1 / 29

Opioid Substitution Therapy (OST)

Opioid Substitution Therapy (OST). If injecting, assistance to stop injecting drugs. Hierarchy of Harm Reduction. Never start using drugs Even if using drugs, don’t inject If injecting, get assistance to stop injecting drugs If not able to stop injecting, don’t share

joy-short
Download Presentation

Opioid Substitution Therapy (OST)

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. Opioid Substitution Therapy(OST)

  2. If injecting, assistance to stop injecting drugs Hierarchy of Harm Reduction Never start using drugs Even if using drugs, don’t inject If injecting, get assistance to stop injecting drugs If not able to stop injecting, don’t share If not able to stop sharing, ensure clean equipment before every use Contd…

  3. Hierarchy of Harm Reduction Those who are motivated & want to stop drugs altogether Detoxification / Rehabilitation If injecting, get assistance to stop injecting drugs Those who are motivated but are not able/willing to stop drugs altogether Opioid Substitution Therapy

  4. 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)

  5. Philosophy of OST An illicit, medically unsafe, short-acting, more addictive, opioid, taken by injecting route… … legal, safer, long-acting agonist medication of known purity and potency along with psychosocial rehabilitation is substituted with…

  6. 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 NGOs

  7. Benefits of OST

  8. Injecting vs. OST contd…

  9. Why OST? • 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…

  10. Why OST? Contd…

  11. 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 Contd…

  12. Why OST?

  13. Process to Start Client on OST

  14. OST: Basic Facts • OST is given ONLY to those who use opioids and 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

  15. Criteria for OST Exclusion Criteria • Severe medical illness • Established history of severe side-effects to buprenorphine • Unable/incapable of providing informed consent • Concomitant use of other drug(s) Inclusion Criteria • Diagnosed case of opioid dependence with injecting drug • > 18 years of age • Attempted detoxification earlier • Willing to provide informed consent

  16. Steps to Initiate OST • 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…

  17. 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

  18. 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

  19. 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

  20. 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.

  21. Myths About Substitution Treatment

  22. 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

  23. 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

  24. 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

  25. Role of Project Manager

  26. 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 Contd…

  27. 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 • Advocate for greater acceptance of OST

  28. 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 other services

  29. THANK YOU!

More Related