Muktsar, Punjab: With a single storey and a tiny entry gate, Kiran Hospital and De-Addiction Centre* looks unassuming on the outside. However, upon entry, one notices multiple rooms; one for the resident doctor/psychologist, one for visiting doctors, and two for counsellors.
The hospital has a large waiting area for patients and relatives and even has private rooms and an ICU for admitted patients. The waiting area is seemingly indistinguishable from other local hospitals, with its white tile flooring and uncomfortable iron chairs. However, what differentiates Kiran Hospital from others are the posters on its walls, with slogans such as “Say No to Drugs” or “No More Drugs”.
The patients and relatives in the waiting area are primarily male, belonging to no particular age group. There are many older men with greying beards, seemingly in their late 60’s and 70’s.
Ajit Singh, a 65-year-old labourer, from the village Chak Giddewala, in district Muktsar in south-west Punjab, is one of these patients. Singh first took afeem (opium) at age 15, after observing his father, who regularly ate some opium, to calm his nerves, and continue working. At age 65 now, Singh has been regularly consuming opium in some form or other for the past 40 years. When he started afeem, it cost a mere 5 rupees per tola (about 10 grams). Today, a tola costs over 2000 rupees; this increase in price is a reflection of inflation and more significantly, a decrease in the supply of opium.
While the possession and consumption of opium have technically been illegal since British times, Punjabis have been consuming it for generations. It is common for family elders to eat a tiny amount of afeem if they are experiencing anxiety or sleep issues. Additionally, afeem features in multiple poems and songs written by renowned late Punjabi artists such as Bulleh Shah. A verse from Shah’s poem ‘Bulleya Ki Jaana Main Kaun’ is as follows:
Bulleya Ki Jaana Main Kaun (I know not who I am)
“Na main andar ved kitaabaan
Na vich bhangaan, na sharaabaan
Na vich rindaan masat kharaabaan
Na vich jaagan na vich saun”
(Not in the holy Vedas, am I
Nor in opium, neither in wine
Not in the drunkard’s intoxicated craze
Neither awake, nor in a sleeping daze)
In the above poem, Shah reflects on identity and selfhood and says that his inner self is bigger than who he is under the influence of alcohol or opium. Evidently, opium consumption has been normalised as a part of Punjabi life for a long time now. However, since the early 2000s, the price of opium has risen significantly, and it has become increasingly difficult to obtain, as the government of Punjab has been aggressively clamping down on its supply.
“Actually afeem and post (also a form of opium) are not available these days. Even if they were expensive, it would’ve been okay, but they are not even available. Earlier, we would go to Rajasthan to buy afeem, but now even those thekas have closed down,” said Ajit Singh, while referring to the 2015 Rajasthan High Court ruling which ordered the closing of stores selling afeem and post in the neighbouring state.
Due to the lack of availability of affordable afeem and post, Singh, like many other opioid-dependent individuals, now visit de-addiction centres like Kiran Hospital to obtain their weekly dosage of Buprenorphine tablet; the WHO recommended drug used to treat opioid dependency through Opioid Substitution Therapy or OST.
Singh is careful with his dosage; he takes 2 tablets daily, one after breakfast and the second at 2 pm. He adds, “I work very hard, in the field and at home. My arms and legs start to hurt which is why I started opium. When I take it, I feel energised and reassured. That’s why I take these tablets. I need the energy.”
While older folks like Ajit Singh took relatively less potent drugs like afeem or post, 76% of opioid-dependent individuals in Punjab belong to the 18-35-year-old age group and are dependent primarily on the more toxic heroin. Singh knows one such boy in his community. He said, “In my village, there is a boy who took smack (slang for heroin) and completely shrank in size. Despite coming from a well-off family, he even started stealing to fund his dependency. Right now he is admitted to a hospital in Ganganagar and they are trying to treat him.”
According to Singh, young boys become dependent when they try out drugs by looking at each other or their elders. Although their elders had post and afeem, due to their lack of availability, these boys are instead turning to more serious drugs like heroin and becoming dependent on them.
Singh believes that the solution is for the government to ease stringent rules and allow for the recreational or medicinal usage of afeem. He says, “At least afeem and post won’t kill you. The government should relax its rules. We have been having these drugs for generations. Or maybe they can make some kind of a permit. We are now 60-70 years old and it’s so difficult for me to come to this centre weekly. I am going to die soon anyway, at least let me die comfortably.”