Why prescription drug abuse is a growing public health problem.

A recent print media campaign by the Government of India, “Say Never to drugs”, would hopefully, have not missed your attention. The origin of the “Just Say No” campaign is attributed to former American First Lady, Nancy Reagan, who proffered these words in 1982, as a solution to the drug menace that was assuming almost epidemic proportions at the time. The essential philosophy behind this campaign is that a better way to deal with drugs is to reduce the demand for them, rather than spending large proportions of preciously limited resources on fruitless efforts at limiting supply.

While it’s easy to blame the supply chain of the “drug industry” for causing dependence on their products (for, like the FMCG industry, drug lords are also highly dependent on “repeat buying”), I believe, like many others, that the more prudent thing to do would be to remind the population at large that they have a choice in the matter. If they can be persuaded to take greater responsibility for their choices, nothing would be better, for, banning a product, as common sense will doubtless tell us, virtually guarantees its popularity. Unfortunately, when we start exhorting people to take more “personal responsibility”, we tend to come across as sanctimonious and preachy, however matter-of-fact we try to be. There’s little point in telling drug users what they already know: that drugs aren’t good for them. Making them feel “uncool” for using drugs would probably achieve better results.

Typically when we talk about preventing the abuse of drugs, we instinctively think of alcohol and what are generally referred to as “street drugs” (drugs like marijuana, heroin, cocaine etc). While these are certainly the cause of major problems, the focus of this piece is on the grossly under-reported, but perhaps as serious, problem of prescription drug abuse. Most educated urban Indians can actually tell when someone they know abuses street drugs or alcohol, for, the levels of awareness on these issues have grown exponentially over the years. However, when it comes to prescription drugs, it’s not so easy recognising an addict, for they source their “fix” not from some sleazy street-corner dealer or bootlegger, but from a perfectly legitimate and acceptable retail outlet — the pharmacy.

Highly addictive

There are, of course, a variety of drugs that are abused, but the most dangerous ones are the tranquillisers and psychotropic drugs, for, many of these, particularly those belonging to a category called the benzodiazepines (drugs like alprazolam, diazepam and the like) are highly addicting. They are excellent drugs, of course, but only when they are prescribed for the clinically challenging situations that they were intended for. Unfortunately, they tend to be over-prescribed and even though they are Schedule H Drugs (under the Drugs and Cosmetics Act, they are to be dispensed only on a prescription from a registered medical practitioner), and may also be Schedule X drugs (listed under the Schedule of the Narcotic Drugs and Psychotropic Substances Act), some, though not all, pharmacies may not be averse to supplying them over the counter.

Dependence on these prescription drugs often takes place by accident, rarely by design. Typically a doctor may prescribe a drug for a specified period of time, but patients, finding it to be extremely effective and even calming, tend to extend the old prescription of their own accord at a friendly neighbourhood pharmacy, until they are soon dependent on it. At this point, even if the doctor who originally prescribed it says the drug may be stopped, it’s too late, for, the patient is already hooked on the drug, believing it to be a harmless one. Sometimes, people who experience insomnia may pick up the drug on their pharmacist’s advice or because a friend recommended it or because they read about on the ever-so-helpful Net. The very same Net also opens up new horizons for younger hard-core addicts to expand their drug cocktail by using psychotropic drugs. In recent times, it is true that pharmacies are certainly more careful in dishing out Schedule drugs, but there are a variety of ways in which addicts can and do procure them. For obvious reasons, I don’t intend to list these out here.

In this situation too, we could rant about the laxity of the system, demand more monitoring of doctors’ prescriptions and pharmacy’s stock and sales registers and exhort the government to come out with more stringent punitive measures to curb this growing public health problem. However, the way I see it, while these will help, of course, by placing some deterrents, we live in a country where traffic rules are inviolate only when a policeman is present. Which means, law or no law, we’ll still find some loophole to exploit.

At the end of the day, the only way to prevent the development of “accidental” dependence on prescription drugs is by taking more personal responsibility for our health and well-being. We can do this by understanding our illnesses, acquiring knowledge about the medication we are prescribed and by taking them only in the dosage and for the period they are prescribed. Another good thing to do would be to stop looking for over-the-counter quick-fix solutions to our health problems.

vijay.nagaswami@gmail.com