The Media Coverage of Drugs and Alcohol in Punjab during Covid‐19 Pandemic

Punjab, a border state in Northern India, has faced a persistent substance-use problem that has driven political agendas and policy directives since many years. Punjab is the only state that tops in all type of substance abuse from alcohol, opioid, cannabis sedative, and amphetamine-type stimulants (ATS), with risky injecting drug use patterns (Ambekar et al, 1). In fact the Central government was all set to assist Punjab, where 18 of its 22 districts are most affected, as part of a National Action Plan for “Nasha Mukt Bharat” (addiction-free India) (Vishnoi, 30), when it hit an unexpected roadblock in the form of the new COVID-19 pandemic. When COVID-19 cases began to rise in India in March 2020, the Prime Minister Narendra Modi announced a 21-days nationwide lockdown to mitigate its spread. Punjab was one of the first to impose a curfew on March 23 after people were found rampantly flouting lockdown orders. Fears over community transmission further prompted the extension of lockdown to May 31, 2020. Apart from the pandemic, Punjab faced the added burden of dealing with its other public health crisis of drugs and alcohol-use. The disruption of regular movement affected the legal trade in alcohol and tobacco (that fetches 13%–20% excise duties), and illicit drugs. On April 1, a week after the lockdown, the Ministry of Home Affairs' national directives banned sales of liquor, tobacco, and use of smokeless tobacco products in public places. Soon, alcohol and drugs became some of the most newsworthy COVID-19 lockdown stories. Numerous memes, tweets, and social media videos on alcohol pangs found space in news. Punjab's Chief Minister was widely quoted in the national media as saying that the “only good thing” out of the ongoing COVID-19 crisis was the disruption of drug supply and smuggling into the state (Ghazali & Roy, 6). This article, therefore, examines post-lockdown news pertaining to drugs, tobacco, and alcohol in Punjab. News is central to anti-addiction agenda-setting and health advocacy, particularly in the communication of crucial health information and risk during pandemics. This review reveals the broader discourse about addictive substances through exploring the complex ties of governance, economy, rehabilitation drives, policing, and health concerns that mediate media coverage of substance-use crisis during a pandemic. The article relies upon qualitative analysis specifically inductive thematic analysis to identify themes emerging through the data (Braun & Clarke, 3). Online news and reports were collected from English national newspapers such as The Indian Express, The Hindu, Hindustan Times, Times of India; regional and local papers such as The Tribune, The Statesman, Punjabi Tribune, and news sites such as India Today and The Print from the lockdown period, from March 23 to May 31, 2020. Seventy articles were selected (35 on drugs, 30 alcohol-related, and 5 tobacco-related stories) and analyzed to reveal the following themes. Health risks due to crowding and poor social distancing at liquor vends was a theme that made sensationalist prime time news prior to the center's alcohol ban (as Punjab initially exempted alcohol as an “essential” item), tempered with huge liquor sales after reopening 40 days later. Some public health concerns were highlighted locally, such as alcohol shortages affecting the production of sanitizers as exorbitant prices created problems in this agrarian state. Marginal farmers already battling labor shortages struggled to follow government directives, to source sanitizers for their laborer's and farm equipment, prompting the farmer's union to seek government permission to make their own low-cost sanitizer “using alcohol and aloe vera” (“Seek nod,” 23). Few reports exposed gaps in risk communication and prevalence of fake news. For instance, low awareness about COVID-19 in rural areas and popular social media messages had led many to believe that onion, water, and liquor were cures for COVID-19 (Sehgal, 24). Yet, there were no reports about alcohol addiction in Punjab, though local papers reported “How to make alcohol at home” was trending on Google Search during the first lockdown week of March 22–28 (“How to,” 8). There was no media attention to health risks of using adulterated liquor in COVID-19 context, although the ban effectively bolstered the grey market of hooch (cheap (desi) liquor). Mostly, stories covered the political innuendoes over funding to states by center and drying liquor revenues due to lockdown. This played out alongside a national coverage of livelihood losses facing tobacco growing farmers and alcohol and tobacco products industry. Overall the most prominent theme was economics: revenues, “Covid” taxes on liquor, provisions of liquor home-delivery, lobbying, corruption, and the political storm over excise revenue losses due to illicit liquor trade. Two stories noted opposition to home-delivery by women activists and a political row after a local official issued orders to village temples and gurdwaras to publicize the government's home-delivery decision through loudspeakers. A series of articles on the “liquor scam” and subsequent state-wide crackdown on distilleries supplying liquor to illegal distilleries, besides misusing permits to sell liquor while evading taxes, was attributed to “The Tribune's Impact” (Khanna, 13). The most prominent focus of drug-related stories was on government initiatives and positive impacts (28%). Primarily, government and police were quoted as advocating therapeutic access to rehabilitation centers, with some involvement of helplines, village sarpanch and municipal councilors, to prevent fatalities, relapse, and suicide bids during lockdown. The COVID-19 strategy involved swift tweaking of substance abuse