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Ganapathi L, Srikrishnan AK, McFall AM, Gunaratne MP, Kumar MS, Lucas GM, Mehta SH, Solomon SS. Expanding single-venue services to better engage young people who inject drugs: insights from India. Harm Reduct J 2024; 21:170. [PMID: 39272091 PMCID: PMC11401385 DOI: 10.1186/s12954-024-01084-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/30/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Over the last decade, India has had an alarming rise in injection of opioids across several cities. Although scale-up of public sector services for people who inject drugs (PWID) in India has occurred over decades, accessibility has been diminished by fragmented services across physical locations. To circumvent this barrier, and in alignment with the World Health Organization's guidelines to provide comprehensive care to key populations, Integrated Care Centers (ICCs) were established across 8 Indian cities as a public-private service delivery model for providing free single-venue services to PWID. ICCs have been very successful in expanding service availability and convenience for PWID generally. However, few studies from low- and middle-income countries (LMIC) have evaluated how well young PWID (defined as those ≤ 29 years of age) engage with single-venue service models like ICCs or specific services provided in such models. Young PWID are an important subpopulation in India, as they bear a disproportionate burden of new HIV infections because of greater risk and evidence of lower receipt of HIV testing and harm reduction services compared to older PWID. In this comment, we offer insights specific to young PWID drawn from multiple quantitative and qualitative studies examining the reach and effectiveness of ICCs, which may provide generalizable insights into limitations of services for young PWID more broadly in India and globally. FINDINGS Our studies suggest that while ICCs have expanded service availability, particularly in cities with emerging injection drug use epidemics, population-level reach to foster initial engagement among young PWID can be optimized. Additionally, young PWID who do engage with ICCs experience gaps in substance use treatment receipt and retention, and experience barriers to receipt of ICC services that are distinct from those experienced by older PWID. Notably, HIV incidence among ICC clients is concentrated in young PWID. Finally, ICCs were not intended to reach adolescent PWID, and new services are needed for this subpopulation. CONCLUSIONS In addition to co-locating services, iterative optimization of models such as ICCs should incorporate youth-specific differentiated interventions and be accompanied by policy changes that are critical to improving the reach and effectiveness of harm reduction and HIV services among young PWID in India.
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Affiliation(s)
- Lakshmi Ganapathi
- Division of Pediatric Global Health, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
- Division of Pediatric Infectious Diseases, Massachusetts General Hospital for Children, 55 Fruit Street, Boston, MA, 02114, USA.
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Aylur K Srikrishnan
- Y.R. Gaitonde Centre for AIDS Research and Education, No. 34, East Street, Kilpauk Garden Colony, Chennai, Tamil Nadu, 600010, India
| | - Allison M McFall
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 733 N Broadway, Baltimore, MD, 21205, USA
| | - Mihili P Gunaratne
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 733 N Broadway, Baltimore, MD, 21205, USA
| | - Muniratnam Suresh Kumar
- Y.R. Gaitonde Centre for AIDS Research and Education, No. 34, East Street, Kilpauk Garden Colony, Chennai, Tamil Nadu, 600010, India
- Psymed Hospital, 49 Harrington Road, Chetpet, Chennai, Tamil Nadu, 600031, India
| | - Gregory M Lucas
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA
| | - Shruti H Mehta
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 733 N Broadway, Baltimore, MD, 21205, USA
| | - Sunil S Solomon
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA
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Nyashanu T, Scheibe A, Visser M. 'I went for rehab many times and it never worked, but the harm reduction process has given me renewed hope'. Perceptions on the effectiveness of harm reduction and community-based opioid substitution therapy. Health Promot J Austr 2024; 35:653-661. [PMID: 37605794 DOI: 10.1002/hpja.789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/23/2023] Open
Abstract
ISSUE ADDRESSED The accessibility of opioid substitution therapy (OST), one of the recommended treatments for opioid dependence, remains low. This study sought to explore the perceived effectiveness of OST from the perspectives of peer outreach workers and OST clients in a community-based harm reduction programme. METHODS The research was done within the Community-Oriented Substance Use Programme (COSUP) in Tshwane, South Africa. Fifteen peer educators (13 males and 2 females) took part in two focus group discussions. Thereafter, there were semi-structured interviews in which 15 OST clients (11 males and 4 females) participated. A convenience cross-sectional study was used. Interviews were audio-recorded. Using thematic analysis, themes were examined to evaluate how OST and the harm reduction approach were perceived to contribute to the improved health status of people with opioid dependence. RESULTS Peer outreach workers and COSUP clients significantly endorsed OST as an effective treatment for opioid dependence. Participants perceived greater effectiveness of OST compared to abstinence-centred inpatient rehabilitation programmes. However, there were sentiments that more community education on OST was needed to motivate people with opioid dependence to access services and to address misconceptions about OST. CONCLUSIONS There is a lack of multi-level and multi-sectoral engagement of various stakeholders in opioid dependence services, needed to accelerate utilisation of OST services. SO WHAT?: The research unpacks the need for an integrated approach to service use optimisation, and the need to evaluate the role that increased awareness and community education on harm reduction strategies can play in enhancing the utilisation of OST services.
