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  Diversion of buprenorphine in India: 29% addicted to pain medication

Posted: April 10, 2006 13:38

Dear Colleagues,

The 'The Hindu' newspaper on April 5 has a front page story on the widespread abuse of buprenorphine in Kerala State which has apparently been increasing over a number of years. The current publicity surrounds a heist of 20,000 ampoules (see selected quotes and url below). Not unconnected may be an indication that India has experienced a 'heroin drought' similar to Australia (see excerpts below).

The situation seems comparable with Wellington, New Zealand in 1991 when the drug was being used widely for pain management but found a large niche with addicts. In a careful comparison before and a year after the national switch to a combination formula, the addition of naloxone was associated with twin effects of reducing the proportion of addicts injecting the drug from 80% to 60% but was also associated with reportedly easier access to the drug and a lower street price. I would still consider this wholesale abuse, especially considering the drug was ostensibly only for analgesic indications. The drug was withdrawn shortly afterwards.

There have been sporadic items from France, Finland, Western Australia, Melbourne, United States and India about the abuse of buprenorphine. The most obvious way of avoiding these problems is to increase access to supervised, evidence based addiction treatments as well as limiting access of young, healthy people to uncontrolled quantities of opioids from naïve or unscrupulous doctors.

"The Hindu"

Online edition of India's National Newspaper

Wednesday, Apr 05, 2006

"Illegal diversion of buprenorphine to State" Reporter: G. Anand

"The drug is cheaper compared with heroin in the market"
Thiruvananthapuram: A particular brand of medicine containing opium is being illegally diverted to Kerala in large quantities for sale in the street as a substitute for heroin, Narcotic Control Bureau (NCB) officials said.
An indication of the trend came last year when the NCB investigated a case relating to the delivery of 20,000 ampoules of the medicine, buprenorphine, to a stockist of pharmaceutical products in Perinthalmanna in Malappuram district.
The buprenorphine was sourced from a medicine factory in Gujarat. During investigation it was found that the stockist in Perinthalmanna had not placed the order for the drug. The NCB revealed <snip>
... two persons were arrested ... sale as a narcotic substance in the black market. The ampoules had already reached the hands of drug peddlers by the time the agency got to the bottom of the case, an NCB official said.
The decreased availability of heroin, owing to a drastic reduction of illegal opium production in Afghanistan, is a crucial factor that has resulted in the increased availability of buprenorphine in the illegal market, according to the NCB.
Buprenorphine has been used widely in heroin de-addiction therapy for reducing the craving for the drug and easing the withdrawal symptoms of `brown sugar' addicts. The drug, having a street price of Rs.100 for an ampoule, is relatively cheap compared to heroin.
... there had been instances of medical prescription forms ... being stolen or forged to procure buprenorphine ...
... only few medical shops in the State have the licence to stock and sell buprenorphine.
... Alcohol and Drug Information Centre-India, said that a random assessment of drug abuse conducted in 14 urban centres in India had found that at least 29 per cent of injectable drug abusers in Thiruvananthapuram were addicted to buprenorphine.
<snip>

Comments by Andrew Byrne ..

 

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