Indian Cafe in Pune Serves Hemp-Infused Food

India is moving into the hemp space—as a new eatery serving infused food in Pune demonstrates. The establishment serves sandwiches, coffee, and other foods infused with hemp. The 30 year owner of the Hemp Cafe, Amruta Shitole, is actually a serial cannabis entrepreneur, having opened the Ganja Cafe previous to this, and has been successfully selling cannabis infused food products for the last four years.

She is not the only ganjapreneur in the country of course. There have been numerous projects—and products—launched recently. One that caught the recent eye of the foreign and travel press? A new gin produced in Goa called Satiwa which calls itself a “happy high gin” because it is also infused with hemp.

But this is just the tip of the iceberg.

What Is the State of Cannabis Reform in India?

Cannabis has been used in India for thousands of years. It has also traditionally been utilized in many different forms—from resin (called charas) to ganja (flower) and bhang (the seeds and leaves). The use of cannabis is mentioned in texts which date back to 1000 CE.

In 2019, a study conducted by the All India Institutes of Medical Sciences—an autonomous group of government public medical universities under the jurisdiction of the Ministry of Health and Family Welfare—reported that about 7.2% of Indians used cannabis in the last year. In a country of 1.38 billion people this is not incredibly significant when it comes to the percentage of the population who are cannabis users. In real terms, however, this represents as many as 99 million people—or about one third of the total population of the United States.

According to the UNODC, the retail price of cannabis was lower than anywhere else in the world—about $0.10 per gram. New Delhi and Mumbai clocked in as the third and sixth highest cannabis consuming cities in the world in 2018. As of 2022, heroin and high THC cannabis are the two most used “illicit” drugs in the country. Both illegal cultivation networks and seizures are up too, which is why authorities are turning to drones for interdiction, particularly in parts of the country that are remote and hard to access by other means.

The Sleeping Cannabis Giant

While the trade and consumption of all high THC cannabis is still illegal here per the Narcotic Drugs and Psychotropic Substances Act of 1985, there have been increasing calls for its legalization. In the meantime, intriguing projects are afoot across the country. Much like the U.S., individual Indian states have wide leeway to formulate their own laws about the cultivation, warehousing, processing, and interstate transport of the drug.

It is clear that there is huge interest in cannabis—both as a domestic product and as an export. Indian pharmaceutical firm Dr. Reddy’s actually bought a German narcotics distributor in Frankfurt in February of this year.

On the recreational side of the discussion, Mallana Cream, cultivated in a small Himalayan village to which the strain owes its name, is one of the most expensive cannabis strains in the world. Connoisseurs trek here to sample it from around the world.

As legalization comes, expect India’s most famous strain to become a highly sought, legally exported product.

In the meantime, the industry is growing here, particularly on the hemp side of the discussion. The Indian Hemp Expo, the first B2B exhibition of its kind in the country, kicked off in mid-May this year in Delhi. It was heavily attended by a wide range of firms and individuals across the burgeoning industry domestically and internationally.

India Vs. China—The New Hemp Capitals of The World?

How the industry develops here, particularly in relation to its Asian neighbor China, will be interesting to watch. At present, two Chinese provinces account for over two thirds of global hemp fiber production—and cultivation has dramatically increased year over year for the past 7 years.

However, it appears, at least so far, that China will focus more on textiles and biocomposites than edibles. For that reason, India is certainly strategically well-positioned to enter the global hemp industry across a range of products.

Of course, it won’t just end there. It never has.

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OnlyFans Appoints Cannabis Industry Insider as CEO

Amrapali “Ami” Gan, 36, will serve as Chief Executive Officer of OnlyFans, effective December 21, 2021, according to an announcement. Bloomberg first reported the change in leadership, and a representative from OnlyFans—the leading subscription-based adult content creation platform—told High Times “we can confirm the appointment of Amrapali Gan as CEO.”

