Transcript Day 5 Session 1 OST june 13

Opioid Substitution Therapy
(OST)
1
Hierarchy of Harm Reduction
Never start using drugs
Even if using drugs, don’t inject
If injecting,
get assistance
stop
injecting
drugs
If injecting,
assistancetoto
stop
injecting
drugs
If not able to stop injecting, don’t share
If not able to stop sharing, ensure clean equipment before
every use
2
Contd…
Hierarchy of Harm Reduction
If injecting, get
assistance to
stop injecting
drugs
3
Those who are
motivated & want to
stop drugs altogether
Detoxification /
Rehabilitation
Those who are
motivated but are not
able/willing to stop
drugs altogether
Opioid
Substitution
Therapy
What is OST ?
Defined as:
Administration of daily dosage of opioid
medicines with long-lasting effects to
patients with opioid dependence under
medical supervision (prescribed)
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Philosophy of OST
An illicit,
medically unsafe,
short-acting,
more addictive,
opioid, taken by
injecting route…
5
is substituted with…
… legal, safer,
long-acting agonist
medication of
known purity and
potency along with
psychosocial
rehabilitation
OST Under NACP III
 Is a medical intervention
 Includes following medicines:
 Buprenorphine (available in India)
 Methadone (soon to be available in India)
 Administration of buprenorphine sublingually
(under the tongue); doses used in OST are
not available in pharmacies
 Regulated under the Narcotics Drugs and
Psychotropic Substances (NDPS) Act, can be
dispensed only in approved centres
 OST is not currently available in all the TI
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NGOs
Benefits of OST
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Injecting vs. OST
High
chances of
HIV & other
BBV
Not prescribed
medically
Severe
withdrawal
symptoms
High chances of
overdose
Craving
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contd…
Why OST?
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●
Life of an IDU is
chaotic
●
Life revolves around
drugs – procuring,
using & recovering
from its effects
●
Hence, not able to
focus on other
activities,
responsibilities
●
Involved in illegal
activities to procure
drugs
Contd…
Why OST?
10
Contd…
Why OST?
 OST medicines have long period of action
 Help in breaking the chain of opioid use
(shown in earlier slide)
 Dose is adjusted  no cravings or
withdrawals
 no high
 Patient able to focus on other areas of life
because of stabilisation
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Contd…
Why OST?
Family
Society
Decreased
violence
Decreased
demand for
money
Quality time spent
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Increased
employment
Increased
productivity
Less thefts/crime
Responsible citizen
Process to Start Client on
OST
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OST: Basic Facts
 OST is given ONLY to those who use opioids and




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are dependent on them
 Those who are not dependent on opioids but
are dependent on other drugs, do not benefit
from OST
Specific inclusion and exclusion criteria for OST
Initiated only by a physician, after examination
Patient has to visit the centre daily for receiving
the dose, in front of the nurse
OST medicine alone does not suffice: additional
psychosocial counselling helps in increasing
retention
Criteria for OST
Inclusion Criteria
Exclusion Criteria
 Diagnosed case of opioid
●
Severe medical illness
 > 18 years of age
●
Established history of
severe side-effects to
buprenorphine
●
Unable/incapable of
providing informed
consent
●
Concomitant use of
other drug(s)
dependence with injecting
drug
 Attempted detoxification
earlier
 Willing to provide informed
consent
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Steps to Initiate OST
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
Detailed history-taking and physical
examination by a doctor

Assess the client to initiate OST

Initiate OST after fulfilling inclusion and
exclusion criteria

Explain concept of OST to client
Contd…
Steps to Initiate OST
 Consent form signed by the client before
starting OST
 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
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Client on 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 IDUs to treatment &
improves their chances of staying away from
drugs
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Termination of Treatment
 Treatment continues till the client
 Is stabilized psychologically & socially
 Stops injecting (drugs)
 Starts working and being productive
 Duration of treatment
 Usually 9 to 12 months; some may require
longer time to stabilize
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OST Alone is not Enough…
 OST is a facility based program and should
be provided in addition to:
 NSEP
 BCC
 General health care
 Linkages/referrals
 ART
 DOTS
 ICTC, etc.
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Myths About
Substitution Treatment
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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
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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
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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
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Role of Project Manager
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Key Areas of Work
 Role of PM in OST-TIs:
 The PM is a key person in the OST team
 Co-ordinating and communicating with all
stakeholders (clients, their families, staff, SACS,
NACO, other service providers, local administration, law
enforcement, media and the general community)
 Maintaining stock registers for buprenorphine
 Supervision of record maintenance
 Procurement & storage of buprenorphine
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Contd…
Key Areas of Work
 Role of PM in TIs which do not have OST:
 Educate staff on the benefits of OST
 Liaise with centres providing OST
 Establish a system of referrals with the OST
centre
 Ensure OST clients in the project area are
followed up
 Ensure drop-out clients are re-initiated to
OST/provided NSEP if the client relapses
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 Advocate for greater acceptance of OST
Conclusion
OST:
 Is cost-effective
 Is simple
 Has minimal side-effects
 Has minimal chances of overdose
 Requires regular follow-up, family support &
acceptance
 Does not require extensive clinical set-up
 Acts best if provided supplementarily with
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other services
THANK YOU!
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