Spasmo-proxyvon (SP) is the most abused drug in the country

Drugs: At a glance, it looks like any other capsules sold over the pharmacy counter. The blue coloured odourless capsule looks harmless. It is actually a pain reliever.

But Spasmo-proxyvon (SP) or Sonam Penjor, as known on the streets of Bhutan is the cause of lot of pains to those who abuse it. It is the most abused pharmaceutical drug in the country.

Composed of paracetamol (400mg), dicylomine hydrochloride (10mg) and propoxyphene napsylate (100mg), SP is a multi-ingredient synthesized opioid used as a painkiller. It is the presence of Propoxyphene napsylate that makes the drug highly addictive and causes dependency among the users.

Consumed in excess quantity, expert said abuser could suffer from paracetamol poisoning and liver toxicity. Thimphu referral hospital’s clinical officer, Kunzang Tenzin warns that a maximum of four doses in 24 hours (five grams) is a lethal dosage. The recommended dosage of paracetamol is 1,000mg and up to 4000mg a day for adults.

“With people consuming at least 10 to 15 capsules of SP in 24 hours, the chances of paracetamol poisoning is high,” he said.

There is no proper count of the capsules that are smuggled in and seized by police, but after a major crack down, the Royal Bhutan Police has arrested 1,373 people in connection with smuggling or abuse between December 2013 and October 2015. Majority of it was SP.

Nitrosun (N-10), another drug that is commonly abused looks like the white paracetamol tablet. It is used for sedation and anxiety control. Used largely by people suffering from insomnia as a self-treatment, N-10 can make an abuser hooked to it.

Abusing these controlled pharmaceutical drugs for pleasure affect the pleasure center of the brain, the limbic system, making a person dependent on the drug, according to Bhutan Narcotics Control Agency officials.

Explaining how its affect the abuser, they said it is in the limbic system of the brain, the drug mimics the neurotransmitter dopamine, which is responsible for stimulating pleasure in the body. When a person abuses these drugs, it stimulates excess secretion of dopamine in the brain causing a euphoric feeling.

BNCA’s deputy chief counsellor, Sonam Jamtsho said that the euphoric feeling then becomes addictive whereby the dosage of the drug intake also increases with time. During the normal functioning of the body, dopamine is released in the brain when an individual derives pleasure from the acts of eating, sex, love and other activities.

“The brain in order to secrete more dopamine requires more dosages resulting in addiction,” the chief counselor said.

Another abused controlled pharmaceutical drugs is the codeine-based cough syrup such as Corex.

Belonging to the opioid group, Corex, according to Sonam Jamtsho, was an effective cough reliever. However, as people started abusing the drug, it is no longer available in the syrup form.

Sonam Jamtsho said that apart from death caused by the drug itself from over dosage, psychosis is the most common mental problem caused. Drug-induced-psychosis where an individual behaves in an abnormal manner along with hallucinations is a common symptom of addiction.

However, to help those individuals seeking a way out of their addiction habits, measures are already in place to help them recover. BNCA have established seven drop-in-centers in the country. The centers help addicts communicate their issues and provide necessary counseling.

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Sonam Jamtsho said that detox facilities with trained doctors are available throughout the country. “The first batch of certified school counsellors in all the dzongkhags will also be ready by next year,” he said.

Meanwhile, on August 14 last year, Thimphu referral hospital introduced a replacement therapy where individuals suffering from opioid and alcohol addiction are treated with substitution drugs.

The pilot project helps in detoxifying the individuals and helps them recover with a substitution drug. Bruprenorphyne is used for the opioid addicts and disulfiram for the alcoholics.

Younten Tshedup