The Punjab Healthcare Commission’s drive against quackery has dealt a sharp blow to the fake drug rehabilitation centers. It is one thing to dispense a treatment laced with spurious healing method, and another to turn the treatment centers into a criminal’s den. Most of the drug rehabilitation centers in Punjab, raided and sealed by the PHC, were involved from giving wrong treatment to providing a safe haven to criminals escaping imprisonment for petty crimes. Since the Supreme Court’s decision to give the PHC a lead role in the drive against quackery, out of 86 the commission has sealed 41 Addiction Treatment Centers across Punjab. Around 1017 Patients are evacuated from these ATCs and a total fine of 11 million have been imposed.

A multitude of rehabilitation centers have been operative in Punjab treating people afflicted with drug abuse, psychiatric disorders and alcohol addiction. The treatment in these centers is packaged in different offerings depending on the fees the patient’s guardian or relatives afford to pay. A range of packages from Rs1,000 to Rs10,000 is available. It entirely depends upon the facilities the guardian of the patients wants to avail.

According to the United Nation’s report of drug addiction in Pakistan, released in 2013, there had been 7.6 million drug addicts, out of which 78 per cent were men and 22 per cent were women. The report also revealed that the drug addicts grew at the rate of 40,000, a year. Heroin users were the fastest-growing addicts with the average age of heroin users falling below 24. In 2013, the number of drug users in Balochistan was 280,000. Due to its large share of the population, Punjab has the highest number of drug users. Approximately 2.9 million people used illicit substances in 2013, and approximately 260,000 people injected drugs.

The number of injection drug users has sharply increased in recent years. In 2007, Pakistan had an estimated 90,000 injecting drug users, but the number had risen to around 500,000 by 2014. This increase has also been accompanied by an increase in HIV positive cases. According to the latest research, in 2005 about 11 percent of Pakistani drug users were HIV positive. That number had risen to 40 percent in 2011.

The sheer number of drug addicts is evidence that society is not concerned as to why such a large number of its people had taken to drugs. Society’s apathy reflects also in the poor and inadequate treatment centers operating in the country. With the government response always poor, the private sector has been either too expensive or practicing spurious method of treatment to con the poor patients. According to the UN report 64 per cent of the respondents reported difficulties getting treatment. Stunningly enough, almost 80 per cent people could not afford treatment for drug addiction.

According to the PHC observation collected during several raids, almost in all of the rehabilitation centers patients were kept in sub-human conditions. The centers were overcrowded. Because of the inadequate number of beds and unauthorized doctors patients were accommodated on the floor. Unscientific methods were used to treat addicts leading to more complications. The overall picture that emerges after seeing these rehabilitation centers is that of a ‘Detention center.’ Another dark side of these centers is their usage as criminal dens. Criminals escaping police had been found hiding in these centers. Families could also get an ‘unwanted,’ member admitted in these centers either as a drug addict or as psychotic.

The PHC survey also revealed that no screening was done at the time of the admission of the patients at the centers. Torture is a routine method of behavior management applied to handle difficult patients. As per Punjab Mental Health Act 2014, drug addiction treatment cannot be held without the consent of the patient. On the ground, this rule is ignored and addicts are admitted against their will, and just on the request of the family members or guardians. In the absence of infection control program, prevalence rate of contagious diseases such as HIV and hepatitis is comparatively high in these centers. The law dictates that withdrawal should be carried out under the supervision of a qualified doctor. However, these rehabilitation centers neither have full-time doctors nor properly trained paramedic staff for that. The worst agony inflicted on the patients is that they are not allowed to meet their relatives or guardians. This phenomenon of no contact with the outside world plays havoc with the mental health of the patients---creating more disconnect between them and the real world. After every raid the PHC assess the mental health of the patients. In 90 per cent of the cases the patients were found fine and ready to go home. The rest of the patients are sent to different psychiatric facilities.

The discussion above is a synthesis of indifference and apathy of both the government and society. The culture of impunity has given rise to illegal practices in every institution, making quality the first casualty in the process. The drug rehabilitation centers are no exception. It is to fill this vacuum that the PHC is developing Minimum Service Delivery Standards so that quality could be improved through a gradual process.

The author is a columnist based in Lahore.
Durdananajam
1@gmail.com

The sheer number of drug addicts is evidence that society is not concerned as to why such a large number of its people had taken to drugs.