Gan arrives with first-hand knowledge working in challenging industries, including the first-of-its-kind restaurant serving cannabis-infused food. Her appointment as OnlyFans CEO is causing a significant buzz in East Asian media cycles. Why? OnlyFans is home to 180 million registered users as of the time of writing—and the company says it pays out more than $5 billion to its two million content creators annually.

Before OnlyFans, Gan worked as a marketer by profession in Mumbai, India, where she was born. She started in 2007 with PepsiCo under its Marketing Leadership Program, and worked with Quest Nutrition as the Head of Brand Communications, and for Red Bull Media House focusing on Activation & Communications. 

Most recently though, Gan worked as VP of Marketing and Communications with Andrea Drummer and others to unveil the historic, first-of-its-kind restaurant, The Original Cannabis Cafe in West Hollywood, California—which was formerly known as Lowell Cafe. The cafe featured CBD, THC or both in every dish, with an emphasis on highlighting cannabis’ benefits for personal wellness. It was the first brick-and-mortar cannabis-infused restaurant, mirroring other cafe projects that claim similar “first” titles. 

OnlyFans Founder Tim Stokely will hand over the reins to Gan, as Stokely prepares “to pursue new endeavors.” He’s ready to shift gears as he steps down from his role.

“Ami has a deep passion for OnlyFans’ business and I’m passing the baton to a friend and colleague who has the vision and drive to help the organisation reach its tremendous potential,” said Stokely. “OnlyFans is still a new company and Ami brings a fresh energy and reflects who we are as a business.”

Gan served as Chief Marketing and Communications Officer of OnlyFans, after joining the team in 2020, working closely with Stokely. Ami is taking over this role from Stokely, who has been at the helm since founding the company in London in 2016. He will continue with OnlyFans as an advisor guiding this leadership transition.

OnlyFans CEO Ami Gan. Photo courtesy of OnlyFans

“I am proud to assume this role. I look forward to continuing to work closely with our creator community to help them maximize control over, and monetise, their content,” said Gan. “I will be leading an exceptionally talented team at OnlyFans that is delivering a unique experience for our creators and fans. By blending state of the art technology with creative capital, we are committed to being the safest social media platform in the world.”

OnlyFans is a subscription-based social platform focusing on typically adult material. The site is inclusive of artists and content creators, giving creators the opportunity to monetise the content that they share. 

The rapidly evolving nature of social media platforms means adaptability. Citing pressure from the banks that process payments on the site, OnlyFans announced it would ban all sexually explicit content from the platform in August but quickly reversed the decision not long after. After all, many people turned to OnlyFans into a means of income during the pandemic, including single mothers.

Gan’s new job will be to ensure to promote the company’s growth and drive its vision and commitment specifically to empowering content creators. As a woman of color, she also brings a spark of diversity to OnlyFans’ leadership team.

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Celebrity Drug Bust in India Leads to Questions About Privacy & Civil Rights

It was lurid news in India when Aryan Khan — the son of Bollywood superstar Shah Rukh Khan, and a celebrity in his own right — was detained by the country’s equivalent of the DEA while on a luxury cruise ship headed from Mumbai to the party town of Goa. 

In the Oct. 2 raid, agents seized 21 grams of charas (hashish), 13 grams of cocaine, five grams of mephedrone and 22 pills of MDMA (popularly known as ecstasy). Eight of Khan’s fellow high-class revelers were also taken into custody.  

Denied Bail for 27 Days

The nine were locked up in Mumbai, and formally charged the next day with violating several provisions of the Narcotic Drugs & Psychotropic Substances Act. This was despite the fact that no drugs were actually found on Khan. 

The Narcotics Control Bureau (NCB) said they had been eavesdropping on his WhatsApp chats and found evidence that Khan was a “regular user of contraband,” and might even be involved in international drug trafficking. On this basis, he was denied bail.

