A 26-year-old resident of the Indian state of Mizoram visits the drop-in center for female drug users in Aizawl to collect her daily dose of opioid substitution therapy on May 30. She began using in 2013, which has left her with painful abscesses on both her legs. She is one of many users who claim to have been beaten by Young Mizo Association volunteers on the streets. (Sarita Santoshini for Foreign Policy)
A 26-year-old resident of the Indian state of Mizoram visits the drop-in center for female drug users in Aizawl to collect her daily dose of opioid substitution therapy on May 30. She began using in 2013, which has left her with painful abscesses on both her legs. She is one of many users who claim to have been beaten by Young Mizo Association volunteers on the streets. (Sarita Santoshini for Foreign Policy)

Dispatch

India’s Hill Country Is the First Stop on Heroin’s Deadly Route

In the nation’s northeast, Christians and activists struggle over the future of addicts.

AIZAWL, India—On a hot evening in June, the 30-year-old V.P. stood uncomfortably in front of a small group of Christian vigilantes, trying to comfort her 3-year-old daughter as the men joked, probed with questions, and took snaps. A few hours earlier, the single mother, once a popular local musician, had been caught dealing about $400 worth (based on the current exchange rate) of it—roughly three and a half months’ income for many people in the town—on the streets, her daughter in tow. She dealt to support her own desperate habit, which had been getting fiercer in recent months, but that won her no sympathy from the men who were detaining her. “My life is sometimes very hard. I don’t want to do this, but I have to. My body needs it,” she said.

Mizoram is a remote, hilly state in northeastern India with a population of just over a million—less than some suburbs of New Delhi—with a variety of local ethnicities, including the main tribal group, the eponymous Mizo. It’s also ground zero for India’s opioid epidemic. At least 223 people overdosed in Mizoram in the last five years, 34 of them in the first two months of this year alone.

Mizoram’s health minister told the media last year that the state had about 25,000 drug users and addiction affected almost every family. Those figures are most likely to be significantly underreported, said Debashis Mukherjee, an independent researcher and survey lead of the baseline study on drug abuse in Mizoram, released in 2017. According to the 2016-2017 HIV sentinel survey conducted by India’s National AIDS Control Organisation, the state has an HIV rate of almost 20 percent among injecting drug users—the highest in the country.

At the front line of the struggle against drugs are faith-based groups in the majority Christian state, especially the Young Mizo Association (YMA), the largest community-based organization in the area, modeled after the zawlbuk tradition of young men living together, with a dose of the U.S. YMCA (although the YMA now accepts women). The groups’ vigilante patrols take in dealers and users like V.P. But experts say they’re also getting in the way of finding real solutions to the state’s drug and HIV crisis.

The state’s drug epidemic is largely because of its geography. Mizoram shares a 251-mile-long international border with Myanmar, and because of close cross-border cultural ties, both governments have agreed a 10-mile free movement zone around the border for the tribal groups divided between the two countries. The border is virtually open, with just one operational checkpoint, and many tribal groups are divided between the two countries.

A view of the hilly town of Aizawl from the central office of the Young Mizo Association on May 30. (Sarita Santoshini for Foreign Policy)

Myanmar is the world’s second-largest producer of opium, and thus Mizoram is today the first stop on the flow of heroin out of the region. While drugs have seeped through the unfenced border for many years, the heroin trade has seen a steep rise in recent years. That rise comes in part as demand for heroin in the United States has severely increased, with the number of American addicts more than doubling in the last decade. But there are also local reasons driving the trade. From 1997 to 2014, Mizoram had a total ban on alcohol, pushed by local churches. According to Peter Zohmingthanga, the public relations officer of the state’s excise and narcotics department, once the restrictions were lifted, local dealers—like the mob at the end of Prohibition in the United States—switched from alcohol to drugs.

Yet even legal alcohol remains tightly regulated, and the authorities have had to divert more manpower to monitor and supervise it, leading to a shortage of personnel to cover drug issues. The national focus, meanwhile, has been on Manipur, which also shares a border with Myanmar. Heavier security there has caused traffickers to switch to the more insecure Mizoram.

Many young drug users who were interviewed for the article said they had shifted from injecting crushed-up pharmaceutical pills that contain the opioid dextropropoxyphene, such as Spasmo-Proxyvon (India banned the pain killer in 2013), to heroin in recent years.

