The sudden demise of Bollywood star Sushant Singh Rajput (SSR) on June 14, 2020, by suicide once again raised the issue of mental health in the national debate. However, soon after, the discussion shifted from mental health to unreasoned stories and innuendo of black magic, and a manipulative girlfriend who allegedly dragged the actor into drugs that eventually lead to his suicide. Nearly two and half months after the actor’s death, Narcotics Control Bureau of India arrested Rhea Chakraborty (girlfriend of the late actor at the time of his death) for consuming marijuana and procuring the same for Sushant.
Almost a week before her arrest, Rhea confessed in an interview that Sushant was suffering from depression and periodically dependent on drugs. During that period, Sushant had also consulted many psychologists regarding his mental illness and was very anxious about his mental health issues getting public. Amid all speculative groundless stories buzzing on national TV, Sushant’s therapist came forward and confirmed the late actor’s diagnosis of mental illness and his struggle to get over it.
Sushant’s battle with depression is not idiosyncratic. Some individuals suffering from mental illnesses experience the same pattern. Rhea’s arrest by the NCB was debated across the country and divided people into two groups — one favouring and the other opposing her arrest. The truth is yet to be unfolded, but this debate has brought two issues on the discussion table — mental health and drug use.
The way these two issues are being reported in the media in the context of Rhea’s arrest reflects the mass perception towards mental health, drugs and drug users. These two patterns of drug use and mental illness are highly likely to co-exist together; there is a varying level of sympathy associated with victims of both.
Other than Sushant, millions of people every year die by suicide in India. In 2018, India reported 1,34,516 suicide deaths. From 2004 to 2013, 25,000 people killed themselves due to drug abuse. These statistics highlight the pressing problem of mental health among drug users that needs drug regulatory legal reforms in India.
In the wake of the Mental Health Act of 2018 of India aims to ensure a supportive and stigma-free climate for people battling with mental illnesses. At this point, it is essential to identify groups that are at a more vulnerable position to experience mental illnesses. Drug users and addicts are one group who need care, support and sometimes, medical treatment, preferably being subjected to legal justice trial.
This piece of writing argues decriminalisation of drug consumption and possession (for personal use) to meet the mental health needs of drug users and addicts. Decriminalisation would minimise the social exclusion of drug users/addicts and build a supportive environment to seek medical help. For a country committed to mental health, it is high time to re-think how to approach drug users and addicts as ‘criminal(s)’ or ‘victim(s)’.
It is important to clarify here that not all people who are facing mental illnesses are necessarily drug users. There is another side to this as well: people who use drugs for recreational purposes do not necessarily suffer from a mental illness. A mental illness can occur to anybody without any history of substance use or abuse.
Having stated these, it has been well-established in research that people who are dependent on drugs are at a high risk of facing a mental illness. On the flip side, individuals suffering from mental illnesses might feel more inclined towards consumption of drugs to escape from their feelings of despair and emptiness. Both disorders can trigger the occurrence of the other.
Moreover, the bio-psycho struggle is way harder for individuals dealing with both disorders simultaneously. In such situations, the social stigma and shame around drug users makes the withdrawal journey even more complicated, and in majority cases, drug users suffer in isolation due to fear of facing their families, community, and of course, a legal trial.
In light of the discussion around mental health, we need to address society’s prejudice and criminal-like attitude towards drug users. Drug regulatory laws in India need to distinguish between ‘victim’ and ‘criminal’ in matters related to drugs. A drug user consuming drugs for recreational purposes is undoubtedly harmless, while a drug addict probably needs urgent medical help and a more sympathetic attitude.
In both instances, criminalisation of drug use and possession does not seem like a rational approach to fix the issue. A drug user or addict possessing drugs for personal use is certainly not a criminal, but might be just a victim of the bio-psycho social cycle. In India, over 77 lakhs opioid users are in urgent need of help. However, it does not seem justifiable to put them under a legal trial to prove their innocence.
In India, the Narcotic Drugs and Psychotropic Substance (NDPS) Act of 1985 and Prevention of Trafficking in Narcotics Drugs and Psychotropic Substance Act of 1988 deal with cases related to consumption, possession and trafficking of drugs. Official statistics say that in 2018, 60,156 people were arrested under the NDPS Act. Section 27 of the NDPS Act defines consumption of any drug (cannabis and opioids) as illegal in India, and culprits are subject to an imprisonment of six months to a year.