Khan’s powerhouse dad lined up India’s former Attorney General Mukul Rohatgi for his defense team, but the special anti-drug chamber of the Bombay High Court kept on refusing to grant bail until Oct. 30. Khan and his fellow arrestees each had to put up a bond of 100,000 rupees (approximately $1350) and surrender their passports. 

Khan could face 10 years in prison if convicted. 

And the case has spawned a secondary investigation by Mumbai prosecutors into claims that NCB agents tried to shake down Shah Rukh Khan’s manager Pooja Dadlani for a bribe to release the younger Khan without bringing charges. Dadlani has been summoned to testify in this case but has twice failed to appear. 

Other High-Profile Busts 

This is but one of several cases in the headlines now that are shaking India’s elite. Another concerns the son-in-law of none other than the chief of the NCB, Nawab Malik, who is also a minister in the government of Maharashtra state, the second most populous state in India. The son-in-law, Sameer Khan, was arrested in Jan. in connection with a raid on a private home in an upscale Mumbai suburb that turned up almost 200 kilograms of cured cannabis. 

Sameer Khan wasn’t present at the raided house, but was nonetheless promptly charged with conspiracy to traffic on the basis of his WhatsApp chats. He was finally granted bail of 50,000 rupees on Sept. 27, and faces a maximum term of 20 years if convicted. 

Interestingly, authorities said the 200 kilos were imported into the country. Although India is a major cannabis producer, with a millennia-long tradition of spiritual use of the plant, Canadian hydroponic is said to be all the rage among the country’s fashionable classes, with authorities clocking recent large seizures of the stuff.

And in yet more grist for India’s yellow-press mill, actor Armaan Kohli, the son of legendary Bollywood producer Rajkumar Kohli, was arrested by NCB agents in August for possession of 1.2 grams of cocaine. He is being denied bail by a Mumbai court while the NCB investigates trafficking charges against him — again on the basis of his WhatsApp chats.

Privacy and Civil Rights Concerns 

Although these cases have won attention because they have ensnared scions of India’s elite, they raise issues that are of concern to the common people in a country where political space has been closing under seven years of right-wing rule.  

It has been speculated that Aryan Khan was targeted because he belongs to a prominent Muslim family that has failed to line up with the Hindu-fundamentalist government of Prime Minister Narendra Modi. Bollywood has been much criticized by the “Hindutva” right for supposedly eroding traditional values in much the same terms that Christian fundamentalists lambast Hollywood in the United States. 

Aryan Khan’s case has also brought public attention to how a citizen may remain locked up for a significant period without any conviction — even one from a wealthy family that can afford to put up bail. A full 70% of those behind bars in India are in pre-trial detention. At the end of 2019, more than a lakh (100,000) had been in prison awaiting trial for more than a year, The Hindu newspaper reported last year.

And then there’s the question of police surveillance in the digital age, in which every communication leaves an indelible record. A pair of Indian legal scholars, in a commentary on the Aryan Khan affair for Jurist website, write: “The case is also a fitting example of how easily a privacy infringement can be committed by authorities under the garb of national security by looking into our private chats on forums like WhatsApp… One can only hope that the Aryan Khan saga would bring much more to the fore than just another episode of Bollywood gossip.”

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Henna, Herb & Healing with Natasha Singh

Natasha Singh is no stranger to trauma. The henna artist and cannabis advocate, who has been rising to fame on Instagram with her incredibly ornate designs and vulnerable confessions in her captions, has witnessed a darkness that she cannot seem to shake.

“Life has led me to be the first responder to complete strangers and family members attempting or succeeding in taking their life,” Singh says. “As a result, I have suffered from anxiety and PTSD. I decided to start using cannabis and to this day, it’s the only thing that works for me and my body.”

Singh’s story is unfortunately not unique; but many people are now finding relief from a myriad of mental health conditions through the use of cannabis. What is remarkable about Singh are her efforts to not only remove mental health stigmas but also to break down cultural stigmas regarding the use of medical marijuana. Singh is from Fiji and of Indian descent, and says she has become one of the first cannabis advocates within her community.

