Sophie Cousins

fter selling heroin on the streets all morning, former school teacher Jenny is tired and in need of her next hit. Carrying her earnings, she travels to a decrepit house on the outskirts of Imphal, capital of the north-eastern Indian state of Manipur, to find some relief.

It’s here that drug users openly inject and unwind, and where Jenny, 46, picks up her next gram of heroin to sell on the streets. She can’t remember when she began injecting heroin – she thinks it was about 10 years ago when problems with her husband reached boiling point – nor can she remember the last time she saw her two children.

“Heroin is very good at getting rid of all my problems. If I don’t get it, it’s very hard,” says Jenny, while describing how she lives on the streets, sometimes sleeping in public toilets or the nearby forest, other times at hotels where she does sex work. “I need treatment. I will quit, just tell me where to go.”

In 2011 India was hailed for its introduction of methadone maintenance treatment (MMT) to reduce drug dependence and HIV and hepatitis C infections among users. Methadone works by blocking the “high” caused by using opiates and helps reduce cravings and withdrawal symptoms.

But six years on, despite strong evidence of its benefits, the criminalisation of drug use, inadequate services and an emphasis on detoxification and rehabilitation remain major barriers to the ability of drug users to access treatment.

ForJenny, simply being female makes it even harder. She faces the double stigma of being a drug user and a woman, which immensely hinders the ability of people like her to overcome addiction.


We’re lucky to live in the US where there is treatment available–though so many addicted people choose to avoid treatment and continue the captivity of the disease!  Medication-Assisted Treatment with medications such as buprenorphine (Suboxone) are the answer!  So many methadone clinics put their “patients” (clients?, annuities?) on much higher than needed doses to keep them indentured and coming back day after day indefinitely; the higher dose means worse withdrawal symptoms and more of a guarantee that the patient will be back on a daily basis!

Dr. Raymond Oenbrink
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