OPIOID SUBSTITUTION THERAPY

WHAT IS OST? Harm Reduction has multiple tiers of service delivery Along with NSEP, Opioid Substitution Therapy (OST) is a well accepted strategy for HIV prevention, and forms the second tier of harm reduction OST is substitution of the drug user’s primary drug of use with a medically safer drug OST is substitution of primary route of use (injecting) with non-injecting route (Oral/ Sublingual)

PHILOSOPHY OF OST

INJECTING Vs OST High chances of HIV & other BBV Not prescribed medically Severe withdrawal symptoms High chances of overdose Craving

WHY OST? IDU’S PERSPECTIVE

CONTD.

CONTD. Decreased violence Decreased demands for money Quality time spent Family Increased employment Increased productivity Less thefts/crime Responsible citizen Society

OST UNDER NACP III Is a medical intervention Includes Buprenorphine and Methadone Administers Buprenorphine in sublingual (under the tongue) form and in doses, which are not available in pharmacies Is regulated under the Narcotic Drugs and Psychotropic Substances (NDPS) Act, it can be dispensed only in approved centres

CRITERIA FOR OST Inclusion Criteria Exclusion Criteria Diagnosed case of opiod dependence with injecting drug > 18 years of age Attempted detoxification before Willing to provide informed consent Exclusion Criteria Severe medical illness Established history of severe side effects to buprenorphine Unable/incapable to provide informed consent Concomitant use of other drug

THE PROCESS… Steps in administration: Induction after history taking and physical examination by a doctor Administration of medicines by nurse Daily attendance at clinic for receiving medicine (Daily Observed Treatment - DOT) Regular follow-up by doctor and nurse Regular psychosocial therapy with counsellor

OST ALSO REQUIRES… Psychosocial intervention: Information about treatment including dosage, duration, relapse, etc. Referrals to ICTC, TB, ART, etc. Motivational support Counselling for employment, harm reduction, etc. Family Support: Enhances retention of IDU to treatment & improves their chances of staying away from drugs

TERMINATION OF TREATMENT Treatment continues till the client: is stabilised psychologically & socially stops injecting (drugs) starts working and being productive Duration of treatment usually 9 to 12 months; some may require longer time to stabilise

OST ALONE IS NOT ENOUGH… OST is a facility based programme and should be provided in addition to: NSEP BCC General health care Linkages/referrals ART DOTS ICTC, etc.

MYTHS ABOUT SUBSTITUTION TREATMENT

MYTH #1: PATIENTS ARE STILL ADDICTED FACT: Addiction is pathologic use of a substance and may or may not include physical dependence Physical dependence on a medication for treatment of a medical problem does not mean the person is engaging in pathologic use and other behaviours

MYTH #2: BUPRENORPHINE IS SIMPLY A SUBSTITUTE FOR ILLEGAL DRUGS FACT: Buprenorphine is a replacement medication; it is not simply a substitute Buprenorphine is a legally prescribed medication, not illegally obtained Buprenorphine is a medication taken sublingually, a very safe route of administration Buprenorphine allows the person to function normally

MYTH #3: PROVIDING MEDICATION ALONE IS SUFFICIENT FOR OPIOID ADDICTION FACT: Buprenorphine is an important treatment option. However, the complete treatment package must include other elements, as well Combining pharmaco-therapy with counselling and other ancillary services increases the likelihood of success

CONCLUSION OST: Is cost effective Is simple Has minimal side effects Has minimal chances of overdose Requires family support and acceptance Does not require extensive clinical set up Acts best if provided supplementary to other services