Opioid Availability

Current status of Opioid Availability – September 2007

The Narcotic Substances and Psychotropic Substances (NDPS) act of India brought out in 1985 made procurement of morphine so difficult that use of morphine in the country dropped steeply in succeeding years. Even today in some states in India, not even one institution has oral morphine.

The WHO Collaborating Center at Madison-Wisconsin has been working to improve access to opioids and for this, have been working with Indian palliative care activists. Based on recommendations by Mr David Joranson, the Government of India in 1998 gave instructions to all state governments to amend their narcotic regulations, simplifying them. (see the letter from Government of India). But response from the state Governments was poor, and so many workshops were done in many states to improve the situation.

The following is the current status of opioid availability in India.

A. Simplification of Narcotic Regulations

Some states/Union territories have amended their narcotic regulations following the guidelines given by the central government. The states with the amended regulations appear to be:

1. Arunachalpradesh
2. Dadra & Nagar Haveli
3. Delhi
4. Goa
5. Jammu and Kashmir
6. Karnataka
7. Kerala
8. Madhyapradesh
9. Mizoram
10. Orissa
11. Sikkim
12. Tamilnadu
13. Tripura

Disclaimer: This list is based on unofficial information received from the Department of Revenue of Government of India. We cannot assure of the accuracy of the information.

B. Modernisation of the Government factories at Ghazipur and Neemuch has been completed recently.

C. Morphine consumption

Controller of Government Opium and Alkaloid factories has provided us with data on the quantity of morphine salts sold to manufacturers from the Government factory in recent years as follows:

1. 1998–> 45.739 Kg
2. 1999–> 116.098 Kg
3. 2000–> 261.000 Kg
4. 2001–> 178.108 Kg
5. 2002–> 76.100 Kg
6. 2003–> 109.400 Kg
7. 2004–> 87.000 Kg

We have been unable to obtain the data since then. In the absence of indicators of actual consumption, this is the only reliable data that we have. But this is fallacious because much of the drug that went out of the factory may not actually be consumed. For example, the high consumption in 2000 and in 2001 is likely to have been because of the huge quantities ordered by WHO for free distribution to cancer centers. For one thing, much of this quantity remains unused till today. Secondly, many centers have continued to use the stock left over from 2002 so that they did not order any more in subsequent years.

D. Standard Operating Procedures: Giant step forward in Tamilnadu.

In August 2007, the Drugs Controller of Tamilnadu brought out detailed “Standard Operating Procedures” for implementation of its amended narcotic regulations. ( We thanked the Drugs Controller of Tamil Nadu and Congratulate Mr. Mallika Thiruvadanan on this achievement )

E. Methadone approved for “de-addiction” treatment:

Recently, the Union Health Minister announced that methadone will be available for treatment of people with substance-use problems. Thanks to the initiative from Dr Vivek Khemka at New Jersey who prepared the draft of a letter, and thanks to the prompt action by Dr Sukdev Nayak, president of the Indian Association of Palliative Care, a representation has been given to the Health Minister to permit its use for treatment of pain too. (See a copy of the letter)

F. Public Interest Litigation

The Indian Association of Palliative care represented by the chairman of its opioid availability committee Dr M.R.Rajagopal, Ms Poonam Bagai, a cancer survivor and president of the NGO, Cankids, and Dr Ravi Ghooi, a pharmacologist, have together moved the Supreme Court of India. The prayers are that palliative care policy be adopted by central and state governments, that the simplification of narcotic regulations and adoption of standard operating procedures be effected and that palliative care be included in the basic medical and nursing curricula by the Medical and Nursing Councils of India. (See a summary of the document)

G. Manufacturers of morphine:

We are aware of the following who manufacture oral morphine in the country. If there are any other, please inform us at Contact us… so
that we can update the list for the information of everyone concerned.

For direct supply of oral morphine powder for preparation of morphine solution in your own pharmacy, order with advance payment needs to be sent to: Govt. Opium & Alkaloid Factory, Ghazipur 233001, Uttar Pradesh, INDIA Tel: 0548- 220228, Fax: 0548- 220601

H. Report in New York Times

On 11 September 2007, the New York Times came out with a report on the opioid availability problem in India: View Report

I. Publications in scientific journals on opioid availability in India

1. Improving Access to Opioid Analgesics for Palliative Care in India
   David E. Joranson, M.R. Rajagopal, and Aaron Gilson
   View entire document (PDF format)
2. Medical Use, Misuse, and Diversion of Opioids in India
   M.R. Rajagopal, David E. Joranson and Aaron M. Gilson
   View entire document (PDF format)
3. India: opioid availability – an update.
   Rajagopal MR, Joranson DE.
   J Pain Symptom Manage 2007; 33:5: 615-622
   View abstract