The Rajya Sabha was recently informed that between 2020 and 2024, narcotics worth approximately ₹11,310 crore were seized at Indian ports. While this reflects effective enforcement of narcotics laws, it also highlights the alarming scale of substance abuse in the country.
The National Centre for Health Statistics reported over one lakh drug overdose deaths in the US in 2021. In 2019, for the first time, the National Safety Council, US, declared that people are more likely to die from opioid (opium-like substances) overdose than car crashes.
This conveys the mammoth problem of substance abuse encountered by the US and other developed nations. Substance abuse is not a new story; it has its roots deep in human history.
Ancient civilisations were known to use addictive substances, which were not limited to alcohol. Use of hallucinogenic plants such as cannabis - Dhatura (India), Ayahuasca (South America), or stimulants such as cocoa leaf dates back to the ancient past.
But the genesis of the present drug epidemic stems from human development and advancement of pharmaceutical science rather than traditional plant use.
The crisis came to the limelight around 2016, when 11 million US citizens were reported to be misusing prescription opioid pain relief medications and 2.1 million were reported to be addicted to these drugs. Several pharmaceutical companies made substantial profits due to these sales.
Noteworthy among these was Purdue Pharma, responsible for the sales spike in opioid painkiller 'OxyContin' over the years. Many still believe that they should be held responsible for the genesis of the US opioid crisis. Most of the US states filed lawsuits against the 'Sackler family' owners of the company, and they consented to give $10-$12 billion in compensation.
In October 2020, they pleaded guilty to charges brought forth by the Department of Justice and had to pay $225 million.
The reason for such action was the aggressive marketing by the company. The marketing included bribing doctors to prescribe the extremely addictive medications for minor pain symptoms.
A similar case was that of John Kapoor, an India-born entrepreneur and former chairman of the Board of Insys Therapeutics. The Indian pharmacy graduate from the Institute of Chemical Technology obtained his doctoral degree from the University of New York, Buffalo.
He marketed a synthetic opioid, Fentanyl nasal spray, as a pain relief for terminally ill cancer patients. But later the marketing team of the company boosted the sales by making the product available for all sorts of minor pains, resulting in serious opioid addiction cases across the nation.
One of the methods used by Kapoor's team was to give incentives to doctors for prescribing higher doses of the spray. A lethal dose of this synthetic chemical for a human is around 2 milligrams, and it is about 100 times more potent than morphine; several times more potent than heroin.
According to the Centres for Disease Control and Prevention (CDC), synthetic opioid related deaths have increased by around 56% between 2019 and 2020 and are responsible for 82% of opioid overdose-related deaths in the US.
Opioid abuse is difficult to handle due to the nature of human physiology. Nerve cells in our body communicate with one another through chemicals called 'neurotransmitters', the natural painkiller of our body: endorphins. All opioids block this pain signalling process due to their chemical similarity to naturally present endorphins and result in the production of reward or 'feel good' chemical, dopamine, in the brain.
But after continuous use, nerves reduce the action of the substance and hence, a tolerance is built up in the body. This results in increased doses of the opioid substance to get a similar 'feel good' sensation.
In case of an overdose, opioid depresses the respiratory system, which can result in death unless treated within a few minutes with an opioid signal blocker, commonly known to health care professionals, as Nalaxone.
But we are doing much better. India was always safeguarded from the opium misuse by the 'Drugs and Cosmetic Act, 1940,' and 'Narcotic Drugs and Psychotropic Substances (NDPS) Act, 1985'. These impose harsh punishments for selling and cultivating the opium plant or distributing opioid substances.
But registered medical practitioners can store or prescribe several drugs without any licence as per the Schedule K of the Drugs and Cosmetics Rules, 1945.
A 2019 report suggests that only 4% of the male and 0.2% of the Indian female population are under the influence of opioid substances. But under-reporting makes this data unreliable.
India may have unknowingly played a small yet significant role in the substance trafficking to the West. In May 2018, $75 million worth of tramadol, a lesser-known opioid drug, was confiscated on its way to Misrata and Tobruk, Libya. In September 2008, a company was alleged to be violating Section 18 (c) of the Drugs and Cosmetics Act, 1940. This pharmaceutical firm had been manufacturing cold medication product Pseudoephedrine and I-Ephedrine, which can be used by drug cartels to manufacture non-opioid, synthetic, dopamine-stimulating drug - MDMA (3,4-Methylenedioxymethamphetamine).
The Combat Methamphetamine Epidemic Act of 2005(US) controlled the sale and export of precursor chemicals of MDMA to curb the supply of this dangerous drug to US youths.
The flow of Fentanyl to the USA is largely from China and Mexico. But India should learn a lesson from the role of Pharmaceutical companies, Pill mills and corrupt medical practitioners in the start of the current opioid epidemic in the US. Issues such as addiction rise during financial slumps, recessions, when more troubled, lost souls try to find solace in the arms of dangerous, addictive chemicals.
There was a 20% rise in addiction cases in India in 2022, which accounts for 292 million people. Drug abuse among students is even more concerning. Overall, the control of narcotics has been successful in India.
Amid the recent international financial turmoil, India should also bring strict regulations and policy-level interventions to limit the use of prescription, opioid pain killers and safeguard the youth of the nation.
(The Author is a professor and dean at Jindal School of Environment and Sustainability, OP Jindal Global University, with a research focus on environmental and health issues.)
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