OPIOID
SUBSTITUTION
THERAPY:
POLICY AND
PRACTICE
EXPERIENTIAL
ACCOUNT:
EXPERIENCE AT A
GOVERNMENT
GENERAL HOSPITAL
DR. AMIT ARYA
ASSISTANT PROFESSOR
DEPARTMENT OF PSYCHIATRY
KING GEORGE’S MEDICAL UNIVERSITY
19-04-2015
LUCKNOW
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
OST CENTRE
2.PROBLEMS
3.CHALLENGES
4.ADVANTAGES
AND BENEFITS






5.OTHER ISSUES
6.CONCLUSION


OST centre started in May 2013.
Slot Allocated- 150
Number of clients registered till date-193
Active clients- 80
Regular clients- 72
Clients who did not receive OST even once during
previous month: 89
Number of clients tested HIV+ : 49
Number of clients receiving ART services: 4
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
OST CENTRE
Staff in place
Yes/No
Name of the training
organization
Assistant Nodal Officer/ Backup
Doctor In charge
Yes
NDDTC, AIIMS, New Delhi
Doctor In charge
Yes
NDDTC, AIIMS, New Delhi
Nurse
Yes
NDDTC, AIIMS, New Delhi
5.OTHER ISSUES
Backup Nurse
Yes
NDDTC, AIIMS, New Delhi
6.CONCLUSION
Counselor
Yes
NDDTC, AIIMS, New Delhi
Data Manger
Yes
Training done at RTTC, Lucknow
Staff allotted (as per the
contract)
2.PROBLEMS
3.CHALLENGES
4.ADVANTAGES
AND BENEFITS
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
PROBLEMS ENCOUNTERED
1.INTRODUCTION
INITIAL HICCUPS IN ESTABLISHING OST
2.PROBLEMS

3.CHALLENGES

4.ADVANTAGES
AND BENEFITS

5.OTHER ISSUES
6.CONCLUSION



Delay in MOU between University authorities
and UPSACS
Difficulty in appointment of staff especially
Medical officer
Coordination with the TI Unit, UPSACS
Difficulty faced in transfer of the fund
Delay in release of budget for refurbishment
Delay in refurbishment of the allocated
building by UPRNN.
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
CHALLENGES FACED
1.INTRODUCTION
2.PROBLEMS
CHALLENGES ENCOUNTERED IN DELIVERING OST
SERVICES

3.CHALLENGES
4.ADVANTAGES
AND BENEFITS


Renewal of MOU between University
authorities and UPSACS:
Delay at SACS level
Delay at University level
5.OTHER ISSUES
6.CONCLUSION
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
CHALLENGES FACED
1.INTRODUCTION
2.PROBLEMS
CHALLENGES ENCOUNTERED IN DELIVERING OST
SERVICES

Human Resource Management:
Frequent dropout by the staff
3.CHALLENGES
 Delay in getting new staff member
 Organizing training for untrained new
4.ADVANTAGES
personnel
AND BENEFITS
 No provision of leaves in spite of working in
government setup creates a sense of unrest
5.OTHER ISSUES
among staff
 Dealing with the psychosocial issues of staff in
6.CONCLUSION
itself is a challenge
 Arrangement of backup staff and ancillary
Presented at the national CME
"OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
staff

CHALLENGES FACED
1.INTRODUCTION
2.PROBLEMS
CHALLENGES ENCOUNTERED IN DELIVERING OST
SERVICES

3.CHALLENGES

4.ADVANTAGES
AND BENEFITS

5.OTHER ISSUES

6.CONCLUSION


Difficulties with the NGO TI Unit:
Budget allocation as per lower estimation
leads to poor service delivery
High dropout rate of staff
Lesser number of ORW
Delay in honorarium for PM and PE
No kits for STI at TI
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
CHALLENGES FACED
1.INTRODUCTION
2.PROBLEMS
3.CHALLENGES
4.ADVANTAGES
AND BENEFITS
CHALLENGES ENCOUNTERED IN DELIVERING OST
SERVICES



5.OTHER ISSUES
6.CONCLUSION


Erratic supply of funds:
Irregular release of funds is a major problem
Limited time to utilize the funds, unutilized
funds had to sent back leading to
unaccomplished work
Limited contingency head
Delay in disbursement due to bureaucratic
hassles
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
CHALLENGES FACED
1.INTRODUCTION
2.PROBLEMS
FUND SUPPLY CHAIN
3.CHALLENGES
4.ADVANTAGES
AND BENEFITS
5.OTHER ISSUES
Budget
allocated
and
released by
NACO
Funds
received by
Treasury
Funds
released by
UPSACS
Deposited in
the Joint
account
Withdrawal
requires
signature of
both the
signatories
Unutilized
funds had to
be sent
back
6.CONCLUSION
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
CHALLENGES FACED
1.INTRODUCTION
2.PROBLEMS
CHALLENGES ENCOUNTERED IN DELIVERING OST
SERVICES

3.CHALLENGES

4.ADVANTAGES
AND BENEFITS

5.OTHER ISSUES




6.CONCLUSION
Problems dealing with difficult clients:
They stay in and around campus
Limited family involvement by the clients
Had opened shops around the centre itself
Identified secluded places in the campus for
injecting
Some threatens the OST and hospital staff
Some are expelled due to serious
misconducts, even then they keeps on
coming
Reports of theft and pity crime increases

Presented at the national
on 18th-19th
at AIIMS,
New Delhi
A CME
lot of"OST:
timePolicy
hadand
to Practice"
be given
to dealApril
with2015
such
incidences
ADVANTAGES AND BENEFITS
1.INTRODUCTION
OST ADDED TO THE TEACHING, TRAINING AND
RESEARCH ACTIVITIES
Provide us an opportunity to see severe form
of addiction which we otherwise did not.
 Adds to the teaching of MD students
3.CHALLENGES
 It teaches us to deal with difficult situations in
our clinical field
4.ADVANTAGES
 We learn HR management
AND BENEFITS
 Provides opportunities of learning for students
of various discipline social work, Psychology,
5.OTHER ISSUES
clinical psychology and nursing
 PG thesis entitled “Psychiatric Comorbidity
6.CONCLUSION
among Opioid Dependant Injecting Drug
Users” has been done in the department.
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
 Some other research work are in pipeline.
2.PROBLEMS

OTHER ISSUES
1.INTRODUCTION
2.PROBLEMS
OTHER ISSUES WHICH ARE IMPORTANT

3.CHALLENGES
4.ADVANTAGES
AND BENEFITS
5.OTHER ISSUES
6.CONCLUSION





Change in guidelines and policies leads
to practical difficulties:
Field visit by a nurse is not practically possible
Counselor will not be paid for field visit
Lesser increment in the salary of nurse
Backup nurse is not paid for working days
Increase in registration fee under CPMS leads
to difficulties in providing hospital services to
our clients.
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
CONCLUSIONS
1.INTRODUCTION
2.PROBLEMS
3.CHALLENGES
4.ADVANTAGES
AND BENEFITS
5.OTHER ISSUES
6.CONCLUSION
 Running
a OST centre in a GHPU is a
challenging task
 It is teaching and learning asset to the
department
 Issues related to budget and funding
needs to be dealt
 Guidelines and policies should be
implemented effectively
 TI Units and Rehabilitation services
require more emphasis
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
OST CENTRE, DEPARTMENT OF PSYCHIATRY
KGMU, LUCKNOW
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
KGMU, LUCKNOW
THANK YOU
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi