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Despite the fact that India has long been one of the world’s largest opioid producers, the majority of the country’s population didn’t have access to these medications until recently due to restrictive pharmaceutical laws. India is a major producer of drugs such as tramadol and fentanyl for American pharmaceutical companies; however, strict drug laws in India meant that these drugs were for export use only. For centuries, Indians predominantly relied upon holistic methods for pain management, leaving millions in unresolved pain.
The major laws that control the country’s pharmaceuticals include the Narcotic Drugs and Psychotropic Substances Act (NDPS) of 1985 and the Prevention of Illicit Trafficking in Narcotic Drugs and Psychotropic Substances Act of 1988. These strict laws included an automatic 10-year mandatory minimum prison sentence for violations involving the possession and distribution of narcotic drugs.
The NDPS was amended three times over the years including 1988, 2001, and one final time in 2014. The 2014 amendment was the product of decades of lobbying by palliative care activists, and officially recognized the need for pain relief as a central duty of government. The revised law created a class of medications available for wide-spread prescription called the “essential narcotic drugs” list, which included drugs like morphine, fentanyl, methadone, oxycodone, codeine, and hydrocodone. The introduction of this law had a drastic impact on patient care as pain went largely untreated in India due to the government’s hesitation and fear of addiction. The legalization of these medications provided hope for millions throughout the country struggling with chronic pain.
Following this 2014 change, pain management using pharmaceuticals quickly became a flourishing industry in India, with multinational drugs companies discovering new markets there. With a population of 1.3 billion people, India offered struggling American pharmaceutical companies facing multiple lawsuits back home a new source of costumers and income.
Similar to the start of America’s opioid epidemic, India’s campaign for the need of pain management began due to the multitude of diseased and dying people that were struggling to live and perform daily tasks due to chronic pain. Advocates and doctors shared heartbreaking stories from suffering patients to show a true need for opioid medications. As valid as that need is, it also gave room for misuse and promised countless new costumers to American pharmaceutical companies that have a track-record of pushing drugs despite addiction.
Multiple American-affiliated companies, such as Mundipharma which is an associate of Purdue Pharma, came in to supply the in-demand opioid medicines and flood the market with the drugs. Medications that were once banned can now be seen lining the shelves of not only in doctor’s offices and clinics, but unregulated kiosks. For-profit pain clinics have opened by the score across Mumbai, Kolkata, Bangalore, and other cities throughout the nation. Retail regulation of pharmaceutical dispensing has posed a major challenge for government officials.The explosion of availability of opioid drugs has led to countless accounts of addiction and medications spilling into the streets and onto the black market.
As I see it, India has an epidemic of opioid drug use and an epidemic of pain.
Indian doctors are now scared to prescribe the medications due to fear of repercussions for over-prescription. Several physicians have been arrested and jailed in recent years over allegations of over-prescribing opioid medications and now colleagues are “wary of drug control authorities.” The disparity between those who need pain medication and those who are actually able to receive now remains an ongoing problem. Just like in the U.S., this has led multiple addicted or desperate individuals to turn a stronger and cheaper opioid – heroin.
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According to Dr. Ambekar: “There is a ‘flood’ of heroin in certain parts of India at the same time as a ‘drought’ of opioid medications for genuine patients almost everywhere in India. The unfortunate reality is that both situations exist simultaneously.”
While there are countless parallels between the American opioid crisis and the one currently emerging in India, there is still hope. Indian government officials know that vigilance is crucial, and that efficient regulation of the industry will be key to preventing a future epidemic of wide-spread addiction.
Jena Hilliard earned her Bachelor’s of Arts degree from the University of Central Florida in English Literature. She has always had a passion for literature and the written word. Upon graduation, Jena found her purpose in educating the public on addiction and helping those that struggle with substance dependency find the best treatment options available.