ANIL BANYMANDHUB

The debate over substance misuse in Mauritius seems to be bordering on opiniated hysteria currently. Every Tom, Dick and Harry has expertise apparently.  Nevertheless a few individuals have been shouting in the desert for decades in vain attempting to warn authorities of the epidemic inflicting us.  Since 2013, as a former Dual Diagnosis Consultant Psychiatrist, my views too have been royally discarded. And suddenly we wake up in a panic to death and social destruction of substance misuse.

Worldwide there is a politico financial complicity that overrides social and health issues.  Alcohol and cigarettes are not only freely sold but generate zillions in state revenue through direct and indirect taxations. Formula 1 racing was a prime example of financial double standards under Prime Minister Blair.  Whilst government enforced legislation to ban smoking in public places, ban cigarette advertisement, Formula 1 was given an exemption after threats to stop the sport. Economics won over legislators!!! Even today the cinema industry remains the best backdoor advertising agent for alcohol and cigarette.

Health economics in developed societies are being reviewed insightful of the enormous financial burden on the state.  In the UK the labour government of Attlee brought in the health service for the increasing pulmonary ailments of coal miners and T.B due to social deprivation.  He never planned the model to cater for specialized tertiary care, heart transplants, PET scans, and radiotherapy for example. He was not aware of the financial clout of the pharmaceutical companies! This system is not viable long-term.  Mauritius pay heed!

Tony Blair brought in the private-public initiative to build new hospitals. A disaster the tax payer will endure for twenty-five years. David Cameron brought the austere, dramatic 5% recurrent cuts in an attempt to close the bottomless pit public health is in the UK.  Not a success to date either! To conclude sadly wealth seems to mean health. I was in medical management under both Blair and Cameron for my sins.

Alcohol and substance misuse is a well established psychiatric sub-specialization in the UK. It has expert teams with social workers, psychologists, specialized nurses and works closely with the police and prisons. It is an expensive service delivery model. Methadone dispensation falls under their remit. And rest assured the Mauritian model thankfully has not been adopted in the UK.

Human dignity of addicts is foremost in the UK. They are patients and a vast majority are mentally ill. The re-admission rate to psychiatric units is very high and murder/criminality is as expected a reality, so is suicide. A mentally, not disordered addict is not considered for dual diagnosis input!  The legal system is available with prison doctors to intervene.

Abusing alcohol, cigarettes, illicit drugs if not mentally disordered is a choice.  A vast majority develop mental/physical ailments and thus enter the health pathway of care provision. An expensive BURDEN to any nation. Government must understand this subtle yet crucial backbone of any viable initiative to tackle substance misuse.

Methadone is only a treatment substitute for opiates. It is not a treatment alone!!!  Do not be misled.  The cost is worth the financial savings for the state. It allows control of type over criminality, physical /psychiatric illness/relapse and suicide.  A money saving initiative for the state, a just trade off!

Thus the whole hypocrisy! You may note I do not use my medical know-how in this opinion. The substance misuse issue is far from the tiny pawn medicine remains in the big picture. The big picture is a weekly magazine sold by addicts in the U.K.  They are cared for by non-governmental funds. Social initiatives must be genuine.  Society must be true. We never have developed this skill. Trust me, the rich in Mauritius too have those issues in their own families.  Yet, ever heard of ONE in the press or television.  This is the hypocrisy.  Since they control us politico-financially, a nonstarter to me. Substance misuse has no creed, colour or ‘class’.

The few U.S.A states, Canada and a minority of nations have legislated different options regarding gandia.  Medicinal, recreational excuses! The end hope is to decrease opiate addiction.  This is our planet’s curse. Since all our opiate addicts have used cannabis as a pathway, the aim is to save the cannabis user from the under graduate users to the opiate addicts.  That simple!  As regards pharmaceutical issues, morphine does not cure!  I stop here as regards cannabinols.

This overview is based on truths! An article in the press remains an opinion.  We are nearly a failed state as regards the issue of substance misuse. In the U.K, we have regulated health, financial, customs and police services.  Do we in Mauritius?

To conclude, terms like depenalisation, decriminalization, and legalization are expressions of new freedom. As I recently read ‘freedom is like toothpaste; once it’s out it is hard to put it back into the tube’. Thus though with frenzy we talk the talk, authorities must tread gently walking the walk.