As a follow up of the meeting with Dr Sanjay Chugh, Founder Chairman of International Institute for De-addiction Research and Therapy (IIDRT) at Dimapur on the 20th of August in regard to his proposed Naltrexone implants on Drug Users, the Nagaland Drug Users & PLHA Forum and Lawyers Network for HIV/AIDS have been holding consultation meetings with other stakeholders such as NGOs, lawyers, doctors and the state consumer forum. It has come to our notice that Dr Chugh has already performed implants on a few drug users at Dimapur and that the cost of the treatment was much higher than the price he quoted to our representatives who met him.
We are extremely concerned and deeply disturbed that this expensive treatment which is not evidence-based and over which sufficient research has not yet been carried out is being conducted in Nagaland.
We are all aware that addiction is an extremely complex and hugely challenging issue for people affected by it, especially the user and his or her family. In their desperation for a way out they are often willing to go to any extent and spare no expenses. From our confidential conversations with people who have undergone this treatment both in Dimapur and in Delhi, we are made to believe that they had very limited understanding of the treatment processes as well as the implications of such a treatment.
We take it as our moral responsibility to create public awareness and collective responsibility so that individual decisions for such a program are based on informed choice. In this process we held several meetings among ourselves and also consulted national experts on the issue. We particularly sought the advice of Mr Anand Grover, Project Director of Lawyers Collective whose professional support we highly regard.
We take this privilege to share the facts we collected during this process and we hope it will generate public awareness and a healthy response on the issue.
• As in any other forms of medical treatment and de-addiction programs, it is imperative for the patient to be aware of the pros and cons of the treatment in detail before undergoing the implant. We believe that this treatment is administered on the basis of the patient’s Informed consent. Unwilling clients who undergo this treatment out of family compulsion stand the danger of subsequent relapse once the effects of Naltrexone wear out.
• While the rationale for Naltrexone implants is persuasive – it must also be clear that this is not a single-time remedy, and as such needs to be repeated every 3months, 6 months or 1 year at the cost of Rs. 75,000, Rs. 1,35,000 and Rs. 2,10,000 per operation respectively. A Naga drug user who underwent this treatment informed us that he paid an amount of Rs. 4.5 lakhs for an implant for his Brown Sugar addiction and for his alcoholism. He was told that the alcohol treatment would last him 3 months and for his brown sugar dependency, one year. We are informed that quite a number of drug users have recently undergone this treatment in Dimapur and that the next phase of implants will be around December 2006.
• The treatment involving Naltrexone implants is not evidence-based and has not been approved by the Food & Drugs Administration (FDA) – therefore it should be understood that such treatment offered by individual doctors is not a part of Public Health Interventions.
• Naltrexone is what is called a “pure antagonist” - it completely blocks the effects of any opioids taken afterwards, however it still does not block the effects of non-opioids such as Diazepam, Nitrazepam, Avil, ganja, hashish, alcohol, etc. Therefore, especially for a poly-drug user there is the danger of succumbing to the abuse of other drugs against which Naltrexone offers no resistance.
• If Naltrexone is taken orally, it can be stopped if and when the patient requires other forms of emergency treatment; but when it is implanted, the patient cannot be administered Morphine or anesthetic drugs like Midazolam or Fentanyl congeners unless the implant is removed.
Having said that, we are still left with the fact that Drug Dependence issues are still not addressed by this form of de-addiction through Naltrexone implants, as Drug Use is by its very nature a “chronic relapsing disease” and for sustainable, long-term recovery there needs to be psycho-social interventions that go side-by-side with any treatment given. Although Dr Sanjay Chugh mentions the importance of post-implant psycho-social support in his brochure, we are not aware of such support systems put in place by him in Nagaland.
We invite public discussions around this issue and we extend our willingness to facilitate such a process.
1. Abou Mere, Chairperson, Nagaland Drug Users and PLHA Forum
2. W.C. Humtsoe, Chairperson, N-Naga DAO,
3. Ashu Theyo, Lawyers Network for HIV/AIDS,
4. Kezhokhoto Savi, President, Nagaland Voluntary Consumer Organization (NVCO)