The Los Angeles-born mother of an 18-month-old daughter recently went public with her medical cannabis use in an effort to show that there are patients of all ages, races and cultures benefiting from the plant. However, if you would have asked Singh if she thought she would be an acclaimed henna artist and cannabis activist someday, she more than likely would have laughed.

Natasha Singh says she took years to go public about her cannabis use because of conservative attitudes in the Indian American community.

In 2009, Singh tried cannabis recreationally for the first time. She immediately noticed it had a profound effect on her creative side. Simple doodles on notebook pages soon turned into elaborate drawings on her friends’ hands and feet.

“Before I started smoking, I wasn’t an artist — I never even drew,” says Singh. “In fact, I remember skipping art class in high school.”

Soon, Singh had quit her job in banking and enrolled in cosmetology school. Her talent for intricate and ornate henna tattoos (as well as lash extensions and traditional make-up) developed quickly. However, in 2010, Singh began to develop symptoms of PTSD after bearing witness to several suicides.

“While in cosmetology school, my life experiences caused my anxiety and PTSD to manifest severely, so I decided to visit a psychiatrist,” Singh says. “As a result, I was prescribed several medications to help combat these issues. After just two office visits, I knew prescription drugs were not for me; they actually worsened my condition.”

Despite the fact that Singh began consuming marijuana in 2012, it wasn’t until recently that she decided to go public with her use. She credits her hesitation to the conservative nature of Indian culture, but says that her move has since inspired others in the Indian community to learn more about the potential benefits of cannabis.

“[In late 2017,] I openly shared my cannabis experience and how I finally was brave enough to share my usage of this miracle plant with my Indian parents,” she says. “There’s a lot of stigma created around cannabis within the Indian community. Cannabis is labeled as a ‘hard drug,’ and I’m working hard every day to combat this false information.”

Today, Singh runs a henna and lash business called My Shanti Bar, which has locations in both Los Angeles and Seattle. She says she designed the bars to offer a relaxing environment with individualized beauty services available, with the goal of leaving clients refreshed and feeling their best.

“The ability to be a woman and an entrepreneur, and make other women feel amazing every day, all day long, is truly a gift that I do not take for granted,” Singh says. “I feel like cannabis not only saved my life, but in a way built it. I don’t claim to be a cannabis expert — experience is all I have to share — but I am so enlightened and encouraged that it’s gotten me this far, and if I’m able to help even one person by telling my story, I’ve done my job. Advocacy was a pure fluke, and is just my life.”

Originally published in the print edition of Cannabis Now. LEARN MORE

TELL US, do you use cannabis to treat PTSD?

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Ancient Cannabis in India? Featuring Bhang!

When it comes to using cannabis, India has been ahead of the curb for thousands of years, literally. Bhang has been enjoyed since ancient times. This is understandable considering it’s made with the female cannabis plant. Not only is it delicious, but it also gets you baked! For those of you who are missing out, […]

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Travel Vicariously With These International Cannabis Features

Take a journey around the world without leaving your chair with our round-up of international cannabis stories, from sampling Moroccan hash in the Rif mountains with Ed Rosenthal to traveling through India with Swami and Nikki.

READ: Dutch Passion Spreads the Seeds

Legendary seed company Dutch Passion is moving towards creating an international cannabis product line.

A Journey to the Heart of Moroccan Hash

READ: A Journey to the Heart of Moroccan Hash

The homeland of hash production lies deep in the Rif Mountains.

READ: Fragrant Possibilities: Craft Cannabis in Canada’s Legal Market

Canada may be the first G-7 nation to fully legalize adult-use cannabis, but the country has deep roots when it comes to cultivating. At the dawn of a new era for legalized, corporate weed in Canada, one craft grower aims to bring the beauty of the bud back to the foreground.

Swami and Nikki Cannabis Now Magazine

READ: Surviving India Without Ganja

Longtime Emerald Triangle cultivators Nikki Lastreto and Swami Chaitanya try traveling sans cannabis.

