Showing posts with label INJECTING DRUG USER. Show all posts
Showing posts with label INJECTING DRUG USER. Show all posts
June 14, 2019
मैडिकल ड्रग्स दुरपयोग क्या है ?
January 7, 2019
WHAT ARE THE QUALIFICATIONS AND KEY AREAS OF WORK OF A PROGRAMME/PROJECT MANAGER OF OST?
OST=OPIOID SUBSTITUTION THERAPY
PROGRAMME/PROJECT MANAGERThe programme/ project manager plays a pivotal role in the overall running of the programme and center. There shall be at least one project manager in every OST center.
Qualifications -
The project manager should preferably be a graduate.
If he has completed higher secondary education, he should have worked with drug users for at least 5 years.
Roles and responsibilities -
The project manager shall be the key person heading the OST team and will be responsible for coordinating and communicating with all stakeholders i.e., clients, their families, staff, SACS, NACO, other service providers, local administration, law enforcement, media and the general public.
Key areas of work -
- Taking lead in implementing the project activities.
- Preparing an action plan for the project.
- Coordinating different activities of the project.
- Writing/Preparing monthly reports.
- Establishing and documenting referrals linkages with other service centers.
- Observing and supervising all activities of project staff.
- Planning and conducting advocacy activities.
- Coordinating and/or conducting in-house staff training.
- Conducting staff meetings regularly.
- Managing uninterrupted supply of buprenorphine
- Ensuring regular functioning of DIC.
- Tasks or responsibilities assigned by SACS/ NACO from time to time.
September 18, 2018
WHAT IS UNSAFE INJECTING PRACTICES?
IDUs indulge in a number of unsafe injecting practices, making themselves vulnerable to the development of abscesses.
• IDUs inject at places which are not frequented by the general community. These may include railway tracks, abandoned buildings, cremation grounds, by the side of an open drain/sewer. These unhygienic places can pose a definitive risk for infection and abscesses.
• IDUs may lack adequate knowledge on how to inject safely. Also, IDUs do not get enough time to practice safe injection and hence IDUs invariably inject in a hurry. This may be due to withdrawal, fear of police or fear of getting caught in the act of injecting. As a result, they may not clean the site properly before injecting, inject in unsafe veins, spill the drug out of the vein during injecting or may inject in arteries. These improper techniques of injection can result in abscess formation.
• Sharing needles and syringes and using non-sterile injecting paraphernalia can
lead to the formation of abscesses, apart from contracting blood-borne diseases like HIV, hepatitis B, and hepatitis C.
• The IDU may repeatedly use the needles/syringes used by him/her earlier. Reusing the same needle over and over again results in blunting the tip of the needle. The blunting of the tip results in damage to the vein into which it is injected and can lead to the formation of the abscess.
WHAT ARE THE PRESCRIPTION DRUGS?
Prescription drugs: injection of pharmaceutical preparations also poses a risk for the development of abscesses. A street cocktail is usually made using injection buprenorphine or pentazocine (Fortwin) mixed with either a benzodiazepine (e.g. Diazepam), pheniraminemaleate(Avil) or promethazine (Phenergan). Pentazocine is notorious for causing abscess when used through the injection route. It can cause cutaneous changes such as erythema, deep or superficial ulcers at or near the injection sites, pigmented halos around the ulcers, bruising, woody induration, edema of the legs and cellulitis. Patients may also develop fibrous myopathy and
limb contractures upon repeated use of pentazocine injections. Repeated use of these chemicals leads to irritation to the veins. An IDU may use these combinations two to four times a day, which results in irritation to the veins resulting in abscess formation.
Risk factors -
Unsafe Injecting Practices
Prescription drugs
Dextropropoxyphene
Buprenorphine
Brown Sugar
TELL ME ABOUT DEXTROPROPOXYPHENE.
Dextropropoxyphene: is an opioid pain medicine used to relieve mild to moderately severe pain associated with cancer. It may also be used in a combination with other medicines such as paracetamol and ibuprofen for treating pain. This medicine should be used with extreme caution in children and only under the supervision of a healthcare professional.
commonly sold as Spasmoproxyvon, is available as capsules. Often, these capsules are injected by dissolving the contents of the capsule in water, which is then boiled and the mixture is injected. The contents of the capsule do not completely dissolve in water, minute particles are pulled into the syringe and injected, which act as irritants. These irritants induce an inflammatory response and result in an abscess.
Risk factors -
Unsafe Injecting Practices
Prescription drugs
Dextropropoxyphene
Buprenorphine
Brown Sugar
WHAT ARE THE RISK FACTORS WITH THE USE OF BUPRENORPHINE BY IDU.
WHAT ARE THE RISK FACTORS WITH THE USE OF BROWN SUGAR BY IDU?
September 8, 2018
WHAT ARE THE RISK FACTORS FOR ABSCESS DEVELOPMENT AMONG INJECTING DRUG USERS?
Risk Factors
In India, the drugs used by IDUs differ from one region to another. It is observed that in the Northeastern states, IDUs inject heroin (pure form) and at times when heroin is not available, they resort to injecting Dextropropoxyphene capsules.
In other parts of India, brown sugar (an impure form of heroin) mixed with water or a cocktail of various pharmaceutical drugs is injected. This cocktail contains buprenorphine either alone (which is an uncommon practice) or often mixed with benzodiazepines (e.g. Diazepam), pheniramine maleate (Avil) or promethazine (Phenergan). In some other places, pentazocine (Fortwin) alone or in combination with other sedatives/hypnotics is injected. It may be noticed that many of these drugs such as heroin, brown sugar or dextropropoxyphene capsules are not prepared in injectable form.
