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LETTER TO EDITOR
Year : 2017  |  Volume : 31  |  Issue : 2  |  Page : 136-137

Tramadol for maintenance in poppy husk dependence


1 Department of Psychiatry, All Institute of Medical Sciences, All Institute of Medical Sciences, New Delhi, India
2 Department of Psychiatry, National Drug Dependence Treatment Centre, All Institute of Medical Sciences, New Delhi, India

Date of Web Publication20-Apr-2017

Correspondence Address:
Siddharth Sarkar
Department of Psychiatry, National Drug Dependence Treatment Centre, Room No. 4096, Teaching Block, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-4958.204830

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How to cite this article:
Tewari A, Sarkar S. Tramadol for maintenance in poppy husk dependence. J Med Soc 2017;31:136-7

How to cite this URL:
Tewari A, Sarkar S. Tramadol for maintenance in poppy husk dependence. J Med Soc [serial online] 2017 [cited 2020 Oct 25];31:136-7. Available from: https://www.jmedsoc.org/text.asp?2017/31/2/136/204830

Sir/Madam,

Natural forms of opiates such as poppy husk and raw opium have been in use in Central and South Asia since many centuries.[1],[2] Supply and demand reduction measures aimed at curbing substance use has resulted in elderly opiate users, who had otherwise been taking these substances since a long time, to seek treatment.[3],[4] We present a case of an elderly gentleman who presented with the use of poppy husk for the past four decades who was successfully treated with tramadol.

Mr. S, a 56-year-old Sikh gentleman, previously a farmer by occupation attended our outpatient services for the treatment of his addiction to “doda” (colloquial name for poppy husk). He initially started opioid use in the form of “afeem” (raw opium) about four decades back when he was 14 years of age, to alleviate tiredness after working for long hours on the farms. He became a daily user over the period of few months and would take it once or twice a day. He noticed that nonavailability of this substance would lead to withdrawal symptoms such as body ache, yawning, watering from eyes and nose, and diarrhea. Due to increasing cost of raw opium, he shifted to the use of poppy husk. He would consume it 3–4 times a day by either swallowing the dry husk with water or consuming it with tea. He would not be able to work in his fields without consuming sufficient amounts of poppy husk. Monthly consumption would be around 2–3 kg of husk, which he would obtain easily from dealers. He could arrange for the money from his farm income and did not resort to illegal activities to fund substance-taking behavior. He denied the use of other opiates such as heroin and other substances such as tobacco and alcohol.

Later, the patient got involved in religious activities after handing over his farms to family members. He would go on religious foot trails lasting weeks, consuming poppy husk during the pilgrimage. He was advised to quit poppy husk use by his religious group and had financial difficulties in getting poppy husk and thus sought treatment at our center. On evaluation at our center, the patient was given an option of either quitting the substance (detoxification) or taking controlled amounts of replacement opioid agonists (harm reduction). The patient was given tramadol for maintenance in doses up to 350 mg/day based on his desire for opioid agonist, and his reluctance to come frequently for buprenorphine dispensing as per hospital policies. The patient was given “take home” supply of tramadol for 2 weeks at a time. The patient has been maintaining well for a period of 1 year without the use of poppy husk, and no adverse effects noted with tramadol.

Tramadol has been previously reported to be used by patients for relieving opiate withdrawals [5] and as replacement medication when opiate supply is limited. The medication is probably more useful for mild to moderate opioid dependence. The present case suggests that tramadol can also be utilized for maintenance treatment for elderly patients with opiate dependence though caution needs to be exercised for excess use and side effects need to be monitored. Apart from the well-established opioid agonist agents such as buprenorphine and methadone, tramadol offers another agent for maintenance treatment though it may be better used for less severe cases.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Mattoo SK, Singh SM, Sarkar S. De-addiction services in India. In: Malhotra S, Chakrabarti S, editors. Developments in Psychiatry in India. India: Springer; 2015. p. 405-16.  Back to cited text no. 1
    
2.
Kulsudjarit K. Drug problem in southeast and southwest Asia. Ann N Y Acad Sci 2004;1025:446-57.  Back to cited text no. 2
    
3.
Balhara YP, Mishra A, Sethi H, Ray R. A retrospective chart review of treatment seeking middle aged individuals at a tertiary care substance use disorder treatment centre in north part of India over five successive years: Findings from drug abuse monitoring system. ScientificWorldJournal 2013;2013:316372.  Back to cited text no. 3
    
4.
Grover S, Irpati AS, Saluja BS, Basu D, Mattoo SK. Drug dependence in the geriatric age group: A clinic-based study. Ger J Psychiatry 2008;11:10-5.  Back to cited text no. 4
    
5.
Sarkar S, Nebhinani N, Singh SM, Mattoo SK, Basu D. Tramadol dependence: A case series from India. Indian J Psychol Med 2012;34:283-5.  Back to cited text no. 5
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