1. health and fitness
2. disease
3. aids and hiv

Opioid Substitution Therapy (OST):
Models of programme design and
implementation
Dr. M. Suresh Kumar MD DPM MPH
Consultant Psychiatrist
National CME: “Opioid Substitution Therapy: Policy and Practice”
Organised by NDDTC & AIIMS
New Delhi
Presented at the national CME "OST: Policy and
Practice"
April
18 2015on 18th-19th April 2015 at AIIMS, New Delhi
Outline of presentation
1.
OST in various settings and models of OST
2.
OST as drug treatment vs OST as HIV prevention
3.
Integrated OST services
4.
Key gaps in OST program implementation
5.
Summary
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
1. OST IN VARIOUS SETTINGS AND
MODELS OF OST
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
OST in various settings

OST in specialised exclusive clinics

OST in hospitals

OST in drug dependence treatment clinics

OST in primary care settings

OST in community settings
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

OST in custodial settings
OST in various settings

OST in hospitals



OST in primary care settings



Department of Psychiatry
Department of General Medicine
OST in primary health care settings
OST delivery through Pharmacies
OST in community settings




Government sponsored OST Clinics
NGO run OST Clinics
With Outreach Programs
With Peer Support
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

OST in custodial settings
“Everyone deserves services
no matter what”
Client centeredness
Low threshold services
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Low threshold OST

Disagreement between professional groups and programs on
definition of ‘low threshold’ OST

Abstinence from opioids and other drugs is not the treatment goal

High involvement of GPs and community health providers

Prescription of buprenorphine or slow release morphine

Reduce barriers for admission

Facilitate treatment retention
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Strike et al, Int J Drug Policy 2013; 24(6):e51-6
Facilitators of OST

Government sponsorship

No dispensing fee

Attractive to poor opioid dependent clients

Mobile units
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
MMT in North America
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Methadone: IRAN
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
MMT, Specialized clinic: Iran
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
MMT, General hospital: Iran
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
OST Clinic: Melbourne, Australia
WHO Jakarta
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Pharmacy delivery: Australia
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Community MMT Clinic: China
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
MMT Clinics in China
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
OST in Asia

Methadone scaling up in:


Methadone established in:



China, Malaysia, Indonesia
Hong Kong, Thailand, Myanmar, Vietnam, Cambodia
Nepal, Bangladesh, Afghanistan, Maldives
Buprenorphine substitution in:



India
Malaysia
Detoxification using buprenorphine in Indonesia, Malaysia, India,
China, Myanmar
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Models of delivery in South Asia
Model
Bangladesh
India
Maldives
Nepal
Drug used
Methadone
Buprenorphine
Methadone
Methadone
Beneficiaries
PWID
PWID
People with
Opioid
dependence
PWID
Location
GO run
hospital
NGO run TIs
GO-NGO
Model
Govt
Dept of
Psychiatry,
Medical
College
Urine testing
No
No
Random urine No
screen
Methadone
Rao et al, Bull World Health Organ 2013; 91:150-53
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
OST in Asia
Country
Estimated no. of
PWID
No. of OST sites
in 2008
OST
in prison
Est. no. of PWID
covered by OST in
2008
China
1,800,000–
2,900,000
531
Indonesia
190,460–247,800
35
4
3300
India
106,518–223,121
47
1
4600
Malaysia
170,000–240,000
68
4
22000
Maldives
400–500
1
45
Myanmar
60,000–90,000
7
500
Nepal
28,000
2
192
Thailand
160,528
147
4000-5000
Viet Nam
135,305
6
1484
159,439
Presented Adapted
at the national
"OST: Policy
and Practice"
on 18th-19th
April
2015 Policy
at AIIMS,
New Delhi
from:CME
Chatterjee
& Sharma
/ International
Journal
of Drug
21 (2010)
134–136
OST Scale-up in India (March 2014)
400
350
350
300
250
250
200
175
150
104
100
50
0
147
94
Current Status
Targets
29 32
No of states
with OST
No of Districts
with OST
Services
No of OST
Centres
No of OST
centres with
Govt
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Community based OST Clinic: Chennai
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Community based OST Clinic: Delhi,
India
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Implementation of OST within
prison

