Magical remedies

Vishav Bharti in Chandigarh

“Maharaja Sahib, the blue strip that you have made freely available has saved our youth. One or two tablets a day keep chitta away. Please make it available freely.”

During a meeting at Chandigarh’s Punjab Bhawan, Khemkaran MLA Sukhpal Bhullar, along with other MLAs, was expressing gratitude to Punjab Chief Minister Captain Amarinder Singh for allowing free flow of de-addiction drug buprenorphine. An amused CM appreciated the health minister’s efforts and asserted: “Our drug de-addiction programme is excellent. Let’s not bother about media reports.”

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Since the formation of the Congress Government in the state, it has been a common belief in the corridors of power that buprenorphine is the ‘magical remedy’ to Punjab’s drug problem.

The medicine is a derivative of opioid and is far more potent than morphine and is a longer lasting pain reliever. Pharmaceutical experts don’t rule out the use of a combination of the medicine for recreational purposes and it has been used intravenously by addicts. That is why, under the State Drug Policy-2017, the government regulates the sale of buprenorphine along with five other drugs. The medicine cannot be dispensed for more than seven days in a single visit. Additionally, it can be sold at only at designated de-addiction centres.

While the Punjab Government was going gaga about buprenorphine weaning addicts away from chitta, the state’s Food and Drug Administration (FDA) was grappling with an important question: How much does this habit-forming drug sell? The FDA through its field staff started collecting data regarding its sale from all the de-addiction centres. The outcome was baffling.

It was found that six crore tablets had been dispensed in a year; of these, 4.5 crore had been given in the government sector and 1.6 crore in the private sector. The report on this was kept a closely guarded secret for several months before it was reported in The Tribune. “We are replacing one addiction with the another,” an official closely monitoring everything said.

However, a major breakthrough came last year when, acting on a tip-off, a drug inspector in Ludhiana found a cache of 1.6 lakh tablets (a combination of buprenorphine and nalexone) stocked with a wholesaler, Oracle Laboratories. It was then that the lid over the illegal sale of this medicine blew off. As per the instructions of the DCGI, the highly habit-forming de-addiction drug, can only be supplied directly to de-addiction centres by the manufacturer. Hoarding it was illegal.

Later, it emerged during the investigation that the network was much bigger than what the state had imagined. The medicine was being manufactured in pharmaceutical factories in Gujarat and Uttrakhand and making way into Punjab through courier companies, AC buses and railway parcel systems.

From Ludhiana, the drug was not just being supplied within the state, it was being sent to de-addiction centres in Delhi, Haryana and Rajasthan as well.

Not only did it turn out to be a case of illegal procurement, storage and dispensation of the medicine, tests also confirmed that the medicine being manufactured didn’t meet the standards. The amount of salt in the tablets was much lesser than what was mentioned on the strip. However, owner of Oracle Laboratories increased government’s problem further when he said that his company was not the only one indulging in this practice. “There are at least 15 companies in Punjab that are doing the same thing, but no action has been taken against them,” Vikas Bansal, director of the company said, alleging he was being singled out.

When it comes to salt variation in the medicine, Oracle is not the lone defaulter. Punjab Government is investigating three big manufacturers whose de-addiction drug buprenorphine was found to contain 17-25 per cent more salt than allowed, while one had below the dose given on the label. 

The three companies include Rusan Pharma (Addnok-N) that operates from Uttarakhand, Maan Pharmaceuticals (Cizdol-N), Gujarat and SBS Biotech (QTRUGS), Haryana. The state government has written to their respective states. Earlier fearing that a bigger dose can vitiate the entire de-addiction programme, the state government had even recommended suspension of sale of the medicine from the three drug companies.

The unholy nexus

De-addiction has emerged as a big business proposition in the state and besides companies, de-addiction centres are also indulging in illegal activities. Some of the centres have been found doing business at a scale which is not humanly possible without indulging in unlawful activities.

A reality check revealed that a Tarn Taran centre employing just one doctor dispensed 50 lakh tablets of buprenorphine in just six months. The FDA expressed fear that such centres were acting as bulk sale points of the medicine. The state government chose to act against a few but spared big fish, like the centre in Tarn Taran.

The situation is such that even at the top level the government has faced allegations of helping one player monopolise the buprenorphine business. 

Even psychiatrists have said that they are not being allowed to prescribe the medicine because the government wants only a few favourites to control the market.

Guns have been trained on health minister Brahm Mohnindra too and he filed a defamation suit in Patiala district court against Lok Insaaf Party MLA Simarjeet Singh Bains on the issue.

However, the mess in drug de-addiction programme has shaken the highest quarters at the government. Even the CM, who had hailed the free flow of de-addiction drug in January, was soon instructing all the deputy commissioners “to check misuse of buprenorphine tablets by unscrupulous elements.”

Tackling illegal sale

Taking queue from the Ludhiana raid, FDA Punjab started visiting several transport and courier companies and railway authorities to sensitise them about how they were being taken for a ride by unscrupulous elements. The situation slipping out of hand on the ground forced the FDA to issue new guidelines regarding transportation of de-addiction medicine. As per the revised guidelines, the medicine can be sent only through India Post’s Speed Post and not by any other mode of transportation. Besides asking Gujarat and Uttarakhand governments to investigate the three companies involved in illegal sale of the medicine in Punjab, the state FDA has also taken up the matter with Drug Controller General of India to tighten the noose around the companies creating menace in the state by violating the instructions.

Taking drug meance head on

• 166 Out-Patient Opioid Assisted Treatment (OOAT) centres opened last year.

• The state government has procured 1.5 crore tablets in 2018, which is a 300 times increase as compared to the past years. However, the annual purchase of the medicine used to be just 50,000 tablets till mid 2017 as the drug was only given to indoor patients.

• Since beginning of the programme, total 59,993 addicts have enrolled with the centres.

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