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History of Opium: from an addictive substance to pain relieving medicine

Author: Dr. Nandini V, National Faculty, Indian Association of Palliative Care
24 February 2014

On 21st February 2014, India amended Narcotic Drugs and Psychotropic Substances Act. Dr. Nandini V, writes about the history of opium cultivation and trade in India, opium wars, recognition of its use as a pain relieving medicine, and the evolution of NDPS act.

Opium is not an indigenous crop. It was brought to India sometime in the 15th century probably through Arab travelers. In Indian it was mainly used as a food and beverage item and as a medicine in the Ayurveda system. India was predominantly an opium eating country. Its euphoric properties on smoking were known, but it did not gain much popularity.

Opium achieved status as a commodity in Mughal era.  The poppy plants were cultivated in India’s fertile gangetic planes. After the decline of the Mughals, in the 17thcentury, European traders noted its commercial value in the international market especially in the opium smoking countries of east. 18th century saw the phenomenal growth of opium as a global commodity with aggressive marketing and competition amongst the traders for monopoly for the best quality product. By mid-18th century, British, through the East India Company, established their monopoly in cultivation and international opium trade with the high quality poppy cultivated in India.

Their chief market was China, an opium smoking country, and not India.

The trafficking continued illegally despite regulatory edicts by the Chinese emperor Quing.  As per the regulations implemented, the trade of opoium was illegal. After the victory of the British in the opium wars [ A D 1838-1858] against China, the  trade was legalised. 1906 saw the historic high of opium trade in China with nearly 13.7 million addicts.  A large proportion of the income in millions of pounds to the imperial government was coming through this trade.

The primary aim of regulations on opium by the British in India was to maintain / increase this enormous revenue through strengthening their monopoly on cultivation and movement of this commodity, and control on all aspects of trading. It had nothing to do with its use as a medicinal drug.

They did this for promoting free trade and mass consumption in South East Asia and prohibiting cultivation and direct trade within India to protect their own monopoly. This was the basis for all the laws that emerged.

The regulations thus exerted control on cultivation, import, and transport from foreign territories [means territories of India NOT under direct control of British] to the British provinces except on behalf of the government.

With global awakening against legal opium trade, several conventions –Shanghai 1906, Hague 1912 and Geneva 1925, were organised to help form consensus on national and international regulations to curb this form of usage of opioids.

It was in this climate of early 20th century, that the British government in India shaped its narcotic laws based on the earlier laws of 19th century designed for monopoly, and retained the same language of restrictions and mistrust between different provinces belonging to the same country.

By late 20th century, the effectiveness of opioids as pain medications for the persistent severe forms of pains as seen in cancer patients, HIV patients, and few other chronic conditions became well known. But, for most of the world which had seen the addictive dimension of certain formats of opioids, this was difficult to acknowledge. Thus the NDPS Act of post-independent India also retained much of the regulatory language and the chief scope of the act was to prohibit usage. The ensuing NDPS Rules at state levels besides varying from state to state strongly reflected the prohibitory scope of the Act.

In most states of India, several sanctions and licenses were required, and the institutions seeking these licenses had to put up with the bureaucratic complexities of different government agencies e.g.  import license for the state that is receiving the medicine, export license for the one sending it; transport license, possession license, quota,  etc. Validity periods of these licenses were also different for different regions. Pharmacies and institutions stopped stocking these medications as violations on any of these stipulations would entail rigorous imprisonment of 10years. The end result was that those doctors who got their training after enactment of this Act have had no exposure to using opioids for pain management and to prescribe, even when they see patients in severe pain. Eventually, it was the patient in pain, irrespective of the socio-economic status, who suffered.

Currently, with active advocacy and training in its usage, the understanding and acceptance of these medications for pain control is slowly improving. The western world uses it sufficiently for patients with severe persistent pain. India has listed opioids in the Essential Medicines List, but the usage is poor with 96% of adults and 99% of children who need relief having no access to these medications.

The new NDPS Amendment Bill 2014 has brought in the much needed balance within our narcotic regulations. The amendments ensure uniformity of Rules for a group of drugs; the essential narcotic drugs, in the country. It also entrusts one agency, the state drug controller with the authority to “recognize” medical institutions with trained staff and adequate infrastructure to stock and dispense these medicines and eliminates need for multiple licenses. There is much to be done in terms of adequate state level translation and implementation of the new clauses of the Act. Yet, this is definitely the beginning of progressive reforms towards better pain management for our patients who are needlessly suffering.

India Amends NDPS Act

 

 

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