OST reduces HIV transmission within prisons

It serves as a conduit to care after release from prison

It reduces the adverse consequences of injection drug
use, including overdose both within prison and after
release
Presented at the national CME "OST: Policy and Springer,
Practice" on2010.
18th-19th
April 2015
at AIIMS,
New Delhi
Addiction,
105,
224–225
MMT in Prison Malaysia
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
OST in prisons: Malaysia
Attitudes of prisoners to MMT



Secondary HIV prevention among prisoners in Malaysia
is crucial to reduce community HIV transmission after
release
Half of the surveyed HIV+ prisoners believed that OST
would be helpful, only a third said they needed it to
prevent relapse after prison release
Those reporting the highest injection risks were more
likely to believe OST would be helpful
Presented at the nationalBachireddy
CME "OST: Policy
and Practice"
on 18th-19th
April 2015 116
at AIIMS,
Delhi
et al, Drug
and Alcohol
Dependence
(2011)New
151–157
2. OST AS DRUG TREATMENT
VS
OST AS HIV PREVENTION
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Opioid Substitution Therapy (OST):
Triple Action
Objective
Target population
Responsible
sectors, agencies
OST as HIV prevention
IDUs
Ministry of Health
Prison authorities
NGOs
OST to improve treatment
adherence to ART and TB
DOTS
HIV + IDUs
IDUs with TB
Ministry of Health
ART Centres
Hospitals
Prisons / custodial settings
NGOs
Private Sector
OST as drug dependence
treatment
Opioid dependent persons
(includes both IDUs and
non-injecting drug users)
Ministry of Health
Public Security
Drug treatment and
rehabilitation centres
Prisons / custodial settings
NGOs
Presented at the national CME "OST: Policy and Practice" on 18th-19th April
2015 at AIIMS, New Delhi
Private sector
COCKRANE REVIEW: MMT



Methadone is an effective maintenance therapy
intervention for the treatment of heroin dependence
It retains patients in treatment and decreases heroin use
better than treatments that do not utilise opioid
replacement therapy
It does not show a statistically significant superior effect
on criminal activity or mortality
Presented at the national CME Mattick
"OST: Policy
Practice" on
18th-19th Syst
April 2015
AIIMS,
et al,andCochrane
Database
Rev. at2009
Jul New
8;(3)Delhi
Impact of MMT Program, China



In 2008 and 2009, respectively, an
estimated 2969 and 3919 new HIV
infections (excluding secondary
transmission) were prevented
Consumption of heroin was
reduced by 17.0 tons - 22.4 tons
$US939 million - US$1.24 billion in
heroin trade were avoided


MMT program is supported
legislatively and financially by the
central government with multisector cooperation
Incorporation of MMT clinics into
existing medical infrastructure,
which has facilitated delivery of
services
Yin et al, International Journal of Epidemiology 2010;39:ii29–ii37
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
MMT Program, China
(128 clinics, 2-year follow-up)
Yin
& Wu,
2008:
Presented at the national CME "OST:
Policy
and
Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Presented at 19th International Conference on Harm Reduction,
11-15 May 2008, Barcelona, Spain
Components of effective methadone
treatment

Flexible but adequate dose of methadone after
stabilisation (usual range 50–150 mg)

Adequate duration of treatment

Goal of maintenance

Rapid and client-centred assessment and induction
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Ward et al, 1999. THE LANCET, Vol 353
Components of effective methadone
treatment



Psychosocial services to deal with social disadvantage
and psychiatric comorbidity
Trained staff with positive attitudes towards MMT and
opioid dependent patients
Affordable - cost of treatment should not exceed ability
to pay
Engagement with clients rather than punishment of
continuing illicit drug use
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

Ward et al, 1999. THE LANCET, Vol 353
Buprenorphine and illicit drug
use
Presented at the national CME "OST:
Practice"Immune
on 18th-19th
April
2015 2011;56:S33–S38
at AIIMS, New Delhi
FiellinPolicy
et al,and
J Acquir
Defic
Syndr
OST in HIV settings:
OST as HIV prevention
Injecting
frequency
OST
↓
Injecting
risks
↓
Sex risks HIV
HIV
infectivity incidence
x
--
↓
Adapted from: Degenhardt et al, Lancet 2010; 376: 285–301
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Evidence for MMT as HIV
prevention
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Metzer et al, J Acquir Immune Defic Syndr. 1993 Sep;6(9):1049-56
Effectiveness of MMT



