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Although the law makes it mandatory for all drug addiction treatment and rehabilitation centres to obtain licenses from the Department of Narcotics Control ( DNC ), none of the 115 such centres in the capital has any.
Almost all of those centres also do not have any trained doctor and nurse despite a gazette notification by the home ministry on July 2, 2005 making it mandatory for those centres to have full-time doctors, psychiatrists, and trained nurses. With absolutely no monitoring by DNC, which is responsible for the job, the centres are virtually run by people who are tantamount to quacks, resulting in a majority of the patients relapsing into the addiction even after getting treatment or after being 'rehabilitated'. An investigation by The Daily Star revealed that even former heroin addicts are running a number of those centres. The capital witnessed a mushrooming of drug addict treatment and rehab centres over the years as the business has proven to be a money churner. A recent DNC survey reveals that there are 115 drug addiction treatment and rehab centres in the capital, all of which are operating without any license. When contacted, Joint Secretary ( administration ) to the Home Ministry Mostafizur Rahman said the director general ( DG ) of DNC is the appropriate authority for looking after the matter. He advised these correspondents to talk to him. DNC DG Humayun Kabir told The Daily Star that they are working to ensure that the treatment clinics and rehab centres stay alert about the responsibilities vested upon them. In the face of total flouting of the government guidelines by the clinic authorities, the government is now mulling a plan for slackening the guidelines, said a DNC director seeking anonymity. Mohor Ali, who has been into heroin for the last 15 years, received treatment from drug addiction treatment clinics five times already, but he has also been slipping a couple of days into the completion of each treatment course of 10 to 15 days. "Although I came out after completing my treatments, my body was still craving the drug after each of them, accompanied by body cramps, which led me to take heroin a couple of days into the completion of every course of treatment," a trimmed beard Mohor, who looked a bit older than his age of 35, told The Daily Star.
Mohor said he was treated in Hadi Madakata Raash Complex at Dayaganj twice, in a clinic at Eskaton twice, and once in a clinic at Tejgaon.
Neither DNC nor any non-governmental organisation has any statistics on how many heroin addicts relapse into the deadly habit even after receiving treatment. DNC also has no statistics on the number of drug addicts in the country. However, DNC officials and a number of doctors said almost all the addicts who receive treatment in substandard clinics, end up relapsing into the addiction. Around a dozen of addicts, with whom these correspondents talked, said many drug addiction treatment clinics do not even have any full-time doctor and trained nurse. Doctors attached to the so-called treatment centres visit those only once or twice a week, although it is mandatory by law for the centres to appoint a sufficient number of full-time doctors. A fulltime psychiatrist is also a must according to government guidelines for all drug addiction treatment centres, but hardly any clinic complies with the government edict. A top DNC official said they have allegations that some sub-standard rehabilitation centres are carrying out heroin trade under the cover of treating and rehabilitating addicts. To check whether the allegations are true, The Daily Star correspondents and a photographer visited at least five such treatment and rehabilitation centres, with the result of not being allowed to enter four of them -- Natun Jibon Drug Addict Treatment and Rehabilitation Centre at West Jatrabari, Al Amin Madakashakta Niramoy Kendro at Sutrapur, Dishari Madakashakta Niramoy Kendro at Jatrabari, and Shah Jalal Hospital at Mohammadpur. Former patients of at least two of the clinics, which denied The Daily Star access, said those clinics even supply heroin to their patients who have sufficient money to pay for the illicit drug - under cover of treating them. Only Hadi Madakata Raash Complex allowed these correspondents to enter the premises and showed a permission from the Ministry of Health to run the clinic. The clinic's manager Zakirul Alam Liton said although they do not have any full-time doctor, they do meet all the other government guidelines. He said they charge only Tk 3,500 from general ward patients and Tk 5,000 from patients who live in cabins for a 10-day treatment course, making it a losing concern. The owner considers the establishment a social work, he added. Usually reputed drug addiction treatment clinics and rehabilitation centres charge Tk 15,000 to Tk 30,000 from a patient while the substandard ones charge Tk 5,000 to Tk 8,000, to lure in clients.