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Affiliation(s)
- Tichaenzana Nyashanu
- Department of Psychology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Andrew Scheibe
- Community Oriented Primary Care Research Unit, Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Maretha Visser
- Department of Psychology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
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Shakya P, Jangra J, Rao R, Mishra AK, Bhad R. Assessment of treatment retention rates and predictors of retention on opioid agonist treatment among adolescents. Drug Alcohol Rev 2024. [PMID: 38884374 DOI: 10.1111/dar.13890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 05/09/2024] [Accepted: 05/28/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION Opioid agonist treatment (OAT) is an effective treatment for opioid dependence syndrome in adults. However, studies on effectiveness of OAT in adolescents are limited; existing studies show varying retention rates. The present study aimed to assess OAT retention rates in adolescent patients with opioid dependence syndrome registered in a community drug treatment clinic in Delhi, India, and to analyse factors associated with retention at 1 year. METHODS Retrospective cohort study. All adolescents (n = 130) aged 10-19 years, started on OAT from January 2020 to July 2022 were included. Baseline and follow-up data was extracted from online record system maintained at the clinic. OAT retention rates at different timepoints were assessed. Multivariable logistic regression was used to discern factors associated with one-year retention. RESULTS The participants' mean age was 16.9 (SD 1.4) years. Mean age of starting opioids was 14.9 (SD 2.2) years; 29.5% (n = 38) injected opioids. The 6-, 12-, 18- and 24-month retention rate on OAT was 64.4%, 45.6%, 38.7% and 29% respectively. The retention rates with buprenorphine and methadone were comparable. Multivariate logistic regression showed retention for less than 12 months to be significantly associated with younger age of starting heroin, involvement in illegal activities, absenteeism from school and substance use in family. DISCUSSION AND CONCLUSIONS The 12-month retention rates on OAT in adolescents is comparable to retention rates in adults. Various factors associated with early age of onset of opioid use are also associated with lower retention rates on OAT.
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Affiliation(s)
- Pooja Shakya
- Department of Psychiatry, Institute of Human Behaviour and Allied Science, New Delhi, India
| | - Jaswant Jangra
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra Rao
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Ashwani Kumar Mishra
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Roshan Bhad
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
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Kathiresan P, Patel V, Jangra J, Chattopadhyay A, Abdus S, Jadhav M, Rao R, Arya A, Bansal PD, Chinggouman C, Bhad R, Ambekar A, Agrawal A, Chatterjee B, Yadav D. Experience of patients on methadone maintenance treatment receiving take-home methadone doses during COVID-19 pandemic: A multi-site study from India. Asian J Psychiatr 2024; 95:103979. [PMID: 38442535 DOI: 10.1016/j.ajp.2024.103979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/18/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Methadone take-home doses for opioid dependence treatment are strictly regulated due to diversion and overdose concerns, so patients must visit the clinic daily for dispensing. This was also done in India until the COVID-19 pandemic, when lockdown restriction compelled take- home dispensing of methadone. This study examined experience of patients who received take- home methadone during COVID-19 pandemic in India. METHODS Observational, cross-sectional design. We contacted all consenting methadone centres in India during the lockdown and selected those that provided take-home doses for the study. Patients who received daily methadone before the lockdown and take-home doses after were interviewed using a study-specific questionnaire. RESULTS The study had 210 participants. Take-home methadone was dispensed for 2.5 days on average in each dispensing. When taking methadone at home, 3.3% split their dose 25% took less than the prescribed dose to save it for a rainy days, and 3.3% reported an overdose episode. Adherence improved in 58.6% participants after take-home methadone. Participants perceived many benefits from take-home methadone such as reduced hospital visits and travel time to collect methadone, improvement in work, and financial savings. About 54.3% participants reported storing their take-home doses safely, and 1.9% reported that their family consumed methadone by mistake. CONCLUSIONS Take-home methadone was found to be beneficial to most participants in terms of time saved and improved productivity. Preconceived concerns of providing take-home methadone in terms of its overdose, diversion, or accidental ingestion by others are not commonly seen when individuals are provided take-home doses of methadone.