MMT is associated with a significant decrease in
injecting drug use and sharing of injecting equipment
MMT is associated with a lower incidence of multiple sex
partners or exchanges of sex for drugs or money, but no
change, or only small decreases, in unprotected sex
Studies of seroconversion, suggest actual reductions in
cases of HIV infection
Farrell et al, International Journal of Drug Policy 16S (2005) S67–S75
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Evidence for OST:
Other benefits in HIV integrated care
BHIVES Collaborative findings
•
•
Established in 10 sites as integrated models of HIV primary care and
substance abuse treatment
OST with buprenorphine/naloxone potentially effective in improving
health related QOL for HIV-infected patients with concurrent opioid
dependence
•
Integration of buprenorphine/naloxone into HIV clinics increases
receipt of high-quality HIV care
•
Buprenorphine/naloxone provided in HIV treatment settings also
decreases opioid use
Presented at the national CME "OST: Policy and Practice"
on 18th-19th
2015
at AIIMS,
New Delhi
J Acquir
ImmuneApril
Defic
Syndr
2011;56
Evidence for OST as HIV prevention:
Buprenorphine in reducing HIV related
risk behaviours
Presented at the national CME "OST:
Policy et
andal,
Practice"
onAbuse
18th-19th
April2008;
2015 at35(1):
AIIMS,
New Delhi
Sullivan
J Subst
Treat.
87–92
OST medications: Is there a
choice?
Methadone
Buprenorphine
Most researched and proven
effectiveness as HIV prevention and
dependence treatment
Relatively less researched; evidence for
HIV prevention and dependence
treatment exists
Cheaper; cost effective option
Expensive
Overdose not uncommon
‘Ceiling effect’ – Safety of the drug
Drug interactions with ARVs – need to
adjust doses
No clinically significant drug
interactions with ARVs
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Key findings from WHO
collaborative study on OST and HIV



OST can achieve similar outcomes consistently in a culturally
diverse range of settings in low- and middle-income countries to
those reported widely in high-income countries
It is associated with a substantial reduction in HIV exposure risk
associated with IDU across nearly all the countries
Results support the expansion of opioid substitution treatment
Presented at the national CME "OST: Policy and Lawrinson
Practice" on 18th-19th
AprilAddiction,
2015 at AIIMS,
Delhi
et al, 2008;
103,New
1484–1492
Methadone vs Buprenorphine




Methadone clients have more severe substance abuse and
psychiatric and physical problems compared to buprenorphine
clients
Clients on methadone are more likely to remain in treatment
However, those retained on buprenorphine are more likely to
suppress illicit opiate use and achieve detoxification
Buprenorphine may also recruit more individuals such as those
who do not want methadone to treatment
Presented at the national CME "OST: Policy
andetPractice"
on 18th-19th
at AIIMS, New Delhi
Pinto
al, J Subst
Abuse April
Treat.2015
2010;39(4):340-52.
The SUMMIT Trial
Effectiveness of OST with
methadone or buprenorphine



There is strong evidence that OST with methadone or
buprenorphine suppresses illicit opioid use
Both access to and effectiveness of OST contribute to
sustaining adherence to HAART in HIV-infected IDUs
There is also evidence that OST for HIV-positive IDUs is
associated with improved health outcomes
Farrell et al, International Journal of Drug Policy 16S (2005) S67–S75
Roux
et al,
2008;
Addiction,
103,on1828–1836
Presented at the national
CME
"OST:
Policy
and Practice"
18th-19th April 2015 at AIIMS, New Delhi
Effectiveness of OST with
methadone or buprenorphine




Buprenorphine is an effective medication in the
maintenance treatment of heroin dependence, retaining
people in treatment at any dose above 2 mg
Compared to methadone, buprenorphine retains fewer
people when doses are flexibly delivered and at low
fixed doses.
If high doses are used, buprenorphine
and methadone appear no different in effectiveness
care.
Methadone is superior to buprenorphine in retaining
people in treatment
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Mattick et al, Cochrane Database Syst Rev. 2014 Feb 6;2
3. INTEGRATED OST SERVICES
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Integrated Services

