AMRITSAR: Still getting to grips with the horror of its durg-abuse phenomenon, Punjab is discovering that the problem has mutated into version 2.0. Rehab professionals and deaddiction centres across the state are reporting that addicts are getting hooked on the very drugs being used to treat them.
The most serious problem is with buprenorphine and tramadol, both drugs of choice to treat serious heroin addiction. Patients walk out of detox centres clean, but many relapse, this time habituated to the two prescription drugs, both of which are easily available across the state.
At the Government Drug De-addiction Centre in Amritsar, I met a 22-year-old youngster who had been hooked on heroin for three years. He told me he used to take at least two grams of heroin per day, spending up to Rs 4,000 some days. One day he collapsed in the bathroom of his house in Tarn Taran, and was brought to the rehab centre in Amritsar by his parents.
After the initial detoxification, he was administered buprenorphine, which is part of the Punjab health department’s oral substitution therapy (OST) for treatment of drug addicts. He got hooked to the medication as well.
Buprenorphine is a narcotic analgesic. It works on the nervous system to reduce pain. It is mostly administered to addicts who are HIV positive or those suffering from cancer or hepatitis C. The drug, meant only to be dispensed at deaddiction centres, has found its way into the open market and is sold on the sly by chemists.
Another typical relapse case was of Sandeep Singh (name changed) at a government run de-addiction centre. After his medical reports confirmed heroin addiction, he was administered 5 mg buprenorphine per day. After he was discharged eight months ago, he continued to procure the drug through an acquaintance, and was taking it daily. He is now back in detox again.
Professionals in anti-narcotics policing and rehab services said drug addiction 2.0 is proving to be just as lethal as heroin.
“We give buprenorphine only to those patients whose urine test reports are positive for heroin or any other drug addiction. The dosage per day is between 2 mg and 4 mg. However, with so many government and private centres around, this drug is falling into the wrong hands,” explains Dr P D Garg, head of the department (HoD) at the Guru Nanak Dev Hospital in Amritsar.
Recently, Narcotics Control Bureau (NCB) director-general Rajeev Rai Bhatnagar informed the Union home ministry that an unintended consequence of stricter anti-narcotics vigilance by the Border Security Force and the Punjab Police was the switch to buprenorphine and tramadol. “The drug abuse pattern in Punjab is changing and more and more people are getting addicted to medications,” said Bhatnagar.
J P S Bhatia, a psychiatrist who runs the Hermitage Deaddiction Centre in Amritsar confirmed this: “The drug is to be administered only in rehab centres but yes it is being abused. I have come across reports suggesting that the government is planning to ban the drug altogether.”
However, many doctors are reluctant to elaborate on the abuse of buprenorphine since it may not reflect well on the reputation of deaddiction centres.
Doctors say they find buprenorphine very effective against heroin addiction. “We give one mg of the drug (buprenorphine) five times a day for two days and reduce it to three times a day for the next two days. After that, only one tablet is given for three days and the treatment lasts for about 10 days,'' Dr Bhatia explained.
Asked whether they get more cases of heroin, opium, cocaine addiction when compared to buprenorphine or tramadol, both Dr Garg and Dr Bhatia said yes. However, the Chandigarh-based zonal director of NCB, Dr Kaustabh Sharma begs to differ. “In my opinion, more and more people are getting hooked to buprenorphine and tramadol and other prescription drugs when compared to heroin. It comes cheap and is easy available, so why would they go for other substances?” he says.
Dr Sharma is emphatic that tramadol and buprenorphine are increasingly being dispensed over the counter, despite the fact that they are meant to be given out only at rehab centres. “Some deaddiction centres are procuring it in bulk and the drug is ending up with peddlers,'' he says.
Anti-narcotics professionals say they have inputs that some private psychiatrists who have been issued sale licences by the health department are hoarding the drug and then supplying to addicts for small profits.
A senior IPS officer told New Indian Express, ''Besides those working in drug de-addiction centres, some chemists are able to procure buprenorphine in bulk and are selling it to addicts.'' He added that these drugs are being abused more than heroin, opium, poppy or cocaine.
A Health Department official, speaking on the condition of anonymity, said that cases of buprenorphine reaching drug addicts have come to light. “It is true that addiction to such drugs is on the rise,'' he added.