1 / 21

Dr Anil Jhugroo Consultant Psychiatrist Apollo Bramwell Hospital, Mauritius

Role of Naltrexone implants in managing the spread of HIV caused by injecting buprenorphine in Mauritius. Dr Anil Jhugroo Consultant Psychiatrist Apollo Bramwell Hospital, Mauritius. 1.2 million inhabitants Indian/African/Chinese/European/Mixed race Nearly one million Tourists/year

gavril
Download Presentation

Dr Anil Jhugroo Consultant Psychiatrist Apollo Bramwell Hospital, Mauritius

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Role of Naltrexone implants in managing the spread of HIV caused by injecting buprenorphine in Mauritius Dr Anil Jhugroo Consultant Psychiatrist Apollo Bramwell Hospital, Mauritius

  2. 1.2 million inhabitants Indian/African/Chinese/European/Mixed race Nearly one million Tourists/year Textile and Sugar industry Stable democracy

  3. About 2 % of population are believed to be injecting drug users, World Drug report, 2010About 2 % of the 14-49 year-old group is believed to be HIV positive.23 % of prison inmates have tested HIV positive over the last year

  4. OPIATE USE PER CAPITA, 2010

  5. Report of the International Narcotics Control Board for 2009 • “There is evidence of an increase in the smuggling of heroin to the islands of the Indian Ocean, particularly Mauritius. • Opiates from India and Pakistan are smuggled into Mozambique and then South Africa and from South Africa into Europe, as well as into East African countries, notably Mauritius and Seychelles. • Mauritius now has one of the highest levels of opiate abuse in Africa, a spillover effect of the heroin trafficking in that country.”

  6. From heroin to buprenorphine… • Heroin • 80’s & 90’s • purity getting lower (higher purity in the Seychelles) • has lesser desired effect • difficulty with chasing, usually injected. • is expensive • shorter lasting • More difficult to smuggle • Buprenorphine • Drug dealers: easier in importing and concealing; more lucrative. • IVDU: cheaper & lasts longer (cheaper than marijuana) • Last decade, demand and supply in favour of buprenorphine • Currently accounts for about 80% of drug used by IVDU in Mauritius • IVDU buy one eighth of this 8-mg pill at about Rs 300 (7.50 euros)

  7. Buprenorphine seizures: about 80 000 tablets in 2007 and about 40 000 tablets in 2008. Price has fallen from Rs 3,000 (75 euros) a tablet to Rs 1,200 (30 euros) a tablet over past 2 yrs. Changing pattern of drug selling: extensive use of mobile phone; cleaner to handle coming from other countries

  8. POLICE SEIZURES Heroin 2007 5,7 kilos 2008 11,5 kilos 2009 9,5 kilos Buprenorphine 2007 79 617 tablets 2008 38 770 tablets

  9. IVDU & HIV/AIDS • “Mauritius also has a high prevalence of injecting drug use and a concentrated HIV epidemic among these users.” World drug report, 2010 • Number of injecting drug users in Mauritius estimated at between 10,000 and 18,000 people. • “Prevalence of HIV in Mauritius estimated at 1.8% representing approximately 12,000 people” UNAIDS in 2007

  10. Harm reduction programmes • In recent years Mauritius has recognised the seriousness of its injecting drug use problem and injection driven HIV, scaling up harm reduction programmes in the form of • Needle & Syringe exchange programme • First African country • Started Nov 2006 • 46 sites across the island • About 5,400 registered users out of 10,000-18,000 IVDU • Methadone substitution programme • Introduced in 2006 • About 3,000 on treatment • Information campaign • TV and radio • Posters

  11. Between 2007 and 2010, 24 opiate dependent patients travelled to Perth from Mauritius to have the O’Neil double Naltrexone implant Went in batches of 4-6, accompanied by care workers 4 of them later had repeat Naltrexone implants Upon return to Mauritius, reviewed regularly by their care workers for general follow up and to assess their level of opiate abstinence. Random urine drug screening tests were also performed

  12. Percentage of opiate free patients after 1st implant at follow up 6 months 100 % 1 year 83 % 1½ years 46 % 2 years 42 % 2½ years 42 % 3 years 39 % 4 years 38 %

  13. Abstinence over time after first implant

  14. Benefit of 2nd implant • After 1st implant, 42 % remained fully abstinent (10 out of 24) • Four patients had repeat implants • In the period between 6 to 18 months after the 1st implant • Three of them following relapses • One was still abstinent but wanted prophylactic treatment • More wanted to have repeat implant but had visa restrictions • After 2nd implant, • All 4 remained abstinent from opiates to date. • 54 % are currently abstinent (13 out of 24) • Of those 11 patients who are currently in relapse, • 7 are on a methadone programme (29%) • 4 have gone back to injecting heroin or buprenorphine (17%)

  15. After 2nd Naltrexone implant

  16. Among those who relapsed • Reasons for relapses • An identifiable precipitating factor • Relationship difficulties • Work related problems • Reasons for not repeating naltrexone implants • Visa restrictions • as not locally available • Financial reasons • Costs of travel and accomodation abroad • If available locally and at appropriate pricing, • would be considered by all those who have relapsed

  17. To minimise risk of relapses, Need to perform Naltrexone implant operation in Mauritius Less expensive Local support No visa restrictions Infrastructure facility and trained staff available Current discussions with Government officials to set up unit.

More Related