in our state or nation to see the same changes through right policy?
My colleagues and I, with pure intention, is to build a society or a community where everyone can feel safe, happy and healthy and this needs to come from every level, individual, political and society.
Mr. Johann Hari, a researcher has correctly said “opposite of addiction is not sobriety; opposite of addiction is connection/Bonding”.