Part 5: Prescription Drug Abuse in India — A Public Health Crisis

Disclaimer: This article is written purely for public health awareness and education. If you or someone you know is struggling with substance dependence, please contact the NIMHANS Helpline (080-46110007) or the Vandrevala Foundation (1860-2662-345).

India faces a growing, often invisible crisis: the abuse of legally manufactured, prescription-grade pharmaceutical drugs. Unlike illicit street drugs (heroin, methamphetamine), these substances are produced by legitimate pharmaceutical companies, prescribed by doctors, and sold at chemist shops. This very legitimacy makes them more accessible and far more insidious.

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The Scale of the Problem

• The Ministry of Social Justice and Empowerment’s National Survey on Extent and Patterns of Substance Use in India (2019) — conducted by AIIMS — found that approximately 3.1 crore (31 million) Indians use opioids (including prescription opioids), and roughly 1.18 crore (11.8 million) need help for opioid use disorders.
• India is the world’s largest manufacturer of generic pharmaceuticals, producing medications at a fraction of global costs. While this is a blessing for affordable healthcare, the sheer volume and accessibility of drugs creates opportunities for diversion and misuse.
• The unregulated sale of prescription drugs at pharmacies — often without verifying prescriptions — is a critical supply-side driver.

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The 5 Most Commonly Abused Prescription Drug Categories in India

1. Opioid Analgesics (Painkillers)

• Drugs: Tramadol, Codeine (in cough syrups), Buprenorphine, Pentazocine.
• Why Abused: They bind to opioid receptors in the brain, producing powerful feelings of euphoria, warmth, and pain relief.
• The Indian Crisis: Tramadol abuse is catastrophic in North-East India (Manipur, Nagaland) and Punjab. Entire communities have been ravaged. The government reclassified Tramadol under the NDPS Act in 2018 to combat this.
• Codeine Cough Syrups: Brands containing Codeine Phosphate are mixed with soft drinks (“Lean” or “Purple Drank” culture imported from the US) and consumed recreationally.
• Side Effects of Abuse: Severe respiratory depression, fatal overdose, constipation, physical dependence, and a brutal withdrawal syndrome.

2. Benzodiazepines (Anti-Anxiety / Sedatives)

• Drugs: Alprazolam (Alprax, Restyl), Diazepam (Valium, Calmpose), Lorazepam (Ativan, Lopez), Clonazepam (Rivotril, Epitril), Nitrazepam (Nitravet).
• Why Abused: They produce rapid, intense relaxation, anxiety relief, and a feeling of detachment from reality. They are also used to “come down” from stimulant highs.
• Side Effects of Abuse: Memory blackouts, physical dependence, life-threatening withdrawal seizures, respiratory depression when combined with alcohol.

3. Gabapentinoids (Nerve Pain Drugs)

• Drugs: Pregabalin (Lyrica, Pregastar), Gabapentin (Gabapin, Neurontin).
• Why Abused: At doses higher than prescribed, they produce a floating, alcohol-like euphoria. Their abuse has surged globally and in India in recent years.
• Side Effects of Abuse: Severe dizziness, breathing problems, suicidal thoughts, and a withdrawal syndrome similar to benzodiazepines.

4. Z-Drugs (Sleeping Pills)

• Drugs: Zolpidem (Stilnox, Zolfresh), Zopiclone (Zopicon, Imovane).
• Why Abused: If the user takes the pill and deliberately fights sleep, it produces a trance-like, disinhibited, euphoric state. It is also combined with alcohol.
• Side Effects of Abuse: Sleepwalking, “sleep-driving” (performing complex activities while not fully conscious), amnesia, and dependence.

5. Stimulants

• Drugs: Methylphenidate (Ritalin, Concerta), Modafinil (Modalert, Provigil).
• Why Abused: Used by students for “cognitive enhancement” — staying awake for extended study sessions. Also abused for its euphoric and focus-enhancing effects.
• Side Effects of Abuse: Heart palpitations, anxiety, psychosis, severe insomnia, and cardiovascular events.

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Other Substances of Concern

• Dextromethorphan (DXM): An OTC cough suppressant. At very high doses (“Robotripping”), it produces dissociative and hallucinogenic effects.
• Antihistamines (Promethazine, Diphenhydramine): At high doses, first-generation antihistamines can cause hallucinations and delirium.
• Ketamine: Medically used as an anesthetic. Increasingly diverted from veterinary and medical supplies for use as a “club drug.”
• Muscle Relaxants (Carisoprodol/Soma): Abused for their sedative effects, similar to benzodiazepines.
• Anabolic Steroids (Nandrolone, Stanozolol): Widely abused in gyms and by amateur athletes for muscle growth and performance enhancement.

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What Is Being Done?

1. Schedule H1 (2013): Created a stricter tier with mandatory record-keeping for habit-forming drugs.
2. Tramadol under NDPS Act (2018): Elevated Tramadol to a controlled narcotic substance.
3. AIIMS/NIMHANS De-Addiction Centers: Government-funded treatment centers across the country.
4. Nasha Mukt Bharat Abhiyaan (Drug-Free India Campaign): A national campaign focused on prevention, education, and community de-addiction.

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Helplines

If you or someone you know is struggling with substance dependence:

• NIMHANS Helpline: 080-46110007
• Vandrevala Foundation: 1860-2662-345
• iCall (TISS): 9152987821
• National Drug De-addiction Helpline: 1800-11-0031 (Toll-Free)

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Sources: Ministry of Social Justice and Empowerment (National Survey 2019), AIIMS, NIMHANS, Narcotics Control Bureau, Indian Journal of Psychiatry.

Next: Read Part 6: Why AI-Generated Prescriptions Are Dangerous and Illegal