Different models of integration
 Co-located services

Case management

Referral networks
Role of medical providers in screening and
intervention
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi

Integrated Services

Different models of integration
 Clinic site level integration
 Same
physician delivering addiction and
medical services
 Two
physicians working together at the
same clinic
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Integrated Services

Psychosocial services

Mental Health Services

Pregnancy and reproductive health services

Infectious diseases care services – HIV, HCV,
TB
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Integrated Services

Potential benefits of providing integrated
substance use and medical care services

Increase drug treatment capacity

Reduce health and administrative costs

Diminish duplication of services

Improve health and drug treatment outcomes
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
New Initiatives at Integrated
Services



Integrating the Substance use and HIV
services
Buprenorphine HIV Evaluation and Support
Services (BHIVES)
Integration into community and hospital based
clinics
Weiss et al, J Acquir Immune Defic Syndr Volume 56, Supp 1, March 2011
BHIVES Collaborative
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Evidence for OST:
Positive HIV treatment outcomes
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Altice et al, J Acquir Immune Defic Syndr Volume 56, Supp 1, March 2011
BHIVES Collaborative
Reasons for poor adherence to
OST and ART

Perception of adverse effects

Alcohol consumption

Depression
Roux etonal,
2008; Addiction,
1828–1836
Presented at the national CME "OST: Policy and Practice"
18th-19th
April 2015 at103,
AIIMS,
New Delhi
Integration with mental health
services

High prevalence of personality disorders

Depression

Co-morbid substance use disorders

Integrated services
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
OST, Pregnancy and
Neonatal abstinence syndrome



Methadone has been the recommended standard of care for
opioid-dependent pregnant women
Buprenorphine is an alternative to methadone for the treatment
of opioid dependency during pregnancy
The benefits of buprenorphine in reducing the severity of NAS
among neonates with this complication suggest that it should
be considered a first-line treatment option in pregnancy
Presented at the national CME "OST: Policy and Practice"
18th-19th
2015
at AIIMS,
New Delhi
Jones etonal,
N EnglApril
J Med
2010;
363:2320-31
How to improve and ensure effective
linkages?

Co-location of services

Collaboration between various departments

Cross training of health professionals

Treatment literacy for IDUs

Other supportive services
 mental health, psychosocial support, nutrition
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
4. KEY GAPS IN OST PROGRAM IMPLEMENTATION
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
OST adoption




Despite evidence, detoxification is preferred than opioid
substitution therapy by several addiction programs
Leadership qualities critical to OST adoption
Leaders’ training treatment orientation, tenure determine
OST adoption
Leaders less ideologically grounded in abstinence only
approaches
Presented at the national CME "OST:
Policy and
on 18th-19th
AprilRes
20152010,
at AIIMS,
New Delhi
Friedmann
etPractice"
al, J Behav
Heal Serv
37(3):322-37
OST: Key challenges for the
resource poor settings



What is the most effective model for implementing
OST?
How can OST become a fundamental component of
integrated HIV prevention?
How can the quality of the OST programmes be
ensured and evaluated?
Kermode, Crofts, Kumar & Dorabjee, Bull World Health Organ 2011;89:243
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Efficient ways of delivering opioid
substitution medication

Prescription by general practitioners

Community pharmacies

Community based approach to OST

Integration into primary care
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Key obstacles to safe and effective
delivery of opioid substitution medication

Restricted Government funding and support for
OST

Limited patient capacity to pay for OST

Prejudices against OST

A balance between overregulation and laissezfaire provision
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Advocacy in Islamic Republic of Iran
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Islamic Republic of IRAN
This order is to remind judges at all courts of justice and
prosecutors’ offices throughout the country that, since a major
element of criminal action is verifiable malicious intent, the
aforementioned interventions are clearly void of such intent and,
instead, are motivated by the will to protect society from the
spread of deadly contagious diseases, such as AIDS and hepatitis.
Therefore all judicial authorities must consider the lack of
malicious intent in the interventions of the Ministry of Health and
Medical Education as well as those of other centres and
organizations that are active in this field. They must not accuse
service providers of assisting in the criminal abuse of narcotics
and must not impede the implementation of such needed and
beneficial programmes.
Seyed Mahmood Hashemi Sharoudi
ofNew
the Judiciary
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 atHead
AIIMS,
Delhi
24 January 2005
Policy and OST




