BOOK ON CLINICAL GUIDELINES ON OPIOID SUBSTITUTION THERAPY ( O S T )

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.

A pdf book available to provide all information on OST from

 National AIDS Control Programme (NACO).

BOOK NAME - 

 Opioid Substitution Therapy

 Under National AIDS Control Programme
Clinical Practice Guidelines for Treatment with Buprenorphine

FREE DOWNLOAD LINK

CLINICAL GUIDELINES ON OPIOID SUBSTITUTION THERAPY ( OST )

NACO WEBSITE

ओपियाड सॅब्स्टिट्यूशॅन थैरेपी - OST

ओपियाड सॅब्स्टिट्यूशॅन थैरेपी - OST एक प्रकिया है जिसमे ओपियाड निर्भर इंजैक्शन ड्रग्स यूजर को ज्यादा समय तक प्रभावी ओपियाड एगोनिस्ट दवाई मैडिकल देखरेख मे लंबे समय तक प्रदान की जाती है जिसमे सायको -सोशल हस्तक्षेप भी जुड़ा होता है। ओपियाड सॅब्स्टिट्यूशॅन थैरेपी एक लंबे समय तक चलने वाला इलाज है। इंजैक्शन ड्रग्स यूजर का जीवन अवैध ओपियाड प्रयोग के आस -पास ही घूमता है। उसका पूरा दिन ड्रग्स को प्राप्त करने ,उसे उपयोग करने या उसके प्रभाव से निकलने में ही बीत जाता है। ओपियाड प्रयोग से जुड़े विड्रॉल व क्रेविंग उसे बार बार ओपियाड प्रयोग के लिये विवश करते है। क्योकि ओपियाड ड्रग्स का प्रभाव कम समय के लिये होता है इसलिये इंजैक्शन ड्रग्स यूजर दिन में कई बार इंजैक्शन को लगाता है। इसके परिणाम स्वरूप वे जीवन के अन्य पहलू जैसे काम-काज,परिवार व समाज की ओर ध्यान नहीं दे पाते। वे अपने ओपियाड ड्रग्स के लिये रुपयों की पूर्ति करने के लिये अवैध कार्यो से जुड़ने के लिये विवश हो जाते है। 

  ओपियाड सॅब्स्टिट्यूशॅन थैरेपी - OST इन सब  पहलूओ पर  कार्य करती है।

 1. OST  में प्रयोग की जाने वाली ओपियाड दवाईया ड्रग्स से जुड़े विड्रॉल व क्रेविंग को ख़त्म करती है जिससे ड्रग्स यूजर को विड्रॉल व क्रेविंग दूर करने के लिये ओपियाड ड्रग्स का इंजैक्शन लेने की जरूरत नहीं पड़ती। 

2. अवैध ओपियाड की तुलना मे जो तुरंत व कम समय के लिये असर करते है OST

 में प्रयोग की जाने वाली  ओपियाड दवाईया धीरे धीरे  व लंबे समय तक असर करती है जिससे इंजैक्शन ड्रग्स यूजर को अपना समय बार बार अवैध ओपियाड को ढूंढ़ने व लगाने में बरबाद करने की जरूरत नहीं रहती तथा वह अपना समय काम -काज व परिवार को दे सकता है। 

3. अवैध ओपियाड इंजैक्शन द्वारा प्रयोग की जाती है जिसके कई नुकसान होते है इसके विपरीत OST में प्रयोग की जाने वाली ओपियाड दवाई मुँह के द्वारा दी जाती है जो एक सुरक्षित तरीका है। 

WHAT IS OPIOID SUBSTITUTION THERAPY MEDICINES?

OPIOID SUBSTITUTION THERAPY MEDICINES
The medicines used in OST should have certain properties that help the clients obtain the benefits discussed above. The OST medicine should:

•  Have action similar to the illicit opioid used by the clients. This is essential to effectively suppress the craving and withdrawals associated with cessation of opioid use. This means that an OST medicine should also be an agonist on the OPIOID receptors.

•  Have lesser addiction potential as compared to the illicit opioid being consumed by the client. Any OST medicine will have some liability to result in addiction, as it is an opioid. However, its street value should be much less than the illicit opioids, i.e. users should not prefer the OST medicine over illicit opioids for their addiction/intoxication.

•  Be easy to administer i.e. the medicine should be effective on oral or sublingual administration.

• Have action lasting for at least 24 hours, so that the frequency of administration should be once a day at the maximum.

•  Be well tolerated. The side effects should be minimal so that the clients find it acceptable to continue OST medicines for a long period of time

•  Be cheaper, easily available, easily stored and transported, so as to provide for a large number of clients with minimal financial or logistic constraints.

In India, methadone, buprenorphine and slow release oral morphine have been used as OST medicine. However, the use of buprenorphine exceeds that of the other two; OST programme under NACP currently uses buprenorphine as the OST medicine, and hence buprenorphine has been discussed in detail in subsequent sections. Methadone based OST is also being implemented as a pilot at five sites in India.

PHARMACEUTICAL COMPOUNDS COMMONLY USED AS OST MEDICINES

1. Methadone: Methadone was the first and currently, the most common opioid used as an OST medicine globally. Methadone is a pure opioid agonist, available for oral use either as a liquid or as a tablet.
2.  Buprenorphine: Buprenorphine is a partial opioid agonist available for use as a sublingual tablet. It is the second most commonly used OST medicine worldwide.
3.  Slow Release Oral Morphine: Morphine is a pure opioid agonist and commonly used in cancer patients for alleviation of pain. The slow release formulation is available as a tablet.

WHAT IS OST ?

Various terminologies have been used to describe the clinical practice of maintaining opioid-dependent drug users on opioid medicines over a long period of time.

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.

OST CENTER IN SONIPAT FOR DRUG ADDICTS.

At the oral substitution treatment (OST) center in civil hospital Sonipat  131001,Haryana India  -more than 150 recovering drug addicts distributed food in public (BHANDARA)  and spread awareness about the drug addiction . The programme was  started by civil surgeon Dr. Jaswant Punia and nodel officer Dr. Tarun Yadev.

OST CENTER has been established in district by the government and health department for the treatment of drug addicts especially who do drugs via injection. This OST center is on first number in Haryana and third in India. At  the  center doctors provide medication by themselves besides injection . At present more than 1000 patients are registered with the center. More than 150 drug addicts are in recovery.

Bhandara was organized by recovering addicts. Hospital’s officers and employees provided cooperation. Civil surgeon Dr. Jaswant Punia said “ Drug addiction is a dangerous habit. Drug addiction brings along TB , Cancer ,H.I.V. etc diseases. Even death might happen. The Government and health department is working to save people from drug addiction. In every district one OST center has been  opened. Best services is provided to patients. More than 150 people have started a new life. They also spread awareness in public  which is a good initiative.”. At this occasion Dr. Satyavati Sharma, staff nurse Sushila and Rajnish Tomer  were also present.

by Dainik jagran Sonipat 12/6/2018

Oral Substitution Therapy (OST) Centre Accreditation

List of OST Centres

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