Injections are prepared in much more sterile conditions as compared to tablets/capsules. At the street level, these drugs are often mixed with adulterants, which can cause further irritation to the skin when injected. The capsules/tablets contain a number of inactive ingredients (such as starch, lactose, magnesium stearate) along with the active chemical, which is required to bind and dissolve the tablet/capsule. These adulterants/inactive ingredients can enter the vein during injecting and can cause abscesses.
ABSCESS ANONG INJECTING DRUG USERS.
Abscess is a localized collection of pus and infected material in a body part. Whenever any germs or other materials enter the body, the body recognizes them as ‘foreign bodies’. As a reaction,the body deploys the white blood cells and other cells in its attempt to get the foreign body out. This results in collection of pus (which is generally made up of dead tissues, germs and white cells) in and around the foreign body, leading to formation of abscesses. Abscesses often take between two and five days to develop but sometimes can develop instantaneously.
The affected part may be hot, red, swollen, tender and fluctuant (indicating pus formation).
Abscesses can occur in any part of the body. However, a majority of the IDUs have abscesses on the skin due to unsafe injecting practices. These are called cutaneous abscesses. This SOP addresses issues and management of cutaneous abscesses. Cutaneous abscesses are usually caused by common skin bacterium (Staphylococcus Aureus).
Abscesses can be of two types:
1. Exploding: where infection breaks out onto the outer skin surface.
2. Impounding: where the pus formation takes place under the skin and infection keeps spreading under the skin, without breaking out onto the skin surface.
Why Abscesses Occur in IDUs? ( IDU- Injecting Drug User )
Abscesses are caused by germs, such as bacteria and foreign substances entering the body through needles piercing the skin and contaminating the injection site. An area of tissue becomes infected and initially looks like a hard boil. If ignored, white blood cells move into the infected area and collect within the damaged tissue and pus forms. If further ignored, the infected area could increase and break/ breach the skin leading to formation of an ulcer. If overlooked, the site could become infested with maggots after which gangrene could set in. This could result in amputation of the limb or infected part. In IDUs, abscesses occur because of a number of factors – from the drugs being injected to the unsafe injecting practices followed by the IDU. Finally, the physical status of the IDU may play a role in the formation of abscesses.
July 4, 2018
WHAT IS OST ?
These include–oral substitution treatment, opioid substitution treatment, oral substitution–buprenorphine, medication-assisted treatment, buprenorphine maintenance treatment, methadone maintenance treatment, etc. All these terminologies describe the same practice.
Under the National AIDS Control Programme, the term ‘Opioid Substitution Therapy’ (OST) is currently in use.
OST is a process in which opioid-dependent injecting drug users are provided with long-acting opioid agonist medications for a long period of time under medical supervision along with psycho-social interventions.
Short term treatment of opioid dependence lasting for a couple of weeks called ‘detoxification’ which involves management of acute withdrawals alone, is associated with very high rates of relapse.
Long term treatment is hence necessary for opioid dependence.
OST is one such long-term treatment option.
The lives of IDUs revolve around illicit opioid use.
Most of their day is spent in procuring the drugs, using them and/or recovering from the effects of the drugs.
As a result, they are not able to concentrate on other aspects of their life, including their work, family and social roles/responsibilities.
They are also forced to indulge in illicit activities to finance their drug use.
OST addresses a number of such issues faced by the
IDU clients:
1. The opioid medicines used for OST relieve drug-related withdrawals and craving and do not lead (when used in appropriate doses) to acute intoxication (which is seen with the use of illicit opioids). Thus, the client is maintained in a state which produces neither intoxication nor withdrawals, nor craving. Due to this, the client does not need to use opioids to produce relief of withdrawals or craving.
2. As compared to the illicit opioids that act quickly and for a short period of time, opioid medicines used for OST act slowly and for a long period of time (for at least 24 hours). As a result, the client does not have to spend time on procuring or using opioids frequently in a given day and can focus on other important activities like occupational and family responsibilities.
3. The illicit opioids used by the clients are taken by routes that are potentially harmful. Many harmful effects faced by IDUs are due to the injecting route of administration. On the other hand, opioid medicines used for OST are administrated orally or sublingually, which is a much safer route. This saves the client from incurring harmful effects of opioid use.
4. As the IDUs procure the opioids mostly through illegal channels, they are often not aware of the purity of the opioid product they inject. This is especially true for heroin and its impure form, smack. The purity of street heroin varies across different time periods as well as across the drug suppliers. This may result in life-threatening overdose situations if the heroin is purer than usual. On the other hand, the potency and purity of opioid medicines used for OST is known; this helps in averting overdose situations.
5. As the street opioid drugs are costly, IDUs often resort to illegal activities to finance their drug use. However, as the opioid medicines used for OST are available in government-supported centers/ hospitals free of cost, the client does not have to resort to illegal means. This helps in reducing legal complications faced by the clients and also reduces instances of petty crimes like thefts, etc. in the society.
6. During the illicit drug use phase, IDUs are often branded as anti-social or criminal by the families and the society.When on OST,such IDUs are seen as sufferers and ‘patients.This renewed status helps the clients to seek help for other problems as well and makes them amenable for other help that can be provided.
6. During the illicit drug use phase, IDUs are often branded as anti-social or criminal by the families and the society.When on OST,such IDUs are seen as sufferers and ‘patients.This renewed status helps the clients to seek help for other problems as well and makes them amenable for other help that can be provided.
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