1. OPIOID SUBSTITUTION THERAPY

2. 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)

3. PHILOSOPHY OF OST

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

5. WHY OST? IDU’S PERSPECTIVE

6. CONTD.

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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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.

14. MYTHS ABOUT SUBSTITUTION TREATMENT

15. 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

16. 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

17. 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

18. 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