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Affiliation(s)
| | - Vinit Patel
- All India Institute of Medical Sciences, New Delhi, India
| | - Jaswant Jangra
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Sabir Abdus
- Medical Officer, Manipur Health Services, Government of Manipur, India
| | - Monali Jadhav
- All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra Rao
- All India Institute of Medical Sciences, New Delhi, India.
| | - Amit Arya
- Nodal Officer, Drug Treatment Clinic, King George Medical University, Lucknow, India
| | - Pir Dutt Bansal
- Nodal Officer, Drug Treatment Clinic, Civil Hospital, Bathinda, India
| | | | - Roshan Bhad
- All India Institute of Medical Sciences, New Delhi, India
| | - Atul Ambekar
- All India Institute of Medical Sciences, New Delhi, India
| | - Alok Agrawal
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Deepak Yadav
- All India Institute of Medical Sciences, New Delhi, India
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Parmar A, Chakraborty R, Balhara YPS. Current status of harm reduction in India: Are we doing enough? Indian J Psychiatry 2024; 66:388-391. [PMID: 38778856 PMCID: PMC11107929 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_963_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 05/25/2024] Open
Affiliation(s)
- Arpit Parmar
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Radhika Chakraborty
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Yatan P. S. Balhara
- National Drug Dependence Treatment Center, All India Institute of Medical Sciences, New Delhi, India
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Shukla L, Shivaprakash P, Kumar MS. HIV, hepatitis B & C in people who inject drugs in India: A systematic review of regional heterogeneity & overview of opioid substitution treatment. Indian J Med Res 2023; 158:522-534. [PMID: 38265946 PMCID: PMC10878493 DOI: 10.4103/ijmr.ijmr_1930_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND OBJECTIVES This systematic review evaluates the human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV) burden among people who inject drugs (PWIDs) in India. In addition, we selectively examined research on opioid substitution treatment (OST)-related services due to their role in antiviral treatment uptake and adherence. METHODS Data were sourced from peer-reviewed and government publications between 1991 and September 20, 2023, searched in MEDLINE, Scopus and EBSCOhost. English language studies reporting weighted prevalence or raw numbers and recruitment sites were included for review. Quality was assessed using the Joanna Briggs Institute tool. Data synthesis was done in graphs and tables. RESULTS We included 50 reports, yielding 150 HIV, 68 HCV and 24 HBV prevalence estimates across India, revealing significant regional heterogeneity. Notably, 16 States had a single community-based HIV estimate, and 19 States had limited or no HCV data. The highest HIV and HCV prevalence was in Manipur (74.7% and 97.5%, respectively) in 1996. Recent spikes included 50.2 per cent HIV prevalence in Punjab (2010) and 73 per cent HCV in Uttar Pradesh (2021). Nationally, OST coverage in 2020 was under five per cent, with some northeast, north and central States exceeding this, but most others were falling below two per cent. No studies on the cost-effectiveness of directly observed treatment models for OST were identified. INTERPRETATION CONCLUSIONS There is a lack of sufficiently granular and generalizable estimates for HIV prevalence and any estimates for HCV and HBV among PWIDs in large parts of the country. Community-based representative studies are required to quantify the prevalence and severity of these diseases and allocate resources.
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Affiliation(s)
- Lekhansh Shukla
- Department of Psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Prakrithi Shivaprakash
- Department of Psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - M. Suresh Kumar
- Schizophrenia Research Foundation (SCARF), Chennai, Tamil Nadu, India
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Vashisht S, Jha S, Kant S, Thakur N, Rai S. Challenges Faced and Coping Strategies Adopted by Injecting Drug Users during COVID-19 Lockdown-A Qualitative Study. Indian J Community Med 2023; 48:846-851. [PMID: 38249706 PMCID: PMC10795882 DOI: 10.4103/ijcm.ijcm_649_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/30/2023] [Indexed: 01/23/2024] Open
Abstract
Background The lockdown due to COVID-19 pandemic has adversely affected the lives of vulnerable population, including the injecting drug users (IDUs). The objective of the study was to document the coping mechanism adopted by IDUs and suggest measures to mitigate the adverse effects, if similar situation were to arise in future. Materials and Methods A qualitative study was conducted at the Targeted Intervention Non-Government Organizations catering to IDUs in Delhi and Ghaziabad district of Uttar Pradesh. Four focus group discussions among 41 IDUs and 7 key informant interviews of the NGO staff were conducted in the study. The Hindi recordings were coded and the data analysis was performed manually using grounded theory approach. Results We found that the lockdown affected the lives of most of the IDUs and they found it difficult to access the harm reduction services. To cope with this, many IDUs started following alternate methods to support the drug habits. There was an increase in reuse of needles and syringes. Conclusion The lockdown during COVID-19 and the resulting challenges negatively impacted the physical and mental health of the IDUs. We recommend that in any similar future scenario, travel pass may be issued to the IDUs and the TI-NGO personnel.
