On the occasion of the International Day Against Drug Abuse and Illicit Trafficking, celebrated on June 26 every year, our Office brings to you the following story about the increasing use of prescription drugs amongst injecting drug users in South Asia.
South Asia: The growing use of narcotic and psychotropic prescription drugs amongst injecting drug users
'Death for 50 rupees' - is what photographer Enrico Fabian calls his latest photo work. His stark black and white photographs from Jahangirpuri, a settlement in New Delhi, India, stand witness to a grim reality - the growing use of narcotic and psychotropic prescription drugs by injecting drug users. Pharmaceutical drugs are used in the prevention, diagnosis and treatment of various diseases and disorders. They may be procured without any restrictions (over-the-counter drugs) or may be procured upon a physician's prescription (prescription drugs). Certain narcotic and psychotropic prescription drugs, eg - opiate pain killers like morphine and some anti-cancer drugs, are under stricter regulatory controls.
Enrico's photographs however tell a different story. During the eleven months that he spent interacting with injecting drug users in the Jahangirpuri, he has seen a number of young boys and men who have been destroyed by the injection of prescription drugs - thanks to their easy availability from nearby pharmacies. "Purchasing these drugs is as easy as buying cough syrup at the supermarket", observes Enrico. "The medicine, not supposed to be given to anyone without prescription from a doctor, is sold for a price that even the poor can afford. An ampule Buprenorphine (a semi-synthetic opioid actually used to treat opioid addiction), an ampule Diazepam (a benzodiazepine derivative drug also known as Valium), an ampule Avil (a antihistamine which lessens the side effects of the two other drugs) and two disposable syringes are sold for 50 rupees, a little less than 1 US Dollar. Depending on the customer's relation to the pharmacy owner, an additional strong antidepressant tablet or extra morphine is handed out for free."
Easy access, affordability and high purity of narcotic and psychotropic prescription drugs make them attractive substitutes for illicit drugs among drug users. According to UNODC's recently released World Drug Report 2011, stable or downward trends for heroin and cocaine use in major regions of consumption worldwide is being offset by increases in the use of synthetic and prescription drugs. Non-medical use of prescription drugs, such as a number of synthetic opioids, tranquillizers and sedatives or prescription stimulants is reportedly a growing health problem in a number of developed and developing countries. Even in the absence of regular studies for the majority of countries in Asia, available reports indicate substantial non-medical use of prescription opioids, tranquillizers and amphetamines in many Asian countries. In Bangladesh, Nepal and India, buprenorphine is commonly injected amongst drug users.
While high-risk injecting practices such as sharing of contaminated equipment increase the risk of spreading infections such as HIV and Hepatitis C, injecting pharmaceuticals can also pose health hazards such as abscesses, tissue necrosis, gangrene and nerve paralysis. Another issue of concern is the growing numbers of poly drug users among illicit drug users, who also use prescription drugs in combination with their illicit drug of choice to enhance the effects of the main drug.
A complex problem with a multitude of causal and confounding factors, the diversion and abuse of narcotic and psychotropic prescription drugs demands a multi-sectoral and sensitive approach to tackle it; sensitive because the drugs should be easily available for patients who genuinely require them. Since the narcotic and psychotropic prescription drugs which are abused in most of South Asia are largely available through pharmacies, there is a need for greater awareness amongst the pharmaceutical trade and industry about the possibility of abuse of these drugs. It is essential to encourage them to establish codes of conduct and ethical practices also to impress upon them that selling narcotic and psychotropic drugs over the counter is a criminal offence. This should be combined with region-wide dissemination of good practices among doctors and other medical professionals as well as awareness and sensitization programmes for the general public, government agencies, policy makers, judiciary and other stake holders.
Smugglers and traffickers find it lucrative to traffic pharmaceuticals within South Asia or from one country of region to another. The recent emergence of illegal websites (established outside of South Asia in countries like USA, UK, Europe etc) offering unregulated trade in a range of prescription-only medicines over the internet is a matter of serious concern for South Asia, since it is from here that the drugs are largely sourced. While almost all countries of South Asia have a largely adequate legal and regulatory regime in place to deal with the issue, gaps still remain in their proper implementation. Strengthening the legal, policy and regulatory regimes in the region, building capacities of regulatory and law enforcement officials along with strengthening their existing coordination mechanisms at policy and operational level is vital.
There is also a pressing need for more studies and surveys to better understand the nature and extent of the problem, to elicit informed responses from different stakeholders such as policy makers, law enforcement officials, pharmacists, the pharmaceutical industry and drug treatment service providers.
Photo Credits: Enrico Fabian (www.enrico-fabian.com)