A Clinical Study of Opioid Substitution Therapy in a Tertiary Care Center of Eastern India

Abstract

Background: Opioid substitution therapy (OST) is an evidence-based intervention for opiate-dependent persons that replaces illicit drug use with medically prescribed, orally administered opiates such as buprenorphine and methadone. OST reduces HIV risk behaviors and harms associated with injecting opioid. Most of the evidence for OST effectiveness has been generated in middle- and high-income countries where programs are mostly located in dedicated health-care settings; evidence regarding the outcomes of OST programs in low-income countries where OST is often provided in grassroots settings such as drop-in centers is limited. Aims and Objectives: To study the sociodemographic variables, HIV ELISA status, HIV risk behavior, comorbid substance use pattern, and required dose of buprenorphine used for treatment of injection drug users (IDUs) attending oral substitution therapy (OST) center at a tertiary health care center. Methodology: A total of IDUs aged 18–60 years who attended the OST center during 1-year period at a government medical college are included in the study. Results: Majority of the IDUs are male with mean age of 32.8 years. The mean dose of buprenorphine used for the substitution was 4.6 mg/day at the start of therapy. Most of the IDUs are of lower educational status and educated up to primary or middle school. 32.50% of the participants who are unemployed are totally dependent on the family. Most common substance abuse among IDU users were tobacco (74.17%), followed by heroine (57.5%). High-risk behavior found among OST clients was unprotected sexual intercourse (19.17%), sharing needle (11.67%), and sexual intercourse with multiple partners (6.67%). HIV ELISA testing showed positive among 2 (1.67%). Conclusion: These findings have relevance to other parts of India and Asia, where injecting drug use is common and is a first step toward filling the gap in knowledge regarding the effectiveness of community-based OST programs delivered in resource-constrained settings.

High risk injection drug use and uptake of HIV prevention and treatment services among people who inject drugs in KwaZulu-Natal, South Africa

“…Participants had a median age of 28.5 years (IQR 26.6-32.3) and were predominantly male (58%), heterosexual (91%), had completed secondary education (87%) and were currently (76%) or recently (92%) homeless as indicated by Table 1. The median reported starting age of injecting drug use was 22 years (IQR [19][20][21][22][23][24][25][26]. The majority of participants did not use other (non-injection) drugs (85%) or alcohol (64%).…”

“…In addition, access to harm reduction services that included access to housing, food, and naloxone nasal spray may improve survival and adherence to medical therapies [12]. Outreach and mobile medical services targeting the homeless and drug using population could assist in introducing this population to medical services; however, evidence-based interventions for low-to-middle income countries (LMIC) are limited [26][27][28].…”

Changing Pattern of Opioid Users Attending an Opioid Agonist Treatment Clinic in North India

“…24 Another study from India also reported a lower dosage of OST similar to the current study. 25 Another observation was a decreasing trend of comorbid substance use disorders like cannabis and alcohol. Could this be alluded to the fact that there is difficulty in procuring these substance (as alcohol is considered a taboo in a conservative Muslim society like Kashmir) or more adolescents experimenting with opioids directly, only future studies could make us wiser?…”

The Therapeutic Potential of Cannabidiol in Revolutionising Opioid Use Disorder Management

“…There are a variety of social, economic, and psychological factors that influence ORT availability and retention rates. Studies have estimated that up to 15% of individuals with OUD are on ORT [ 37 , 43 , 44 ]. Although it is widely used for dependence and addiction, there remains an existing social stigma, preconceived negative views, and a general lack of awareness that ORT is a medically prescribed and evidence-based method to manage OUD [ 37 , 40 , 44 ].…”

“…There are a variety of social, economic, and psychological factors that influence ORT availability and retention rates. Studies have estimated that up to 15% of individuals with OUD are on ORT [37,43,44].…”