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Affiliation(s)
- Shruti Vashisht
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shreya Jha
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shashi Kant
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nishakar Thakur
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Rai
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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Kumar A, Mahajan H, Chaturvedi S, Kumar A, Kumar S, Sahoo GC, Das VNR, Pandey K. Hepatitis C virus seroprevalence among patients enrolled at the opioid substitution therapy center in Bihar: A cross-sectional study. PLoS One 2023; 18:e0287333. [PMID: 37319276 PMCID: PMC10270565 DOI: 10.1371/journal.pone.0287333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/02/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND AND AIM Hepatitis C virus (HCV) infection poses a major public health challenge in Indian settings due to its huge population and easy transmissibility of HCV among individuals who inject drugs (PWID, which is increasing in India). The National AIDS Control Organization (NACO), India has started the Opioid Substitution Therapy (OST) centers to improve the health status of opioid dependent PWID and prevent the spread of HIV/AIDS among them. We conducted a cross-sectional study to find out the HCV sero-positive status and associated determinants in patients attending the OST centre in the ICMR-RMRIMS, Patna. MATERIALS AND METHODS We utilized the routinely collected (as a part of the National AIDS Control Program) and de-identified data from the OST center from 2014 to 2022 (N = 268). We abstracted the information for exposure variables (such as socio-demographic features and drug history) and outcome variable (HCV serostatus). The association of exposure variables with HCV serostatus was examined using robust Poisson regression. RESULTS All the enrolled participants were male and the prevalence of HCV seropositivity was 28% [95% confidence interval (CI): 22.7% - 33.8%)]. There was a rising prevalence of HCV seropositivity with number of years of injection use (p-trend <0.001) and age (p-trend 0.025). Approximately, 6.3% participants were injecting drugs for >10 years and reported the maximum prevalence of HCV seropositivity (47.1%, 95% CI: 23.3%-70.8%). In adjusted analyses, being employed compared to unemployed patients [adjusted prevalence ratio (aPR) = 0.59; 95% CI: 0.38-0.89]; graduated patients compared to illiterate patients [aPR = 0.11; 95% CI: 0.02-0.78]; and patients with education up to higher secondary compared to illiterate patients [aPR = 0.64; 95% CI: 0.43-0.94] had significantly lesser HCV seropositivity. A-one year increase in injection use [aPR = 1.07; 95% CI: 1.04-1.10] was associated with 7% higher prevalence of HCV seropositivity. CONCLUSIONS In this OST center-based study of 268 PWIDs residing in Patna, ~28% of patients were HCV seropositive, which was positively associated with years of injection use, unemployment, and illiteracy. Our findings suggest that OST centers offer an opportunity to reach a high-risk difficult to reach group for HCV infection and thus support the notion of integrating HCV care into the OST or de-addiction centres.
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Affiliation(s)
- Ashish Kumar
- Indian Council of Medical Research—Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Hemant Mahajan
- Indian Council of Medical Research—Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Sanjay Chaturvedi
- Indian Council of Medical Research—Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Ashok Kumar
- Indian Council of Medical Research—Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Shiril Kumar
- Indian Council of Medical Research—Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Ganesh Chandra Sahoo
- Indian Council of Medical Research—Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Vidya Nand Rabi Das
- Indian Council of Medical Research—Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Krishna Pandey
- Indian Council of Medical Research—Rajendra Memorial Research Institute of Medical Sciences, Patna, India
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Ganapathi L, McFall AM, Greco KF, Srikrishnan AK, Suresh Kumar M, Mayer KH, O’Cleirigh C, Mehta SH, Lucas GM, Solomon SS. Buprenorphine treatment receipt characteristics and retention among people who inject drugs at Integrated Care Centers in India. Drug Alcohol Depend 2023; 246:109839. [PMID: 37031487 PMCID: PMC10416117 DOI: 10.1016/j.drugalcdep.2023.109839] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/21/2023] [Accepted: 03/06/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND India is facing overlapping opioid injection and HIV epidemics among people who inject drugs (PWID) in several cities. Integrated Care Centers (ICCs) provide single-venue HIV and substance use services to PWID. We evaluated PWID engagement in daily observed buprenorphine treatment at 7 ICCs to inform interventions. METHODS We analyzed 1-year follow-up data for PWID initiating buprenorphine between 1 January - 31 December 2018, evaluating receipt frequency, treatment interruptions (no buprenorphine receipt for 60 consecutive days with subsequent re-engagement), and drop-out (no buprenorphine receipt for 60 consecutive days without re-engagement). Using descriptive statistics, we explored differences between ICCs in the opioid-endemic Northeast region and ICCs in the emerging opioid epidemic North/Central region. We used a multivariable logistic regression model to determine predictors of treatment drop-out by 6 months. RESULTS 1312 PWID initiated buprenorphine (76% North/Central ICCs vs. 24% Northeast ICCs). 31% of PWID in North/Central, and 25% in Northeast ICCs experienced ≥ 1 treatment interruption in 1 year. Over 6 months, 48% of PWID in North/Central vs. 60% in Northeast ICCs received buprenorphine ≤ 2 times/week (p < 0.0001). A third of PWID in North/Central vs. half in Northeast ICCs experienced treatment drop-out by 6 months (p < 0.001). In the multivariable model, living in Northeast cities was associated with increased odds of drop-out while counseling receipt was associated with decreased odds. CONCLUSIONS Retention among PWID initiating buprenorphine at ICCs was comparable to global reports. However, regional heterogeneity in retention, and low daily buprenorphine receipt suggest patient-centered interventions adapted to regional contexts are urgently needed.
