Undermining human heritage

NARC and ISRD

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THAT the practitioners of traditional systems of medicines (TSM) in India cater to the health needs of the majority of the rural poor needs little proof. That opium and cannabis products are important ingredients in several medicines prepared by TSM practitioners too is well known. None of the UN Conventions related to drugs proscribe medicinal use of cannabis and opium and the same is the case with Indian laws on the subject.

The Narcotic Drugs and Psychotropic Substances Act, 1985 (NDPS Act) permits their use for the treatment of domestic animals, cattle and human beings; it further mandates the government to establish a mechanism to supply these drugs to pharmaceutical companies and registered medical practitioners treating human beings and animals.

Though India is a welfare state, there are no mechanisms to provide social security to the poor and it is the natural helping networks that have catered to people’s needs. Take the case of delivering babies: when one looks at the social organisation of child bearing in India, dais (traditional birth attendants) have traditionally delivered the maximum number of babies in rural India. Fortunately the national and international authorities have accepted their role and there is a major project underway to upgrade their skills and provide them a kit containing new blades and cotton swabs to reduce the incidence of tetanus caused by use of rusted scissors.

TSM practitioners are another such group of healers found in each of the half a million villages dotting the country. They base their practice on either Ayurveda, Siddha or Unani systems, folk medical practices developed by thousands of dispersed tribal communities and home remedies which are all well documented, researched and have a thousand or more years of demonstrated effectiveness. Their role needs to be acknowledged and supported, at least till college trained doctors are available in sufficient numbers and are willing to live and work in villages.

This paper presents a profile of 53 practitioners drawn from two districts of Gujarat (Junagadh and Porbunder), their use of cannabis and opium in their medications, the source of these drugs, and the difficulties they face. It advocates policy changes to prevent the decay of these traditional medical practices and the convergence of TSM with underworld operators in order to protect the health and wellbeing of the poor in our villages and small and medium towns. It also outlines the situation in Sri Lanka where revival of Ayurveda has been one of the key components of Sinhala nationalist mobilisation.

This pilot study is based on a limited sample; the sampling is purposive with the intention of covering as many characteristics of TSM practitioners in the chosen districts. There is no register in the country providing the universe of TSM practitioners. Some background information on the respondents is presented below.

Seventeen of our respondents were women and 36 were males. Only one had completed 10 years of schooling and 14 had never gone to school. Most of the respondents were above 41 years of age (37). Thirty practised in small towns and the rest were village based. While three disapproved of allopathic medicine, most claimed to practice TSM because it was cheap, not harmful and effective.

We discovered that some caste groups such as the Rabaaris and Barwaad have practised TSM with animals for generations. Their help is often taken by zoo personnel to treat lions and other dangerous animals. When quizzed on how they manage to treat zoo animals, when there were veterinary doctors officially appointed by the government, there were the usual answers: ‘The monkey does the tricks; the owner collects the money.’ One of them said that he treated lions and deer. ‘I took ten years to learn from my father how to catch these animals, how to treat the claws, what medicine to give for what illness.’

The Tantrik tradition is strong in the Saurashtra region. Tantriks live in the forests and know many herbal medicinal plants. They walk from village to village. Apart from performing religious functions or giving devotional orations, they also treat the sick and train their disciples in traditional medicine. They are best known for treating snake and scorpion bites.

 

 

All of them undergo long years of apprenticeship. Twenty eight had undergone training under an expert vaid for periods ranging from 6-20 years. This is the system by which traditional medical knowledge is handed over. In the past only one of the family members would be trained. However, the hereditary nature of these medical practices seems to be waning and 41 of our respondents had worked as vaids for over 10 years.

Only a third of our sample were treating people/animals for all ailments. Most TSM practitioners (TSMPs) specialise in one set of ailments. Our pilot study included midwives (4); child specialist (1); bone setters (2); muscle pain reliever (1); asthma specialist (1); and two hakims practising Unani medicine. All the TSMPs in our sample use opium or cannabis in their practice.

Specialising in

 

Deliveries/Dais

10

Bone specialist

4

Asthma

1

Children

9

Muscle related

18

Jaundice

8

Cattle

10

Other animals (monkeys, lion, deer, dogs, goats)

16

General – treat all ailments

18

(N.B. Multiple answers; hence frequency exceeds the N = 53)

 

Though none of the respondents were registered with any authority, they did attract many clients. In the month prior to the interview, 52 vaids and hakims had together treated 989 patients (an average of 19 patients per practitioner). In the medicines that they gave to 802 patients, 81% contained either opium or ganja or their combinations in various forms!

