India’s response to addiction is often shaped by fear and moral outrage. Fear is understandable. Drug dependence can damage families, livelihoods and trust. Communities want the state to act firmly. Families want their children back. Governments want to show that they are serious. But when fear becomes the organising principle of policy, treatment itself can begin to feel punitive. Patients are repeatedly made to prove their worthiness. Doctors are asked to behave less like clinicians and more like guards. Families are left to manage shame, relapse and disruption.
There is a persistent fear that giving a medicine for opioid dependence merely replaces one addiction with another. This is not how we think about other chronic conditions.
This is the larger problem we need to confront. Addiction is still too often treated as a failure of character or a threat to public order, rather than as a chronic, relapsing health condition. This does not mean that trafficking, coercion or predatory drug markets should be ignored. They require firm action. But the person seeking treatment is not the same as the person profiting from addiction. A health system that cannot make this distinction will struggle to help people recover.
For opioid dependence, one of the most important evidence-based treatments is opioid substitution therapy. The idea is straightforward. A person dependent on dangerous, short-acting opioids is treated with a safer, longer-acting medicine under medical supervision. In India, buprenorphine, often combined with naloxone, is an important medicine for this purpose. It reduces craving and withdrawal, improves retention in treatment, lowers illicit opioid use, and gives people time to rebuild work, family and social stability.
This paper by Kaur and others (https://doi.org/10.24966/aad-7276/100173) argues that opioid substitution therapy is most effective when treatment duration is adequate, dosing is appropriate, patients are involved in treatment decisions, and medication is combined with psychosocial support.
Punjab has allowed opioid substitution therapy, but its standard operating procedures limit take-home buprenorphine-naloxone to 14 days or 100 tablets, whichever is less. A rule designed to prevent misuse may, in practice, make lawful treatment harder to continue.
Yet public policy often remains uneasy with this approach. There is a persistent fear that giving a medicine for opioid dependence merely replaces one addiction with another. This is not how we think about other chronic conditions. We do not say that a person with diabetes is addicted to insulin, or that a person with hypertension is addicted to blood pressure tablets. We understand that long-term medication can support stability. Addiction medicine deserves the same clinical seriousness.
Punjab offers a useful example of how good treatment can be undermined by excessive control. The state has faced a severe opioid crisis, with the Punjab Opioid Dependence Survey estimating around 2.3 lakh opioid-dependent persons, many of them young adults. In response, Punjab has allowed opioid substitution therapy, but its standard operating procedures limit take-home buprenorphine-naloxone to 14 days or 100 tablets, whichever is less. This means that even stable patients may have to return every two weeks for medicines. For a daily wage worker, truck driver, migrant worker, farmer or person living far from a treatment centre, this is not a small inconvenience. It can mean lost wages, travel costs, stigma, repeated absence from work and avoidable instability. A rule designed to prevent misuse may, in practice, make lawful treatment harder to continue.
Stable patients who are working, connected to families and regularly following up should not be forced into needless disruption. The system’s default design should help people remain in care, not push them out.
The concern about diversion is no doubt real. Medicines with misuse potential must be monitored. But policy must distinguish between misuse for intoxication, informal sharing during withdrawal, and treatment-seeking by people who cannot easily access formal care. Better access, counselling, follow-up and clinical judgement may reduce diversion more effectively than rigid restrictions alone.
Subscribe to stay connected
We will send you a monthly newsletter listing all the articles that were published in the month.
India needs to move from a suspicion-based model of addiction care to a trust-based, accountable model. This does not mean weak regulation. Treatment centres should be monitored. Doctors should document decisions. Patients should receive counselling and social support. Diversion should be tracked. But stable patients who are working, connected to families and regularly following up should not be forced into needless disruption. The system’s default design should help people remain in care, not push them out.
Addiction policy must become less moralistic and more practical. The question is not whether we approve of drug use. The question is whether our systems reduce harm, prevent death, restore functioning and help people return to ordinary life. The task before us is not only to fight drugs. It is to build a health system in which people with addiction can stay long enough to heal.