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Affiliation(s)
- Lakshmi Ganapathi
- Division of Pediatric Global Health, Massachusetts General Hospital for Children, 55 Fruit Street, Boston, Massachusetts 02114
- Division of Pediatric Infectious Diseases, Massachusetts General Hospital for Children, 55 Fruit Street, Boston, Massachusetts 02114
- Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115
| | - Allison M. McFall
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 733 N Broadway, Baltimore, Maryland 21205
| | - Kimberly F. Greco
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, 21 Autumn Street, Boston, Massachusetts 02215
| | - Aylur K. Srikrishnan
- YR Gaitonde Centre for AIDS Research and Education, No. 34, East Street, Kilpauk Garden Colony, Chennai, India 600010
| | - Muniratnam Suresh Kumar
- YR Gaitonde Centre for AIDS Research and Education, No. 34, East Street, Kilpauk Garden Colony, Chennai, India 600010
| | - Kenneth H. Mayer
- Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215
- The Fenway Institute, 1340 Boylston Street, Boston, Massachusetts 02215
| | - Conall O’Cleirigh
- Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Shruti H. Mehta
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 733 N Broadway, Baltimore, Maryland 21205
| | - Gregory M. Lucas
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, Maryland 21205
| | - Sunil S. Solomon
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, Maryland 21205
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Predictors of Treatment Completion in an Inpatient Substance Use Treatment Service in India. J Addict Med 2023; 17:e101-e109. [PMID: 36149004 DOI: 10.1097/adm.0000000000001076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Treatment completion is associated with a better outcome in substance use disorders. We examined the rates of treatment completion and its predictors in patients admitted to specialized addiction treatment settings over a 13-year period. METHODS Ours was a retrospective cohort study. We included consecutive 2850 patients admitted to the inpatient treatment between January 2007 and December 2019. We divided the patients into 2 groups: completed versus premature discontinuation of treatment. The predictor variables were based on previous research, clinical experience, and availability of the digital record. RESULTS The number of patients who completed and discontinued treatments was 1873 (72.6%) and 707 (27.4%), respectively. The inpatient treatment discontinuation rate varied widely during the study period (18% in 2007 and 41% in 2012). The average rate of treatment discontinuation was 27%. The change-point analysis showed 5 statistically significant change points in the years 2008, 2010, 2012, 2014, and 2016. Patients who were prescribed medications for alcohol and opioid dependence and those who were on opioid agonist treatment had 4.7 and 6.3 higher odds of completing inpatient treatment than those who were not on medication. Patients with physical and psychiatric comorbidities had higher odds of treatment completion. Patients with a primary diagnosis of opioid dependence had lower odds of treatment completion than those with alcohol dependence. CONCLUSIONS The rates of discontinuation may vary with concurrent changes in the treatment policies. Awareness of the risk factors and policy measures that may improve treatment completion must aid in informed decision making.
