In India, Illicit Pharmaceuticals Ravage Communities and Lives

For Indians too poor to buy heroin, neighborhood pharmacists are willing dealers, further entrenching a cycle of addiction, infection, and death

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An injecting drug user (IDU) fills a syringe with buprenorphine on a roadside in Chandigarh / Reuters

NEW DELHI, India -- Dharminder was just 17 years old when his half-naked body was found one morning in an alley near Jahangirpuri station, the northern terminus of the New Delhi Metro's yellow line. The teen's body was slung onto a vegetable cart and covered with a blanket that left his bare toes exposed as he was wheeled down the main road leading from the Metro station to the morgue.

Dharminder's official autopsy from Babu Jagjivan Ram Memorial Hospital describes various external injuries to his ribs, chest, abdomen, and shoulders, caused by a "blunt" implement. On arrival, he was wearing "pants only, soiled with fecal matter." The document guesses his age incorrectly at 18 or 19, but it doesn't matter. Dharminder was a junkie, and the locals disparage junkies -- they steal, they carry disease; they're untouchable beyond caste.

No one is exactly sure how he expired, but 23-year-old Nikhil Kumar, who works in a nearby metal-cutting shop, believes Dharminder was beaten to death by three other junkies the night before his body was discovered. Whether it was for the drugs or money he may have been hoarding, no one willing to talk knows for certain.

This area in northwest Delhi is best known for the Azadpur Fruit and Vegetable Market, but across National Highway 1, Jahangirpuri is home to another roaring industry: hawking products with longer sell-by dates than the tons of bananas and tomatoes that come through Azadpur: illicit pharmaceuticals. This is not the only neighbourhood in Delhi with a drug problem -- areas like Yamuna Bazar and Silampur are also notorious for the numbers of addicts trawling their streets. What makes Jahangirpuri so dangerous is that, here, the chemists are the drug dealers. This would be easy enough to hide -- if the Jahangirpuri chemists who sell prescription pharmaceutical drugs over the counter actually felt the need for discretion. But they don't. It's as easy to obtain and shoot pharmaceuticals here as it is to get a free meal at the nearby Sikh temple and save money for another hit.

For Dharminder, like many before him and many others sure to follow, Jahangirpuri truly was the end of the line.

•       •       •       •       •

"Young people get old here very quickly," says Rajiv, a 47-year-old ex-user with a pronounced limp in his left leg, as he roots around in a hidden compartment inside his blue track pants for a match to keep his beedi going. He lights the undecided ember into a glow under his push-broom moustache and exhales. "Here, in every house you have a junkie."

Rajiv would know. After years of drug abuse, he has been staying at a centre in Saket, in South Delhi, run by Sahara, an NGO that treats and houses injecting drug users. Sahara opened a treatment centre in Jahangirpuri in 2001, and in 2006 received expanded funding as part of the United Nations Office on Drugs and Crime's (UNODC) Project H13, intended to curb the spread of HIV/AIDS in South Asian countries. But it didn't last long -- as Mike Marshall, the former director of projects at Sahara, tells me, "All UNODC projects in India lost their funding and had to close due to the global recession."

There has been no recession, however, for those who cater to the addictions of India's abject. Chemists here know what users need, and they have conveniently bundled the requisite gear into a kind of Japanese bento box: one two-milliliter ampule of diazepam, a tranquillizer better known as Valium, also used to stop seizures and aid in alcohol withdrawal; one two-millimeter ampule of buprenorphine, a synthetic opioid like methadone used to treat addiction to opiates; and one two-milliliter bottle of Avil, an antihistamine meant to be injected intramuscularly (though many users prefer a 10-milliliter bottle so they can use the larger receptacle to mix all three drugs); one syringe; and two detachable needles. Users say the antihistamine is good for preventing rash, but it's mostly to increase the volume of a shot. One Jahangirpuri chemist, to attract new customers, has begun to throw in a digestif of a Netrovet-10 tablet, a strong sedative. A set costs 50 to 60 rupees, about one dollar.

Before Sahara shut its doors here, this is where Rajiv spent most of his reclaimed time after his withdrawal period, doing the legwork he and other independent aid workers describe as crucial: knocking on doors and talking to families who have no idea how to stop this surge of over-the-counter pharmaceuticals from stealing away their loved ones.

Rajiv, like the independent aid workers who have effectively, albeit unofficially, replaced Sahara and H13, says that the door-to-door canvassing is the only thing they see making a real difference.

"Dharminder's case is very common," an aid worker whom I'll call Sita later tells me. "We find dead kids on the sides of the road here all the time."

Dharminder left the town of Harpalpur in Uttar Pradesh when he was 12, already sniffing away his pick-pocketing profits in glue and solvents. In Jahangirpuri, he scavenged for scrap metal and took advantage of the tight-packed transience in the sprawling Azadpur market to reappropriate carelessly placed wallets. Before he died, Dharminder told me he made 50 to 100 rupees, about one to two U.S. dollars, a day.

Rajiv takes shelter from the afternoon sun near the alley where Dharminder's body was found. National Highway 1 and its last run of elevated Metro line are a few hundred feet away, just after a stretch of houses that look as if something has bitten their fronts off; just past where the truckers park and bring local, often casual, prostitutes to assuage the loneliness of the road. A little further east are the various recyclers who buy the materials from scavengers, who often then circle back to an alley adjacent to Mahendra Park to shoot up. Then it's back across the road to scour Azadpur for enough money to complete the circuit again.

Before long, an elderly woman nearby recognizes Rajiv and hurries over with a frantic tale, pointing to her son, who is rocking on his haunches in front of a nearby door. Rajiv explains something quietly to the child -- he can't be more than 13 or 14 tops -- who plants his forehead on his knee-hugging arms and begins to cry. Laying out the consequences that await users, Rajiv proffers himself as an example, pointing to his leg with the limp.

Neju, a junkie from an older generation, scampers over and squats, opening the buttons of his grease-sheened shirt to show Rajiv how his shoulder has healed. Most of the cap's muscle, where an abscess had been successfully removed, looks like an old shark bite. Sita tells me that abscess management is a big part of their work -- much more than detoxification. According to a UNODC report from April 2009, Sahara treated abscesses in up to 30 people per month in Jahangirpuri. This cauterized circuitry is Neju's good news to share. As he shows off his healed shoulder, a long knife falls from the left pocket of his pants.

"Put that away," Rajiv scolds him.

"It's for cutting fruit," replies Neju, who credits his longevity to his moderate pharmaceutical intake. He files the blade back into his pocket.

"Probably true," whispers Rajiv. "For real fights, they keep a surgical blade that'll cut you to the bone hidden in their mouths."

The woman thanks Rajiv for his counsel and takes his card as she leads her son away. This boy is one of the more fortunate addicts. He has a home: access to regular meals means his rate of decay will be slower than those who sleep on these streets. For him, there's no competition with fellow scavengers at the end of a hard day's work to divvy up the remains of a pharma cocktail and be tempted to take that little bit more than he should. Maybe that's what killed Dharminder.

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Dave Besseling has been employed as a graphic designer, language teacher, visual artist, tattoo designer, travel writer, and journalist. His first book will be published in 2012.

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