Pharma opioids, Punjab’s bane

Vishav Bharti

Along with heroin, poppy and opium, pharmaceutical opioids have also emerged as a big problem in the state. The fact came to the fore in Magnitude of Substance Use in India, a report prepared by the Ministry of Social Justice and Empowerment, which was released last month.

A survey found that Punjab tops among 13 states in the country, in which the prevalence of opioid-use disorders is more than one per cent. The situation indicates that it has become a major public health concern. The report observed: “Besides those in the north-eastern region, a state which stands out in terms of opioid use is Punjab. Punjab has a high prevalence of current use of opioids as well as of opioid-use disorders.”

As per the report, a substantial proportion of people using opioids are using it in a dependent or harmful pattern. Among opioid drugs, heroin has the highest prevalence of current use as well as harmful use/dependent use. The current use of pharmaceutical opioids follows closely behind. Of the approximately 77 lakh opioid users in the country, more than half are contributed by just a few states. Uttar Pradesh, Punjab, Haryana, Delhi, Maharashtra, Rajasthan, Andhra Pradesh and Gujarat house the highest number of people with opioid use problems.

According to estimates, there are 3.3 lakh people in Punjab with opioid dependence. Earlier, some other studies had also reported similar findings. In the recent past, two large studies focusing on opioid dependence in Punjab have documented the high magnitude of the opioid problem.

Rx: Government to relax prescription norms

With the aim to break the hegemony of a handful of players in the buprenorphine business, the state government is considering relaxing the restrictions regarding prescription of the de-addictive medicine.

According to rules, only designated de-addiction centres can prescribe buprenorphine and this has allegedly led to monopoly of a few players. At present, not even psychiatrists are allowed to prescribe the medicine. However, they have been demanding that when MBBS doctors with just one-week of training have been allowed to prescribe the medicine, why have psychiatrists, whose core area is de-addiction, been denied the right. According to sources, Punjab Government is looking into the demand and forming a policy to allow even psychiatrists to prescribe the drug. Even the Drug Controller General of India (DCGI) has written to the government in this regard. Punjab’s Additional Chief Secretary Satish Chandra confirmed that they have received a communication into this regard from DCGI. “We are discussing the same and considering public interest, a decision will be taken,” he said. The psychiatrists had given a representation to the Union Health Minister JP Nadda, following which the DCGI had written to the state government.

There are 91 psychiatrists in the state and they have been accusing the government of monopolising the business.  “If we decode the initiatives taken by the state health department under the de-addiction programme, one sees that only a few businessman have been given free hand to control the entire de-addiction treatment programme. The Association of Psychiatrists has alleged that the government is making sure that private psychiatrists don't practice,” said Dr Simmi Waraich, vice-president of the Association of Psychiatrists.

“The current scenario requires that private psychiatrists be utilised optimally to break the nexus of pharmaceutical companies and politicians,” says Waraich.

— Vishav Bharti