We attempted to check the source of opium or cannabis procurement and the problems TSM practitioners faced. Policy-makers and administrators should take note of the fact that the majority of these practitioners were either illiterate or semi literate, they were unfamiliar with government procedures, and would find it difficult to fill up long or complex forms or to maintain ledgers. Nor would they be comfortable to go the collectorate or the narcotics commissioner’s office in Gwalior which are highly guarded formal structures. It may instead be useful to follow the Sri Lankan system which is decentralised to the district level and TSM practitioners are supplied through hospitals designated as supply depots.

 

 

Though the reports of the Narcotics Commissioner indicate that his office indeed supplied opium for medical purposes, our experience in Tamilnadu and in Gujarat was that only pharmaceutical companies (both allopathic and Ayurvedic) and a few graduate TSMPs managed to get their quota; the vast majority of the TSMPs do not. Few of them knew that they could obtain opium and ganja from the Collector or an authorized officer, nor were they aware of any form (OPI or OP IV or B-I or B IV).

The inability to officially access opium or cannabis pushes them into the arms of black marketers who may sell them adulterated stuff. This affects the efficacy of their medicines and erodes the faith of the people in their practice. Further, if opium/ganja is not provided at controlled rates, patients end up paying more. This will gradually result in the demise of the traditional systems of medical practice.

A few years ago the Government of India organised a SAARC level seminar on traditional systems of medicine and opium/cannabis products. Its focus was on the role of TSMs in the treatment of addiction. There is a need to organise a similar meet on the supply of opium and cannabis to TSMPs. But none of the national councils for research in these systems of medicine have done anything in the context of the NDPS Act.

 

 

This has led to extreme frustration in our respondents. Some comments were: ‘What is the government sitting there doing, I do not understand anything.’ ‘Why they have banned it?’ One felt the anger in some of their expressions: ‘Ganja and opium should not be banned. But who can educate officials sitting in Delhi?’ ‘The government policy is wrong;’ ‘The government is crazy.’

Some pleaded: ‘At least for making medicine, it should be taken out of purview of the law; the blessing of humanity will be on the government.’

‘If you can get ganja and opium out of the ban, please do. I am telling you for the sake of humanity (insaaniat ke liye bolta hoon). These drugs save people and help them survive. They are medicine. You will see that those who use these two drugs live a long life. But alcohol, gard, nasha ka injection should be banned because people can die from their use.’

‘There is no potency in the black market opium. Don’t ask about the price of opium. It seems as though the government is out to bankrupt us... the price per tola has gone up by 15 times.’

The Malay community, who came to Sri Lanka along with the Dutch soldiers, supposedly introduced opium use in the country. Subsequently, by the end of the 19th century, opium use had spread to other communities. Opium was used by the rich as an ingredient in their drink or food. Its use as an aphrodisiac from the time of the Sinhala Kings has been documented. Another use of opium was for medicinal purposes. Other than eating of raw opium, considered a habit of uncultured lower classes, other types of use did not meet with social disapproval.

The NDPS Act in India provides for the supply of opium/ganja to certified addicts, who are registered with the Narcotics Commissioner’s office. However, the register was frozen way back in 1957. With reduced access to traditional drugs such as opium and ganja/charas, many have been forced to turn to crude heroin and pharmaceutical drugs such as buprenorphine.

A similar process happened in Sri Lanka, and a shift took place from opium to heroin in the 1980s because supply of opium through licensed shops was stopped. Earlier, opium and cannabis were also available from itinerant traders, either Chinamen or Muslims.

 

 

The historical events that led to creation of a system for distribution of opium to medicinal practitioners, including vedarala (equivalent of the Indian vaid) can provide useful clues for other countries where similar practices exist. A Commission was set up in 1909 to assess the medicinal requirement for opium among traditional practitioners and to establish a mechanism to meet the requirement in a systematic manner. The data supplied by government agents in several provinces listed 3,815 practising vedaralas. The amount required by well known practitioners was documented and calculated at 8 ozs per practitioner per year. In case of those with an extensive practice the amount could be as much 1lb a year.

In Sri Lanka, TSM practitioners use opium in treating dysentery, diarrhoea, cholera, rheumatism and diabetes. It is also used for treating malaria and enteric fever, though this is not common. In medicinal preparations opium is administered in combination with other substances in the form of pills, powders or electuaries.