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Pant SB, Thapa SB, Howard J, Ojha SP, Lien L. Psychological distress and quality of life among Opioid Agonist Treatment service users with a history of injecting and non-injecting drug use: A cross-sectional study in Kathmandu, Nepal. PLoS One 2023; 18:e0281437. [PMID: 36745666 PMCID: PMC9901755 DOI: 10.1371/journal.pone.0281437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/23/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Opioid use disorder is a serious public health problem in Nepal. People who use opioids often experience psychological distress and poor quality of life. Opioid agonist Treatment (OAT) is central in managing opioid dependence. This study aimed to examine factors associated with quality of life and serious psychological distress among OAT service users in the Kathmandu Valley, Nepal and compare those who had injected opioids prior to OAT and those who had not. METHODS A cross-sectional study with 231 was conducted using a semi-structured questionnaire, the Nepalese versions of the Kessler 6 psychological distress scale and World Health Organization Quality of Life scale (WHOQOL-BREF). Bivariate and multivariate analyses were undertaken to examine factors associated with quality of life and serious psychological distress. RESULTS Most participants were males (92%) and about half had injected opioids before initiating OAT. Serious psychological distress in the past four weeks was significantly more prevalent among participants with a history of injecting (32.2%) than those who did not inject (15.9%). In the adjusted linear regression model, those who had history of injecting were likely to have lower physical quality of life compared to non-injectors. Those self-reporting a past history of mental illness were more than seven times and those with medical comorbidity twice more likely to have serious psychological distress over last four weeks. Lower socioeconomic status and a history of self-reported mental illness in the past were found to be significantly associated with lower quality of life on all four domains. CONCLUSION Those who had history of injecting were younger, had frequent quit attempts, higher medical comorbidity, lower socioeconomic status and remained longer in OAT services. Alongside OAT, the complex and entangled needs of service users, especially those with a history of injecting drugs, need to be addressed to improve quality of life and lessen psychological distress.
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Affiliation(s)
- Sagun Ballav Pant
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Institute of Medicine, Tribhuvan University, Kirtipur, Nepal
- * E-mail: ,
| | - Suraj Bahadur Thapa
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Institute of Medicine, Tribhuvan University, Kirtipur, Nepal
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - John Howard
- National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Saroj Prasad Ojha
- Department of Psychiatry, Institute of Medicine, Tribhuvan University, Kirtipur, Nepal
| | - Lars Lien
- National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
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Goeieman DS, Nonyane DS, Nzaumvila DK, Janse van Rensburg MNS. Retention of service users on opioid substitution therapy in the City of Tshwane, South Africa. Afr J Prim Health Care Fam Med 2023; 15:e1-e10. [PMID: 36744456 PMCID: PMC9900307 DOI: 10.4102/phcfm.v15i1.3392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Opioid substitution therapy (OST) is evidence-based treatment for opioid use disorders and, when taken as maintenance therapy, has proven health and social benefits. The benefits of OST are achieved through the retention of service users in the treatment programme. AIM To identify factors that affected retention of service users who had OST interrupted in less than 6 months of being in an OST programme. SETTING This qualitative study was conducted with 19 service users from eight Community-Oriented Substance Use Programme (COSUP) sites in the City of Tshwane, Gauteng, South Africa. METHODS Participants were COSUP service users who had interrupted OST in less than 6 months since initiation and were purposefully selected from all COSUP sites. Demographic information was obtained and four focus group discussions covered challenges of OST retention. Discussions were recorded, transcribed and qualitatively analysed using Attride-Stirling's thematic networks framework. RESULTS The 19 participants were all male, mostly black African, with a mean age of 26 years. Facilitators of retention in OST were individual readiness to change OST accessibility, positive family and peer support, treatment monitoring, understanding and managing expectations of service users, contribution in society and meaningful opportunities for engagement. Barriers were the cost of OST, bureaucracy within the programme, inability to communicate challenges timeously and effectively to treatment providers, boredom, cravings and poverty. CONCLUSION Opioid substitution therapy programmes can ensure a holistic approach to prevent and treat harms related to illicit opioid use if they remain person-centred and are well-funded.Contribution: Understanding the barriers to, and facilitators of retention on OST can contribute to improved community-based service delivery.
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Affiliation(s)
- Daniela S. Goeieman
- Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Tshwane, South Africa
| | - Dimakatso S. Nonyane
- Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Tshwane, South Africa
| | - Doudou K. Nzaumvila
- Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Tshwane, South Africa
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Ganesh R, Rao R, Deb KS, Bhad R, Yadav D. Digital Capacity and Interest in mHealth Interventions Among Individuals on Opioid Agonist Maintenance Treatment: A Cross-Sectional Community-Based Study. Indian J Psychol Med 2022; 44:354-358. [PMID: 35949629 PMCID: PMC9301754 DOI: 10.1177/02537176211027239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Integrating mobile technologies in healthcare (mHealth) is helpful to manage various medical conditions. mHealth applications can bridge the gap in the management of patients with opioid use disorder (OUD). Research evaluating the feasibility of mHealth to address OUD is limited in developing countries. We aimed to assess the digital capacity and interest in mHealth interventions in patients maintained on opioid agonist treatment (OAT). Methods 150 patients on OAT from a community drug treatment clinic in New Delhi, India, were included. We assessed the participants on their pattern of mobile and Internet use and their willingness to use mHealth technology to access health information and services related to OUD. Results 88% of participants (n = 132) owned a mobile phone at assessment; 2.7% (n = 4) had never used a mobile phone in their lifetime. 70% (n = 105) participants had Internet access. 80% (n = 120) of participants showed interest in receiving text messages related to the management of OUD. 60% of participants showed a willingness to download and use applications for monitoring their substance use. Conclusions In India, there is an interest among people on OAT to use mHealth interventions to manage their substance use. This population also has access to mobile phones and the necessary knowledge to install and run applications needed for various mHealth interventions.
