Chandigarh, 24 July — Medicines meant to wean heroin addicts off the drug are increasingly being misused as substitutes, sparking concern among health officials, de-addiction experts and law enforcement authorities across North India. Originally prescribed as part of opioid substitution therapy (OST), drugs like buprenorphine and tramadol are now finding their way into the illegal market, creating a new layer of addiction that often goes unnoticed.
Across Punjab, Haryana, and parts of Himachal Pradesh and Jammu, buprenorphine, a mild opioid, is being misused by recovering addicts and even first-time users seeking a legal high. These drugs, available with a doctor’s prescription, are supposed to help heroin users gradually quit by replacing the dangerous street drug with a regulated alternative. But in many cases, they have become the new drug of choice.
“These medicines were designed to help people recover, not to create another form of dependency,” said Dr. Ashwani Kumar, a psychiatrist running a private rehabilitation centre in Ludhiana. “But what we’re seeing on the ground is alarming. Patients who should be tapering off are doubling their doses or mixing the drug with alcohol. Some even crush and inject the tablets, which can be deadly.”
The problem stems in part from lax regulation and easy availability. In smaller towns, some pharmacists reportedly sell buprenorphine strips and other synthetic opioids without proper documentation. Worse, in many places, the drugs are being sold outside medical channels altogether. “I’ve personally seen street vendors selling these strips in small plastic packets for Rs 100 apiece,” said an NGO worker in Amritsar who requested anonymity. “Kids as young as 15 are hooked. They think it’s safer than smack because it comes in a strip or capsule.”
Law enforcement officials admit they are struggling to keep up. “Unlike heroin or cocaine, which are banned substances and easy to track under the NDPS Act, these prescription drugs exist in a grey area,” said a senior officer in Punjab Police’s narcotics division. “They are legal if prescribed, but when they are diverted and sold illicitly, it becomes hard to prove intent or control supply routes.”
The National Drug Dependence Treatment Centre (NDDTC) under AIIMS has also acknowledged the issue in multiple field studies. According to a 2022 study conducted in Punjab, around 37% of buprenorphine users admitted to taking the drug without any doctor’s supervision. “The intent of OST is harm reduction, but when there’s no follow-up, no counselling, no monitoring, the medicine itself becomes addictive,” said Dr. Rajeev Rathi, a clinical researcher who worked on the study.
Recovering addicts confirm this dark underbelly. Sahil (name changed), a 27-year-old former heroin user from Patiala, shared his experience. “I was clean for six months on buprenorphine. Then I started craving again. I found I could take two extra strips and still feel a high. Slowly, I began hoarding them, lying to the doctor about lost doses. Eventually, I was injecting them like I used to inject heroin.”
When asked if he thought buprenorphine had helped or harmed him, Sahil was quiet for a moment. “It saved me from dying of heroin, yes. But it also gave me a false sense of safety. I replaced one master with another.”
Experts say that unless OST is accompanied by long-term therapy and strict accountability, it risks becoming a revolving door. “Addiction is not just chemical. It’s emotional, psychological, and social,” said Dr. Meenakshi Rawat, a clinical psychologist in Shimla. “If you give someone a replacement drug but don’t address their trauma, the loneliness, the peer pressure—they will find new ways to numb themselves.”
In response, some states have begun clamping down. In March this year, the Haryana government issued a circular requiring stricter controls on the sale of Schedule H1 drugs, which include buprenorphine, tramadol, and pentazocine. Pharmacists are now required to maintain a separate register, with Aadhaar verification of patients and copies of prescriptions. But activists argue that enforcement on the ground is still weak.
“There are loopholes everywhere,” said Arjun Bedi, who runs a rehabilitation outreach in Panchkula. “Doctors often over-prescribe, and pharmacists don’t ask questions. The system is stretched. We need a massive overhaul—public awareness, stricter checks, and above all, compassion.”
Meanwhile, community volunteers are stepping in where institutions lag. In border towns like Pathankot and Fazilka, former users are running peer support networks, holding informal counselling sessions and even tracking who’s abusing substitution medicine. “We know who is slipping. We talk to them, we try to bring them back,” said Vikram, a former user turned mentor. “But we can’t do it alone. The system needs to wake up.”
The Centre has so far maintained that opioid substitution therapy is critical to controlling heroin addiction, especially in high-risk states like Punjab. But with mounting evidence of misuse, the conversation is shifting.
“There is no doubt OST saves lives,” said Dr. Rathi of AIIMS. “But without supervision, it becomes a trap. What we need is a combination—medication, therapy, community support, and above all, dignity for the patient. Otherwise, we are just creating a new epidemic in the shadow of the old one.”
As the lines blur between cure and craving, the challenge remains not just medical but moral: how to protect the vulnerable without pushing them into another cycle of dependency.
