Beyond pain control: Public health impact of analgesic abuse in India

General
, , ,
1

Painkiller misuse in India involves both over-the-counter (OTC) analgesics and prescription opioids, each associated with distinct health risks. Easy availability, widespread self-medication practices, and limited public awareness have contributed to increasing misuse.

Paracetamol is the most commonly used analgesic due to its OTC availability and perceived safety. However, overdose or prolonged high-dose use can lead to severe hepatotoxicity, sometimes progressing to acute liver failure.

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, diclofenac, and aceclofenac are frequently misused for musculoskeletal pain. Chronic or excessive use is linked to gastric ulcers, gastrointestinal bleeding, renal impairment and increased cardiovascular risk.

Tramadol, a prescription opioid, is widely misused in India due to easy access. Its abuse can result in dependence, seizures, serotonin syndrome and withdrawal symptoms.

Codeine, commonly present in cough syrups and combination analgesics, is abused for its euphoric effects and may cause addiction, respiratory depression, particularly among adolescents.

Tapentadol, a newer centrally acting opioid analgesic, acts through μ-opioid receptor agonism and norepinephrine reuptake inhibition. Although initially considered to have a lower abuse potential compared to traditional opioids, increasing evidence from Indian clinical and forensic reports suggests misuse, dependence and withdrawal symptoms with prolonged or unsupervised use. High doses may lead to sedation, dizziness, respiratory depression and increased risk when combined with other CNS depressants. The perception of tapentadol as a “safer opioid” has contributed to its inappropriate prescribing and non-medical use.

Indian studies highlight high rates of analgesic self-medication, especially among students and urban populations. Despite this, painkiller abuse remains under-reported and poorly regulated. Strengthening OTC drug policies, improving public awareness and promoting rational analgesic use are essential. Pharmacists play a crucial role in patient counseling, early identification of misuse and prevention of long-term harm related to analgesic abuse in India.

MBH/AB

1 Like
2

This is a timely and well-articulated overview that’s often overlooked in India.The normalization of painkiller use,easy over the counter availability,and the misplaced perception of its safety—especially with drugs like paracetamol and newer opioids such as tapentadol—have quietly fueled misuse and preventable morbidity. Addressing analgesic abuse requires more than regulation alone; it calls for rational prescribing,stronger physician counseling, improved public awareness,and a better surveillance of drug use patterns-A multidisciplinary, system-level approach is essential if we are to balance effective pain relief with patient safety and long-term public health.

1 Like
3

Long term misuse of analgesic metamizole may also have myelosupressive and myelotoxic effects.

1 Like
4

Very underrated topic about misuse and self-administration of painkillers. Doctors & pharmacists play a very important role in spreading awareness about this issue, and thereby we can stop this self-administration of medicines. (painkillers)

1 Like