The commission recommended that:

* Vedaralas should be registered after the Board verifies their credentials.

* There should be uniformity in the maximum number of registered vedaralas to be allowed for each province or revenue district.

* During registration, the maximum amount of opium that can be obtained on an annual basis should be recorded.

* The depot from which the vedaralas can obtain opium should be the same as the one they are registered with.

* The maximum permissible quantity per year, except in special cases, should be fixed at 8 ozs.

* Opium should be issued to the registered vedaralas in person.

* The vedaralas should be required to pay a registration fee to cover the cost of administration, and to certify that the opium would be used only for medicinal purposes.

* The government agent should have the power to cancel registration subject to an appeal to the governor.

 

 

Subsequently, other modifications were made for regulating the supply of opium supply for medicinal purposes under The Poisons, Opium and Dangerous Drugs Ordinance (1964).

* Registered vedaralas would be issued a certificate of registration specifying the quantity of opium which may be supplied to them.

* Whenever the registration of a vederala is cancelled or the allowance of opium altered, the government agent shall forthwith inform the vedaralas, who shall within 14 days of being informed surrender the certificate of registration issued to them.

* Registered verdaralas shall not supply opium for eating or smoking or for any purpose other than the treatment of disease.

Since opium is also used for preparation of cattle medicine, especially in the treatment of rheumatism, the Government of Sri Lanka made an additional provision under the Ordinance for veterinary surgeons.

In Sri Lanka, Ayurveda received strong support from the government during the 1970s. The vedaralas were registered with the district hospitals and received their quota of opium from these hospitals. This system continued till the end of the millennium. However, the international donor community, through the auspices of the UNDCP, prevailed upon the Government of Sri Lanka to scrap this system and the authorities complied meekly. A practice that had been extensively debated in Parliament, a system that was put in place in 1937 and periodically reviewed by further commissions of enquiry, was dismantled by the UNDCP overnight on 30 December 2000.

Even though Indian law and the rules provide that any owner of cattle or domestic animal can apply for opium or ganja for treating animals, only the registered medical practitioners are treated as eligible. None of the 53 TSM practitioners interviewed were registered with any authority. We need to start this process of registering village level TSMPs with the help of village councils. It needs reiteration that most TSM practitioners went through long periods of apprenticeship with a senior experienced medical practitioner.

In 1977 India launched a ‘barefoot doctor scheme’ and created a vast cadre of youth across the country who were permitted to dispense allopathic medicines in the villages. How then can we deny TSM practitioners their right to use opium or cannabis? It must also be noted that TSM practitioners use nearly all parts of the cannabis plant for various purposes. Thus, the definition of medicinal use needs to be modified to stress that medicine does not only mean allopathic medicine.

 

 

This paper is based on primary data collected through an interview schedule from 53 purposively recruited respondents from Porbunder and Junagadh districts in the Saurashtra region of Gujarat. They are practitioners of TSMs of various sorts, healing human beings and animals. The sample included both women and men. Each of the villages/small towns had more than one TSM practitioner. Thus the number of practitioners in half a million villages of India could easily be a million.

 

 

On the basis of our study, we recommend:

* The Ministries of Health, the Narcotics Control Bureau, the Central Councils for Research in Ayurveda, Siddha, Unani and Homeopathic Medicines may together pass a government order explicitly declaring the TSM practitioners as an eligible group of persons entitled to register with the relevant authority to apply for and obtain pure opium and cannabis legally at government controlled prices.

* The Collectors or their designated nominees may constitute a district level health committee to create a data base or registry of all contemporary TSM practitioners, both male and female, those treating animals and human beings, those with specialisation and those who are all-rounders.

* Create an idea bank of their medical practice, specifically including a section on their use of opium and cannabis.

* Request the village councils created under the 73rd Constitutional Amendment to participate in this process of identifying the village TSM practitioners; the participation of the entire adult village community will eliminate spurious entrants from the underworld.

* Operationalise the relevant sections of the NDPS Act and rules under the act.

* Publicise these provisions of the law through the village councils.

* Enable the million-odd TSM practitioners to treat the poor and preserve this aspect of our national heritage.

 

* This study was carried out by Molly Charles, Gabriel Britto, A.A. Das from NARC, Mumbai, and E.J. Masihi and Bhaskar Jani from ISRD, Ahmedabad.

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