Drug De-Addiction Regulations in Punjab Need Relaxation

Punjab has the highest burden of drug dependence vis-a-vis its neighbouring states, with an estimated 15% of its population affected by substance use disorders, according to PGIMER, Chandigarh. Despite this, its de-addiction policies remain the most stringent, making access to treatment more difficult compared to other states. The requirement of a full-time psychiatrist to operate de-addiction centers, coupled with stringent BNX (Buprenorphine-Naloxone) management rules, has made treatment inaccessible to many.

Understanding BNX and Its Role in De-Addiction

• BNX (Buprenorphine-Naloxone) is Safe, Effective & Useful medicine: WHO lists BNX as an essential medicine for opioid dependence and recognizes it as a safer alternative to methadone.
• Regulation Under NDPS Act: While buprenorphine is a controlled psychotropic substance, naloxone is not. The combination is strictly regulated but widely used in opioid substitution therapy (OST).
• Burden on Mental Health Professionals: Stringent BNX dispensing and reporting requirements limit the time available for patient care, deterring organizations from running de-addiction centers in Punjab effectively.
• Need for Rationalization: When used correctly, BNX has a significantly lower potential for addiction compared to full opioid agonists. However, some studies suggest that buprenorphine, a component of BNX, may have a mild dependence risk, though it is substantially safer and least addictive.

Buprenorphine molecule is a partial agonist at mu receptor and an antagonist at Kappa receptor. In addiction, it is combined with and antiopioid Naloxone, making possibility of addiction of BNX minimal.

Policy Comparison: Punjab, Haryana, and Himachal Pradesh

1. Licensing and Regulation

Punjab:

• Most restrictive regulations; mandates a full-time psychiatrist for de-addiction centers.
• Heavy administrative burden due to stringent BNX management rules.
• SOPs (2018) focus excessively on opioid treatment control rather than accessibility.
• Licensing and renewal process is cumbersome, discouraging private sector participation.

Haryana:

• Drug De-Addiction Centre Rules (2010, amended in 2018) allow operation under a part-time psychiatrist or a doctor with three months of de-addiction training.
• License is granted for three years, ensuring continuity with provisional license till renewed to regular license (to be obtained within 6 months).?
• No stringent BNX management rules, making it easier for centers to function.

Himachal Pradesh:

• Categorises centers based on treatment duration (short-term, long-term, psychiatric-linked).
• No full-time psychiatrist requirement; only access to one on-call is sufficient.
• No time-consuming record-keeping for buprenorphine centred orientation thinking, thereby reducing time for patient treatment and well-being.

2. BNX Management Policies

• Punjab: Excessive regulation, complex record-keeping, physical and digital submission of reports, limiting access to medication.
• Haryana: Prescription-based dispensing, no exhaustive paperwork.
• Himachal Pradesh: Minimal restrictions, medicine dispensed based on doctor’s prescription, no separate buprenorphine record maintenance.

Impact of Restrictive BNX Policies in Punjab

1. Shortage of Psychiatrists: Punjab has only one psychiatrist for 2.5 lakh population, significantly below the WHO-recommended 3 psychiatrist for per lakh population.
2. High Cost of Treatment: Psychiatrists demand ?3 lakh+ per month including food and lodging, leading to delays and gaps in service provision. Even then retention time of the psychiatrist has not been more than 3 months during last 20 years of experience at Akal Drug De-Addiction Centre, Cheema, Sangrur? leading to various complaints and inquiries causing obstruction in the treatment of the patients who require more time and focus on them as compared to patients of other disciplines of medicine.
3. Limited Access to Treatment: According to the Punjab Opioid Dependence Survey (2015):

• 80% of opioid-dependent individuals attempted to quit, but only one-third received support.
• Only 1 in 10 opioid-dependent individuals received OST.
• At current capacity, it would take 10 years to treat the entire opioid-dependent population.

Need for Policy Reform in Punjab

1.??? Relaxing Psychiatrist Requirement

• It is suggested to adopt Haryana’s model to a allow trained doctors (not just psychiatrists) to operate centers with psychiatrist visits.
• Increase the availability of trained personnel through targeted training programmes.

2.??? Rationalising BNX Distribution

• Simplify BNX record-keeping regulations to reduce administrative burden.
• Allow prescription-based dispensing without excessive regulation.

3.??? Encourage Private & Social Sector to Contribute

• Simplify licensing and renewal processes.
• Provide financial incentives to private centres to offer de-addiction services.

4.??? Expanding Treatment Coverage

• Relaxing regulations would immensely contribute in harm reduction in drug abuse. Establishing OPD-based BNX dispensing centers in rural areas will help bring more individuals into treatment. Additionally, all psychiatric facilities and vacant centers should be regularised to offer addiction treatment.
• Ensuring wider accessibility of BNX on a chargeable basis will generate revenue for the state while also curbing the illicit pilferage of BNX medication.

Punjab’s de-addiction policies, particularly around BNX regulation and psychiatrist mandates, have created barriers to treatment access. A comparative analysis with Haryana and Himachal Pradesh shows that a more flexible policy approach can improve treatment coverage without compromising safety. Rationalizing BNX availability, reducing administrative burdens, and relaxing psychiatrist requirements will help Punjab address its drug crisis more effectively.