Some of the drug trade goes the other way. The state also serves as an active route for the trafficking of ephedrine and pseudoephedrine—controlled substances found in over-the-counter cold tablets and used as precursors to produce meth—from northern Indian factories to meth labs in Myanmar. India is the second-largest source, after China, of seized shipments of these illicit precursors, which are shipped as far as Central America, as per a 2011 report by the United Nations Office on Drugs and Crime.

The border town of Champhai, locals and officials admit, has seen a surge in wealth and property, which is attributed to profits made from smuggling the precursors. According to Zohmingthanga, in 2013 smugglers could earn back their investment a thousand times over, but he added that both price and demand have fallen in recent years due to fear of prosecution. This year alone, however, the department has already seized more than 1.1 million tablets of pseudoephedrine.

K Lalengmawii Khiangte, a counselor at Light for Comprehensive Development—a rehabilitation home run under the authority of Mizoram’s social welfare department for juvenile drug users—speaks to a 17-year-old heroin user who peddled drugs and slept on the streets for months before being admitted to the home, on May 28. She is infected with both HIV and hepatitis C, and her brother and mother are also users. (Sarita Santoshini for Foreign Policy)

Like the rural U.S. states hit by the opioid epidemic, Mizoram is finding dealing with the rash of addiction a long and painful struggle. Thanks to its remote location, Mizoram has a weak economy. In spite of a high literacy rate and good human development indicators, the state has high unemployment, especially among young people, many of whom migrate to other Indian cities in search of opportunities.

Mizoram relies almost entirely on the central government for funding, often faces delays in receiving money for the AIDS programs, and has only just begun attempting interventions in the opioid crisis.

Where the state has failed, the community has stepped in—taking on a role between vigilantes and social workers. Mizoram is almost  90 percent Christian, thanks to extensive missionary efforts under British rule, and Presbyterian and Baptist churches dominate. V.P came to addiction relatively late; the average age for Mizoram addicts to begin injecting heroin is just 19. But she has struggled to access proper treatment since she first began injecting heroin four years ago.

The men who detained her that evening belonged to the Supply Reduction Service (SRS) of the YMA, to which at least one member of each Mizo family, including many political leaders and government officials, belongs. Established in 1935 by Welsh Christian missionaries, the YMA exerts vast influence in the community. As part of its objectives, which include “good use of leisure” and Christian ethics, it carries out relief work during disasters, disseminates important information related to government or public services, and makes funeral arrangements in the event of a death in the community, among other things. It has also been fighting the drug trade for a decade.

In the state capital of Aizawl, 20 SRS volunteers regularly patrol the town and round up about five to 10 people at the end of every day, most of them drug users. What they do with those detained is up to their discretion: Users are physically punished, provided faith-based counseling, forced into overcrowded addiction centers, or sometimes handed over to the excise department or the police.

In the YMA’s office, the amount of heroin seized from dealers is proudly displayed and regularly updated on a chalkboard. It poses a tricky problem for the police. According to Zohmingthanga, roughly 20 percent of the excise department’s cases are handed over by the YMA, and its vast presence has helped them seize large consignments of heroin. But he also added that the YMA does not always follow the law, often failing to hand over detainees or seized heroin to the courts. (The fate of the seized heroin is unknown.)

The YMA’s huge influence in the state makes it impossible for the authorities to act against it. “Sometimes it puts us in an awkward position,” Zohmingthanga said. “We have joint meetings with their leaders where we tell them that they can’t keep those people and articles by themselves. But we cannot get them checked every day.”

According to Vanlalfela, the 56-year-old secretary of the SRS, the volunteers sometimes hit users and dealers in order to scare them straight. “Bible says when you love your sons and daughters, you can beat them,” he said. “We beat them with love. We don’t hate them—we talk to them with love, which is why the people we beat don’t hate us either.”

For the lean 39-year-old V.R., getting clean has been a long journey—and one that the YMA nearly blocked. V.R. started abusing pills at 13 and weaned himself off the needle thanks to the use of opioid substitution therapy, where users take methadone or other substitutes for heroin as part of the process of getting clean. It’s a standard global practice, but many church leaders in Mizoram are strongly opposed to it. The Bible camps that V.R. was sent to, like many drug users are, discouraged its use, prohibiting attendees from accessing it.

In the drop-in center in Aizawl, an injecting drug user gets her blood sample collected to be tested for HIV on May 30. (Sarita Santoshini for Foreign Policy)

V.R. is one of thousands of drug users that the YMA and local authorities have sent to Tawngtai Bethel Camping Centre, a faith-based treatment center. The site is badly overcrowded, with as many as 900 users crammed into a space designed for fewer than a hundred, and former inmates report high levels of abuse, as well as a spate of deaths, with at least five inmates dying in the site. The only treatment offered is Bible lessons. “I have never been to jail, but the ones who have told me it’s just like that—the lack of activities, the exploitation. It’s the same. Nobody wants to stay there,” V.R. said.

