In 1981, as a young research chemist in Mumbai, I was handed a problem India had no answer to. Buprenorphine, the medicine that lets someone hooked on heroin stop injecting and live again, was not made here. It took us years to produce it affordably. I believed once the medicine existed, patients would reach it. Four decades on, I see that was only half the task.
Picture a 24-year-old in a Punjab border district. He started on heroin at 19. He has sold his mother’s gold and his motorcycle to keep going. Last month, he decided to stop. The nearest clinic that prescribes buprenorphine is two hours away by bus. Within two weeks, he is back with his dealer.
He is not rare. The last national survey found about 77 lakh Indians need clinical help for opioids. Some 5.7 crore drink at harmful or dependent levels, and only one in 38 alcohol-dependent people reports any treatment. Add 26.7 crore adults who use tobacco.
His family pays first, in debt and violence at home. Then society pays, through courts and hospitals. Shared needles spread HIV and hepatitis C; HIV among people who inject rose from 6.26 to 9.03% between 2016 and 2021. Addiction raises TB risk too. In Punjab, police have caught terror handlers turning jobless drug runners into grenade carriers. Its chief minister partly blames drugs for fewer young Punjabis joining the Army.
Nasha Mukt Bharat Abhiyaan has reached over 29 crore people. It may be what gave him the courage to ask for help. What it could not give him was a clinic. About 54,000 people were on opioid substitution therapy in 2023-24, under 1% of those who need it. Global health agencies want 40 in every 100 people who inject drugs on such treatment. India reaches about six.
He did not need another survey or lecture. He needed a doctor in his district, trained at NIMHANS, PGIMER or AIIMS, with affordable medicine for whatever he uses, a slow, supervised taper and a job to return to. Government hospitals and private partners can deliver that together.
The Centre’s three-year Nasha Mukt Bharat roadmap, tripling de-addiction centres to 1,751 by 2029, is a step in the right direction. A problem this large needs serious public funding, with government hospitals and private partners delivering treatment together.
We have done this for TB, lifting treatment coverage from 53 to over 92% in under a decade. Addiction deserves the same political will. The medicine I worked on in 1981 is made in India today. It still has not reached him.
(The views expressed are personal)
This article is authored by Navin Saxena, chairman, Rusan Pharma.