Policy shifts increase coverage of OST
In Vietnam, Malaysia and China, shift from punitive
law enforcement to evidence based treatment has
increased coverage
Policy shift in Ukraine increased OST coverage
Russia’s stand against OST and closing down
access to information on methadone
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Degenhart et al, Int J Drug Policy 2014; 25(1):53-60
Workforce and Training



Limited training and teaching in addiction
medicine during MBBS
Possibility for one day training course for
prescribing buprenorphine
Training of nurses, pharmacists and other
healthcare workers
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
MMT in China: Barriers and
facilitators
Barriers to MMT for
clients
Requirement for registration in the police department
Perceived societal stigma; Logistic difficulties;
Side effects; Inappropriate perception of methadone;
Fear of being addicted to another drug;
Lack of additional services; Economic burden
Barriers for Service
Providers in MMT
Financial difficulties; Lack of professional training
Difficulties in pursuit of career; Lack of institutional
support
Concern for personal safety; Low income
Large work load; Misunderstanding by society
Factors associated
with successful MMT
MMT clinics affiliated with local CDCs have more clients,
higher retention rates
Longer operating hours
Incentives for compliant clients
Lin et al, J Subst Abuse Treat. 2010; 38(2): 119.
Presented
theInt
national
CME
"OST: 2010;
Policy 21(3):
and Practice"
on 18th-19th April 2015 at AIIMS, New Delhi
Lin etatal,
J Drug
Policy.
173–178
Lin, 2009. Dissertations & Theses, UCLA
Factors that maximise
participation in OST programs
Client related
Ease of access
Extended opening hours at clinics
Sufficiently high doses
Service Providers
related
Non-judgemental clinicians
Professionally & technically competent to deal with
addiction related issues
High staff morale
Access to allied medical, psychological and welfare
services
Support related
Significant peer support
Family support
Support groups
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
OST: Key gaps identified
•
OST is available for a limited number of IDUs at present in
most countries of South Asia
•
Lack of exclusive OST centres for women injecting drug
users
•
•
Effective linkages with other services such as ICTC, ART,
TB DOTS, Drug dependence treatment is a significant
challenge
Pharmacological options for OST need to be expanded
–
Methadone; Buprenorphine; Buprenorphine-Naloxone; Oral morphine
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Evidence for OST as HIV prevention:
Coverage is critical
Country
IDU
prevalence
(%)
OST
availability
HIV
incidence
among
IDUs, 2005
HIV
incidence
among
IDUs, 2006
Russian
Federation
Current IDU
1.78
OST not available
72/million
79/million
Ukraine
Current IDU
1.16 (1.00, 1.31)
OST mostly
unavailable (~1%)
134/million
153/million
USA
Current IDU
0.96 (0.67, 1.34)
OST available
(1998–2004:
15%–25%)
18/million
NA
Canada
Lifetime IDU
1.3 (1.0, 1.7)
OST available
(2003: ~26%)
7.2/million
7.3/million
EU (27 countries)
Current IDU
0.19 (0.16–0.21)
OST available
(2004: ~33%)
6.4/million
5.9/million
Australia
Current IDU
OST available
1.6/million
1.4/million
1.09 (0.65–1.50)
(2006:
~50%) on 18th-19th April 2015 at AIIMS, New Delhi
Presented at the national
CME "OST: Policy
and Practice"
Weissing et al, Am J Public Health 2009; 99:1049–1052.
Why OST is needed for non-injecting
opioid dependent users?
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Strathdee et al, Lancet 2010; 376: 268–84
5. CONCLUSION
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
Conclusion
•
OST is an effective evidence based drug use treatment for injecting
as well as non-injecting opioid dependent individuals
•
OST is evidence based opioid use disorder treatment
•
OST in HIV settings is primarily to prevent HIV and improve ART
adherence; often benefits go beyond HIV related issues
•
Integrated OST services are essential
•
The identified gaps in OST in Asia can be effectively addressed in
future through scaled-up efforts (in community & custodial settings)
and multi-sectoral collaboration
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi