The government’s crackdown on drugs, which has led to hundreds of arrests of users and street peddlers across Punjab, is slowly pushing addicts to de-addiction centres for opioid substitutes that are normally used in treatment but which addicts see as an inexpensive alternative to their usual fix. Doctors at several de-addiction centres in Punjab are reporting a gradual uptick in the number of patients as narcotic supplies go underground, and their prices spike. During the previous government’s 2014-2015 drive against drugs, addicts flocked to de-addiction centres for Buprenorphine, an Opioid Substitute Therapy drug used to treat narcotic addiction, as an easy alternative to heroin that went underground during the crackdown.
As addicts purportedly under treatment got hooked to Buprenorphine, an opioid medication, it found its way to chemists shops and elsewhere where it was being sold illegally. In 2015, the government had to restrict the availability of Buprenorphine to 75 de-addiction centres, including specified OST centres. Doctors no more prescribe Buprenorphine in OPDs, and administer it only to in-patients.
This time, doctors said, there are already indications that addicts could be latching on to Tramadol, an opioid pain medication. Available in the form of tablets, Tramadol is administered in small quantities for a brief period to treat narcotic addiction. But if continued over a long period, users develop a dependence on it, not unlike a narcotic addiction. Taken in large unsupervised doses, Tramadol can lead to serious medical complications such as eplipetic seizures.
“The number of patients has increased over the last 10 days. Patients say there is a shortage of narcotic drugs in the market, leading to an increase in their prices,” said Dr Arun Bansal, consultant psychiatrist at the civil hospital in Fazilka. He said the number of patients in the OPD had increased “by 20 per cent.” “The addicts who come to us for treatment ask to prescribe Tramadol drug.”
A strip of 10 tablets of 50 grams costs approx Rs 60, The prescribed dosage differs from case to case, doctors said.
Dr Sudha Vasudev, a psychiatrist at the Samrala Sub-divisional Hospital, said: “We have started seeing an increase slowly both in OPD and IPD.”
“In our IPD, number of admissions in one week used to be five. Now, there are five admissions in a single day,” said Dr Sandeep Bhola, psychiatrist at the civil hospital in Kapurthala. He said the numbers at OPD had also increased.
Many of the addicts who visit the hospital have a history of using Tramadol and going in and out of de-addiction centres, doctors said.
“The problem is that anyone can prescribe the medicine and it is available at chemist shops on prescription. There should be some regulation to stop the misuse,” said Dr BS Sidhu, psychiatrist at Government Medical College, Patiala. “Fearing that patients might get addicted, we don’t prescribe this medicine to our OPD patients. We see at least one patient in the OPD every day who shows Tramadol dependency.”
Dr Sandeep Bhola said that to prevent the misuse, he prescribed Tramadol only if a family member was accompanying the patient in the OPD. But he warned that Tramadol was “definitely going to get misused” as the supply of illicit opioid goes down. “Although it’s used with caution by government hospitals and authorized pharmacies, enforcement authorities needs to keep a check on illegal sales,” said Dr Bhola.
The problem is compounded by the absence of follow-up mechanisms in the de-addiction regime that exists in Punjab. The understaffed de-addiction centres have no records of patients who have been prescribed Tramadol earlier. Nor do they have a mechanism to ensure that walk-in addicts continue to come for the entire course of the treatment so that they can be sent to a rehabilitation facility. “They (addicts) can even visit private doctors and get the medicine prescribed,” said a psychiatrist posted in Ludhiana district.
“People are abusing Tramadol in place of opium, husk and heroin. Drugs like Tramadol can be sold by a pharmacist on prescription. The drug authority should ensure there is no misuse of this drug,” said Kaustav Sharma, Regional Director of the Narcotics Control Bureau, Chandigarh.
“We have seen cases in the hospital where an addict has taken around 30 tablets of Tramadol (100mg) a day. Patients are shifting from opioids to this drug because it is comparatively cheaper,” said Dr Arvind Sharma, head of department of psychiatry and de-addiction at Guru Gobind Singh Medical College, Faridkot. “Patients now tell us they shifted to Tramadol recently because other opiates are not available in the market easily.”