When it comes to opium production, India is one of the largest producers and exporters of opium. But while India supplies the world with opioids—the cheapest, most effective painkillers out there—the story back home is very different. We are only equipped to provide opioids for 40,000 patients—less than 1% of the national requirement. At the moment, opioid painkillers are used mostly as anaesthesia for severe cases such as road accidents or surgeries.
The needs of others who can also benefit from opioids, however, are not being met. Millions of Indians currently battling incurable, debilitating conditions such as cancer, lung or heart failure, HIV are left in the lurch. While these cases are often terminal, a lot can be done to improve the quality of life even in their final days. This begins with managing their pain and reducing their suffering.
Known as palliative care, this approach focuses on improving the quality-of-life for patients and their families. Palliative care can be provided with or without the ongoing curative treatment. It begins as soon as the patient’s survival chances become clear and not necessarily just at the end of life. The World Health Organization (WHO) has declared opioid-based painkillers, especially morphine, as the “gold standard” for pain relief in such cases.
So, why do Indians not have better access? A key reason is the stigma attached to these substances. Take the opioid crisis currently unfolding in the US, for example. Between 1999-2017, overdose deaths due to prescription opioids in the US increased 5X. All told, some 218,000 deaths related to prescription opioids occured in the same period.
Purdue Pharma’s OxyContin, a brand of step II opioid oxycodone, has been held largely responsible for the widespread addiction and deaths due to overdose. After realising that the market for acute pain, pain after surgery or at end-of-life is small, Purdue changed its positioning and went after the chronic pain market, such as arthritis and backache. The company produced false evidence about OxyContin’s safety in daily use, influencing doctors to prescribe and patients to demand.
But India’s problems with opioid access predate the US situation. They go all the way back to 1985 when the government introduced the Narcotic Drugs and Psychotropic Substances (NDPS) Act in response to the global war on drugs. It stipulated rigorous punishment for medical professionals unable to produce proper documentation for storing and prescribing opioid medications.
The fear of falling foul of the NDPS Act saw doctors avoid opioids altogether. Sales of the cheapest strong opioid, morphine, dropped 97%, according to a 2002 study in the Journal of Pain Symptom Management. And while the stringent regulations have since been scaled back through a 2014 amendment, the problem of opioid access persists.