In recent years, the rise in opioid use disorder (OUD) in India has become a matter of increasing concern. Although we may be more familiar with the opioid crisis that has ravaged countries like the United States, we must not overlook its growing presence in India. The question now arises: Are we facing an opioid epidemic of our own? And if so, what are the unique factors contributing to its growth in different parts of the country, especially Bihar?
In this blog, I will take you through the key issues surrounding opioid use in India, particularly in Bihar, where the state’s alcohol prohibition policy inadvertently shifted the substance abuse landscape. As a psychiatrist, I have encountered many individuals affected by this growing crisis, and through their stories, we’ll explore the impact of opioid use disorder on families, communities, and individuals.
To understand the opioid problem in India, we need to recognize that while the opioid epidemic in Western countries is largely driven by prescription drug misuse, India's situation is more complex. A 2019 national survey reported that about 2.1% of India's population uses opioids, which is nearly three times the global average?1?. Among states, Uttar Pradesh has the largest number of opioid users, while northeastern states like Mizoram and Nagaland have some of the highest prevalence rates.
However, opioid addiction is not just a problem in distant regions. It is creeping into the everyday lives of individuals across the country. In the state of Bihar, opioid use has taken a new and more dangerous shape following the prohibition of alcohol. But before diving into Bihar’s unique situation, let’s understand what opioid use disorder entails.
Opioid use disorder (OUD) is a medical condition characterized by an inability to stop or control opioid use despite the harmful effects it may have on one’s life. Opioids include both legal prescription painkillers like morphine and codeine, and illegal drugs like heroin. The allure of opioids lies in their powerful pain-relieving properties, but they also come with a high risk of addiction. Prolonged use leads to dependence, meaning the body starts to require the drug to function normally.
In my experience as a psychiatrist, I have seen patients fall into opioid addiction through a variety of paths. Some started with prescription opioids following an injury, while others were introduced to drugs like heroin by peers. Whatever the route, the outcome is often the same—devastating consequences on mental, physical, and social well-being.
Let me share the story of a patient who came to me in a desperate situation. Rajesh (name changed for privacy) was a 28-year-old man from a rural village in Bihar. His initial problems began when alcohol was banned in the state. Like many others, Rajesh had previously consumed alcohol to cope with stress from his difficult job in agriculture and the pressures of providing for his family. However, after the alcohol prohibition, he turned to opioids, which were easily available in his community.
At first, it started with a few pills that he could purchase from an unregulated pharmacy, but before long, Rajesh found himself using opioids daily. As his use escalated, his life started to unravel. He became irritable, lost his job due to poor performance, and his family noticed that he seemed distant and distracted all the time. Rajesh’s addiction had taken hold of him, and he could no longer function without the drug.
This story, unfortunately, mirrors the experiences of many people across Bihar.
In 2016, Bihar made a bold move by banning the sale and consumption of alcohol. This decision was driven by concerns about alcohol’s role in increasing domestic violence, crime, and public health issues. While the prohibition aimed to create a healthier, safer society, it had an unintended consequence—many individuals who had previously consumed alcohol began turning to other substances, including opioids and cannabis?2?.
In fact, a study in Bihar's healthcare settings revealed that opioid consumption surged after the alcohol ban was enacted. The number of people reporting opioid use jumped from 40% before the ban to nearly 70% afterward?2?. This significant rise in opioid consumption shows that the state’s prohibition policies inadvertently fueled the opioid crisis.
The sudden rise in opioid use post-prohibition can be attributed to a few key factors:
When alcohol was no longer available, many people sought alternative substances to satisfy their addiction. Unfortunately, opioids were one of the most accessible substitutes. With little to no regulation in place, people turned to local pharmacies and dealers for drugs like heroin or prescription painkillers.
India’s opioid crisis isn’t entirely homegrown. Global pharmaceutical companies have increasingly targeted developing countries like India to expand their markets, leading to greater availability of prescription opioids?1?. Additionally, there are unregulated de-addiction centers (nashamukti kendras / ????????? ??????) that sell opioids without prescriptions, further contributing to the rise in substance abuse.
Bihar is one of India’s poorest states, and the economic pressures faced by its population can drive individuals to substance use. Opioids, in particular, offer an affordable escape from the harsh realities of daily life. However, this temporary relief comes at the cost of long-term health and well-being.
It’s not just individuals like Rajesh who suffer from opioid addiction—their families and communities are also deeply affected. In rural areas of Bihar, I have seen families devastated by the effects of addiction. Parents and spouses struggle to support their loved ones while battling shame, stigma, and financial hardship.
