Experts in TN warn of HIV spike as youth move to painkiller injections

CHENNAI: Touted as the pioneer in AIDS-control and prevention, Tamil Nadu’s socio-medical interventions had yielded heartening results over the years. However, the risk of HIV among youngsters is increasing, thanks to the cross-abuse of syringes used to inject themselves with painkillers.

The number of HIV cases among youngsters, especially among college students, is rising due to substance abuse, warn the Drugs Control Department (DCD), Tamil Nadu State AIDS Control Society (Tansacs), and even several counsellors, psychologists and psychiatrists who treat them for several mental health issues.

Availability of painkillers

“In the last two years, I’ve seen HIV cases spike due to the cross-usage of syringes. Tydol, a popular painkiller, is commonly used in a powdered form for intoxication and sedation. Such cases are identified at the hospital either due to some physical illness, suicidal risk or homicidal and aggression risk,” said a psychotherapist from the Institute of Mental Health (IMH).

In addition to HIV, these patients are also at risk of Hepatitis B and C among other illnesses.

These painkillers are also being procured or ordered through courier. Even as the DCD continues to monitor their sale, and has implemented measures to control the smuggling operations from other States as well, officials opined that incidents of HIV continue to rise, especially among youngsters who cross-use syringes.

“We’ve received several reports of Nitravet and Tapentadol tablets being procured through courier and online. Other drugs that are used to treat chronic pain and muscle problems are being crushed to powder, dissolved in water and self-injected for a high,” said MN Sridhar, Joint Director, Drugs Control-cum-Controlling Authority.

Experts say that cross-usage of syringes to inject drugs carries 97% risk of HIV transmission, the highest among other modes of transmission. Sameer* (26) was admitted to Stanley Medical College Hospital because of a suspected intake of prescription-drugs by injection. Doctors found that he was using drugs at a friend’s house, when he became unconscious due to an overdose, and hence, was taken to the hospital. They had bought these drugs from a medical shop in their area.

This is not an isolated case. Tydol, Nitravet, Pentazocine, Meperidine and Tapentadol are available as over-the-counter painkillers, which are some of the most sought-after drugs abused.

Control and Monitoring

As of March 2024, there were over 1.32 lakh persons living with HIV in Tamil Nadu, including 61,490 men, 65,573 women, 499 trans persons, 2,540 boys and 2,199 girls. The numbers of persons with HIV being treated at ART centres across the State has surged to 2,900-3,000 this year.

Drug users with AIDS make up for 6.2% of the national average and 1.25% of the population in TN. Five cases of positive injectable drug users (also called ID users) were identified in 2022-23, and two users till August (2023-24).

The drug control authorities have also written to the State Drug Controller of other states including Bihar, Maharashtra, and Gujarat to monitor the bulk sales of painkillers, in an effort to control smuggling through courier and online platforms. The department is also monitoring the sale through drug inspectors. Cancellation of licences is also being undertaken in the case of irregularities.

R Seethalakshmi, project director of Tansacs said that the department was working towards creating more awareness on the risk of HIV because of ID usage. “We’re also implementing targeted intervention to conduct a census on identifying ID users through government organisations and NGOs, so that we can bring behavioural changes among high-risk groups, including ID drug users,” she pointed out.

As many as 650 injecting drug users have been covered as part of the intervention until August this year. However, there are ID users who stop for the time being, and restart at a later stage.

Therapeutic assistance

The IMH offers opioid substitution therapy (OST) after AIIMS Delhi, along with the support of Tansacs. “Among 650 ID users identified by Tansacs, around 130 have been given OST,” stated Dr M Malaiappan, director-IMH. “We have an out-patient count of 30-40 individuals on all working days.”

Buprenorphine, a drug used to treat Opioid Use Disorder, is given as part of OST. A combination of 0.4 mg and 2 mg is given free of cost and administered sublingually. “OST is aimed at harm reduction. Patients are also given counselling and continuously monitored. The dosage depends on the individual’s consumption of narcotics. In case of severity, OST begins with 2 mg twice or thrice a day and the dosage is reduced subsequently,” said Dr Janakiram, deputy director, Targeted Intervention-Tansacs.

A network of same-needle users

Dr M Janakiram, deputy director, Targeted Intervention-Tansacs, pointed out that the risk of HIV transmission through injection was more than 97% – higher than parental and sexual transmissions. “ID users never function independently. They’re often part of a network that uses drugs, ganja or others collectively as a group,” he stated. “When a youngster connects with someone in the group, he/she gradually begins injecting drugs. Since people in these groups are not first-time users, they use the same needle across the group. “So, even new members in the group are at a high risk of infection.”

Commonly-used medicines abused as drugs

• Nitravet: A psychotropic drug used to treat sleeping disorders, but a prolonged use or usage in high doses can lead to addiction

• Tapentadol: Used for treating severe pain and pain due to nerve damage. A scheduled H1 opioid analgesic, it’s recommended in case a patient requires opioid treatment. However, they are also used as an alternative to sedatives

• Tydol: Used to relieve moderate to severe pain in the case of musculoskeletal pain, dental pain and post-operative pain. Usually prescribed for short-term use of up to 5 days and under medical supervision. Overuse can lead to dependence, addiction, or side-effects, including respiratory depression

• Meperidine/Pethidine: An opioid that’s also a very strong painkiller. When used for a long time can become habit-forming, causing mental or physical dependence

• Fortwin: Helps relieve pain in joints and muscles mainly. Prescribed to those with rheumatoid arthritis and osteoarthritis. Habit-forming after prolonged use

• Pentazocine: Anaesthetic and painkiller given when other methods of pain-relief do not work. A habit-forming drug that can cause respiratory depression, hallucinations and sedation.