The YMA receives support from both the government—in 2013, it received a national award from the Ministry of Social Justice and Empowerment for its “outstanding service in the field of prevention of alcoholism and substance (drug) abuse”—and the churches for its work. The political power of Christianity in Mizoram means the government walks a tightrope when dealing with the churches and the projects they back. The end to prohibition in 2014 drew ire from evangelical leaders, who had pushed the original teetotaler initiative—but also brought in badly needed money from the alcohol tax.

The power of the churches had also made effective campaigning harder in some cases. “In the second and third phases of the National AIDS Control Programme, India received a lot of foreign funding, which went into mobilization and involvement of churches and the community,” said Kunal Kishore, the associate director for drug use and harm reduction at India HIV/AIDS Alliance. “But while the state actively implemented harm reduction programs, it did not see a change in heart. There is still a lot of moral policing.” In a study conducted among 293 Presbyterian leaders in Aizawl in 2016, about 70 percent believed that disobedience to biblical teachings led to HIV, and only 34 percent was willing to advocate condom use.

During one afternoon in May, a drop-in center run by Agape, a church-funded organization that implements the targeted intervention project for female users ultimately funded by the Mizoram State AIDS Control Society (MSACS), was almost empty. Following complaints by the community against the gathering of drug users, the staff had been forced to ask its clients to limit or restrict their visits to the center to avoid unrest stirred by local residents. Things were this way in most of MSACS drop-in centers across town. One of a handful of users who came in for a dose of an opioid substitute that afternoon carried abscesses on her legs and bruises on her arm after being beaten by the YMA.

“Service delivery has been very difficult,” admitted Betty Lalthantluangi, the joint director of MSACS’s targeted intervention program. She said that while the community and the YMA meant well, their approach was different, and the program was losing clients because of it. “[Users] do not get syringes on time, they do not have their medical examination on time, and by the time we are able to get [services] back to them, they are already infected with HIV,” she said.

Members of the Supply Reduction Service in the Young Mizo Association’s central office in Aizawl on May 30. (Sarita Santoshini for Foreign Policy)

Peter Chhakchhuak, the convener of the SRS, was sure that harm reduction was not the right approach and only encouraged addiction. He was also doubtful of the state’s high HIV rate. “Here, MSACS has gotten more and more people tested, so the result has come high,” he said.

The churches’ role in Mizoram makes them a critical potential component of any treatment program—but also a frustratingly difficult one.

The YMA and other faith-based interventions exist largely because of the lack of other options. The YMA has no other option, Chhakchhuak of SRS argued, but to send users to rehabs like the center V.R. attended, which did not refuse anybody and provided free service, in the absence of other facilities that were willing to do the same.

Lalhlupuii Sailo, the CEO of the Mizoram Social Defence and Rehabilitation Board, acknowledged the problem and said officials were currently working on a set of standardized guidelines that the 38 treatment centers in the state, almost all of which are faith-based, would have to adhere to. Sailo added the state has allocated funds toward wide-scale prevention of drug abuse, which would cover both schools and churches, as well as make treatment and aftercare services available and more accessible for existing users.

“People are in a hurry [to fix things]. They feel that they will collect all these people together and put them in one place, maybe put them away for one month, and once they come out, they will be fine. But that is not the way,” said Lalthantluangi, the MSACS director. “Once they come back from this therapy, this is where our troubles begin.” Users might have been physically weaned off the drug, she added, but only unwillingly—and the first thing they do when they get out is look for a fix, often resulting in overdoses.

V.P. is still trying to avoid that fate. The SRS terrorized her into handing over the name of her dealer and then let her go. In the meanwhile, desperately seeking a way out and a better life for her daughter, V.P. consulted a psychiatrist, who admitted her into the general ward of a hospital for two weeks, providing pain killers and sleeping pills. Later, she decided to leave Aizawl and move to a relative’s place in another town, where she knows no one else. “I don’t know if there is any other solution or if this is long term, but I am clean now. I have even put on weight,” she said over the phone in August. “I don’t want to go through what happened in the past again.”

Correction, Oct. 2, 2018: Sarita Santoshini visited the drop-in center run by Agape in May. A previous version of this story mistakenly said she visited the center in June. 

Sarita Santoshini is an Indian journalist.