Opioid substitution treatment with sublingual buprenorphine in Manipur and Nagaland in Northeast India: what has been established needs to be continued and expanded

Abstract

Manipur and Nagaland in northeast India report an antenatal HIV prevalence of > 1% and the current HIV prevalence among injecting drug users is 24% and 4.5% respectively. Through support from DFID's Challenge Fund, Emmanuel Hospital Association (EHA) established thirteen drop-incentres across the two states to deliver opioid substitution treatment with sublingual buprenorphine for 1200 injecting drug users. Within a short span of time the treatment has been found to be attractive to the clients and currently 1248 injecting opioid users are receiving opioid substitution treatment. The project is acceptable to the drug users, the families, the communities, religious as well as the militant groups. The treatment centres operate all days of the week, have trained staff members, utilize standardized protocols and ensure a strict supervised delivery system to prevent illicit diversion of buprenorphine. The drug users receiving the substitution treatment are referred to HIV voluntary counselling and testing. As this treatment has the potential to change HIV related risk behaviours, what has been established in the two states needs to be continued and expanded with the support from the Government of India.

Buprenorphine and Buprenorphine/Naloxone Diversion, Misuse, and Illicit Use: An International Review

“…Buprenorphine was approved for the treatment of opioid dependence in India in 1999 [54]. In Malaysia, buprenorphine was first licensed for prescription in 2003, and was not highly regulated.…”

The Long Winding Road of Opioid Substitution Therapy Implementation in South-East Asia: Challenges to Scale Up

“…33 However, in early 2010 the government approved the use of methadone in a pilot study intended to involve six sites in late 2010. By 2012 four methadone dispensing sites were servicing 350 patients (Kumar R. 2013; personal communication).…”

Commentary

“…However, the preliminary evidence suggests that most who discontintue treatment cite physical distance from to the rehabilitation centers to their home. [3] Advent of buprenorphinenaloxone combination and practise of alternate day maintenance have definitely shown improvement in treatment retention. Again, how signifi cant this change is has not been systematically evaluated.…”