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Introduction I

Accessibility, Pattern of Use and Implications of Restricted Availability of Medicines for Treatment of Substance Abuse in a Tertiary Level Health Care Center in North Eastern India Amit Chakrabarti. Introduction I. Sikkim is a province in North Eastern India

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Introduction I

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  1. Accessibility, Pattern of Use and Implications of Restricted Availability of Medicines for Treatment of Substance Abuse in a Tertiary Level Health Care Center in North Eastern India Amit Chakrabarti

  2. Introduction I • Sikkim is a province in North Eastern India • Substance abuse is more prevalent in North Eastern India • Substance abusers are a significant source of HIV • 8 of the 13 sentinel sites on substance abusers are in North Eastern India Source: www.naco.nic.in

  3. Introduction II • Effective treatment is key to limiting health related consequences • Effective treatment depends on availability of options • Commonest available option is medicines • Medicines can be used for detoxification and maintenance

  4. Objectives • To identify medicines used for detoxification and maintenance • To find out effect of maintenance on retention & relapse • To describe factors determining treatment with medicines, viz., • Availability of medicines • Pricing of medicines • Source of medicines

  5. Study Design • Single hospital based, retrospective, no control group • From April 2001 to September 2003 • Patients for detoxification / maintenance included • Alcohol & injecting opioid (IDU) abuse • Hospital records • SPSS 8.0 used for analysis

  6. Result Summary • Alcohol abuse (26%), injecting opioid abuse (4%)

  7. Lessons I • No effective maintenance therapy • Reluctance of treatment provider • Non-availability: • Oral buprenorphine not used • Methadone not available • Source: • Private pharmacies • No supply through National Mental Health Program (NMHP)

  8. Lessons II • Pricing: • High • Patient reluctance to maintenance • Naltrexone 50 mg, 1 tab – Rs. 40 / $ 1 • Only 2 manufacturers for naltrexone and oral buprenorphine • Treatment not covered by insurance agencies

  9. Implications • Education of treatment providers • Availability of effective maintenance • Availability of newer medicines • Affordability through price control • Supply through NMHP • Encourage to manufacture • Insurance recognition

  10. Research Agenda • Hypotheses: • Reverse Gateway effect • Stopping needle use • Modalities: • Rapid assessment of treatment options • Baseline study on prevalence of abuse • Baseline study on high risk behavior • Pilot study with oral methadone in IDU • Objective: Retention and HIV • Outcome measures: • Retention in program • Reduction in needle use • Seroconversion

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