Opioid Crisis in Punjab

Written by Sahana Tiwana

Punjab, a state in India, once celebrated for its cultural richness and agrarian prosperity, is now at the epicenter of a devastating opioid crisis. Over the past two decades, what began as a transit route for narcotics has evolved into a significant consumption zone. The rise in opioid use, particularly among the youth, has transformed into a public health emergency, demanding immediate attention.

Recent data from the AIIMS Punjab Opioid Dependence Survey estimates over 232,000 individuals in Punjab are opioid-dependent, with heroin being the drug of choice for the majority (2). Most users are young males, often unemployed and marginalized, with injection use being prevalent - exacerbating the risk of HIV and other infectious diseases (3). The co-dependence on substances like alcohol and tobacco further intensifies the health burden (4).

Multiple social and economic factors fuel this crisis. Agricultural decline, widespread unemployment, and peer pressure are key contributors. The youth, lacking opportunities and exposed to cultural pressures and escapism, turn to opioids as a coping mechanism (1). Financially, families are strained—many selling land or incurring debt to afford treatment or fuel a loved one's addiction (2). This socio-economic toll ripples across communities, deepening cycles of poverty and dependence.

While de-addiction and rehabilitation centers are present across the state, their effectiveness remains questionable. Many centers operate without standardized treatment models or qualified personnel (1). Outpatient Opioid Assisted Treatment (OOAT) clinics offering buprenorphine maintenance therapy have shown promise, but face issues like overcrowding, under-resourcing, and societal stigma (4). Repeated detoxification without adequate psychological counseling or long-term care results in high relapse rates (3).

The legal system presents another layer of complexity. A significant proportion of drug-related arrests target users instead of major traffickers. Courts are burdened with backlogged cases, and prolonged trials discourage those suffering from substance use disorders from seeking help (5). The Narcotic Drugs and Psychotropic Substances Act, while intended to control supply, often fails to differentiate between trafficking and personal use, criminalizing those in need of medical support (5).

Furthermore, stigma remains one of the most formidable barriers to recovery. Users are often isolated from their families and communities. The lack of reintegration programs, combined with minimal support for mental health or employment, makes relapse likely (1). Access to care is uneven, with rural populations particularly underserved by OOAT services and psychiatric support (4).

Historically, the drug landscape in Punjab has shifted dramatically. Earlier patterns of substance use, involving cannabis or poppy husk, gave way in the 1980s and 1990s to synthetic opioids and heroin (6). The state’s proximity to the Golden Crescent—a major opiate-producing region—along with weak enforcement and systemic corruption, has made it vulnerable to international drug trafficking routes (1).

Addressing Punjab’s opioid crisis requires a comprehensive, multi-faceted response. Integrating medical, psychological, and social services can provide individuals with a stronger foundation for recovery (3). Expanding and decentralizing OOAT clinics, especially in underserved regions, is essential (4). Legal reforms that focus on harm reduction rather than punitive measures can create a safer path to treatment (5). Reducing stigma through community awareness campaigns and promoting empathy over exclusion will also be crucial (1, 2).

The crisis in Punjab reflects a confluence of socio-economic decay, inadequate healthcare infrastructure, and a legal framework not yet aligned with public health goals. Without urgent and coordinated intervention, the situation threatens to escalate further, with devastating consequences for Punjab’s youth and society at large. Evidence-based, humane, and systemic approaches remain the most hopeful way forward.

References

1. Urgent Need to Revisit the Current Approach Towards De-addiction in Punjab – Herald Open Access. https://www.heraldopenaccess.us/openaccess/urgent-need-to-revisit-the-current-approach-towards-de-addiction-in-punjab

2. Punjab Opioid Dependence Survey Report – AIIMS. https://web.stanford.edu/~rm89/Punjab_AIIMS_Report.pdf

3. Ambekar, A., Agrawal, A., Rao, R., Mishra, A. K., & Khandelwal, S. K. (2018). Challenges in Opioid Substitution Therapy in India. https://pmc.ncbi.nlm.nih.gov/articles/PMC5787955

4. Saran, S., et al. (2023). Feasibility of OOAT in Punjab. BMJ Open. https://bmjopen.bmj.com/content/13/11/e079507

5. Legal Labyrinths: Examining the Complexity of Drug Abuse Cases – Ashdin Publishing. https://www.ashdin.com/articles/legal-labyrinths-examining-the-complexity-of-drug-abuse-cases-pendency-in-punjab-india-105308.html

6. Grewal, H. S., & Dhillon, R. S. (1986). Drug Abuse in Punjab: Changing Trends. https://www.sciencedirect.com/science/article/pii/0376871686900360

7. Repeated for citation purposes: Ambekar et al. (2018). https://pmc.ncbi.nlm.nih.gov/articles/PMC5787955/