Opioid Substitution Therapy: Legal Challenges

By Math, Suresh; Mohan, Ashwin et al. | Indian Journal of Psychiatry, July-September 2018 | Go to article overview

Opioid Substitution Therapy: Legal Challenges


Math, Suresh, Mohan, Ashwin, Kumar, Naveen, Indian Journal of Psychiatry


Byline: Suresh. Math, Ashwin. Mohan, Naveen. Kumar

Drug dependence syndrome is a medical condition classified as a multifactorial health disorder that often follows the course of a relapsing and remitting chronic disease. Opioid substitution therapy (OST) is one of the established standard treatments for opioid dependence syndrome. OST, a process in which opioid-dependent injecting drug users, is provided with long-acting opioid agonist medications for a long period under medical supervision along with psychosocial interventions. OST service provider may have to deal with issues of license/registration/recognition/permission under various legislations such as the Drugs and Cosmetic Act, 1940; Narcotic Drugs and Psychotropic Substances Act, 1985; Rights of person with disability Act, 2016 and Mental Healthcare Act, 2017 depending on the drug prescribed, type of services provided, procuring, transportation, storage, and prescribing these narcotics and psychotropic medicines. The narcotics and psychotropic drugs are administered through various ministries and departments causing huge confusion, lack of coordination, overlapping roles and responsibilities, and various laws/rules and gives an opportunity for the abdication of the responsibilities. The 'public mental health issue,' where the number of opioid users in the country is approximately two million and opioid dependence syndrome is approximately 0.5 million. The number of beds in the public governed deaddiction centers is abysmally low, number of psychiatrist, or trained medical practitioners in OST are also few in number to face this humongous challenge. Against this background, this article focuses on the legal issues surrounding the OST.

Introduction

Drug dependence syndrome is a medical condition classified as a multifactorial health disorder that often follows the course of a relapsing and remitting chronic disease.[1] India and many other countries have endorsed and ratified the following three international conventions on drug-related matters; (a) Single Convention on Narcotic Drugs, 1961 (b) Convention on Psychotropic Substances, 1971, and (c) the UN Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, 1988.[2] India's commitment to prevention of drug abuse and trafficking was in the form of drafting and enacting the Narcotic Drugs and Psychotropic Substances Act, 1985 (NDPS Act 1985) and Rules, which was subsequently amended in 1989, 2001 and 2014.[3]

India's approach toward narcotic drugs and psychotropic substances is enshrined in the Constitution of India under Article 47, the Directive Principles, which directs the State to raise the level of nutrition and the standard of living and to improve public health as among its primary duties and in particular emphasis that the State shall endeavor to bring about prohibition of intoxicating drinks and drugs which are injurious to health.[4] Although these Directive Principles of State Policy are nonenforceable, this provision is frequently invoked to justify punitive drug policies. The Constitution of India also has earmarked subjects on which either Center or State Legislatures could make laws either exclusively or concurrently. 'Drugs and poisons' were placed in the concurrent list allowing both the center and the states to legislate matters related to drugs. The division of legislative powers has played a significant role in multiple drug-related laws, rules, and policies drafted by various States apart from the Centre's National drug policies. Further, adding to this confusion, administration dealing with Supply Reduction is divided not only between central and state governments but also between ministries and departments at the same level. At present the Ministry of Social Justice and Empowerment handles demand reduction (National Institute of Social Defense, Drug De-Addiction Program, Social welfare), the Ministry of Health and Family Welfare (National AIDS Control Organization, Drugs Controller General of India), Ministry of Finance (Department of Revenue, Central Bureau of Narcotics, Customs, and Excise), and Ministry of Home and Defense (Narcotics Control Bureau, Police, BSF, and other paramilitary forces),[5] and besides these, their counterparts at the state level too are responsible for supply reduction. …

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