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Affiliation(s)
- Ragul Ganesh
- Dept. of Psychiatry and National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ravindra Rao
- Dept. of Psychiatry and National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Koushik Sinha Deb
- Dept. of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Roshan Bhad
- Dept. of Psychiatry and National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Deepak Yadav
- Dept. of Psychiatry and National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Shukla R, Kar SK, Dalal PK, Arya A. Psychosocial functioning among current noninjecting opioid users: Is there any difference between methadone maintenance treatment and treatment as usual? Indian J Psychiatry 2022; 64:56-63. [PMID: 35400736 PMCID: PMC8992753 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_682_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/23/2021] [Accepted: 12/19/2021] [Indexed: 11/26/2022] Open
Abstract
Background Patients with opioid use disorder (OUD) have a significant problem in psychosocial functioning domains, which are not systematically studied in India. This study aimed to evaluate the psychosocial functioning in current noninjecting opioid users on Methadone Maintenance Treatment (MMT) versus Treatment as Usual (TaU: Chlordiazepoxide, Zolpidem, Trazodone, Tramadol, Tapentadol, and Buprenorphine). Materials and Methods It is a cross-sectional study on patients of current noninjecting OUD on MMT or TaU for at least in the past month. Comorbidities and illness severity were assessed with the help of Mini-International Neuropsychiatric Interview 7.0.2 and World Health Organization-The Alcohol, Smoking, and Substance Involvement Screening Test 3.0, respectively. Social and occupational functioning assessment scale (SOFAS), WHO Quality of Life (WHOQoL-BREF), and Client Satisfaction Questionnaire (CSQ-8) assessed the sociooccupational functioning and QoL and client satisfaction. A total of 67 participants (37 on MMT and 30 on TaU) were included in the study. Results A significant difference between the two groups (MMT better than TaU) was based on SOFAS scores, CSQ-8, and WHOQoL-BREF. In the TaU group, there was a significant negative correlation between risk of addiction severity with sociooccupational functioning (r = -0.5; P = 0.0046), physical health (r = -0.48; P = 0.0087) and social relationship (r = -0.47; P = 0.0087) domain of QoL. In the MMT group, the association between risk of addiction severity with sociooccupational functioning, domains of QoL, and client satisfaction were insignificant. Conclusion Sociooccupational Functioning, Client Satisfaction, and QoL of patients maintained on MMT are better than those on TaU.
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Affiliation(s)
- Richa Shukla
- Department of Psychiatry, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Sujita Kumar Kar
- Department of Psychiatry, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - P. K. Dalal
- Department of Psychiatry, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Amit Arya
- Department of Psychiatry, King George’s Medical University, Lucknow, Uttar Pradesh, India
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Parmar A, Pal A, Sharma P. National List of Essential Medicines in India: A Story of Deprivation of Substance Use Disorder Treatment. Indian J Psychol Med 2021; 43:531-534. [PMID: 35210682 PMCID: PMC8826205 DOI: 10.1177/0253717620972942] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Arpit Parmar
- Dept. of Psychiatry, All India Institute of
Medical Sciences, Bhubaneswar, Odisha, India
| | - Arghya Pal
- Dept. of Psychiatry, Himalayan Institute of
Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Pawan Sharma
- Dept. of Psychiatry, School of Medicine,
Patan Academy of Health Sciences, Lalitpur, Nepal
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Singh B, Rao R. PerspectivesIs there an opioid epidemic in India? J Public Health (Oxf) 2021; 43:ii43-ii50. [PMID: 34622293 DOI: 10.1093/pubmed/fdab322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Bhrigupati Singh
- Department of Anthropology and Sociology, Ashoka University, Rajiv Gandhi Education City, Sonipat, Haryana 131029, India.,Psychiatry, Carney Institute for Brain Sciences, Brown University, 164 Angell Street, 4th Floor, Providence, RI 02906, USA
| | - Ravindra Rao
- Additional Professor, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
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Shouan A, Ghosh A, Singh SM, Basu D, Mattoo SK. Predictors of retention in the treatment for opioid dependence: A prospective, observational study from India. Indian J Psychiatry 2021; 63:355-365. [PMID: 34456348 PMCID: PMC8363890 DOI: 10.4103/psychiatry.indianjpsychiatry_448_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 04/14/2021] [Accepted: 06/17/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Literature on a longitudinal study of the determinants of treatment retention for patients with opioid dependence is limited. AIM To find out patient- and treatment-related (buprenorphine-naloxone-assisted treatment [BNX treatment] versus naltrexone treatment) predictors for retention in maintenance treatment. MATERIALS AND METHODS A total of 100 participants with opioid dependence were recruited by convenience sampling. The primary outcome was treatment retention - 3 months