Opioid crisis: US and India

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More than 7 lakh deaths since the 1990s have been caused due to drug overdose in America. 68 percent of these deaths are a direct result of opioid overdose. Opioid, a legally approved drug and a primary constituent in pain-relief medications, has been prescribed to patients for treatment of chronic pain, suffered from, during post-surgery or chemotherapy to the excruciating pain experienced during pregnancy. This is because opioids resemble opium’s pain-eluding properties. The “Opioid Crisis” began, when opioid based medications were over-precribed during the early 90s. This went on to become an addiction catastrophe that till today, has America in its grip. On an average, reports according to US Department of Health and Human Services state that, in 2016 and 2017, 130 people die every day, owing to opioid drug-related overdose.

Opioids and kind

Opioids, derived from opium poppy plants, is prevalently synthesized in the form of  hydrocodone and oxycodone. And hydrocone, is the most prescribed opioid medication consumed by patients. Morphine and codeine are however, naturally extracted from opium. And fentanyl, a 100 percent synthetic opioid, is extremely efficient in treating pain relief. It is also used as a supplementary in anaesthesia medications. Uses of fentanyl don’t end there though. Potency of fentanyl, being 50-100 times of that of morphine, is widely used as a recreational drug, lies at the centre of opioid crisis. However, since there are no limitations on the availability of opioid, because of it’s medicinal benefits, fentanyl has a very high risk of addiction and overdose. Fentanyl’s primary producer being China, there have been several raging cases lodged by USA against China, as China-produced fentanyl has caused a significant number of opioid –related deaths. Heroine, however remains an illegal drug, synthesized from morphine, obtained from seed pod of opium plants. It remains to be the first opioid used by people, before other opioids. People who are found to have misused prescription drugs, are mostly heroine addicts. Tramadol, a lesser potent opioid, is traded across continents from India to Africa, without any restriction. Hence, is heavily abused, maximum, from amongst all other opioids.

How opioids work and its effects

In the 90s when opioids were first given out on post-surgery pain management prescriptions, 6 percent of the patients misused it, and continued taking the medication even after the prescribed period. This figure only kept increasing with time. Opoid medications work by binding to receptors which thwart the feeling of pain and induces a feeling of euphoria. As the brain slowly adapts to these feel-good emotions, it demands more of the opioids to produce the same effect. And this is precisely how people start getting dependant on the opioid medications and eventually, after long use of it, become addicted to it. Dependancy and addiction lead to higher tolerance level of the drug in the body, thus making people take more of it, resulting in overdose. And once people become dependant on opioids, they experience withdrawal symptoms, which makes it very tough for the users to stay away from it. During opioid crisis, a severe substance use disorder(SUD) of opioids was rampant across US.

Opioids in India

Veering towards the situation in India, it’s not surprising that opium plants mostly cultivated across Asia, Central America and South America, India is one of the largest producers of opioid medicines. Despite of opium cultivation being legally sanctioned in states such as Madhya Pradesh, Uttar Pradesh and Rajasthan, only 4 percent demand of pain-relief medication in India is met. The reason behind this ranges from restrictive drug policies in India to geographical and financial inequality. India’s Narcotic Drugs and Psychotropic Substances (NDPS) Act of 1985 (amended in 1988 and 2001) imposing 10 year prison term on opioid users and extensive licensing of morphine dealing, has made the pharmaceutical companies petrified of managing morphine stocks. Morphine, being potent and inexpensive, however, is not included in the mainstream medical care medication and thus kept countless poor Indians from getting treatment for chronic pain and cancer pain.

NDPS, with it’s last amendment in 2014, finally lifted the restriction, bringing a sigh of relief, especially amongst the poor in India. But what followed it was disheartening to say the least. Black markets dealing opioids rose largely, for-profit clinics across the slum and downtrodden areas of Mumbai, Kolkata, Delhi, etc mushroomed. Unregulated distribution of opioids led to scores of addiction and overdose cases coming up. Not only this, American pharmaceutical companies availing this opportunity, indulged in striking deals with Indian pharmacies for cheap import of opioids.    

Bottom Line

Like any other medication, opioids have both positive and negative effects. A regulated and controlled approach, if developed and established, towards using it, equipped with a better understanding of the effects of opioid use, both short-term as well as long-term, will put its negative side-effects on the hindsight. For this, the countries cultivating and using opioids should come together and co-operate towards eliminating the stigma and ensuring a safe usage of opioids, with the right intent and permit.  

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