How India Could Fuel the Global Synthetic Drug Epidemic

The largely under-regulated manufacture, sale and consumption of highly potent and addictive substances like fentanyl, tramadol and alprazolam (Xanax) not only threatens Indians, but also global populations.

Today, June 26, is observed as the International Day against Drug Abuse and Illicit Trafficking. However, as the developed world moves towards progressive drug policy reforms, India continues to be caught in a dangerous vortex of trafficking and substance abuse.

No, it’s not exactly what you may have seen in Udta Punjab. Although needles and lifeless bodies are recurring motifs, the substances in question are not the usual suspects (heroin, cannabis or cocaine).

India, it would seem, has developed a particular liking for the trafficking and abuse of pharmaceutical drugs: a concoction of pills and syrups that you would normally be prescribed by a doctor to alleviate pain or a rankling cough.

In February 2019, AIIMS’s National Drug Dependence Treatment Centre released a report in which 2.06% of India’s population (which translates to 27 million people) was estimated to be using opioids, while 0.55% of Indians were in need of help for their addiction problems.

Blister packs, not baggies

As anti-drug trafficking agencies like the Narcotics Control Bureau and special police task forces crack down on the illicit trafficking of heroin and methamphetamine from Afghanistan and Southeast Asia transiting through India, traffickers and addicts have cottoned on to the risks involved in dealing with traditional source countries. Instead, they’ve turned to the neighbourhood chemists and the domestic pharma markets as their new drug dealers.

The largely under-regulated manufacture, sale and consumption of highly potent and addictive substances like fentanyl, tramadol and alprazolam (Xanax) not only threatens the Indian masses, but also global populations.

In January 2019, the Delhi Police Special Cell seized 10 kg of tramadol, 1.3 million tablets of various other narcotics, including alprazolam, 500 grams of ketamine and 100 vials of ketamine and lignocaine injections. Five persons, including a British citizen, were arrested for the illicit trafficking of banned narcotics.

“The [accused] told us this shipment was going to the UK, Nepal and Malaysia,” DCP (Special Cell) Sanjeev Kumar told The Wire.

“Pharmaceutical drugs like alprazolam, tramadol and other precursors like pseudoephedrine are now mostly being smuggled to America, West Africa and Middle East. Some of these especially [go] to Central America for smuggling into [the] US,” an officer of the NCB told The Wire on the condition of anonymity.

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More recently, on May 11, the NCB made the biggest drug haul in India’s history. Officers reportedly recovered 1,818 kg of pseudoephedrine from an IPS officer’s house in Noida along with 2 kg cocaine – collectively worth around Rs 1,000 crore.

Pseudoephedrine is a substance commonly found in cold medication, but is also an essential ingredient in the manufacture of methamphetamine (the blue crystal meth from Breaking Bad). The accused Nigerian national reportedly admitted that the seized goods would be used for the manufacture and sale of illicit drugs, both in India and abroad.

The Indian pharma industry’s role in drug abuse and trafficking

India is the third largest pharmaceutical industry in the world in terms of volume and tenth in terms of value: exports reached $17.2 billion in 2018. In 1970, the Patents Act removed composition patents on foods and drugs, effectively enabling India to reverse-engineer processes for manufacturing all kinds of generic drugs at low costs. But some of these drugs get diverted for non-medical uses – in India and abroad – as indicated by the instances above.

While these substances are technically controlled, their diversion for trafficking and abuse happens primarily because of weak regulatory implementation and monitoring.

International counter-narcotic agencies have already flagged India as the largest source of tramadol trafficking. Tramadol – a synthetic opioid pain-killer – has become the driver of the entrenched opioid epidemic in West Africa, the Middle East, South East Asia. Moreover, while fentanyl is at the centre of the North American opioid epidemic, tramadol abuse is on an unchecked rise there, too.

According to the UN World Drug Report 2018, the non-medical use of prescription drugs continues to be a growing threat. Almost 76% of drug-related deaths worldwide are attributed to opioid-based pain-killer abuse.

Almost 87 tonnes of illicit synthetic opioids were seized globally in 2016-17 – roughly the same amount as heroin for the same period. More than 80% of that was tramadol – mostly seized in West, Central and North Africa and the Middle East. And most of it originated from India.

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The International Narcotics Control Bureau, in a note to the World Health Organisation, said that substances like tramadol and fentanyl are being abused because of the illicit trafficking of both – legally and illegally manufactured substances – from countries like India and China.

The UNODC reports that most of the tramadol seized worldwide in 2017-18 originated from India and, to a lesser extent, China.

But just as tramadol took the authorities by surprise, its emergence should be a cautionary tale for other dangerous substances being manufactured in India.

Shifting focus on India as a source of illicit substances

Fentanyl is a potent synthetic opioid drug used as an analgesic (pain killer). It far stronger than traditional morphine and heroin – 50 to 100 times more potent. It is legally prescribed to counter the extreme pain of end-stage cancer and surgery. But illicitly sourced fentanyl, mixed with heroin and other drugs, is driving the unprecedented number of drug-overdose deaths in North America, Europe and even India.

As China – previously the world’s largest producer and source of illicit fentanyl – begins to heavily regulate the substance (due to pressure from the US), experts believe that manufacturing and export could shift to another pharma-giant with equally less regulation and potentially more exploitable avenues – India.

From 2014 to 2017, the number of fatal drug overdoses in the US skyrocketed from 44,000 to 70,237. Out of that, 47,600 deaths were reportedly opioid overdose deaths. While fentanyl was responsible for only 3,105 opioid related deaths in 2014, that number shot up to 28,466 in 2017 – making up 60% of all opioid-related deaths that year and marking an 800% overall increase.

There is ever-increasing demand for illicit fentanyl and a well-equipped supplier. According to the US-China Economic and Security Review Commission report, China used to be the major source of illicit fentanyl into North America, while India’s contribution made up a fraction of it. However, as China’s role declines, India is expected to fill in its shoes in the coming years.

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While China now controls upwards of 100 fentanyl precursors and analogues, India only regulates 17 of the 24 precursors used to make it and only a handful of its analogues – which range into hundreds of versions that differ very slightly from the original to avoid running afoul of laws. And despite placing tramadol under the NDPS Act in April 2018, illicit trafficking remains as active as ever.

If China successfully controls illicit fentanyl production, it is very possible that chemists in India will step in to supplement the demand. And the writing on the wall is that India will likely take up that mantle. As new substances are being discovered, manufactured and trafficked every day, it makes sense to stay ahead of the curve – rather than always play catch-up.