policy with a solution that would also reduce pressures on health departments and staff working during the pandemic. The media reported that registered patients would be provided free-of-cost, 21-days-take-home medicines after psychiatric evaluations, through government-run outpatient-opioid-assisted treatment (OOAT) centers. Two stories specified buprenorphine and naloxone as de-addiction medications. Reportedly, few mobile OOAT vans were also launched to provide consultations and door-step distribution of medications to mitigate overcrowding at clinics (Goel, 7). A steady stream of media reports, thus, drew national attention to the rising trend of de-addiction registrations (including women) at Punjab's 198 OOAT centers. Almost all stories mentioned actual de-addiction registration statistics, even evidencing district-wise distributions. About 86,000 patients were reportedly registered till May 11, 2020, adding to and taking the total state registrations to over 5 lakhs (Jamwal, 10). Majority of the articles used the stigma-inducing word “addicts” with one report labeling new cases as “undercover drug addicts,” while a minority used the word “patients.” The most quoted explanation for increased registrations was nonavailability of drugs due to break in supply. Drug prices shot up too. For instance, heroin which cost Rs. 3,000 per gram sold for Rs. 12,000 per gram during the lockdown (Bajwa, 2). The increased presence of police due to curfew conditions also deterred movement, although enforcements varied on the ground. Among the half dozen lockdown themed Punjabi songs that emerged, a local artist's (Figure 1.) catchy song about a grateful mother imploring the government to not open the lockdown since her son has started living without chitta (heroin) (Mamupuri and Ng Brother's, 15), showed this association in public imagination. Positive descriptions dominated coverage too. Official sources called the trend of new registrations a success, the “Corona blessing,” a “blessing in disguise,” and “positive fallout of COVID-19” in five articles (14%). Various ministerial sources quoted that the “lockdown had managed to curb the drug menace within one week, something which the government has been trying hard to achieve in the past few years” (Chaba, 4). The Business Standard's “COVID-19 Hinterland Digest” on regional news quoted Dainik Bhaskar's report that the “most crucial aspect” was “no death in the state due to the consumption of drugs in the past 25 days” (Jauhri, 11). However, a closer reading shows a suspected overdose death was reported in The Tribune early in April. Only a lone story noted the risks of “overdose, potential relapse or infection” facing “3.6 lakh registered drug addicts” due to misuse of alternative medications, travel restrictions and fears of police violence, short opening hours, and overcrowding (Sethi, 26). Majority of drug-related stories were about illicit activities. Sensationalist crime events that appealed to wider readerships received national attention. For instance, news about people arrested for allegedly chopping off a police officer's hand for stopping them from defying curfew, mentioned the recovery of drugs, opium-extraction chemicals and weapons (“Punjab: 4,” 18), thus, implying a drugs-crime connection. Events that evoked nationalism such as arrests of wanted smugglers with links to Pakistani militant outfits by Punjab police also received extensive attention on national television and newspapers. Commonly the bigger crime and de-addiction registrations stories had some background about anti-substances strategies. Most news about arrests of local and interstate smugglers emphasized policing themes too such as “vigil” by rural police over drug peddlers “to maintain law and order situation during COVID-19 lockdown” (“Rural Police,” 19). A story regarding police's claims about breaks in smuggling noted the arrests of 498 people for drug smuggling under the Narcotics, Drugs, and Psychotropic Substances (NDPS) Act and police drug hauls since lockdown (Naqshbandi, 16). One local story highlighted the struggles faced by police to thwart smuggling of drugs, narcotics, and liquor in ambulances amid enforcing curfew and manning interstate and interdistrict check-posts while maintaining safe practices to avoid COVID-19 infection (Deswal, 5). Some reports mentioned heightened community vigilance over village borders during the curfew thus drawing positive attention to preexisting initiatives and policing practices that involved communities. However, thematic analysis of local crime news indicated deeper challenges, given the systemic entrenchment of smuggling. For instance, the arrest of ex-servicemen for smuggling drugs into a Central Jail (“PESCO two,” 17) and the arrest of 91 people for smuggling, noted three separate incidents where the police were involved, with one incident reportedly captured on video and circulated in social media by villagers (“In Bathinda,” 9). In contrast, tobacco dependence was least covered in news. Stories that framed tobacco addiction as one of biggest public health threats during COVID-19 appeared in news only closer to May 31 World No Tobacco Day. One highlighted people being “challaned” for smoking publicly and the mobilization of community-level volunteers to spread awareness about anti-tobacco campaign and COVID-19 (“Mission Tandarust Punjab”) in villages (“World Tobacco,” 31), while other, largely quoting government sources detailed the current smokeless anti-tobacco campaign, information about national quit helplines, cessation centers, bans, and fines (“Tobacco Use,” 29). This limited analysis of news aims to provide insights into the differences in representations of addictive substances during the pandemic. Though substance users are a heterogeneous group, two affected communities were given media