UPDATE: The Kerala High Court on Thursday stayed the state government’s decision to provide alcohol to people based on prescriptions. The court has stayed the move for three weeks on petitions filed by Indian Medical Association and Kerala Government Medical Officers Association
The Kerala government, which has drawn widespread praise for its humane and comprehensive measures to contain the coronavirus outbreak, is fumbling while dealing with alcohol dependence in the state during the lockdown.
On Monday night, the state government issued an order allowing people with alcohol withdrawal symptoms to get controlled amounts of liquor from the excise department through a doctor’s prescription.
The order was passed despite widespread criticism from doctors’ bodies, which called the move ‘unscientific’ and ‘unethical’. Doctors from the Kerala chapter of the Indian Medical Association and the Kerala Government Medical Officers’ Association have said they will not provide such prescriptions.
On Wednesday, doctors of the KGMOA protested the government’s decision by wearing black bands to work.
Meanwhile, the state’s excise department had said that it will begin the process of providing alcohol on prescription only after forming guidelines that clarify how much alcohol to give and for how many days. It also said it required clarity on a procedure to check the veracity of the prescriptions brought in by people, Manorama News reported.
On Thursday, the Kerala High Court pulled up the government for its “unilateral” and “disturbing” move as it heard petitions by the IMA and KGMOA.
The State Attorney had submitted that the moderate administration of alcohol in such cases was a recognised practice.
“This is a recipe for disaster,” Justice Nambiar said. “No document in medical literature supports such a prescription of alcohol to persons with alcohol withdrawal syndrome,” he added, LiveLaw quoted.
Kerala’s alcohol problem
Kerala’s first coronavirus case was reported on January 30. In the two months since then, the state has reported two deaths from the disease. Over 200 patients are currently under treatment in the state while 20 have recovered and been discharged.
In contrast, within just a week of shutting alcohol shops, the state reported nine cases of death by suicide. According to The Print, seven were allegedly in depression, one died of a cardiac arrest and another had consumed aftershave lotion as a substitute for alcohol.
According to the 2015-16 National Family Health Survey, Kerala ranked 18th, behind many other states, in terms of alcohol consumption by men, with only 37% consuming alcohol. Only 1.6% women in the state drank alcohol according to the survey.
Despite this, Kerala is known to have the highest per capita alcohol consumption in the country, with its sales making the biggest revenue contribution to the state’s exchequer.
In 2018-19, liquor sales in Kerala hit a record high of Rs 14,508 crore with August—the month when the state was hit by the worst floods in a century—having the highest sales value.
This financial year, during Onam season, the Kerala State Beverage Cooperation sold alcohol worth Rs 500 crore in a week, up Rs 30 crore from the previous year.
The Christmas-New Year season (December 22-31), saw a 16% rise from the previous year, with Rs 10 crore more in sales.
A sample survey conducted under the guidance of National Institute of Mental Health and Neurosciences in 2015-16 said that there was a 4.82% prevalence of alcohol-related abuse in the state. The number was over 11% among men.
“According to the Kerala Mental Health Survey, 2018, there are about 50,000 men suffering from alcohol-related problems. Moreover, nearly 10,000 to 15,000 of them may develop serious problems like alcohol withdrawal fits, hallucinations and depression. The number of deaths in a couple of days endorses the projections available from the survey,” said Dr CJ John, a senior psychiatrist told News18.
It is this dependence that CM Pinarayi Vijayan hinted at while initially resisting shutting down liquor shops as part of the measures to restrict movement of people. The CM said several times that such a move would have “social repurcussions”.
After the shutting of shops, the CM said the government would explore alternate options and consider selling it online.
The govt asked the Excise Department to provide free treatment to and admit people with withdrawal symptoms to de-addiction centres. Every district was instructed to prepare 20 beds for the treatment of those dealing with alcoholism.
Medical bodies condemn move
Both the Kerala Government Medical Officers’ Association and the state chapter of the Indian Medical Association have slammed the Left government’s plan to provide alcohol through prescription.
“Modern medicine does not prescribe liquor to treat alcoholism. Alternative treatments are used to cure the condition. We must use such treatments to cure the condition. We must use such treatments to cure alcohol addiction. Prescribing liquor for alcoholism is unscientific and unethical,” KGMOA said in its statement on Monday.
IMA state president Dr Abraham Varghese told PTI that those showing withdrawal symptoms should be provided scientific treatment which can be given at homes or by giving medicines after admitting them to hospitals,
“The move to supply liquor to such people cannot be accepted on scientific grounds. Doctors have no legal liability to give prescription to get them liquor,” Dr Varghese said.
A ‘liquor prescription’ may even result in the cancellation of the licence of the medical practitioner, he said.
IMA also said that asking doctors to recommend alcohol as treatment for withdrawal would be sending “a wrong message to the public.”
Kerala government’s order said that persons with withdrawal symptoms should approach public health centres, Taluk hospitals, district hospitals, general hospitals or the medical college hospitals and get themselves examined by the doctor.
“If such a person gets a prescription from the doctors saying he has withdrawal symptoms, he could be provided with liquor in a controlled manner,” the order read.
It said the prescription could be produced at the nearby Excise office along with a government issued identity card of the person carrying the prescription and receive a liquor pass.
The pass can be produced before the Beverages Corporation Managing Director, who will take necessary steps to distribute liquor, the order said.