Telangana and Kerala have seen a spike in illicit liquor use, even as de-addiction centres see a rush of persons suffering from alcohol withdrawal symptoms.

Alcohol withdrawal symptoms during lockdown Telangana Kerala tackle spike in cases
Delve Health Friday, April 03, 2020 - 16:02

Just like the other south Indian states, Telangana and Kerala have shuttered liquor outlets and bars in the regions to prevent public gatherings, an effective measure to curb the possible community outbreak of COVID-19. The measure, however, has come with its own set of issues.

From a spike in the number of people depending on illegal liquor to an increase in the number of persons suffering from withdrawal symptoms due to alcohol deprivation, there have been some visible effects. Multiple suicide deaths, that are suspected to be due to alcohol deprivation have also surfaced from both the states in the past one week.

Telangana and Kerala are two states which implemented state lockdowns prior to the national lockdown of the Centre came into force.

De-addiction centres see a rush

In Telangana, Chief Minister K Chandrashekar Rao announced the state lockdown on March 23, two days before the nation-wide lockdown was imposed. Over 2,400 liquor outlets and over 700 bars have since remained shut in the state.

Ever since then, the outpatient facilities at hospitals in Telangana have been witnessing a steady stream of persons with Alcohol Withdrawal Symptoms (AWS) seeking medical help.

Since Saturday, the Institute of Mental Health, Edagadda, Hyderabad reported over 150 cases of persons with alcohol withdrawal at their outpatient (OP) facility. Dr Uma Shankar, the hospital Superintendent told TNM, “In the last three days, the numbers have gone up. On Saturday we saw 16 cases, on Sunday, 25 cases and on Monday alone we received 90 people who came to the OP facility. Over 45 persons were admitted to the hospitals and some were given OP treatment and sent back home as they need only mild treatment.”

The hospital has urged those with withdrawal symptoms not to come to Hyderabad but to seek medical assistance at district-level hospitals. “There are district-level hospitals and medical colleges that have physiatrists, we urge those with withdrawals to visit those hospitals and get treatment,”.

Dr Devika Rani K, a de-addiction therapist working with the Rachakonda Police Commissionerate to counsel those caught drunk driving in the city says, “Toddy addicts are not addicted to the toddy itself, but rather to the diazepam and alprazolam chemicals often added as adulterants. The withdrawals can cause nausea, body tremors and auditory-visual hallucinations,” said Dr Devika.

However, those working with alcohol de-addiction in the state say the number of those visiting are far fewer than the previous two instances in the state when toddy and gudumba ( illicit liquor made out of black jaggery)  were banned.

In 2015 when the Telangana government decided to crack down on illicit and adulterated liquor, 25 persons died and 330 persons were hospitalized over the lack of availability of alcohol. A similar spike in alcohol withdrawal-related deaths was observed when the government of NT Rama Rao banned the sale of illicit liquor in 1995.

Meanwhile, a similar trend has also been seen in Kerala. The de-addiction centres under Vimukthi, the anti-narcotics initiative under the state’s Excise Department, saw an influx since the closure of Kerala State Beverages Corporation Limited (BEVCO) outlets.

Chief Minister Pinarayi Vijayan announced the closure of bars in the state, starting from March 24, but allowed liquor stores belonging to BEVCO to stay open. Following criticisms from medical experts and with a spike in the number of COVID-19 cases, the state government shuttered all 270 BEVCO outlets on March 25.

According to the officials of Vimukthi, ever since then, in just a week’s time, 64 people were admitted to the 14 de-addiction centres under Vimukthi alone. “This is not the usual pattern. Not more than 20-30 people usually get admitted to the Vimukthi centres in a week,” K Muhammed Resheed, Joint Excise Commissioner (Awareness Programme Coordination) told TNM.

Both states have also seen multiple instances of suicides in the past week, that are suspected to be due to alcohol deprivation. While Kerala reported eight sucide cases, Telangana reported four such deaths suspected to be because of alcohol unavailability. Two  suicides allegedly due to alcohol deprivation were also reported from Karnataka in the past week.

Read: How to deal with alcohol addiction during the lockdown

Spike in illicit liquor use

Kerala reportedly has the highest per capita consumption of alcohol in India. Liquor sales contribute a major chunk to the state’s exchequer.

