Help-Seeking Pathways and Determinants of Treatment-Seeking Among Patients with Opioid Dependence: A Comparative Study of Tertiary Care and Outreach Settings in North-western Rajasthan

Background: Opioid dependence syndrome (ODS) presents a severe clinical challenge across North-Western Rajasthan. While raw opium (Amal/Doda Post) and street heroin (Smack) dominate conventional substance use patterns, the unmonitored use of over-the-counter (OTC) traditional formulations containing raw opium—specifically Kamini Vidrawan Ras and Barshasha—has emerged as an iatrogenic route to dependence among patients seeking health or vitality remedies. The aim is to observe the help-seeking pathways, delays in help-seeking and the underlying motivations of ODS patients attending the directly operated psychiatric hospital of the regional tertiary care centre in Bikaner (Sardar patel medical college) and ODS patients attending the rural outreach camp of the District Mental Health Program (DMHP) in Nagaur district. Material and Methods: A cross sectional comparative study design was followed in the study with 250 Male patients of Nagaur district with ODS (ICD-10) were selected. The participants were split randomly into 2 groups of equal size of Bikaner Tertiary Care OPD (n=125) and DMHP Nagaur Outreach Camps (n=125). Structured questionnaires were used to document socio-demographic, clinical, pathway nodes and care motivators. Results: Only 38.0% (n = 95) consulted a mental health professional as their initial contact. Unintentional dependence stemming from OTC AYUSH remedies (Kamini Ras / Barshasha) accounted for 24.0% (n = 60) of primary ODS cases, being significantly higher among rural DMHP outreach attendees (30.4%) compared to tertiary OPD attendees (17.6%, p < 0.001). Patients traveling to Bikaner reported escalating financial expenditure (41.6%) and marital discord (38.4%) as primary treatment drivers, whereas DMHP camp attendees cited physical ill-health (46.4%) and local camp proximity (33.6%). The mean treatment delay from dependence onset was 33.5 ± 17.1 months, being significantly prolonged in the DMHP outreach group (38.6±18.5months). Conclusion: Patients with ODS in Nagaur experience substantial delays before reaching formal psychiatric care, frequently traversing multiple general medical, pharmacy, and traditional health nodes. Over-the-counter AYUSH preparations constitute a notable iatrogenic factor. Outreach camps in rural areas effectively bridge geographical and economic barriers for rural agrarian populations.

Keywords: Opioid Dependence Syndrome (ODS), Help Seeking Pathway, Kamini and Barshasha.