Giving drug users a path

Sumita Thapar - CNS
Oral substitution therapy (OST) saves lives, improves quality of life, and helps people who use drugs to lead functional lives, advocates say. It is like “insulin for a diabetic,” argues Dr M Suresh Kumar, a psychiatrist from Chennai, India, who has worked on substance use disorder for over 30 years. Beneficiaries of OST agree that it turns drug use into a chronic condition, which can be managed with medical and psychosocial help. “By taking care of withdrawal, it saves them from doing ‘desperate’ things.”

OST involves replacing a short acting opioid such as heroin with a long acting substitute drug – methadone or buprenorphine. Taken orally once a day in a clinical setting, dose and adherence are critical to effectiveness. By taking care of withdrawal it helps users to lead functional lives. Drug users living with are also able to adhere better to long-term treatments for HIV, tuberculosis or hepatitis. It reduces the risk of acquiring new infections by doing away with injecting.

Though OST is offered in South Asian countries (except Sri Lanka), the coverage is low. While pilots have been done in Afghanistan and Pakistan, Bangladesh has just a small intervention restricted to Dhaka. In India, OST is going from pilot to scale, with the next phase of the national programme in 2014 and aiming for a coverage of 40%.

Project ORCHID has done pioneering work on harm reduction and OST in Manipur and Nagaland in North-East India for over 10 years. Lessons from the project are now being used in the national programme.

“Equity in service delivery is a major challenge since beneficiaries must visit the centre every day to receive the dosage,” says Melody Lalmuanpuii, Project ORCHID. “The population is dispersed, there are a large number of users in rural areas, and women drug users are hidden since they are stigmatized more.”

Although buprenorphine costs over 10 times more than methadone, countries such as India use it because it does not carry any risk of overdose. Advocates of OST say beneficiaries can be on OST as long as they need to, and this can vary considerably between users.

Sumita Thapar, Citizen News Service - CNS
November 2013

Note: This article was first published in 11th ICAAP INSIGHT, the official daily conference newspaper of 11th International Congress on AIDS in Asia and the Pacific (11th ICAAP) in Bangkok, Thailand. This newspaper was managed by Inis Communication and CNS.