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HEALTH: ADDICTION
Tripping On Medicine
As ominous as narcotics is the growing menace of
addiction to prescription drugs in India
By Supriya Bezbaruah
Under the protective
branches of a huge banyan tree by the Yamuna, three men sit hunched, shivering
in spite of the hot Delhi sun. One has both his ankles tightly wrapped
in dirty bandages. The ring finger of the second man's right hand is swollen
and distorted and is obviously septic. The third lies back to reveal an
amputated leg. The other is grotesquely swollen. But they appear oblivious
to any pain. Eyes bloodshot and wild with craving, they concentrate fiercely
on their task-finding a vein to inject themselves. But it is difficult,
for the veins have been destroyed, and their desperately aimed shots lead
to infection and sepsis.
 The
substance they so maniacally desire is extremely corrosive, extremely
addictive, gives a 24-hour "high" but is cheap-and perfectly
legal. It could be buprenorphine, Avil, diazepam (Calmpose), Tidigesic
or Spasmo Proxivon; or, actually a combination of any three of them. These
are all prescription drugs-and they're driving heroin out of business.
At the other end of town, Mrs Mishra, 62, portrays
a picture of gentility as she delicately balances her tea cup in her neat,
well-appointed living room. Adoring grandmother of three, needlewoman
extraordinaire, art-lover and social worker, she epitomises grace and
dignity. But hidden at the bottom of her sewing box is her little secret-a
daily fix of a fortwin/ phenargen mixture, a habit stemming from the general
physician's injection for abdominal pains a year ago. Fortwin is a painkiller,
and phenargen is a sedative, commonly used for acute pains. But it can
give a "kick". Now she cannot do without it. She is the face
of the accidental addict.
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Nationally
about 10 per cent of drug addiction involves the use of prescription
drugs.
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From housewives to businessmen to ragpickers,
cutting across social barriers, people are abusing prescription drugs
across India. Preliminary data from the first-ever national Rapid Assessment
Survey of Drug Addiction sponsored by international agencies shows that
in every metro there has been an increase in prescription drug abuse in
the past one year. Nationally about 10 per cent of drug abuse involves
prescription drugs. In Bangalore, data from NIMHANS show an increase in
the number of patients who admit to the use of "other opiates"
and "sedatives". "I would even call it an epidemic,"
says Vikram Sarabhai, consultant in respiratory medicine at Escorts Heart
Institute and Research Centre, Delhi, "Around 50 per cent of my patients
have abused prescription drugs."
It is a global problem. Last month the US Government
launched a campaign against prescription drug abuse-the estimated number
of US abusers are four million. Estimates for India go much, much higher.
S. Vohra, senior consultant psychiatrist at Delhi's Indraprastha Apollo
Hospital, says, "We have a huge population that knowingly or unknowingly
is hooked on to prescription drugs." About a third of his patients
are prescription drug abusers.
In most cases, the pill-popping pattern has
innocent beginnings. The patient complains to the doctor that he cannot
sleep or is anxious about a particular situation. It could be anyone-the
high-flying executive trying to cope with the intense work pressures,
a tense young groom-to-be worried about what his future wife will think
of him. Without dealing with the underlying cause of the problem, the
doctor prescribes anti-anxiety drugs like diazepam (Calmpose), alprazolam
(Alprex), lorazopam (Larpoze) and nitrizepam, which are together called
benzodiazapines. Though generally not considered dangerous, "these
medications, if required, should not be taken for more than 2-3 weeks
without the supervision of a physician, and then the drug should be tapered
off gradually", says Vohra. But patients often self-prescribe, and
easily acquire the medicines without prescription. Whenever they try to
stop, withdrawal symptoms manifest themselves. These symptoms vary-sleeplessness,
restlessness, tremors of the hand, slurring, irritability, vomiting, sadness,
altered appetite, and abnormal behaviour, even delirium in extreme cases.
"The problem is," points out Sunil Mittal, general secretary
of the Indian Association of Private Psychiatrists, "it is very difficult
in these cases to make out whether the illness is persisting, or whether
the symptoms are due to the withdrawal of drugs." So they go back
to taking the drug.
It's a vicious cycle. And being on the drug does
not solve the psychological problem. But does it do any harm? Benzodiazapines
are considered safe in prescribed doses, much safer than alcohol. Even
in massive doses, they are not fatal-unless mixed with alcohol or other
psychotropic substances. "But the damage accumulates in small increments,"
says Mittal. There is gradual memory loss, and cross-tolerance to other
drugs. As the body gets used to these drugs, the dosage required for effectiveness
increases. The higher doses would soon show side effects, like liver damage.
There are other subtle changes. Benzodiazapines change sleep patterns
in the brain. They suppress rapid-eye-movement (REM) sleep, which is the
restorative sleep. Perennial exhaustion, therefore, goes hand-in-hand
with benzodiazapine abuse.
Then there are the secondary effects. Sleeping
tablets and sedatives give hangovers which result in accidents while driving
and in manual jobs. Patients also deteriorate socially, leading to possible
job loss and premature retirement. There can be medical accidents too.
For people with sleep disorder and cardiac problems, benzodiazapines overdose
can be fatal.
So why do people take these drugs at all? Why
is there such a great need for prescription drugs in the first place?
Vohra blames the stress of modern living. Others agree. "The rate
of change in our lives is so rapid that one can't adapt to it," explains
Mittal. "There has been a major shift from living in extended families
to living by oneself. The individual now has to absorb all the stress
with no buffers. The drugs provide a way of coping."
Of course, stress is not the only cause. Not
all addicts pick up the habit accidentally. Many are the occasional recreational
abusers, popping a pill along with alcohol or marijuana for an added "kick".
Even here there is the risk of overdose or organ damage and even death
when taken with the other substances. Then there are those who take these
pills around four times a week, either to kill boredom or to redress problems.
They frequently graduate to being hard core users, who rely only on prescription
drugs. Others see prescription drugs as back-up, to be used when their
main source is not available or feasible. This is frequently the case
for addicts while travelling, or those appearing for medical examinations.
Nor are the drugs limited to the anti-anxiety group. Cough syrups such
as Corex and Phensedyl-which have opiates, and antihistamines as well
as alcohol-are extremely popular among students and younger males. "I
have a bottle at a time to get a high, usually three to four times a day,"
says an addict.
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