In case of illegal possession of drugs, the duration of imprisonment is a minimum of 10 years and a maximum of 20 years. Under Section 64A of the NDPS Act, there are few immunity provisions for drug addicts volunteering for treatments. However, the immunity provision is highly conditional and may be withdrawn if addicts leave treatment in between. It is essential to mention here that withdrawal from drugs is a bio-psychologically challenging process, and many addicts even lose their life before completing a full course of medical treatment.
Though there is strict legal punishment for consuming, selling and possessing drugs, the use of cannabis (bhang, ganja, charas) is quite common and visible in India for spiritual, recreational and other purposes.
According to a report in 2018 by the Ministry of Social Justice and Empowerment, a substantial population in India across all groups consumes drugs for various purposes. The report highlighted that 2.8% of the population (i.e. 3.1 crore people) in India use cannabis. Of these, 5% constitute males, 0.6% are females and 0.9% are children between ages 10-17 years. Around 1.21% of the population uses ganja and charas, among which 0.45% are problem users (harmful/dependence).
Cannabis users are highest in the states of Uttar Pradesh, Punjab, Sikkim, Chhattisgarh and Delhi. Further, in India, one in seven users of ganja/charas are dependent on it. If we look into the statistics of opioid (opium, heroin, Pharma Opioids) users in India, the national figure stands at 2.1% of the population (i.e. 2.3 crore people), out of which approximately 77 lakh individuals are in need of urgent help. Although drug consumption is prevalent across all economic groups, the poorest share a higher burden of drug use.
Decriminalisation of drug use refers here to the removal of criminal penalties for violation of drug laws. In 2019, the UN collectively endorsed decriminalisation of drug use and possession. Globally, Portugal, Mexico, Czech Republic, Netherlands, Columbia, Argentina and 18 States of the US removed penalties on consumption and possession of drugs for personal use. The Portuguese model is widely appreciated for focusing on expanding treatment and harm reduction services along with decriminalisation.
Further, countries that decriminalised drug use did not notice any increase in the prevalence of drug use. In fact, decriminalisation reduced the rate of problematic and adolescent drug use and an increase in people seeking treatment. Nonetheless, decriminalisation definitely can play a crucial role in changing social stigma and re-defining drug use as a public health issue instead of an ethical and moral crisis.
“Drug control policies that impose criminal penalties for personal drug use undermine basic human rights… Subjecting people to criminal sanctions for the personal use of drugs, or for possession of drugs for personal use, infringes on their autonomy and right to privacy… The criminalization of drug use has undermined the right to health… [G]overnments should rely instead on nonpenal regulatory and public health policies.”
In India, we need to re-think the approach of decriminalisation that is feasible in the current legal and social situation. India’s drug regulatory policies need a more human right outlook. The drug prevention measures should be oriented to provide welfare services to people affected by drug use instead of subjecting them to the criminal justice system.
Drug prevention measures should be based on a supply reduction approach, and by generating awareness about the potential impact of drug use. Criminalisation of drug use does not treat the problem of its widespread consumption, and only exaggerates social stigma and shame around drugs. The current provisions of the NDPS Act are rudimentary and ill-defined, leaving sufficient room for subjective biases from the part of law enforcement. In the absence of decriminalisation, India needs to at least reclassify and distinguish between possession of drugs for personal and commercial use.
Use of cannabis for recreational purpose is harmless and should not be prosecuted on moral grounds. Opioids come under the hard drugs category and are highly addictive. It is high time to understand that drug addiction (cannabis or opioids) is treated as a public health problem, as is mental health, as both disorders are highly likely to co-occur.
Hence, the problem of drug addiction/dependence should be addressed under the umbrella of mental health. Decriminalisation of suicide in 2018 was the most celebrated moment in India’s mental health history. Now, it is high time to re-address our legal attitude towards drug users in order to create an inclusive environment for those seeking medical help for drug-related mental illnesses and vice versa. Further, along with decriminalisation, drug prevention measures should embrace the awareness generation approach about the potential bio-psycho effects of drug use.