Download Module 3 Session 6

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.
Family
Decreased
violence
Decreased
demands for
money
Quality time spent
Society
Increased
employment
Increased
productivity
Less thefts/crime
Responsible citizen
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
• Diagnosed case of opiod
dependence with injecting
drug
• > 18 years of age
Exclusion Criteria
• Severe medical illness
• Established history of severe
side effects to buprenorphine
• Attempted detoxification
• Unable/incapable to provide
informed consent
• Willing to provide informed
• Concomitant use of other drug
before
consent
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