India’s growing problem of injecting drug misuse

Despite the slowly declining trend of heroin and opium misuse worldwide, injection of synthetic opioid analgesics in India has grown rapidly in the past 20 years.1 Prime Minister Narendra Modi recently described such dependency as a “menace” filled with “darkness, destruction, and devastation.”2

India’s location, between the opioid production and export capitals of central and South East Asia, may be one reason for the hold that these drugs have in the country. Sociocultural changes and economic instability have left some people especially vulnerable. Domestic production of opium and relatively open international trade policies—India is the sole licensed international exporter of raw opium—have contributed to the problem.

Although the prevalence of illicit drug injection in India is relatively low, at less than 1% of the total population, current research and literature reviews estimate that there are between 180 000 and 1.1 million users of injected drugs in the country.3 4 Historically, injected drug use was concentrated in the north east of the country, but rapidly growing populations of users in Punjab and other states in the north west present new challenges for care and management.5

The typical injecting drug user in India is male, aged between 15 and 35, uneducated, and unemployed.6 Up to 20% of injecting drug users are female, and some users are under 18, although the number is currently unknown. In one study 66% of female users also reported engaging in sex work in exchange for drugs.1 The most commonly misused injected drugs in India are moderately potent opioids such as buprenorphine, nalbuphine, dextropropoxyphene, and dicycloverine, which are diverted and trafficked for misuse.7 8