An Avoidable Tragedy: Ending Overdose Deaths

20160626_122515_resizedThe author of this post, Francis Joseph, is the Programme Manager of the Nirantar project at India HIV/AIDS Alliance in New Delhi. He is also a member of the Indian Drug Users’ Forum.  http://www.allianceindia.org/avoidable-tragedy-ending-overdose-deaths/ 

The Delhi Police van took the defendants back to Tihar Prison after their hearing. Ramesh (name changed to protect identity) was happy at the thought that he would soon be able to reunite with his wife and meet his two-year-old son for the first time. He had spent the past two years in jail. During the judgement, the Metropolitan Magistrate acquitted him of the criminal charges against him. He had been arrested on fabricated charges of a petty crime, but due to his criminal record and history of drug use, his detention had been extended for two years due to trial delays.

As soon as Ramesh was released, he boarded the local bus and excitedly started his journey. When his station came, he got off the bus and headed home. The walk was long, and Ramesh started reminiscing about his drug use days when he would get high. Remembering made him crave “just one fix.” He met his old friend Samir who had been anxiously awaiting his return. He hugged Ramesh and said, “It’s been ages since we had a high together. I have the best stuff.” Ramesh was unable to resist and decided to take a quick hit before finally heading home. Samir took him to a nearby half-constructed building and took out his paraphernalia. Ramesh lit a beedi (cigarette) and watched him prepare the dose. Samir prepared a 5 ml dose for Ramesh and injected him. Ramesh could feel the rush of warm chemicals moving in his veins and could feel his eyes closing as he disappeared into darkness.

Samir was horrified when he realized Ramesh’s unresponsive condition and tried all possible ways to wake him up. Samir ran for help and got his parents who took Ramesh to a nearby private doctor. The doctor gave him a medication by saline drip in the hope that it would help him regain consciousness. After six hours, the outcome was clear. Ramesh was dead. He died from an overdose that night without meeting his newborn baby or seeing his wife and the rest of his family. I remember Ramesh so clearly. He had been my drug-using partner, and we were friends for many years.

There are many Rameshs – in Delhi and across India – who die from injecting greater doses of opioids than required in an attempt to get high. Added with other sedatives and cocktails of depressants, they often experience overdoses that go unnoticed by the users themselves and by others around them. Often their deaths are attributed to other factors like HIV infection and malnutrition. A newspaper article reports that nine recent homeless deaths in Delhi were likely due to addiction. People who inject drugs (PWID) all too often die unexplained deaths, and these numbers are increasing. In 2005, the number of unidentified PWID deaths in Delhi was 2,202. By last year, this figure had risen to 3,285.

Overdose is an urgent condition that requires immediate intervention. A simple 1ml injection of Naloxone is a life-saver. It is not at all costly, and the WHO has included it on its list of essential medicines. Overdose deaths are all too common and avoidable. Naloxone is a game-changer. All healthcare facilities should have this drug ready and available.

31st August is International Overdose Awareness Day, so it is especially timely to raise these issues. Let this be a wake-up call to government to end inaction and scale up evidence-based and cost-effective interventions like naloxone that can reduce overdose deaths among PWID. People from drug-using backgrounds are assets to these efforts and should be actively engaged as implementation partners in awareness raising, dissemination of information, and ensuring the availability of naloxone free-of-cost to PWID in need.

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Support rights-centric programs for drug use: Vienna Commission on Narcotic Drugs

G. Charanjit Sharma was selected to represent India as a civil society speaker at the Commission on Narcotic Drugs (CND) on the world drug problem, which took place on 10-11 October 2016 at the United Nations Office at Vienna, Austria. (http://www.allianceindia.org/support-rights-centric-programs-drug-use-vienna-commission-narcotic-drugs/). He presented the following remarks: 

My name is Charanjit Sharma and I work with the India HIV/AIDS Alliance, an organisation that implements programs for people who inject drugs, their partners and families. I am also privileged to be a part of the global Harm Reduction movement of the International HIV/AIDS Alliance and its consortium partners, the Asian Network of People who Use Drugs (ANPUD) and the Indian Drug Users Forum (IDUF).

From my experience with a range of drugs and drug related programs, access to and quality of harm reduction services still continue to be a challenge. Interventions such as needle syringe programs and opioid substitution are yet to be implemented to the scale required in many countries. While TB and Hepatitis C are major health problems among PWID and have resulted in the deaths of many of our friends, most national programs for TB, Hepatitis and HIV continue to function in silos. Overdose remains a major threat among PWID because of barriers in access to life-saving drugs like Nalaxone.

Therefore, as part of larger network of NGOs, we wish to call upon member states to earnestly consider the operational recommendations on prevention and treatment for HIV and drug use programming. The comprehensive package recommended by WHO and other UN bodies is evidence-based and rights-sensitive.

Harm Reduction interventions when implemented to scale, have been seen to effectively address the risks associated with drug use and HIV especially in concentrated epidemics. Member states need to ensure integration of HIV, HCV and TB services with other health and social protection services for people who use drugs.

We recommend the development of innovative service delivery mechanisms especially for hard-to-reach populations, women and those incarcerated.

We urge member states to consider incorporating SRH services, family support interventions and livelihood development to improve the quality of life for PWID and their families. We understand that a multi-sector approach requires considerable commitment and investment on the part of local governments.

We call upon governments to continue to take the lead, in partnership with civil society and community organisations to meet the goal of ‘Ending AIDS as a public health threat’.

We appeal to member states to end criminalization of PUD; eliminate the death penalty for offenses and ensure proportionate sentencing. We advocate for the closure of all compulsory and forced treatment centers and scale up voluntary community-based drug treatment programs that respond best to the needs of PUD.

In keeping with the spirit of meaningful involvement of PUD, we call for the establishment of community committees at local and national levels. We believe that this will enhance the quality of harm reduction programs in design and implementation.

In conclusion, I take this opportunity to appeal to all member states to adopt a non-punitive approach and appreciate the many governments that continue to support evidence-based and rights-centric programs for drug use and HIV.

Thank you.