attention in the lockdown context: one, “drug addicts” susceptible to various withdrawal symptoms, and two, people receiving daily de-addiction treatment and psychological therapy. There was a near complete exclusion of women and marginalized groups. Statements from police specifically featured in almost all stories while the drug-related stories had more quotes from health professionals. Government ministers were among the top sources in drugs-related stories than in alcohol-related stories. The COVID-19 coverage of alcohol highlighted the state as a visible player in alcohol consumption. Though normal revenues were hit, the coverage about government positions on reopening licensed outlets to boost revenues and its “normalization” with silences in relation to alcohol addiction, perhaps weakens the popular notion of the state as an important agency of de-addiction, rehabilitation, and preventive policies. Only one report in a national paper noted both “drug addicts as well as liquor addicts” were “arriving with withdrawal symptoms” at drug de-addiction facilities and civil hospitals across Punjab (Saluja, 20). Thus, alcohol addiction challenges were rendered invisible, as a less severe social problem than illegal substances, although poly-substances continue to damage public health. This absence also indicates the sociocultural acceptance of alcohol usage as harmless pleasure seeking routines and the underestimation of its disorders, unlike the stigma associated with illicit substance usage. Although Punjab's media reported an intense rise in domestic violence cases during March 20–April 20 (“Lockdown: With,” 14) and studies link domestic violence with alcohol-use (Sarkar, Patra, & Kattimani, 22, pp. 8–9), there were no reports that explored these links during a stressful confinement period. In contrast, the media optimistically highlighted Punjab's drug de-addiction services that reduced burden on health-care systems during lockdown. As media coverage of its responsive policy of supplying medicines shows, state advocacy focused on the care of individuals suffering drug withdrawals under the current structural circumstances of COVID-19 epidemic. Yet, reports did not explore the challenges of “take-home-dose” such as monitoring to prevent their misuse, sale or usage by non-registered users. Just two weeks prior to the lockdown, a local newspaper had reported that “de-addiction seems to have become a new addiction in the state.” Citing a government survey, the story noted that about 67,000 treatment seekers (around 17%) were reportedly addicted to buprenorphine (an opioid-agonist medicine widely distributed as part of the state's de-addiction program), and using it to get a “kick from the medicine” instead of treatment (“17pc addicts,” 32). Silence prevailed about the state's poorly regulated private rehabilitation centers too. As Sandhu (21, p. 117) noted collective efforts are therefore necessary to tackle “existing attitudes of various stakeholders toward drug addicts that legitimize their exploitation.” Issues that received minimum attention, such as shortages in de-addiction medicine and protests by pharmacists in de-addiction centers demanding regular jobs and salaries (Sharma, 27; Singh, 28), showed the challenges of de-addiction strategies and the cracks in the broader lockdown narrative. The few reports about trading in illicit substances only skims the surface of how smugglers and customers seem to have changed their strategies. Two articles noted that many “were using link roads to reach out to peddlers, since there was no police presence there,” many were sourcing through social media networks, or using alternate drugs while clandestine supply of liquor continued through mobile apps and windows of shuttered down shops (Khanna, 12; Sehgal, 25). Thus, regardless of the good news about increased rehabilitation cases which appears to be short term, the reports indicate new challenges for health officials, village vigilances, policymakers, and police. During an epidemic crisis the state's and news organizations' understandings of public health perspectives strongly influence the framing of substances-use-related stories. The WHO's advisory on COVID-19 had cautioned against alcohol, tobacco, and drug use as it heightens risk factors due to impaired judgment, weakened immune responses, and comorbidities. The lack of coverage on health risks of alcohol-use in the framing of alcohol stories is a problematic gap. None of the reports addressed health risks of drug-usage behavior during COVID-19 epidemic such as injections, sharing of inhaling equipment and substances, and risky sexual behavior often associated with damaging health and spread of infectious diseases such as Hepatitis and HIV/AIDS. In contrast, four out of five tobacco-related stories quoted public health specialists advising against smoking and smokeless tobacco use to reduce risk of COVID-19 infections. Fear and confinement of lockdown itself could trigger and exaggerate psychological issues, increasing risks and relapse in patients undergoing mental health and drug abuse treatments as briefly noted in the rare stories that quoted mental health experts and psychiatrists. As this review of wide-ranging issues shows, there is an absence of news on health consequences and usage among high risk groups. The differences in information could have broad implications for containment, management, and surveillance strategies of COVID-19, and is therefore, a large gap both in policy initiatives and public risk communication. More attention should be paid to inclusive public health communications as it supports understandings of health risks and actions taken to contain the spread of infections. It is in the broader interest of tackling substance-use crises too

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