International cannabis Sweet Seeds Spain Cannabis Seed Company Cannabis Now

READ: The Rock ‘n’ Roll Seed Scientists of Spain

Sweet Seeds, one of the biggest and most popular seed banks in Spain, has grown from a few friends smoking weed and swapping seeds to a major player in Europe’s rapidly developing seed market.

READ: Japan Among the Worst Places to Have Weed

The penalties for growing cannabis in Japan could be up to seven years in prison.

International cannabis

READ: Coral Reefer’s Guide to Cannabis Down Under

Cannabis-loving adventurers need to put Australia on their map now that the country’s pot policy is catching up to the early medical cannabis system in the U.S.

READ: Cannabis in Africa: Will 2020 Be the Breakthrough Year?

People have been growing cannabis in Africa for centuries, and now legal cannabis production has taken hold in some countries on the continent — with several more anticipating an embrace of the new industry on the horizon.

TELL US, what’s your dream destination?

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The World Sees The Rise Of A Different Kind Of Opioid Crisis

KAPURTHALA,
India (AP) — Reports rolled in with escalating urgency — pills seized
by the truckload, pills swallowed by schoolchildren, pills in the
pockets of dead terrorists.

These pills, the world has been told, are safer than the OxyContins, the Vicodins, the fentanyls that have wreaked so much devastation. But now they are the root of what the United Nations named “the other opioid crisis” — an epidemic featured in fewer headlines than the American one, as it rages through the planet’s most vulnerable countries.

Mass abuse of the opioid tramadol
spans continents, from India to Africa to the Middle East, creating
international havoc some experts blame on a loophole in narcotics
regulation and a miscalculation of the drug’s danger. The man-made
opioid was touted as a way to relieve pain with little risk of abuse.
Unlike other opioids, tramadol flowed freely around the world,
unburdened by international controls that track most dangerous drugs.

But abuse is now so rampant that some countries are asking international authorities to intervene.

Grunenthal,
the German company that originally made the drug, is campaigning for
the status quo, arguing that it’s largely illicit counterfeit pills
causing problems. International regulations make narcotics difficult to
get in countries with disorganized health systems, the company says, and
adding tramadol to the list would deprive suffering patients access to
any opioid at all.

“This is a huge public health dilemma,” said
Dr. Gilles Forte, the secretary of the World Health Organization’s
committee that recommends how drugs should be regulated. Tramadol is
available in war zones and impoverished nations because it is
unregulated. But it is widely abused for the same exact reason. “It’s a
really very complicated balance to strike.”

Tramadol has not been as deadly as other opioids, and the crisis isn’t killing with the ferocity of America’s struggle with the drugs. Still, individual governments from the U.S. to Egypt to Ukraine have realized the drug’s dangers are greater than was believed and have worked to rein in the tramadol trade. The north Indian state of Punjab, the center of India’s opioid epidemic, was the latest to crack down. The pills were everywhere, as legitimate medication sold in pharmacies, but also illicit counterfeits hawked by street vendors.

This
year, authorities seized hundreds of thousands of tablets, banned most
pharmacy sales and shut down pill factories, pushing the price from 35
cents for a 10-pack to $14. The government opened a network of treatment
centers, fearing those who had become opioid addicted would resort to
heroin out of desperation. Hordes of people rushed in, seeking help in
managing excruciating withdrawal.

For some, tramadol had become as essential as food.

“Like
if you don’t eat, you start to feel hungry. Similar is the case with
not taking it,” said auto shop welder Deepak Arora, a gaunt 30-year-old
who took 15 tablets day, so much he had to steal from his family to pay
for pills. “You are like a dead person.”

Jeffery Bawa,
an officer with the United Nations Office on Drugs and Crime, realized
what was happening in 2016, when he traveled to Mali in western Africa,
one of the world’s poorest countries, gripped by civil war and
terrorism. They asked people for their most pressing concerns. Most did
not say hunger or violence. They said tramadol.