Treatment centres supposedly treat addicts helping them to recover from the addiction while rehabilitation centres claim to rehabilitate former addicts to normal life after curing them of the addiction, while some centres masquerade as the providers of both services. RISKY MALTREATMENT A number of drug addicts said substandard treatment centres inject high doses of sedatives into the patients to keep them sedated sometimes even for three days. "As soon as the effect of the sedative wears off in six hours the clinic staff push injections again," said Suruj Miah, a heroin addict. He also said Mukta Chhaya Drug Addiction Treatment Centre at Kachukhet in the capital where he had undergone treatment, used to administer 'bath therapy' -- meaning keeping patients 'cool' through repeated baths. Such a 'therapy' often causes patients to catch cold. Patients are often also forced to massage each others bodies in the treatment centres when someone's body cramp starts due to withdrawals from the drug. "Often the clinic staff beat patients if any of them behaves rowdily," Suruj told The Daily Star. After three days of such treatments if a patient still behaves violently due to the withdrawals, the treatment centres often keep the person confined in a separate room and beat him or her mercilessly. The Daily Star investigation revealed that many treatment centres are visited by doctors only twice or thrice a week. General employees, having no training, run the treatment centres during the rest of the week. Lured by the advertisements of the unsupervised treatment centres, which are usually full of promises and descriptions of mostly non-existent services, the guardians and friends of the addicts put their loved ones under their care. But, a majority of the patients treated by the so-called rehab centres and treatment clinics relapse into the addiction after a short while, experts said adding that the practices of such clinics are dangerous to the society. They said substandard treatment of drug addiction might even cause death. Prof MA Firoz, director of the Institute of Mental Health and Hospital, said a full-time psychiatrist is a must in all treatment centres, but most do not have any. He said there are only 40 active psychiatrists in the capital.
He said to rehabilitate a patient the rehab centres must also have job trainers.
"It takes 7 to 15 days to treat an addict, but due to wrong treatment methods many have to undergo a longer period of treatment," he added. "Wrong treatment also increases the risk of death," Prof Firoz went on.
He also said there are allegations that in a bid to earn quick cash many so-called treatment centres have been supplying heroin to the patients for a long time to keep the patients admitted to the centres sometimes for three months to a year in an effort to hike up the bill. A doctor of a reputed treatment and rehabilitation centre in the city's Panthapath area said keeping a patient virtually unconscious for three days by injecting high doses of sedatives may cause death in cases of patients with high blood pressure, and kidney or liver problems. He said his clinic first diagnoses the level of a patient's addiction through a urine test and then they administer medicines. "We slowly decrease the volume of the dose," he added requesting anonymity. He said they also test the patients for diabetes, blood pressure, and liver and kidney complications, and keep the patients under round the clock observation during the first 24hours of their admissions. The physician also said psychotherapy, entertainment facilities, and proper counselling are also must for complete treatment and rehabilitation of drug addicts. He however said it requires around two months to complete treatment and rehabilitation of an addict.
A physician at government-run Tejgaon Drug Addiction Treatment and Rehabilitation Centre said keeping a person unconscious by injecting sedatives is not an acceptable method of treatment at all. He said important organs of a patient may collapse and the patient may even die if sedated without any diagnosis. GOVT'S INDIFFERENCE In recent years, the capital witnessed mushrooming of substandard drug addiction treatment clinics and rehabilitation centres without any government licence, regulation, or supervision. A recent survey by the Department of Narcotics Control reveals that there are 115 treatment and rehab centres in the capital. DNC officials said apart from the capital, such substandard clinics also sprouted in large numbers in Chittagong, Khulna, Rajshahi, Comilla, Gazipur, Jessore, Satkhira, Bogra, Mymensingh, Barisal, Sylhet, Naogaon and in many other small towns. Almost none of them have the 80 square feet floor space per patient required by the government guidelines issued in July 2005, albeit being much delayed. The guidelines stipulate that a rehab centre must have a full-time psychiatrist, at least one full-time physician with special training on drug addiction treatment, two trained nurses, and a janitor for every 10 admitted patients. Centres having 10 beds are required to obtain licences from the government in exchange for a fee of Tk 20,000, centres with more than 10 but less than 21 beds are required to pay Tk 30,000 for the license, and centres with 21 beds or more are required to pay Tk 50,000 for the license, while yearly renewal fee of the licenses is 50 percent of the license fee for all. License fee for counselling centres, which only provide out patient treatment, is stipulated at Tk 10,000. According to the guidelines, a DNC inspector is supposed to inspect a rehab centre following the receipt of any application for a license, but in most cases the inspections never take place.
There are four government run drug addict treatment clinics and rehabilitation centres in Dhaka, Chittagong, Rajshahi and Khulna cities. The centre in Dhaka is a 40-bed hospital while the rest have five beds each. DNC DG Humayun Kabir said the centres in Khulna and Rajshahi have been closed for a year as no doctor was appointed there. "We sent letters to the health ministry asking for doctors, but it has yet to appoint any," he said.