‘Buprenorphine most successful medicine. Can be used for years without side-effects’

Dr PD Garg, professor of psychiatry at Government Medical College, Amritsar, and director of Swami Vivekanand De-addiction & Rehabilitation Centre at Amritsar, tells Sanjeev Verma about treatment plans for drug addict jail inmates and how OOAT centres in jails are helping treat addiction
How many jails of Punjab have the Outpatient Opioid Assisted Treatment (OOAT) centres till date and what has the response been like?
Eight out of nine central jails in Punjab have been covered under OOAT programme.The OOAT programme is yet to be implemented in Hoshiarpur central jail. Last year, we also conducted a sensitization workshop at Kapurthala for all the jail superintendents and deputy jail superintendents of central jails. After that, we observed that the jail staff showed positive change in their minds about the issue and they started cooperating with us. Initially, there was resistance over starting the OOAT programme in jails. Therefore, this OOAT programme was initially started from government hospitals of Amritsar, Tarn Taran and Moga.
How many prisoners are getting treated for drug de-addiction in Amritsar central jail? What is the total number of inmates in various jails of Punjab taking drug deaddiction treatment?
In Amritsar central jail, the OOAT centre was started on May 18, 2018, along with some other central jails. As of now, we have around 1,500 jail inmates in Amritsar central jail who are undergoing deaddiction treatment. Out of these, six are female inmates. As of now, over 4,200 jail inmates are getting treatment in eight central jails.
Is there a provision to conduct urine or blood tests for checking drug dependence of the accused when he or she is brought to the jail for the first time?
Yes, there is a set procedure. We judge the drug dependence clinically. There are many clear-cut cases where there are visible injection marks on the arms of new jail inmates. These are the clear-cut cases of intravenous drug users. Otherwise too, jail inmates reveal this themselves as they know that there is availability of Buprenorphine, an opioid medication that treats addiction while preventing withdrawal symptoms.
How can a drug addict jail inmate, lodged in a jail where there is no facility of OOAT centre, get medical treatment?
Such drug dependent prisoners are shifted for treatment to the nearest central jail having this facility. Earlier, medicines like Tramadol were available with jail doctors in almost all the jails. These doctors used to provide these medicines to drug dependent prisoners. Jail doctors were also trained three years back and they were also provided urine testing kits. But the OOAT programme of Buprenorphine is more successful as the patient does not have craving for drugs after taking Buprenorphine and this medicine is available in almost all jails.
How much time does it take for a drug addict to get treated or to get out of the medical treatment after coming back to normal routine?
Our line of thought is there is no harm in taking Buprenorphine for years. I can do a survey on this. It is a very safe medicine which can be used for a very long time. There is no side-effect. The latest concept is that a patient is safe till he continues taking Buprenorphine and is out of heroin. Although the recommended period is two years, the Punjab government has decided in its standard operating procedure that Buprenorphine can be stopped after one year if the patient feels so and the doctor also finds that the patient has recovered, and his urine is repeatedly negative for drugs.
Those who quit early generally relapse and start taking heroin again because internally their drug habit has not completely vanished. Many come back again to us for treatment after taking heroin for two or three months.
Has it also come to your notice from interaction with jail inmates that drugs, especially heroin, is available to those jail inmates who can pay the price?
Earlier jails were infamous for easy availability of drugs inside. But such cases have come down drastically. All drug addicts say they cannot live without heroin and it is available in jails. There are many hardcore criminals who openly say that drugs are available inside jails. But in normal cases, when the drug addict jail inmate starts getting Buprenorphine, they do not feel need to have heroin. It is very difficult to completely do away with drugs. It is a social disorder.