One woman said
children stumble down the streets, high on the opioid; parents add it to
tea to dull the ache of hunger. Nigerian officials said at a United
Nations meeting on tramadol trafficking that the number of people there
living with addiction is now far higher than the number with AIDS or
HIV.

Tramadol is so pervasive in Cameroon scientists a few years
ago believed they’d discovered a natural version in tree roots. But it
was not natural at all: Farmers bought pills and fed them to their
cattle to ward off the effects of debilitating heat. Their waste
contaminated the soil, and the chemical seeped into the trees.

Police
began finding pills on terrorists, who traffic it to fund their
networks and take it to bolster their capacity for violence, Bawa said.

Most
of it was coming from India. The country’s sprawling pharmaceutical
industry is fueled by cheap generics. Pill factories produce knock-offs
and ship them in bulk around the world, in doses far exceeding medical
limits.

In 2017, law enforcement reported that $75 million worth
of tramadol from India was confiscated en route to the Islamic State
terror group. Authorities intercepted 600,000 tablets headed for Boko
Haram. Another 3 million were found in a pickup truck in Niger, in boxes
disguised with U.N. logos. The agency warned that tramadol was playing
“a direct role in the destabilization of the region.”

“We cannot let the situation get any further out of control,” that alert read.

Grunenthal
maintains that tramadol has a low risk of abuse; most of the pills
causing trouble are knock-offs, not legitimate pharmaceuticals, and
American surveys have shown lower levels of abuse than other
prescription painkillers. The company submitted a report to the WHO in
2014, saying that the abuse evident in “a limited number of countries,”
should be viewed “in the context of the political and social
instabilities in the region.”

But some wealthy countries worried about increasing abuse also have acted to contain the drug.

The
United Kingdom and United States both regulated it in 2014. Tramadol
was uncontrolled in Denmark until 2017, when journalists asked doctors
to review studies submitted to regulators to support the claim that it
has a low risk for addiction, said Dr. Karsten Juhl Jorgensen, acting
director of the Nordic Cochrane Centre and one of the physicians who
analyzed the materials. They all agreed that the documents did not prove
it’s safer.

“We know that opioids are some of the most addictive
drugs on the face of the planet, so the claim that you’ve developed one
that’s not addictive, that’s an extraordinary claim, and extraordinary
claims require evidence. And it just wasn’t there,” said Jorgensen.
“We’ve all been cheated, and people are angry about that.”

Jorgensen
compares claims that tramadol is low risk to those made by American
companies now facing thousands of lawsuits alleging misleading campaigns
touting the safety of opioids unleashed the U.S. addiction epidemic.

Stefano
Berterame, a chief at the International Narcotics Control Board, said
there is a critical difference: The crisis is not as deadly as the
American one, which began with prescription opioids and transitioned to
heroin and fentanyl. Tramadol does not as routinely cause the
respiratory depression that leads to overdose death.

But it is
mostly afflicting poor nations, where overdose statistics are erratic,
he said, so the true toll of tramadol is unknown.

The
United Nations established the International Narcotics Control Board in
1961 to spare the world the “serious evil” of addiction. It has since
tracked most opioids.

Tramadol’s exemption means authorization
isn’t required as the drug moves across borders. Its easy availability
also leads to confusion about what tramadol even is, experts say. In
many countries, it is thought to be a mood enhancer or treatment for
depression and post-traumatic stress. Some take it to improve sexual
stamina or endure grueling labor.

Grunenthal synthesized tramadol
in the 1960s, as the company was embroiled in scandal over its marketing
of the sedative thalidomide, which caused extreme birth defects in
thousands of babies whose mothers took it. Tramadol was initially
believed to have a low risk of abuse because initial trials studied
injected tramadol, the most potent route for most opioids. But
researchers later found that tramadol releases a far more powerful dose
taken orally because of how it is metabolized by the liver.

