Concern over rising opioid analgesic abuse in Manipur

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The Manipur Police arrested two persons, including a 40-year-old woman, from Thoubal district’s Lilong on September 14 in connection with the seizure of addiction-causing pharmaceutical drugs. The police found in their possession 50 boxes containing 15,000 capsules of “Tramadol Hydrochloride Tramanil”, weighing about 7 kg.

The consignment, allegedly for illegal distribution to specific clients, was seized almost a month after a youth died at a drug rehabilitation centre in the State’s capital, Imphal. He had reportedly been injecting crushed tablets of Tapentadol, an opioid analgesic thrice as potent as Tramadol.

These incidents and the admission of another Tapentadol user at the drug rehabilitation centre with a serious infection due to injections confirmed what anti-narcotic officials and counsellors suspected — drug addicts were shifting to opioid analgesics available as prescription pain management medication from heroin and other narcotic substances made costlier by the ongoing ethnic conflict in Manipur.

“We are investigating to ascertain the source and intended destination of the Tramadol capsules and to determine the extent of involvement of the arrested duo in the possession or distribution of the pharmaceutical drug,” a Manipur police officer said.

The police and drug enforcement agencies in Manipur said data on seizures of opioid analgesics sold or ferried illegally in the State were not immediately available. They, however, said the price factor could have dictated the shift from methamphetamine and heroin, locally known as No. 4.

The prices of narcotic substances increased sharply after Manipur spiralled into seemingly unending violence in May 2023. According to reports in the local media, a vial of heroin, for instance, costs almost ₹5,000. A strip of Tramadol or Tapentadol costs between ₹40 and ₹400 depending on strength, brand, and manufacturer.

“Tramadol and Tapentadol are painkilling compounds derived from opium alkaloids. Taken for pain relief, they cause a sense of well-being, but can develop dependence if these are taken continuously for a few weeks,” Krishanu Krori, a Guwahati-based medicine specialist, told The Hindu.

“Addicts increase the dosage through injections after typically starting with 50-100 mg. Apart from a sense of euphoria, they develop disinterest in daily activities, withdrawal from family and society, and a craving for violence,” he said.

Counsellors in Manipur said pharmacists should strictly observe prescription requirements and health authorities should monitor emerging patterns of Tramadol and Tapentadol misuse. Hospitals and rehabilitation centres also need updated guidance on dependence, withdrawal, and complications associated with its misuse and injection, they said.

Opioid analgesics have become a worry for enforcement agencies beyond India’s northeastern region too. In August, the Directorate of Revenue Intelligence (DRI) unearthed an organised network involved in the clandestine manufacture, concealment, and illegal export of such drugs, a scheduled psychotropic substance, to African countries.

The seized items included 1 lakh Tramadol Hydrochloride tablets, 1 lakh Tapentadol tablets, machinery, and raw materials. The DRI sleuths arrested three key members of the syndicate during the operation at the Mumbai Air Cargo Complex.

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