Supply reduction

India's drug control policy has provisions for surveillance, prevention and management and penalties to empower the law enforcement agencies by criminalising the manufacture, trafficking, possession and personal consumption of illicit drugs under the Narcotic Drugs and Psychotropic Substances Act 1985 (NDPS Act). Table 1 outlines the penalties determined for contravention of the act. The Narcotics Control Bureau (NCB) is the primary enforcing body in the supply-reducing arm of drug control, with activities such as drug seizures, destruction of illicit drug cultivation areas, creation of the National Integrated Database on Arrested Narco Offenders (NIDAAN) Portal, which is a database of identification details of all individuals charged under the NDPS Act, and the National Narcotics Coordination (NCORD) Portal, which provides information on the source and destination of drugs (https://narcoordindia.gov.in/narcoordindia/index-english.php). According to recent a World Drug Report, the NCB has carried out sizeable seizure operations for reducing the global supply of heroin, opium poppy and cannabis.⁴ India's National Policy on Narcotic Drugs and Psychotropic Substances (NDPS), published in 2012, aligns with most of the supply reduction strategies of the NDPS Act. It has strategised how to tackle the recent rise in clandestine laboratories that are illegally manufacturing stimulants and newer psychoactive substances. The United Nations Office on Drugs and Crime (UNODC) and Ministry of Finance have carried out surveys in India to measure stimulant use and newer psychoactive substances respectively.^{3,Reference Chadda, Jain, Lal, Quraishi, Garg and Bala5} The UNODC has organised capacity-building programmes to improve the law enforcement efforts in drug seizures.^6,7

Table 1 Offences and penalties under India's Narcotic Drugs and Psychotropic Substances (NDPS) Act 1985 (amended in 2021)

¹ Rigorous imprisonment is defined as hard labour in the Indian Penal Code.

² Amounts are approximate in US$. In 2023 India's GDP per capita was 2481 USD.

Demand and harm reduction

A shift towards prevention programmes that focus on age-specific life skills development, social cohesion and prosocial lifestyles at the individual, family and community level are crucial for demand reduction. To achieve this, the NAVCHETNA programme has been designed by the Ministry of Social Justice and Empowerment.⁸ India's demand reduction initiatives kickstarted with the Scheme for Prevention of Alcoholism and Substance (Drugs) Abuse in 1985–1986. The key focus of this scheme was prevention and rehabilitation and a key development was the setting up of integrated rehabilitation centres for addicts (IRCAs).⁹ The Drug De-addiction Programme was set up in 1988 to build a nationwide network of de-addiction clinics with the primary focus being provision of medical treatment for substance use disorders and capacity building. These schemes were partially successful.^{Reference Dhawan, Rao, Ambekar, Pusp and Ray10} In 2014, the Ministry of Health and Family Welfare began to set up drug treatment clinics (DTCs) with the goal of providing only out-patient services. Such clinics have been opened in 27 hospitals around the country. In 2019, the Ministry of Social Justice and Empowerment launched the National Action Plan for Drug Demand Reduction (NAPDDR) to provide ‘financial assistance for preventive education and awareness generation, capacity building, skill development, vocational training and livelihood support of ex-drug addicts, programmes for drug demand reduction and running and maintenance of IRCAs’.⁹ Under this plan a nationwide network of addiction treatment facilities (ATFs) is being set up with a focus on both in-patient and out-patient care and availability of opioid substitution therapy. Thus far, 46 such facilities have been set up and the scale-up is ongoing. Community mobilisation is another area that needs focus. The Nasha Mukt Bharat Abhiyaan (‘Making the Country Free of Addiction’) campaign was launched in 2020 as part of the NAPDDR to decentralise the prevention, surveillance and needs assessment campaigns against substance use to district level. This integration of ATFs and DTCs into the existing healthcare systems is a best practice example of a demand reduction initiative in South Asia. As of 2022, most of the first-line medications used to treat drug dependence have been included in India's National List of Essential Medicines.

A key demand reduction objective of the NDPS policy is to strengthen training programmes and assist the voluntary sector and state-run hospitals in delivering affordable and quality care. The policy includes steps to formulate minimum standard of care guidelines for de-addiction centres and to monitor compliance. The policy directs the National Drug Dependence Treatment Centre (Delhi) to train medical personnel in providing drug dependence treatment and the country's National Institute of Social Defence to assist voluntary organisations and local governing bodies in increasing prevention and awareness efforts. The policy focuses on gender-sensitive treatment and rehabilitative services. For people who inject drugs, the policy supports harm reduction strategies such as needle/syringe exchange facilities and opioid substitution therapy, albeit for minimising the spread of blood-borne infections.

As a consequence this focus on harm reduction, one of India's significant contributions in the South Asian region has been its pioneering efforts in setting up widespread access to opioid substitution therapy, via the National AIDS Control Organization (NACO), and to the Needle Syringe Exchange Program (NSEP). A scale-up of opioid substitution therapy for all opioid-dependent patients has been planned under the Ministry of Health and Family Welfare's Drug De-addiction Programme,^{Reference Dhawan, Rao, Ambekar, Pusp and Ray10} and one of the aims of India's National Strategic Plan for HIV/AIDS and STI for 2017–2024 is to increase accessibility to both opioid substitution therapy and the NSEP.