Kochi: Kerala Chief Minister Pinarayi Vijayan's announcement that the government would make arrangements for regulated distribution of liquor for those suffering from alcohol withdrawal syndrome has raised questions of medical ethics among doctors.

The state government has asked the excise department to explore options for regulated distribution of liquor under medical advice as the number of alcohol withdrawal syndrome cases keeps rising in Kerala following the shutdown of liquor outlets as part of the COVID-19 lockdown.

Chief Minister Pinarayi Vijayan announced the decision on Saturday in the wake of increasing number of suicides by people with suspected withdrawal syndrome.

The policy decision has triggered a fundamental question: can a doctor prescribe alcohol to a patient? Psychiatrists who deal with addiction and related problems are not in favour of using alcohol to tackle the situation. It is more or less a quick fix which goes against scientific methods of treating such patients, some of them say.

It is learnt that the excise department has prepared a draft proposal following chief minister's statement.

At the moment, no medical practitioner is allowed to prescribe alcohol as a medicine to treat de-addiction. However, given the unusual situation following the lockdown, the government can issue an order or even bring an ordinance permitting doctors to prescribe a certain dose of alcohol for those in critical condition.

Concerns

The Kerala unit of the Indian Psychiatric Society (IPSK) has conveyed its concerns to the chief minister. In a letter to the CM, the organisation stated that “alcohol withdrawal can be managed successfully using medication.”

“We feel that asking doctors to recommend alcohol to treat alcohol withdrawal syndrome will send a wrong message to the public. We worry that this will motivate many people to approach doctors to get ''prescriptions' for alcohol leading to fraud and malpractice. making a doctor recommend alcohol to a person is not ethical,” read the letter.

The letter, signed by IPSK president Dr Harish MT and secretary Dr Sebind Kumar, also requests the government to reconsider its decision.

“Making a doctor recommend alcohol to a person is not ethical. Prescribing alcohol to treat withdrawal syndrome is not part of scientific treatment. A government order or even an ordinance would be issued if the proposal has to be implemented,” Dr Arun B Nair, consultant psychiatrist, Thiruvananthapuram Medical College Hospital, said.

He said there are roughly five lakh people in Kerala who consume alcohol regularly. Fifty per cent of them suffer from alcohol dependency syndrome. Ten per cent of them may suffer from severe withdrawal syndrome.

Dr Arun said people who are addicted to alcohol or their family members should not hesitate to seek medical help in the current situation.

Kerala Government Government Medical Officers' Association (KGMOA) also said alcohol should not be used to treat withdrawal syndrome.

In a statement, its president Dr Joseph Chacko said: "The decision (to buy liquor with a doctor's prescription) is both unethical and impractical. There are scientific ways to treat those with severe withdrawal symptoms. Giving them liquor is not the solution. Equally problematic would be the large number of people who would crowd primary health centres and other government hospitals to get a prescription from the doctor. This would go against the very policy of social distancing. It could even trigger community transmission of the virus."

The association has already shot off a missive to the health minister and the director of health service pinpointing the dangers of such a decision.

Medical emergency

Dr U Vivek, consultant psychiatrist, Renai Medicity, Kochi, said the situation following the shutdown of liquor outlets should be treated as a medical emergency. “Providing alcohol should not be the way to avert the situation,”he said.

He said the lockdown system should be used as an opportunity to treat those suffering from addiction.

The Indian Society of Gastroeneterology – Kerala Chapter shares a similar view. In a letter to the chief minister, the association said, “we feel this (situation) may be a blessing in disguise to treat patients with alcohol use disorder and would help patients with alcohol addiction.”

Excise Commissioner Ananthakrishnan told Onmanorama that decisions on the mode of distribution and amount of liquor could be taken only on the basis of the recommendations from the health department.

Another excise officer said it would not be a big deal for the government to issue an order provided Kerala has a history of distributing opium to addicted people on the basis of medical prescription.