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Bringing Opioid Substitution Treatment to scale Dr. M. Suresh Kumar. Inter-country Consultation on Preventing HIV among IDUs Scaling Up: From Evidence to Action April 10 2007 Kolkata India. Outreach: Community outreach to reach out to hidden populations; peer education and support

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bringing opioid substitution treatment to scale dr m suresh kumar

Bringing Opioid Substitution Treatment to scaleDr. M. Suresh Kumar

Inter-country Consultation on Preventing HIV among IDUs

Scaling Up: From Evidence to Action

April 10 2007

Kolkata India

essential harm reduction package
Outreach: Community outreach to reach out to hidden populations; peer education and support

Preventive focus: IEC materials, legal access to sterile needles and syringes (NSP), condoms

Clinical focus: Opioid substitution treatment, STI care

Essential Harm Reduction Package
need for effective opioid substitution treatment
Opioid dependence a chronic, relapsing condition

Opioid substitution treatment (most evidence is for methadone) an effective individual and public health tool

Need for effective opioid substitution treatment
un endorsement for substitution treatment
WHO/UNODC/UNAIDS position paper: Substitution maintenance therapy in the management of opioid dependence and HIV/AIDS prevention, 2004

WHO: Methadone and buprenorphine added to Essential Drugs List, 2005

UNAIDS policy on preventing HIV/AIDS among IDU, June 2005

UN endorsement for Substitution treatment
substitution treatment in the world
No of countries reporting injecting drug use 130

No of countries reporting HIV among IDUs 78

No of countries offering substitution treatment 58

No of countries with methadone maintenance 48

No of countries offering buprenorphine33

Substitution treatment in the world

Source: IHRA

injection related risk reduction at follow up opioid substitution chennai india
Injection related risk reduction at follow-up -Opioid substitution, Chennai India

Kumar et al, 2002

crime and employment at follow up opioid substitution chennai india
Crime and Employment at follow-up -Opioid substitution, Chennai India
  • Reduction in number of IDUs in lock-ups
  • Reduction in number of IDUs in jail
  • Increase in employment

Kumar et al, 2002

safe neighborhood opioid substitution chennai india
“ I have been living in this area for the past twenty five years.. You know, we had a bad reputation.. all because of the drug addicts.. They used to snatch chains.. Women cant walk in the street in the evening.. Thank God.. Things are changing now.. I believe the worst guys are going for treatment.. Can we hope that this will last?”

Community key informant

Safe neighborhoodOpioid substitution, Chennai India

Kumar et al, 2002

current state of substitution in india
Development of substitution protocols /modules

UNODC supported by AusAID

Establishment of substitution treatment in selected centres

UNODC supported by DFID and assisted by AIIMS

DFID PMO Projects (Emmanuel Hospital Association, Project Network)

Governmental support for substitution program

SACS support in West Bengal, Maharastra, Tamilnadu

Current state of Substitution in India
opioid substitution treatment with buprenorphine emmanuel hospital association northeast india
Opioid substitution treatment with buprenorphine – Emmanuel Hospital Association, Northeast India

Emmanuel Hospital Association, Jan 2007

benefits of substitution treatment
Attractive to drug users

Acceptable to drug users, families, communities, religious leaders, militant groups

No diversions reported

Linkages with other services like VCCT

Potential for behaviour change

Emmanuel Hospital Association, 2007

Benefits of substitution treatment
opioid substitution or extended detoxification
Many centres in India have used buprenorphine for shorter periods (1-6 months)

Evidence based action or issue of convenience?

Demonstrating the success through follow-up?

Opioid substitution or extended detoxification?
obstacles for scale up in the region
National legal restriction

Substitution treatment seen as issue of law enforcement rather than public health issue

Regulatory requirements

Bureaucratic blocks and delays

Obstacles for scale-up in the region
obstacles for scale up in the region1
Medical, political and societal prejudice – ST ‘condones drug use’, drug users undeserving

Lack of priority or concern for target population

Perpetual pilots and single demonstration projects

Costs, training

Obstacles for scale-up in the region
slide17

Buprenorphine or Methadone?

Buprenorphine

Methadone

Frederic Sorge, 2001

future directions
Opioid substitution policy – consideration of methadone

Integration of substitution treatment in the comprehensive treatment program for drug users

Collaboration between Government, teaching institutions and NGOs for the delivery of services

Training of medical doctors in Opioid Substitution Treatment

Large scale programs – cost considerations

Future directions
acknowledgements
International Harm Reduction Association

DFID PMO Projects

SHARAN India

Emmanuel Hospital Association

SAHAI Trust

National Institute of Epidemiology (ICMR), Chennai

Acknowledgements