Every year on November 1, people who use drugs across the world observe International Drug Users Day; a day to honour their resilience, remember their history, and demand recognition of their rights. The occasion marks a milestone in the global movement for dignity and justice, tracing back to the formal launch of the International Network of People who Use Drugs (INPUD) in Copenhagen in 2008, after its founding in Vancouver during the 17th International Conference on the Reduction of Drug‑Related Harm from the 30 April to 4 May 2006.
It is a day not merely of commemoration, but of assertion: a declaration that people who use drugs are citizens, not criminals. They are individuals deserving of health care, compassion, and respect. On this day, the global community calls for governments to replace stigma with science, and punishment with policy rooted in empathy.
For Manipur, this message strikes a particularly deep chord.
A State’s Long Struggle
For more than half a century, Manipur has lived under the shadow of drug use and its devastating consequences. Since the late 1970s, successive waves of heroin and other substances have shaped not only the lives of individuals but also public health, social structures, and government responses. Alongside addiction came the silent spread of HIV, Hepatitis B and C, and sexually transmitted infections—largely transmitted through unsafe injecting practices.
In the early 1990s, HIV was first detected among injecting drug users (IDUs) inside Manipur’s prisons. What followed was not just a health crisis but a moral panic. Addiction was cast as sin, not illness. Those living with HIV faced double discrimination—stigmatised by society and criminalised by the state. Families distant their loved ones, and communities turned their backs. Yet, in this tragedy, Manipur became one of India’s earliest epicentres of HIV response—a fact both painful and instructive.
From Punishment to Care
The early years of the state’s response to addiction were harsh and punitive. Drug users were chained in the name of “rehabilitation,” beaten by vigilantes, and even shot in the legs by insurgent groups. Some Churches often reinforced moral policing instead of extending compassion. Rehabilitation centres operated on an abstinence-only model, with relapse rates approaching 90 percent, according to anecdotal accounts.
Even so, small pockets of hope emerged. Narcotics Anonymous meetings began in the late 1980s, offering peer support and solidarity. From these gatherings grew community-based organisations (CBOs) led by people with lived experience of drug use. They stood firm against stigma, proved that recovery was possible, and laid the groundwork for a community-led movement that would later become crucial in the fight against HIV.
The Turning Point: Harm Reduction
The 1990s brought a transformation. HIV swept through injecting networks, turning addiction from a personal struggle into a public health emergency. Treatment was scarce, and infection often meant death. Yet the community response was remarkable. Groups of users and their families provided home-based care and compassion where institutions would not.
Under the National AIDS Control Programme (NACP), Manipur became a testing ground for new strategies rooted in global evidence. Harm reduction—needle and syringe exchanges, condom distribution, and later, opioid substitution therapy (OST)—was introduced. These approaches recognised a simple truth: saving lives does not require abstinence, only the reduction of risk.
The rollout of free antiretroviral therapy (ART) in 2004 marked another milestone. For the first time, people living with HIV in Manipur gained access to life-saving drugs. Today, over 13,000 people in the state are on ART. Together, harm reduction and rehabilitation created a continuum of care that once made Manipur a model for rights-based public health policy.
When Systems Falter
But the momentum did not last. As community organisations began to receive international funding and state support, institutionalisation brought stability—but also politics, competition, and corruption. Movements once rooted in compassion began to lose their moral centre.
The state, too, failed to uphold accountability. Manipur’s HIV/AIDS Policy of 1998 and Psychoactive Substances Policy of 2019 remain largely unimplemented. They exist more as symbolic achievements than as living documents guiding action. The absence of regular monitoring, evaluation, and data-driven decision-making means much of the current response relies on outdated models.
Stigma continues to thrive. Young people experimenting with drugs are punished rather than counselled. Women and transgender persons who use drugs face multiple layers of discrimination, often excluded from both treatment and support systems. Families, weighed down by shame, still abandon loved ones. Despite decades of experience, the state’s approach remains more punitive than compassionate.
A Question of Human Rights
At its core, addiction is not a criminal issue, it is a human rights issue. Drug dependence is a recognised medical condition, yet people who use drugs in Manipur continue to face arbitrary arrests, public humiliation, and even violence. Reports of forced confessions, physical abuse, and denial of care persist, cutting across all, especially against women and juveniles. Such violations not only harm individuals but also undermine public health itself.
Civil society, once the moral voice of the movement, must also look inward. Many organisations that once fought fiercely for dignity have become entangled in the politics of funding and representation. The result is a dangerous vacuum in authentic community leadership.
The Way Forward
Manipur now stands at a crossroads. To move forward, the state must rebuild its approach on three pillars: empathy, accountability, and evidence.
First, addiction must be recognised and treated as an illness. Punitive approaches have failed for decades. Strengthening harm reduction and integrating psychosocial care into rehabilitation are essential.
Second, accountability must be embedded at every level. The Manipur State AIDS Control Society (MSACS) and Social Welfare Department must undergo independent evaluation. Civil society groups must recommit to transparency, and donors must ensure that funds translate into measurable outcomes, not symbolic projects.
Third, stigma must be dismantled. Public education should emphasise that addiction is treatable and that HIV is manageable with medication. Families, churches, and local clubs—long the moral anchors of Manipuri society—must replace judgment with compassion.
Finally, research and documentation must guide all interventions. For a crisis that has lasted five decades, Manipur still lacks robust data to evaluate what works and what does not. Without evidence, the state risks repeating its past mistakes.
A Call to Conscience
Manipur’s long battle with drugs and HIV is not a failure of individuals—it is a failure of systems. It is a story of resilience undermined by stigma, of progress weakened by corruption, and of policies celebrated but poorly implemented.
The choice before the state is clear. It can continue with token gestures and half-measures, or it can rebuild a response rooted in humanity, evidence, and accountability.
Addiction will not disappear overnight. HIV will not be conquered by slogans. But if Manipur chooses empathy over punishment, it can once again lead the way in showing that compassion, not coercion, is the path to recovery and dignity.
On this International Drug Users Day, that is the message worth repeating: Empathy heals. Punishment never has.
The writer is a drug user activist
