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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 users 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

WHY OST? IDUS PERSPECTIVE

CONTD.

CONTD. OST UNDER NACP IIIIs a medical interventionIncludes Buprenorphine and MethadoneAdministers Buprenorphine in sublingual (under the tongue) form and in doses, which are not available in pharmaciesIs regulated under the Narcotic Drugs and Psychotropic Substances (NDPS) Act, it can be dispensed only in approved centres CRITERIA FOR OSTInclusion 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 PROCESSSteps in administration:Induction after history taking and physical examination by a doctorAdministration of medicines by nurseDaily attendance at clinic for receiving medicine (Daily Observed Treatment - DOT)Regular follow-up by doctor and nurse Regular psychosocial therapy with counsellorOST ALSO REQUIRESPsychosocial intervention:Information about treatment including dosage, duration, relapse, etc.Referrals to ICTC, TB, ART, etc.Motivational supportCounselling for employment, harm reduction, etc.

Family Support: Enhances retention of IDU to treatment & improves their chances of staying away from drugsTERMINATION OF TREATMENTTreatment continues till the client:is stabilised psychologically & sociallystops injecting (drugs)starts working and being productive

Duration of treatmentusually 9 to 12 months; some may require longer time to stabiliseOST ALONE IS NOT ENOUGHOST is a facility based programme and should be provided in addition to:NSEPBCCGeneral health careLinkages/referralsARTDOTSICTC, etc.

MYTHS ABOUT SUBSTITUTION TREATMENTMYTH #1: PATIENTS ARE STILL ADDICTEDFACT: 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 behavioursMYTH #2: BUPRENORPHINE IS SIMPLY A SUBSTITUTE FOR ILLEGAL DRUGSFACT: Buprenorphine is a replacement medication; it is not simply a substitute

Buprenorphine is a legally prescribed medication, not illegally obtainedBuprenorphine is a medication taken sublingually, a very safe route of administrationBuprenorphine allows the person to function normallyMYTH #3: PROVIDING MEDICATION ALONE IS SUFFICIENT FOR OPIOID ADDICTIONFACT: 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 CONCLUSIONOST:

Is cost effectiveIs simpleHas minimal side effectsHas minimal chances of overdoseRequires family support and acceptanceDoes not require extensive clinical set upActs best if provided supplementary to other services