Civil Society-Driven Drug Policy Reform for Health and Human Welfare—India

Abstract

The lack of adequate access to opioids in India as analgesics and for agonist therapies, forces millions to live with severe unalleviated pain, or languish with suffering associated with drug dependence. Although India is a major opium exporter, the excessively prohibitive 1985 narcotics law formulated to control harmful use of drugs, impeded the availability and access to opioids for medical and scientific purposes. Amendment of this law in 2014 established a new national regulatory framework for improved access to essential opioid analgesics. This article reflects on key elements and processes that led to this landmark achievement. Unlike quick timelines associated with effecting policy reforms for law enforcement, realizing the 2014 drug policy change primarily to mitigate human suffering, was a 22-year-long process. The most exacting challenges included recognizing the multilayered complexities of the prior policy framework and understanding their adverse impact on field practices to chart an appropriate and viable path for reform. The evolution of an informal civil society movement involving health care professionals, lawyers, media, policy analysts, government officials, and the public was pivotal in addressing these challenges and garnering momentum for reform. The success of the effort for improving access to opioid medications was underpinned by a three-pronged strategy of 1) persuading the executive arm of the government to take interim enabling measures; 2) leveraging judicial intervention through public interest litigation; and 3) crafting a viable policy document for legislative approval and implementation. We hope our findings are useful for realizing drug policy reforms, given the current transformed global policy mandates emphasizing humanitarian, healthcare, and quality-of-life considerations.

Palliative care clinicians and online education in India: a survey

“…India’s unmet palliative care needs reflect the challenge of meeting palliative care needs among lower-income and lower-middle-income countries 1 2. One-sixth of the world’s population in need of palliative care resides in India, but less than 1% have access to it 1.…”

“…India’s unmet palliative care needs reflect the challenge of meeting palliative care needs among lower-income and lower-middle-income countries 1 2. One-sixth of the world’s population in need of palliative care resides in India, but less than 1% have access to it 1. Only three (Kerala, Maharashtra, Karnataka) of India’s 28 states and seven Union Territories have committed to palliative care policy, and a national strategy is not yet well implemented 3 4…”

Challenges of using methadone in the Indian pain and palliative care practice

“…For two decades, the palliative care community, the Government and Civil Society Alliance worked to change the mindset of the policymakers and bring about the NDPS Amendment in 2014. [ 1 26 ] The objective of the law is now expanded from controlling illicit use to promoting appropriate medical use. The new regulation, moving forwards, eliminates the need for multiple licenses; applies to all potential medical use of approved opioids (pain and dyspnea relief), and addresses lack of training in opioid usage.…”

“…The state governments are unfamiliar with the purpose of the amendment, and the drug manufacturers are concerned about dealing with opioids as the systems to differentiate licit and illicit use are not yet in place. [ 1 ] The medical fraternity suffers from lack of awareness and an apathetic attitude toward the role of opioids in pain relief.…”

“…The 1985 narcotic drug and psychotropic substances (NDPS) Act made obtaining opiates for pain almost impossible with the multiple layers of licenses. [ 1 2 ] At this point, there are relatively few opioids available and legal in India and these are morphine, methadone, tramadol, fentanyl, and meperidine, (hydrocodone and oxycodone are legal but not available).…”