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Thursday, July 19, 2018

Simply Put: Why an opioid drug used to treat pain has led to petition in HC

Doctors are divided on the use of Buprenorphine to help treat drug addiction. Punjab has started a pilot project to test the impact.

Written by Adil Akhzer | Published: February 21, 2018 12:41:13 am
Jammu kashmir drug cartel, Rajnath singh, Narcotic Control Bureau In India, Punjab is one of the hotbeds of drug abuse. (Photo for representation)

Life expectancy in the United States fell for the second consecutive year in 2017 — apparently due to the worsening opioid crisis. In October 2017, President Donald Trump directed that the opioid crisis be declared a public health emergency. In India, Punjab is one of the hotbeds of drug abuse. A PIL recently filed in the Punjab and Haryana High Court asked that an opioid substitute, Buprenorphine, be made available on a “long-term basis” to help drug addicts. The PIL, filed by Samaj Bachao Mission Committee, a Tarn Taran-based NGO, said: “In Punjab, less than 10% of drug addicts have received opioid substitution therapy (OST). The proper procedure for the treatment… endorsed by the United Nations and the World Health Organisation, is providing opioid medication like Buprenorphine… on a long-term basis.”

What is Buprenorphine?
It is an opioid drug used to treat pain and addiction. It is the main drug in OST, which is often used with Naloxone. The treatment involves doctor-administered doses of Buprenorphine under controlled circumstances.
According to doctors, the drug can play a major role in rehabilitating addicts if used under medical supervision along with psychosocial interventions. But there are risks — patients may get addicted to Buprenorphine, and start consuming it in non-medical environments. If injected along with depressant drugs, this can even lead to death.

Is it commonly available in pharmacies?
Buprenorphine is a Schedule H drug and is available at government-recognised pharmacies only. But in 2014, the Punjab government — which had ordered a high-profile crackdown on drug peddlers — placed further restrictions on it. Said Kaustubh Sharma, who was until recently zonal director of the Narcotics Control Bureau (NCB) in Chandigarh: “Suddenly, there was a boom in the demand for Buprenorphine as addicts found the drug to be an alternative.” Private psychiatrists had started prescribing the drug in excessive quantity to addicts, and it was being sold as an alternative to heroin. “The government issued orders to restrict its supply after there were reports of misuse and illegal sale. Its availability was restricted to government and private rehabilitation centres only,” Punjab’s Drug Controller Pardeep Kumar Mattu said.

So, how severe is Punjab’s drug problem?
This has been an issue of political controversy. Studies have come up with varying numbers. But it is estimated that the state has between 1.7 lakh and 2.7 lakh addicts.

What is the current Congress government’s view on Buprenorphine?
In its election campaign, the Congress had promised to end the drug menace, not only through policing, but also by medical interventions. Kanwar Ajit Singh Sidhu, an NRI drug therapist based in the United States, helped the state government chalk out a plan. He proposed a Buprenorphine-based Outpatient Opioid Assisted Treatment (OOAT) programme. Following Chief Minister Amarinder Singh’s order to set up a committee to study the proposal, the government introduced the OOAT model in October on a pilot basis in three districts (Amritsar, Tarn Taran and Moga). Buprenorphine is currently administered in four rehabilitation and 21 community health centres in the state.

How freely is Buprenorphine available in other states across the country?
Buprenorphine is sold under strict regulations and cannot be purchased without the prescription of a qualified doctor. It is listed as a psychotropic substance under The Narcotic Drugs Psychotropic Substances Act.

Does OST enjoy wider support?
Atul Ambekar, a professor at the National Drug Dependence Treatment Centre at AIIMS, New Delhi, is one of its supporters. “At the moment, the availability of this treatment (OST) is low. This needs to be improved. There is a large section of opioid-dependent people who are suffering due to the unavailability of OST,” Dr Ambekar told The Indian Express.

So who opposes the treatment?
Some experts suggest that extra caution must be adopted while conducting OST. “No one can doubt that OST is the most evidence-based therapy. But the treatment should be recovery-oriented. Patients should not be mindlessly given the drug,” said Dr D Basu, a professor at PGIMER, Chandigarh. He referred to the misuse of Buprenorphine in Punjab in 2014 as an example.

What is the result of OOAT in Punjab?
As of mid-January 2018, 1,712 new patients were registered in the three districts where the pilot is running. Health officials said that 1,406 patients had visited the centres, and the patient retention rate currently stands at 82.13%. “Only after the doctors diagnose the patients for opioid dependence, a call is taken on the line of treatment,” said Ranbir Singh Rana, in-charge of the Tarn Taran drug de-addiction facility.
Punjab’s Health Minister Brahm Mohindra said a call on expanding the project to other districts will be taken after studying the success of the pilot programme.

Is there a debate on Buprenorphine in other countries as well?
In his first State of the Union address, President Donald Trump said the country in 2016 “lost 64,000 Americans to drug overdoses: 174 deaths per day. Seven per hour.” Last month, the US Drug Enforcement Administration allowed more healthcare professionals to prescribe and dispense Buprenorphine from their offices.

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