[dropcap]I[/dropcap]t is often said that a man’s life catches up with him.
This is also true when applied to the collective consciousness of a community that fails to recognise and address the malaise within its contours. When it comes to the issue of drug abuse in Nagaland, yes, the people in the state are paying for a ‘malaise’ it failed to respond to.
Four years after introducing its first viral hepatitis resolution, the World Health Assembly (WHA) the decision-making body of the World Health OTrganization (WHO)—today passed the Hepatitis Resolution, which commits the WHO and United Nations (UN) member states to urgent action to address the global hepatitis pandemic, including that of hepatitis C virus (HCV).
This should come as a shot in the arm for Hepatitis victims in the state of Nagaland with a very high prevalence of Hepatitis victims.
The problem is not just the inherited disease but in the absence of a State Drug Policy the situation has not been monitored nor addressed with the compassion and practical approach it deserves.Hepatitis C is highest amongst long term drug users and HIV patients. Both the affected groups are vulnerable in the state with a history of drug abuse dating back to the 1980’s.So much so that In the 1990’s Nagaland slipped into the dark statistics of topping the list as the state with the highest numbers of Intravenous Drug Users in the country.
One will recall the high death rates in the state which were passed off or rather explained as liver cirrhosis and liver malaise of all kinds … what is now suspected is that these were indeed untreated Hepatitis- C related deaths. No wonder then that the virus is referred to as the “silent killer”
Initiation to Drug abuse / HIV was documented in the State of Nagaland through the investigative research conducted by the Indian Council for Medical Research (ICMR) in 1990. Reports of an estimate of about 5000 Injecting Drug Users through a study by the ICMR and an overall HIV prevalence of 50% among them was a wake -up call.
The Sentinel Surveillance data shows that the HIV among Injecting Drug Users (IDUs) has overall declined from 39% in 1994 to less than 5% in 2009.
The significant reduction in the use of substance abuse has been largely due to the intervention by NGOs the church and most importantly the role played by reformed drug users. It is estimated that currently there are about 25,000-28,000 IDUs in Nagaland. Concentration of drugs are scattered evenly all over the state. However, large number of drugs users can be found along the bordering areas (State Borders as well as in an international borders
According to the President of KRIPA Foundation Abou Mere, who is also Advisor and Acting President of Nagaland Drug Users Network , there are worrying developments of the high prevalence of Hepatitus -C amongst the long term drug users and HIV patients.
The Naga Hospital Authority Kohima (NHAK),seven year report (2006-2012) shows 1.8 prevalence of Hepatitis-C Virus (HCV) among the general population in the state( i.e. for every 100 persons in the general public 1.8 were found infected with HCV).
KRIPA Foundation IDUs referral to Naga Hospital Kohima Authority (NHAK) indicated 27% amongst 98 IDUs, in other words out of 97 intravenous drug users , twenty seven were found to be infected with HCV.
Globally, an estimated 185 million people are infected with HCV.
Since 2010, more than a million of them have died from HCV-related liver disease, although hepatitis C is treatable and curable. Since 2010, 9-12 million people have become infected with hepatitis C, although it is preventable. In addition, in an increasing number of countries, liver disease caused by HCV has become the leading cause of non-AIDS-related death in people co-infected with HIV/HCV.
The resolution comes at a critical moment, as new drugs to treat HCV are hepatitis C virus (HCV) entering the market. These new drugs, called direct-acting antivirals (DAAs), demonstrate cure rates of more than 90 percent in clinical trials and provide radically simpler treatment.
DAAs offer the unprecedented promise of global HCV eradication, especially in low- and middle-income countries (LMICs), where 85 percent of people with HCV live.
The World Health Assembly resolution will help regulate the cost of the direct-acting antivirals (DAAs) that can cost as much as US$140,000 for a 12 week combination regimen while costing less than US$250 to produce.
Little wonder then that during the resolution proceedings, dozens of countries, including Malaysia, Ukraine, South Africa, Venezuela, and France remarked on the prohibitive cost of new HCV treatments.
In India the antivirals can cost anything between Rs 5050 to Rs 17,000 per vial, depending on the geno type of the virus. There are six geno types from I-VI and these require treatment from 24 weeks upto 48 weeks. In Nagaland it is reported that the geno type I and III are the more common. Geno type I requires 48 weeks of treatment and even if it were to cost Rs 5050 per vial the total is an astronomical cost of Rs2,42,400/- clearly a figure out of the reach of most of the population and certainly the section of people afflicted with the virus.
For the last two years the state has been attempting to develop a State Drug Policy. It has recently formed a committee to develop the “Nagaland State Drugs Abuse Preventive Policy” and its decisions are awaited.
The need for a policy will streamline facilities drug abuse related problems which the government is duty bound to provide to keep the population healthy.
All eleven district hospitals in the state require proper Rehabilitation /Treatment Centres. Only two district hospitals maintain a semblance of de-addiction centres such as the one in the Civil Hospital Dimapur and the Naga Hospital in Kohima.
Moreover all the five rehan centres run by NGOs are in the urban centres in Kohima and Dimapur.
With a shortfall of over 200 doctors in the state there are not enough medical specialists to man the rehab centres across the state and the district hospitals which are all manned with a Medical Superintendent can best look after the efficient functioning of the District De-tox Centres.
The state is also facing an acute shortage of experienced psychiatrists.
The need for one becomes more of a necessary than a luxury once the substance abuse users are introduced to the “opiate substitution therapy”, when they most vulnerable and require motivation to assist them to contribute to society.
