He joined the Richmond Fellowship Nepal, a rehab centre for substance users and gradually overcame his addiction. "I regained respect and recognition from a society that despised me as a drug user," he recalls. Ghale now works as a director at the Mother Tongue Centre Nepal that develops a local language curriculum and also as a counselor for drug users.
He is celebrating his fifth 'birthday' on 26 June marking his fifth year since quitting drugs. "The life I am living is my second life," he says.
Jeevan, a 5 feet 6 inch man was 38kg when he joined the centre. He now weighs 74kg and is married with a daughter.
He had started smoking marijuana at school, switching from marijuana to nitrazepam tablets and then injecting buprenonphine within a year. He is one of the lucky ones to not be infected with HIV.
Among drug users, 61.4 per cent inject drugs and among them 29 per cent share needles. An estimated 6,557 intravenous drug users (IDU) are living with HIV or AIDS, which is about 10 per cent of the total HIV/AIDS cases according to UNAIDS. In Kathmandu, about 30 per cent of all people living with HIV/AIDS are IDUs.
"There is a 100 per cent chance of transmitting HIV by needle sharing," says Rajiv Kafle founder and coordinator of rehab organisation Nawa Kiran Plus. HIV prevalence among IDUs in 2003 was 51 per cent. Given the limitations of Nepal's public health surveillance system, the actual number of infections is thought to be much higher. Kafle says many of the users don't even know about the disease.
Nepal was the first country in Asia to establish a harm reduction program with a needle exchange service for IDUs. However, the program has been ineffective due to limited coverage as well as a short supply of syringes. The problem is especially acute now that the potency of drugs has significantly deteriorated, moving users to take bigger doses."A drug user might need more than the two needles a day that they offer," Kafle says.
Bishnu Sharma, program manager of Richmond, says drug users are also highly likely to transmit Hepatitis C. He added that about 94 per cent of drug users in Kathmandu have tested positive for the incurable disease. "Effective prevention interventions need to be scaled up among IDUs," he says.Political instability, low levels of education and
literacy and a lack of voluntary counseling and testing services mean infection figures are only likely to increase.
A survey conducted by Central Bureau of Statistics in 2007 reported there are 46,309 hard drug users in Nepal with 1.2 per cent of them being under 15 years of age. But the problem mainly lies within the age group of 15 to 29, to which half the abusers belong.
The major drugs abused in Nepal are cannabis and codeine which is found in cough syrup, nitrazepam tablets and buprenonphine injections, glue and opiates. Heroin is the second most prevalent drug in the country says SSP Hemanta Malla, chief of the Narcotic Drugs Control Law Enforcement Unit.
According to him, the drugs are mainly smuggled from across the border or sold in pharmacies.
The government drug regulatory body, the Department of Drug Administration, has to get approval from the International Narcotic Control Board to import the drugs that the country needs but this has done little to control the abuse of prescription drugs. "Treatment is not a cure for addiction. The rate of relapse is about 95 per cent in our country while new drug users appear every year, increasing the total number of drug users," he says.
The unit seized 105.6kg opium last year while 225kg opium has been seized in the first six months of this year, a significant rise from the 4.5kg of opium first seized by the police 15 years ago.
The largest heroin haul was the 23kg seized in 2003, while an average of 10kg is seized each year.
But the size of the raids is not indicative of the magnitude of drug abuse in the country. It simply reflects the effectiveness and failure of law enforcement, he says.
There are four measures to be considered in controlling drug abuse: control on production, supply, demand reduction and treatment, rehabilitation and detoxification. "We can not make a drug free society but, we can curb drug abuse," Malla says.
Sniff or inject? - FROM ISSUE #457 (26 JUNE 2009 - 02 JULY 2009)