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OPIOID SUBSTITUTION THERAPY

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

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OPIOID SUBSTITUTION THERAPY

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  1. OPIOID SUBSTITUTION THERAPY

  2. WHAT IS OST? • Harm Reduction has multiple tiers of service delivery • Along with NSEP, OpioidSubstitution 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

  5. WHY OST? IDU’S PERSPECTIVE

  6. CONTD.

  7. CONTD.

  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 • 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

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