“Painkillers are part of the daily routine. They have become more normalized,” says one social worker in India.
At home, major drug manufacturers like Purdue Pharma and Johnson & Johnson are facing declining sales and a plethora of lawsuits. Which is—at least in part—why they have turned their attention to India, a country with a growing middle class population and newly relaxed restrictions on opioid pain medications.
When Dr. GP Dureja founded the Delhi Pain Management Centre, people told him, “Nobody has time to complain about pain in our country.”
Now, that mindset has changed, Dureja said. “I’m getting five to seven new patients per day,” he told The Guardian.
For decades, Indian law tightly controlled access to opioids, because the country historically had issues with opioid abuse.
Normalization Of Opioids
However, in recent years, in part due to lobbying by palliative care advocates, the regulations have been relaxed. Fentanyl and methadone are now readily available for pain relief and are beginning to be abused.
American companies are moving in to profit from the change. Mundipharma, controlled by the Sackler family, sells buprenorphine in India, while Johnson & Johnson sells fentanyl patches.
Indians—like Americans of the early 2000s—see pain relief as a right.
Dr. Dureja summed up the changing mindset: “Don’t listen to your forefathers. They said you should tolerate pain, you should not complain, you should not take painkillers. Now, everybody wants to get rid of pain early.”
Public health expert Dr. Bobby John is concerned that with public opinion on their side, drug companies will find ways to flood India with opioids. “Are people going to figure out every trick in the game to make [opioid painkillers] widely available? Of course it will happen,” he said.
Although Dr. Dureja works in pain medicine, even he is concerned by the proliferation of opioids. “General practitioners have started prescribing these drugs, and we’re not educating the population on when to use and not to use,” he said.
Yet, people who are in favor of expanded access to opioids argue that reducing regulations is important to providing palliative and end-of-life care to Indians who are living—and dying—with chronic pain.
“This is a rather horrible country to die in,” said Dr. MR Rajagopal, an Indian physician who speaks out against what he sees as “opiophobia.”
Rajagopal shared the story of one patient with lung cancer, who came to get morphine tablets. Rajagopal’s clinic was out of the medication.
The patient “told us with outward calm, ‘I shall come again next Wednesday. I will bring a piece of rope with me. If the tablets are still not here, I am going to hang myself from that tree,’” Rajagopal said. “He pointed to the window. I believed he meant what he said.”