In India, Illicit Pharmaceuticals Ravage Communities and Lives

The two addicts sit for a few minutes, before getting up and stumbling out of the alley, back across the road and into the shade under the Metro line. They say it's more comfortable there, with the passing cars and trucks for their air-conditioning.

Left in the alley, Rajiv begins to pick up some of the drug packaging, some of which appears to have travelled from as far as the truckers who pass through the area -- Uttar Pradesh, Uttarakhand, Maharashtra. One receptacle is from fairly close to home: an empty bottle of Avil, made by Paksons Pharmaceuticals in Haryana.

Founded over 20 years ago by Sushil Aggarwal, Paksons produces just about every kind of prescription drug outside of those employed in cancer treatment. The company's injectable drugs plant is in Bahadurgarh, a 30-km drive west of Delhi, and Aggarwal is willing to provide a guided tour. Behind the gates painted with Hindu swastikas and past the garlanded images of Hindu gods, a series of rooms runs clockwise around the ground floor of the building, where the drugs are produced, tested, sterilely packaged, and shipped.

Aggarwal points out that the factory is constantly being visited by incognito representatives of government ministries. "They come every month, sometimes every two weeks, to inspect," he says. "They come so often I don't know which ministries they are from anymore."

Aggarwal says he has little control over his drugs ending up in the veins of junkies. For producers like him, there's another problem, one that he tells me has kept him in court for seven years.

"One day in 2003," he begins, standing in the quality control room, raising his voice over the tingling of ampules like thousands of tiny wind-blown chandeliers, "my distributor called me and asked why I was selling a certain drug in a market in Uttar Pradesh. I told him I didn't sell to that market, and that the drug was not even being produced anymore."

Aggarwal says he went to Bareilly, a city of just under a million people, to investigate. With the local police, he found the seller using the Paksons name to sell knock-offs of his drugs. The man was arrested and a copyright infringement case was filed. It is still pending.

"Why does it take seven years?" he asks, lifting his hands off the steering wheel and opening them to the ceiling, as if asking Krishna to intervene on the drive back to Delhi. "Because I don't pay money," he answers himself. "But police, they take money. ... It's a big problem."

•       •       •       •       •


Rajiv looks out across the roofs of passing buildings as the Metro's yellow line recedes from the end of its route, back south towards another Delhi -- Azadpur market on one side, Mahendra Park on the other, Moti and Rajinder underneath.

Rajiv seems all the more fragile once the train reaches busier stops and people crowd in around him, not aware of how easily he could be injured. "I can't walk around for too long," he says, crossing his left leg over his right. "All the blood goes to my foot and my leg doesn't really have a way to bring it back up. I'll have to lay down for a while when I get back to the centre."

As a manager in a garment company, Rajiv had gotten into heroin during his late 20s and early 30s, smoking "brown sugar" with friends at parties. To save money, he downgraded to morphine and eventually to the same vein-sizzling sets sold in Jahangirpuri. He was forced to stop after he spiked his femoral artery on his inner-left thigh and ruptured it -- short-circuiting the blood flow to his left leg. "Before the CT Scan at LNJP Hospital, the nurses had to call the senior doctor in because they couldn't find a vein," says Rajiv calmly. "He eventually found one in my neck."

He pulls up his left pant leg and exposes dry scales and whorls of would-be abscesses that he has to monitor carefully. "If I get a cut, it won't heal. There's no blood flow. If I break a bone, I'll have to amputate it."

•       •       •       •       •


You'd think that chemists selling illicit substances directly over the counter to obvious addicts would be cagey and nervous in their work. Not so for 50-year-old Vijay Ramesh, the owner of Dumpak Medicals, a nearby chemist's. (Both his name and that of his shop have been changed.) He arrives in Mahendra Park, adjacent to Moti and Rajinder's squalid alley, accompanied by Birendra, who does not want to give his real name because he works in Delhi's municipal corporation. From a distance, Birendra looks like any average Delhiite -- moustache, side-parted hair, slacks -- but as he gets closer, the telltale signs of light scar tissue inside his forearm and a bloated hand give it away. He's an addict, too.

The pair sits in the shade of a tree, their backs to the highway. "The addicts who live on the street buy from me," Ramesh, the chemist shop owner, tells me. "The area is such that I sell more IDU drugs than I do cough medicine." He takes off his shades and twirls one of the arms between his thumb and index finger. "Sure, addiction to anything is bad, but it's a business."

Ramesh, who resembles a subcontinental Steve Buscemi, says he operates with total confidence. Chemists are required by law to keep records of all their sales of controlled substances, but Ramesh says nobody does. Even if licensed drugs were accounted for, there are many grades of suppliers to round out the stock. "Suppliers make drugs in their homes, you don't know if it's legitimate. People make it in huts, the demand is so high."

At the Mahendra Park Police Station, Kaptaan Singh, the investigating officer in 17-year-old Dharminder's case, admits that drugs are being sold to junkies by the area's chemists. "Obviously," he says. "Where else can they buy them?"

Rajiv could have told you that, but to prove it, he sits behind a chemist in one of the local shops and observes, "99.9 percent of the customers are junkies."

Ramesh says he makes monthly payments to the police that go "all the way up. No cop has the guts to [raid] my shop. They all get their money."

Ramesh says there was a bit of a clampdown three years ago, but he hasn't had any trouble from the police since then. And he can afford the monthly kickbacks. "I charge 50 rupees for a set, and I sell between 100 and 300 sets a day," he says.

Officer Kaptaan Singh claims it's not his job to bust the dealers and pins the responsibility on government drug inspectors. It is not clear if they're from the same departments that pay frequent visits to Paksons, and Dr. Surinder Singh, the Drugs Controller General of India, declined to respond to multiple emails and phone calls. His joint and deputy commissioners were equally unwilling to talk.

•       •       •       •       •


Outside Mahendra Park, as cars and trucks pass noisily and Metro trains slice by overhead, a boy of about 12 or 13 spots Vijay Ramesh. The boy is disheveled to the point of falling apart. There are lattices of slash marks on his arms, and a stream of snot drips from his nose, over his mouth to his chin. He's carrying an empty can of Godfather beer, and it is in the manner of a mafia don that Ramesh accepts the boy's supplications. "Uncle, uncle," the urchin pleads, touching his feet, "I haven't had anything since morning."

Ramesh pats him on the head. "Go wait over there, I'll bring you something."

The boy's loyalty is important in a business where many long-term users, 40- to 50-year-olds like Rajinder and Moti, are dying, and men like Urdip are trying to get clean.

Ramesh waves at another passing local as he turns into the lane to Dumpak Medicals, with Birendra, the drug-addicted municipal employee, following close behind. The boy, meanwhile, fidgets in the dust on the side of the road, scratching at various parts of his body, waiting for Ramesh to get him through the afternoon.

"See?" Ramesh says, his black shades back on, hiding his eyes. "Old people are dying, but young people are coming."

Aside from Rajiv, names of all Jahangirpuri locals have been changed

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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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