Tramadol’s
worldwide market quickly expanded in the 1990s. In 2000, the WHO, which
assesses medications and recommends scheduling, noted reports of
dependence. A committee has reviewed the drug numerous times since,
recommended it remain under surveillance but declined to add
international regulation.

There is no alternative to tramadol,
said Forte, the committee’s secretary. It is the only opioid available
in some of the world’s most desperate places; relief organizations rely
on it in war zones and natural disasters. It is used extensively not
because it is a particularly good medication, he said. The most
effective opioid is morphine, but morphine is strictly controlled and
countries in crisis fear abuse. Tramadol became the default precisely
because it’s uncontrolled.

The WHO is analyzing whether any other
drug could take its place but have so far found none. Meanwhile, Forte
said, the agency is working with battered nations to ferret out
counterfeits.

Legitimate tramadol remains a lucrative business:
market research estimates the global market amounts to around $1.4
billion, according to Grunenthal. The medication long ago lost its
patent protection. It is now manufactured by many companies and sold
under some 500 brand names. Grunenthal markets it as Tramal as well as
Zaldiar, tramadol combined with paracetamol. In 2018, those products
brought in 174 million euros ($191 million), according to the company’s
annual report.

“Our purpose at Grunenthal is to develop and
deliver medicines and solutions which address the unmet needs of
patients with the goal of improving their quality of life,” the company
wrote in a statement that said it acknowledges opioids pose a risk of
abuse and addiction. “”We do so with the highest ethical standards.”

Grunenthal
also sells other opioids and is expanding around the world. The
Associated Press this year revealed executives were swept up in an
Italian corruption case alleging they illegally paid a doctor to promote
the use of opioids.

The company has campaigned to keep tramadol
unregulated. It funded surveys that found regulation would impede pain
treatment and paid consultants to travel to the WHO to make their case
that it’s safer that other opioids.

Spokesman Stepan Kracala said
regulation would not necessarily curtail illicit trade and could
backfire: Some desperate pain patients turn to the black market if no
legal options exist. Egypt’s long struggle with tramadol abuse is an
example, he said. The country enacted strict regulation in 2012 and a
later survey found some suffering from cancer using counterfeit tramadol
for relief.

Kracala also pointed to regulatory decisions as proof
of tramadol’s comparable safety: The U.S. in 2014 added tramadol to its
list of controlled substances but included it in a lesser category than
opioids like oxycodone or morphine, signaling it is less risky.

There are growing calls to change that.

The
Mayo Clinic hospital in Minnesota worked to reduce opioids prescribed
post-surgery as the American epidemic escalated, said surgeon Cornelius
Thiels. Doctors there started shifting patients to tramadol because it
was billed as safer. But Thiels and his colleagues analyzed prescription
data and were surprised to find patients prescribed tramadol were just
as likely to move on to long-term use.

They published their
findings this year to alert authorities, he said: “There is no safe
opioid. Tramadol is not a safe alternative. It’s a mistake that we
didn’t figure it out sooner. It’s unfortunate that it took us this long.
There’s a lot more that we need to learn about it, but I think we know
enough that we also can’t wait around to act on this.”

Indian
regulators knew the massive quantities manufactured in the country were
spilling over domestically and countless Indians were addicted. But
S.K. Jha, responsible for the northern region of India’s Narcotics
Control Bureau, said he was shocked to learn in 2018 that tramadol from
India was ravaging African nations. They realized then they needed to
act, he said.

India regulated tramadol in April 2018. Regulators
say exports overseas and abuse at home came down. But they acknowledge
that the vastness of the pharmaceutical industry and the ingenuity of
traffickers makes curtailing abuse and illegal exports all but
impossible. Tramadol is still easy to find.

Jyoti Rani stood on
her front steps and pointed to house after house where she said tramadol
is still sold in her neighborhood of narrow roads and open drains,
where school-aged boys sit hunched over the street in the middle of a
weekday.

