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Bringing Opioid Substitution Treatment to scale Dr. M. Suresh Kumar

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

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  1. 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

  2. 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

  3. 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

  4. 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

  5. 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

  6. Substitution treatment in the world Source: IHRA, 2006

  7. Injection related risk reduction at follow-up -Opioid substitution, Chennai India Kumar et al, 2002

  8. 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

  9. “ 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

  10. 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

  11. Opioid substitution treatment with buprenorphine – Emmanuel Hospital Association, Northeast India Emmanuel Hospital Association, Jan 2007

  12. 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

  13. Opioid substitution treatment – Project Network

  14. 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?

  15. 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

  16. 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

  17. Buprenorphine or Methadone? Buprenorphine Methadone Frederic Sorge, 2001

  18. 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

  19. International Harm Reduction Association DFID PMO Projects SHARAN India Emmanuel Hospital Association SAHAI Trust National Institute of Epidemiology (ICMR), Chennai Acknowledgements

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