ABSTRACT
Opioid use disorders are one of the most serious global health problems. According to the latest national survey, current use of any opioid was 2.1% and an estimated 8.5 Lakh people who inject drugs (PWID) are in India. Opioid Agonist Treatment (OAT) is the most effective evidence-based strategy for management of opioid use disorders. In India, OAT is provided in government hospitals and through community-based OAT clinics. The covid-19 pandemic and nation-wide lockdown have adversely impacted OAT services delivery in the country. The National Drug Dependence Treatment Centre (NDDTC) runs a community drug treatment clinic in an urban impoverished area of East Delhi and provides low-threshold, free-of-cost OAT services for patients residing in the clinic’s vicinity. The clinic responded to the COVID-19 pandemic challenge and continued OAT throughout the pandemic by making substantial changes in its operations. This symposium shares the experience of NDDTC in running community-based OAT services using Clinical Workflow Automation based digital platform, teleconsultations, and various strategies adapted to deliver uninterrupted services during this unprecedented time. The feasibility, perceived satisfaction and retention rates of the patients receiving the tele medication assisted treatment offered is assessed among 100 patients will also be discussed. The various operational challenges faced and lessons learned during delivery of OAT services would also be discussed.
ABSTRACT
Opioids are one of the most common illicit substances used globally as well as in India. Opioid Agonist Maintenance Treatment (OAMT) is the most evidence-based long-term treatment for patients with opioid dependence syndrome. Buprenorphine is the most commonly used opioid medication for OAMT in India, while methadone and slow-release oral morphine are used less commonly. Buprenorphine was introduced in India around three decades back, and since then, many Indian studies have confirmed its effectiveness as OAMT in the Indian opioid-using population. The significant expansion of OAMT in India occurred when it became a part of the National AIDS Control Programme as an HIV prevention strategy. Since then, there has been a gradual expansion of OAMT under the National AIDS Control Programme. However, the provision of OAMT under this programme is limited to only people who inject drugs (PWID), thus leaving out the majority of opioid users in India. The Drug De-addiction Programme (currently renamed as National Program for Tobacco Control and Drug Addiction Treatment) under the Ministry of Health and Family Welfare (MoHFW) provides OAMT through its Drug Treatment Clinics (DTCs) in government hospitals across the country. The number of such DTCs is limited. More recently, the Ministry of Social Justice and Empowerment (MSJE) has approved a scheme of Addiction Treatment Facility (ATF) under which OAMT shall be available in Government hospitals at district level. The symposium will cover many of these issues and challenges. Presenter 1 will give a background of OAMT and will focus on its effectiveness in the Indian population. Presenter 2 will talk about the history and current status of OAMT under the National AIDS Control Organization. Presenter 3 will cover the history and current status of OAMT under MoHFW and MSJE. Presenter 4 will discuss the significant changes in the OAMT programs during the COVID-19 pandemic and the impact. Presenter 5 will discuss the major issues faced during the expansion of OAMT in India during the last three decades and the future directions in the various Indian settings.
ABSTRACT
The COVID-19 pandemic has significantly affected treatment services for people with substance use disorders (SUDs). Based on the perspectives of service providers from eight countries, we discuss the impact of the pandemic on SUD treatment services. Although many countries quickly adapted in provision of harm reduction services by changes in policy and service delivery, some went into a forced abstinence-based strategy. Similarly, disruption of abstinence-based approaches such as therapeutic communities has been reported. Global awareness is crucial for responsible management of SUDs during the pandemic, and the development of international health policy guidelines is an urgent need in this area.