More and more Indians are falling prey to opioid painkillers. Doctors warn of possible ‘pharmaco-opioid epidemic’


In India, addiction experts warn that the current heroin epidemic has created fertile ground for the next wave of the “pharma-opioid epidemic” — a public health crisis caused by the unregulated sale, purchase, and sale of opioid painkillers. And is due to use.

The 2019 National Drug Survey, conducted by the NDDTC, showed that opioids are the most commonly abused substances in India, after alcohol and cannabis. These include opium and its derivatives (such as poppy husk, known as Doda), heroin (including the adulterated variety known as smack or brown sugar), and pharmaceutical opioids.

The survey found that the prevalence of opiate use among the general population in India was 2.06 percent, almost three times higher than the global average of 0.7 percent.

Within the broader category of opioids, the report showed, the population’s addiction rate to heroin — considered the most harmful and addictive opioid — stood at 1.14 percent. However, pharmaceutical opioids followed closely behind, with 0.9 percent of the population addicted to these drugs.

“In the first National Drug Survey in 2004, opium and its derivatives were the most commonly used opioids, with pharmaceutical opioids accounting for a small proportion. But this trend has now reversed,” said Dr. Ravindra Rao, NDDTC. I am a professor of psychology and a researcher on opioids, told The Print. “There are now signs of widespread pharmaceutical opioid addiction in many states such as Punjab and some northeastern states.”

The next round of surveys is expected to provide a clearer picture of opioid use patterns in India, Rao added.

“Given this evidence, the reach of pharmaceutical opioids may be more widespread than most people think,” he said.


Also read: Smack and ‘Hal’ are feeding Delhi’s homeless children. It is a haven for them.


Crops, trade, and the challenge of growing opium

Cultivation and use of opium has been practiced in India since medieval times. However, during the British rule, opium cultivation became an organized and commercial enterprise.

India is now one of the few countries in the world where poppy cultivation is legal for medicinal and scientific purposes. It is also the world’s largest producer of opiates for the global medical market, exporting most of its production as controlled and prescription drugs.

Locally, licensed opium cultivation is allowed in Madhya Pradesh, Rajasthan, and Uttar Pradesh, all under strict government supervision.

In addition, poppy growers operating in notified areas within these states are required to submit their entire production to the Central Bureau of Narcotics. The supply is then sent to Government Opium and Alkaloid Factories (GOAFs), located in Neemuch, Madhya Pradesh, and Ghazipur, Uttar Pradesh.

These state-owned factories process opium, preparing it for export and use in alkaloid plants, which, in turn, supply major pharmaceutical manufacturers around the world.

India also has the distinction of being the only country authorized by the United Nations Single Convention on Narcotic Drugs of 1961 to legally manufacture opium gum. This extract contains several important, naturally occurring alkaloids such as morphine and codeine.

However, despite all this, the country has taken a strict legal stance on the use of opium.

In 1985, he enacted the stringent Narcotic Drugs and Psychotropic Substances Act, which banned the manufacture, possession, sale and use of narcotic drugs and psychotropic substances.

This was followed by the enactment of the Narcotic Drugs and Psychotropic Substances Prevention of Illicit Trafficking Act of 1988, which provides additional measures aimed at preventing illicit trafficking in narcotic drugs and psychotropic substances.

While the problem of prescription opioids has emerged as a major public health challenge in many countries over the past several decades, India is believed to be largely unaffected.

But that seems to be changing. Doctors and manufacturers attribute this to the unconscionable sale of opioid drugs by chemists and pharmacists. This is despite the fact that drugs classified in Schedules H, H1, and X cannot be sold without a doctor’s prescription.

A member of the Indian Drug Manufacturers Association claimed that “H1 scheduled opioids such as buprenorphine and pentazocine, which are used for pain management and also as an alternative treatment for heroin addicts, are freely sold by chemists across the country.” are sold as such.” India

According to Dr. Rao, there has also been an increase in the use of tramadol, an opioid that is less potent than fentanyl, but can be more potent if taken orally by injection because of its chemical makeup.