Let’s consider another example. A young woman I treated came from a small town where her husband, a daily wage laborer, had fallen into heroin addiction. Their household income dwindled as her husband’s addiction deepened. The family fell into debt trying to pay for unregulated treatment at a nashamukti kendra, but the lack of proper medical care and follow-up led to repeated relapses. The emotional and financial strain on the family was overwhelming, leaving the wife as the sole breadwinner while caring for her two young children.
This case underscores the devastating ripple effect of addiction. It affects not just the person using the substance but everyone around them, especially in communities where social support systems are weak.
Addressing the opioid crisis in Bihar is fraught with challenges, some of which are unique to the state, while others are shared across India:
One of the biggest obstacles is the lack of access to proper treatment facilities. While opioid substitution therapy (OST) is available in some parts of India, it reaches only a fraction of those who need it?1?. In Bihar, the situation is worse, with a high reliance on unregulated nashamukti kendras that often lack proper medical care.
There is still significant stigma surrounding addiction in India. Many people view addiction as a moral failing rather than a medical condition. This prevents individuals from seeking the help they need, leaving them to suffer in silence. Moreover, there is a widespread lack of awareness about the dangers of opioid use and the available treatment options.
In Bihar, it is easy to obtain opioids without a prescription. Pharmacies often sell these drugs under the table, and dealers operate with impunity in many areas. This unregulated market poses a huge challenge for law enforcement and public health officials trying to curb the spread of opioid addiction.
One of my patients, Deepak (name changed), was a father of two from Patna who had been using opioids for several years. His addiction started after he lost his job as a driver and was unable to cope with the stress of unemployment. Deepak tried seeking help at a local nashamukti kendra, but the treatment there was more punitive than therapeutic. After months of harsh, ineffective treatment, he returned home, only to relapse within days.
Eventually, Deepak came to me for help. Through a combination of counseling, opioid substitution therapy, and the support of his family, he was able to start his journey toward recovery. But his story illustrates a critical issue: without access to proper, compassionate care, recovery can seem impossible.
Despite the challenges, there is hope for tackling the opioid crisis in Bihar and India as a whole. Here are a few strategies that can help combat this growing issue:
The government and healthcare providers need to work together to expand access to evidence-based treatments like opioid substitution therapy and counseling services. Community drug treatment centers must be regulated to ensure that they provide high-quality care and follow scientifically backed treatment protocols.
Public awareness campaigns can play a huge role in preventing opioid addiction. By educating the public about the dangers of opioid use and breaking down the stigma associated with addiction, we can encourage more people to seek help. Schools, workplaces, and media outlets should all be involved in spreading this message.
It’s crucial to recognize the role that poverty and unemployment play in fueling substance abuse. Policymakers should focus on improving economic opportunities in states like Bihar, while also investing in mental health services that help individuals cope with stress and emotional turmoil in healthier ways.
The availability of opioids in unregulated markets is a major contributing factor to the crisis. Stricter laws and better enforcement are needed to crack down on pharmacies and dealers who sell opioids illegally.
The opioid crisis in Bihar, exacerbated by the alcohol prohibition and the easy availability of opioids, is a growing public health issue. As a psychiatrist, I have seen the toll it takes on individuals, families, and communities, but I also know that with the right interventions, recovery is possible.
Addressing opioid use disorder in Bihar requires a multi-faceted approach—one that includes expanding access to treatment, raising public awareness, addressing underlying socio-economic factors, and tightening the regulation of opioid distribution. Most importantly, we must view addiction through a compassionate lens, recognizing that those affected are in need of medical care and support, not judgment or punishment.
Together, through community, education, and better healthcare infrastructure, we can hope to stem the tide of opioid addiction in India and help those struggling with substance use disorder reclaim their lives.
TAGS: Opioid Use Disorder, OUD, Cycle of Addiction, Bihar’s Alcohol Prohibition, Substance Substitution, Economic Stress, Opioid Crisis, Drug Market, Evidence-Based Treatment, Socioeconomic Factors, ????????? ??????, ????
Disclaimer: All characters and events depicted in this blog are entirely fictional. Any resemblance to actual persons, living or dead, is purely coincidental. The content is intended for informational purposes only and should not be considered as medical advice. Always consult a qualified healthcare professional for medical concerns.
Dr. Saurabh Kumar is founder of Bihar Healthy Minds, specializes in clinical psychiatry, psychosomatic medicine, and expertise in various aspects of mental health. His research explores innovative treatments like Transcranial Magnetic Stimulation (TMS) and addresses stigma and psychopathology in mental illness. You can find Dr. Saurabh Kumar on Facebook , Instagram and Twitter as well.
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