According to officials of Kerala’s Excise Department, there has been a surge in the confiscation of illegal liquor cases.

In just six days starting from March 25, the Excise Department seized 10,000 litres of wash (fermented solution used to make arrack), 9.6 litres of spirit and 2.25 litres of arrack, from various districts in the state.

“On March 30 alone, 2,400 litres of wash was seized from different districts. There is definitely a surge in people turning to illegal liquor after the closure of BEVCO outlets. We are yet to receive data from some districts, so this number is again going to increase,” Sam Christy Daniel, Additional Excise Commissioner(Enforcement), told TNM.

He also said that the amount of wash seized in the whole month of February was 11,232 litres. “When we compare that by what we seized just this week, we can definitely say that there is a surge in illegal liquor dependency,” said Sam Christy.

The department has also recorded 15 cases of illicit liquor seizures in the past one week.

Meanwhile Telangana too is anticipating a similar spike. An official with the Telangana’s Excise Department told TNM that it has so far booked three  cases of illegal sale of gudumba (illicit liquor) in the Dhoolpet area of Hyderabad.

“We have been anticipating the sale of illegal liquor since the lockdown was announced and have been keeping track,” said the official.

Dr SRR Y Srinivas, Head, Department of Psychiatry, Kakatiya Medical College, Warangal states that though liquor shops and toddy shops are closed in cities and towns, their sale goes unchecked in the villages.

“The police can’t keep track of everything. There are fewer cases of persons with alcohol withdrawal being reported at district hospitals which is an indication that alcohol can still be procured despite the lockdown,” says Dr Srinivas.

Tackling the crisis

Taking the gravity of the situation into consideration, the Kerala government has started relief measures to aid those struggling with severe alcohol withdrawal symptoms (AWS). Under the Mental Health Program of the Health Department, counsellings to help people with such issues was started on Monday.

The Primary Health Centres (PHC) and Family Health Centres (FHC) have been equipped to deal with people with AWS. Kerala Health Minister KK Shailaja has stated that medicines that will be required for such patients have been made available at PHCs and FHCs. Directions have also been given to keep aside 20 hospital beds in each district for the treatment of such people.

Going a step forward, the state government also announced that those with severe AWS will be administered a limited amount of alcohol, based on a diagnosis by doctors. The Excise Department is in charge of receiving such notes certifying AWS patients and providing alcohol. On Wednesday, the Excise Department received 40 requests from AWS patients. But the Kerala High Court on Thursday put a stay on the Kerala government’s March 30 order, calling the decision a ‘recipe for disaster’. The stay is for a period of three weeks.

Meanwhile, experts working in the field of drug abuse and de-addiction, say that the government should have anticipated the repercussions of a blanket shutdown of liquor outlets.

“These repercussions should have been anticipated and awareness must have been given beforehand. Along with the announcement of a shutdown of bars and Bevco outlets, it should have been explained how people should cope with this. Common people might not even know that they have to seek medical help,” Mahesh Chithravarnam, an expert in the field, told TNM. Mahesh, a native of Kozhikode district, has been working to create awareness of drug abuse and alcohol addiction among people for the past many years.

However, in Telangana no steps have been taken so far to mitigate the crisis. Health officials say, those experiencing AWS in the state can reach out to district medical officers or landline numbers that are listed on their website, “No other special facility or service has been set up,” said Uma Shankar.

In neighbouring state Andhra Pradesh,on Wednesday, one person died and four others were hospitalised after a group of youngsters consumed chemicals used in sanitizers as a substitute for alcohol.

The state's nodal officer with State Mental Health Authority, Dr S Radha Rani however told TNM that her department has not witnessed any rise in the number of patients with AWS since the lockdown began.“We have had perhaps three cases in Vijayawada district, we aren't getting any reports about a spike in the number of cases from the districts. There could be two reasons, either it could be because the Andhra Pradesh government even before the pandemic has been reducing the number of wine shops in the state, so the state was under a partial prohibition already or it could be because they are still getting access to alcohol,”.

The YSRCP government in Andhra Pradesh, soon after coming to power in 2019 took over the liquor retail business in the state and reduced the number of outlets from 4,380 to 3,500.

Helpline numbers:

Kerala: DISHA - 1056, 0471 2552056

Telangana State Mental Health Authority: 040- 23814441, 040 23814442

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