India is the largest supplier of Tramadol, which is prescribed as a pain reliever. Its stimulant effects can lead people to believe they are doing more even when taking dangerously high doses.

A problem of abundance – and scarcity

Opioids are a common choice for acute pain management. According to Dr Republica Sridhar, pain management specialist and founder of RMD Group of Hospitals in Chennai, they not only reduce the sensation of pain but also increase tolerance to it.

However, there is a contradiction. Doctors say people who need opioids to manage pain for conditions such as cancer sometimes have trouble accessing the drugs because of strict regulations, while those who do not need the wrong drugs. Want to use they can easily get.

“People who use these drugs only for recreational purposes can get them through diversionary routes. Clearly, there is a leak somewhere in the supply chains,” said Dr. Atul Ambekar, Psychiatry at NDDTC. Professor and Secretary General of Addiction Psychiatry Society of India.

On the other hand, patients who are in dire need of palliative care are in constant pain.

Dr. Rajshekhar C. Jaka, consultant surgical oncology and robotic surgery at Manipal Hospital, Bengaluru, said, “Cancer patients suffer tremendously during the last stages of their lives due to inability to access opioids for pain relief. endure.”

Inadequate pain relief can be attributed to poor availability of opioids, lack of skill among health care professionals in prescribing them, and concerns about opioid side effects and addiction, he added. .

Dr Jaka said the current national palliative care policy also needs substantial updates to help address these issues.

In 2014, an amendment to the Narcotic Drugs and Psychotropic Substances Act created a category of six essential narcotics, including codeine, fentanyl, hydrocodone, methadone, morphine and oxycodone. The move aims to improve access to these drugs and eliminate state barriers.

With the creation of this new class of drugs, the government recognized for the first time that it had responsibility not only for the medical use of opioids, but also for making these opioids available to the general public.

Yet, Dr. Jaka points out, less than 10 percent of cancer patients in India have adequate access to pain relief.

Yet, despite the ongoing problem of access to critical pain medications, the relaxation of prescription opioid laws has led to the proliferation of opioid-derived pain relievers in pharmacies, hospitals and pain management centers across the country. .

Balancing Act

Dr. Ambekar highlighted that among the wide spectrum of opioids, heroin is the most harmful and the most widely used in India.

According to him, people who use heroin are more prone to addiction than those who use pharmaceuticals.

“About half of heroin users have an opioid use disorder, compared to one-third of pharma opioid users,” he said.

Ambekar said that given the relatively slow implementation of pharmaceutical dispensing laws in India, it was interesting to see that heroin was used more than pharmaceutical opioids.

At the same time, he said, there is cause for concern about the diversion and abuse of pharmaceutical opioids.

“I don’t want to do a doomsday scenario but yes, the situation with India’s opioid epidemic is dire. So far, it has appeared manageable with a judicious combination of supply control, demand reduction, and harm reduction strategies. Gives.”

Harm reduction refers to measures that reduce the negative consequences associated with drug use. This can include strategies such as providing drugs to reverse overdose, counseling, and even providing clean syringes to prevent blood-borne diseases.

Unless such strategies are consistently used from now on, the situation could worsen in the coming years, warned Dr. Amebakar.

He also warned that over-reliance on supply control measures could be counterproductive, especially given the lack of treatment facilities. If heroin isn’t available, he pointed out, addicts may turn to more harmful methods of drug use, such as injecting.

This method is more ‘economical’, as a small amount of the drug is stronger when injected. Ambekar said it would also increase the risk of mass overdose deaths and the spread of infections such as HIV and hepatitis.

“The current heroin epidemic sets the stage for the next wave of pharma-opioid epidemics, especially if heroin is in short supply and treatment is not available,” Ambekar said. “So while the nation needs to operate on a ‘war footing,’ a ‘war on drugs’ approach should be avoided.”

(Edited by Aswari Singh)


Also read: Reporting poor manufacturing in annual audits: How the government wants drugmakers to improve quality


Leave a Comment

“The Untold Story: Yung Miami’s Response to Jimmy Butler’s Advances During an NBA Playoff Game” “Unveiling the Secrets: 15 Astonishing Facts About the PGA Championship”