Rani’s addiction began with heroin. When her 14-year-old son died, she fell into depression.

“I
wanted to kill myself, but I ended up becoming an addict,” she cried. A
doctor prescribed tramadol to help kick the habit — instead, she formed
a new one. She locked herself in her room, not eating or taking care of
her two children. Rani used tramadol until she ran out of money and
entered treatment. Now her family tells her she’s her old self again.

The
crackdown on tramadol coincided with the opening of dozens of addiction
clinics that administer medicine and counseling to more than 30,000
each day.

“We are trying our level best,” Jha said, “but it’s a challenge for all of us.”

Countries’
efforts to control tramadol on their own often fail, particularly in
places where addiction has taken hold, according to the Center for
Strategic and International Studies.

India has twice the global
average of illicit opiate consumption. Researchers estimate 4 million
Indians use heroin or other opioids, and a quarter of them live in the
Punjab, India’s agricultural heartland bordering Pakistan, where some of
the most vulnerable are driven to drugs out of desperation.

Amandeep
Kaur was pregnant when her husband died of a heart attack. She turned
to the sex trade to make ends meet. She wanted not to feel, and a fellow
sex worker suggested tramadol. She had no idea she’d get addicted, but
eventually needed three pills to get through the day.

“If I didn’t have it I felt lifeless, my body ached as if I was going to die,” she said, and joined the line stretching from the addiction clinic’s doors.


By Emily Schmall and Claire Galofaro. Associated Press journalist Rishi Lekhi contributed to this report. This story was produced with support from the Pulitzer Center on Crisis Reporting.

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India Bans All E-Cigarettes Following Vape-Related Deaths in USA

India has banned the sale of all e-cigarettes in the country in response to the string of vaping-related deaths in the United States, according to a report from CNN.

“Unfortunately, e-cigarettes got promoted initially as a way in which people can get out of the habit of smoking cigarettes. It was to be a weaning process from using cigarettes,” said India’s Finance Minister Nirmala Sitharaman.

“The Cabinet rightly thought it is time and we immediately took a decision so that the health of our citizens, of our young, is not thrown to a risk,” she added.

US Lung Illnesses Prompt Action

Sitharaman said that the rash of lung illnesses that have been linked to vaping in the U.S. and domestic concerns about e-cigarettes led the Cabinet to act. She added that the government will soon issue an emergency ordinance banning all electronic nicotine delivery system (ENDS) devices. The ordinance will then be taken up by the nation’s Parliament during its next session to be enacted into law.

India’s ban on vaping products will prohibit the sale, manufacturing, importing, exporting, distribution, storage, and advertising of e-cigarettes. The ban applies to all ENDS, heat-not-burn, and e-hookah devices, according to a press release.

“These novel products come with attractive appearances and multiple flavors and their use has increased exponentially and has acquired epidemic proportions in developed countries, especially among youth and children,” the government said in the release.

Violations of Ban Carry Stiff Penalties

First-time violators of the ban on e-cigarettes in India could face up to a year in prison, a fine of 100,000 rupees (about $1,400), or both. Further violations of the ordinance could be subject to penalties of up to five years in prison and a 500,000 ($7,000) fine. Storing e-cigarette devices would subject offenders to six months in prison and a fine of 50,000 rupees ($700).

Businesses with vaping devices on hand will be required to declare their inventory and turn over all e-cigarettes and cartridges to their local police station.

US Also Taking Action on Vaping

In the United States, last week the Trump administration announced that it would ban the sale of flavored nicotine vape products. The Centers for Disease Control and Prevention reported late last week that there have been 380 confirmed and probable cases in 36 states of lung illnesses experienced by people who vape.

The previous week the agency had announced that more than 450 cases of pulmonary disease could be associated with vaping, but that number also included reports of possible cases. Symptoms of the mysterious illness include severe shortness of breath, vomiting, fever, and fatigue. Other symptoms include coughing, chest pain, diarrhea, and signs of infection, such as fever, without a known cause.

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