Punjab’s prisons are awash with de-addiction pills. But is that good news?

What are buprenorphine and naloxone, and how are they used in opioid substitution therapy?

Buprenorphine and naloxone are combined in an oral medicine used in opioid substitution therapy. Buprenorphine is a less potent opioid that can reduce withdrawal and cravings without producing the same risks as heroin when properly prescribed. Naloxone is added to make misuse, especially injection, less rewarding and more dangerous. The treatment aims to reduce harm and support recovery.

Punjab’s programme gives the pills through Outpatient Opioid Assisted Treatment clinics, including clinics inside prisons. The medicine is meant to be taken orally and under supervision. Unlike heroin, it does not require intravenous injection. That reduces exposure to HIV, hepatitis and other infections. The article also reports an almost zero chance of overdose death under this therapy.

The treatment does not guarantee lasting recovery. Punjab reported that 80-90% of patients completing treatment at state clinics relapse. Rising prison supplies and registrations have therefore prompted concern about supervision, diversion and dependence on the substitute itself.

How many prisoners in Punjab are receiving opioid substitution therapy, and how sharply has the supply of buprenorphine pills to prisons increased?

Punjab’s government reported that 40,830 prison inmates were registered with deaddiction clinics by June 2026. The figure had nearly doubled from 23,367 in 2022. A little over half had registered for opioid substitution therapy for the first time. The article also says nearly 45% of inmates across the state’s prisons were drug-abuse victims seeking treatment.

Supply rose even faster in some comparisons. Buprenorphine tablets sent to prison clinics increased 75%, from approximately 46 lakh in 2022 to more than 80 lakh in 2025. During the first six months of the year covered, another 45 lakh pills had already been supplied to jails. The government also procured over 43 crore pills statewide in four-and-a-half years.

These figures triggered scrutiny because supplies increased more sharply than prisoner numbers. The High Court sought explanations, while a legislative committee questioned whether treatment was creating another dependence. The numbers show expansion, but the government could not specify how many inmates fully recovered.

Why did the Punjab and Haryana High Court question the growing use of buprenorphine in prisons?

The Punjab and Haryana High Court questioned the prison programme because buprenorphine use appeared unusually widespread and was rising quickly. A judge reported that nearly 70% of inmates at Mansa district jail were dependent on buprenorphine and naloxone. The court then sought statewide figures on inmates receiving opioid substitution therapy.

The government’s response showed that Mansa was not an isolated case. Nearly 45% of inmates in Punjab’s prisons were drug-abuse victims seeking treatment through prison clinics. Yet 83% of those drug-dependent inmates had no recorded history of seeking substance-abuse treatment before entering jail. These findings made the court examine whether the programme was being prescribed and monitored appropriately.

Experts and campaigners warned that treatment drugs can also be misused without proper supervision. Rising pill supplies, sharply increased registrations and the absence of recovery data deepened the concern. The court’s intervention focused on explaining the scale of use, not on rejecting harm-reduction treatment itself.

What benefits can supervised buprenorphine treatment provide compared with injecting heroin or other strong opioids?

Supervised buprenorphine treatment can make opioid addiction less immediately dangerous. The article says patients avoid intravenous use, so they are less vulnerable to HIV, hepatitis and other diseases spread through unsafe injection. It also reports an almost zero chance of overdose death. These benefits matter in Punjab, where heroin, known locally as chitta, has caused widespread opioid abuse.

The mechanism is substitution. A less potent opioid is provided in a controlled dose instead of forcing a person to seek heroin or another strong opioid. The patient can take the medicine orally at a clinic. This reduces the need for injection and helps protect against the sharp, unpredictable dangers associated with illicit opioid use.

The treatment is harm reduction, not an instant cure. Punjab reported relapse among 80-90% of patients who completed treatment at state outpatient clinics. Even so, the psychiatrist quoted in the article described the therapy as drastically reducing an addict’s vulnerability. Its benefits depend on proper prescribing and supervision.

What could happen if buprenorphine is distributed without enough doctors, counsellors, monitoring, and medical supervision?

If buprenorphine is distributed without enough doctors, counsellors and monitoring, the treatment can lose its protective purpose. Prisoners may take doses outside the prescribed plan, share or divert tablets, or become dependent on the substitute. The article does not quantify how often these problems occur, but it records strong concern about them.

The key risk is weak control over a medicine given to people already dependent on opioids. Dr Mohan Sharma warned that opioid substitution drugs in jails could be abused by people addicted to strong drugs. The High Court was told that nearly 70% of Mansa jail inmates depended on buprenorphine and naloxone. Supplies to prisons also rose 75% in one comparison.

Poor supervision could therefore shift dependence rather than reduce harm. It may also hide whether patients are improving, relapsing or fully recovering. Punjab’s legislative committee noted that the government could not say how many inmates had completely recovered after jail treatment. Better monitoring would be needed to judge outcomes.

Why might opioid-dependent prisoners begin treatment only after entering jail, even though most had no previous treatment history?

The available figures show a striking gap, but they do not explain it fully. Punjab reported that 83% of drug-dependent inmates had no history of seeking substance-abuse treatment before entering prison. The article does not say whether this resulted from lack of clinics, cost, stigma, limited awareness, personal choice or another barrier. Any single explanation would therefore be uncertain.

What is clear is that prisons had their own outpatient opioid-assisted treatment clinics. Once inmates entered jail, these services gave them a formal route to treatment. Nearly 45% of inmates across Punjab’s prisons were described as drug-abuse victims seeking help through such clinics. At Mansa jail, nearly 70% were reported dependent on buprenorphine and naloxone.

This pattern may indicate that treatment became available or more accessible in custody, but the article does not prove why. It does show the need for better records about previous treatment, access barriers and outcomes. Without that information, officials cannot distinguish new access from newly recorded dependence.

How does opioid dependence work, and why can replacing a dangerous opioid with a controlled medicine reduce harm without necessarily ending dependence immediately?

Opioid dependence develops when repeated opioid use makes a person rely on the drug to avoid withdrawal and manage cravings. Stopping suddenly can be difficult and distressing. Dependence is not necessarily ended just because the original drug is replaced. The replacement changes the risk profile and can create a more controlled path toward recovery.

Buprenorphine is a less potent opioid used in Punjab’s substitution programme. Taken orally in a measured dose, it can prevent or reduce withdrawal and cravings without the same danger associated with injecting heroin. Naloxone is combined with it to discourage misuse. Medical supervision helps determine the dose and observe how treatment is progressing.

This approach reduces harm while recovery continues. The patient may avoid injections, infections and overdose, but can still remain dependent on the medicine for a period. Punjab’s rules allow treatment for at least a year, and relapse remains common: 80-90% of completing patients reportedly return to addiction. Monitoring and follow-up therefore remain essential.

Key Facts:

📌 The pills are intended for oral use under medical supervision.

📌 Buprenorphine and naloxone are used in opioid substitution therapy.

📌 Punjab procured over 43 crore buprenorphine pills in four-and-a-half years.

📌 40,830 inmates were registered with prison deaddiction clinics by June 2026.

📌 Prison buprenorphine supplies rose 75% between 2022 and 2025.

📌 About 45 lakh pills reached jails in the first six months of the year.

📌 Nearly 70% of Mansa jail inmates were reported dependent on the medicines.