and 6 months postentry into maintenance treatment. Multiple assessments were done for the severity of opioid dependence and withdrawal, high-risk behavior, quality of life, and recovery capital - baseline and 3 and 6 months. The secondary outcome was to assess the change observed in the above-listed variables. RESULTS AND CONCLUSIONS Bivariate analysis across retained and the dropout groups brought out significant differences for some (type of opioids and route of administration) but not for other (age, employment, and education) patient-related factors. Multivariate analysis, adjusting for the type of maintenance treatment, rendered these associations statistically insignificant. BNX-based treatment (compared to naltrexone maintenance) was the most significant predictor of treatment retention both at the end of 3 months and 6 months. Even after controlling for the severity of opioid dependence and withdrawal, type and route of opioid use, and high-risk behavior, patients on BNX were eleven times (14 times at the end of 6 months) more likely to be retained in the treatment. BNX group had significant improvements in the domains of recovery capital, quality of life, addiction severity, and severity of opioid dependence. There is a need to scale up the BNX-assisted treatment program in India and elsewhere.
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Affiliation(s)
- Anish Shouan
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Abhishek Ghosh
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shubh Mohan Singh
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Debasish Basu
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surendra Kumar Mattoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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18
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Rao R, Yadav D, Bhad R, Rajhans P. Mobile methadone dispensing in Delhi, India: implementation research. Bull World Health Organ 2021; 99:422-428. [PMID: 34108752 PMCID: PMC8164184 DOI: 10.2471/blt.20.251983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To assess the implementation of a mobile dispensing service to improve opioid users’ access to methadone maintenance therapy. Methods In March 2019, we started mobile methadone dispensing in an urban underprivileged locality in Delhi, India. The doctor was available only at the main community drug treatment clinic for clinical services, while the nurse dispensed methadone from a converted ambulance. We involved patients in identifying community leaders for sensitization and in deciding the location and timings for dispensing. We conducted a retrospective chart review of the programme data collected during delivery of clinical services. We compared the numbers of patients registered for methadone therapy and their retention and adherence to therapy in the 12-month periods before and after implementation of the mobile service. Findings The number of patients registered for therapy at the clinic increased from 167 in the year before implementation to 671 in the year after. A significantly higher proportion of patients were retained in therapy at 3, 6 and 9 months after enrolment; 9-month retention rates were 19% (32/167 patients) and 45% (44/97 patients) in the year before and after implementation, respectively. There was no significant difference in patients’ adherence to therapy between the two periods. Challenges included providing suitable dispensing hours for patients in employment and concerns of local community near to the dispensing sites. Conclusion It is feasible to dispense methadone by a mobile team in an urban setting, with better retention rates in therapy compared with dispensing through a stationary clinic.
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Affiliation(s)
- Ravindra Rao
- National Drug Dependence Treatment Centre, Department of Psychiatry, 4th Floor, Teaching Block, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Deepak Yadav
- National Drug Dependence Treatment Centre, Department of Psychiatry, 4th Floor, Teaching Block, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Roshan Bhad
- National Drug Dependence Treatment Centre, Department of Psychiatry, 4th Floor, Teaching Block, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Pallavi Rajhans
- National Drug Dependence Treatment Centre, Department of Psychiatry, 4th Floor, Teaching Block, All India Institute of Medical Sciences, New Delhi 110029, India
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Basu D, Mahintamini T, Ghosh A, Roub F, Subodh BN, Mattoo SK, Avasthi A. Tapentadol, the new kid on the block in India: Is it time to worry? Indian J Psychiatry 2020; 62:697-702. [PMID: 33896976 PMCID: PMC8052882 DOI: 10.4103/psychiatry.indianjpsychiatry_332_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/24/2020] [Accepted: 08/13/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Large-scale prospective case series of tapentadol abuse or dependence in India is not available. Hence, we aimed to study the prevalence and profile of tapentadol users in a treatment-seeking population. MATERIALS AND METHODS The study had prospective and retrospective arms. We collected 8-month prospective data by face-to-face interviews (n = 70) and 8-year retrospective data from case notes (n = 26) with either tapentadol misuse/abuse or dependence in patients attending a de-addiction center. RESULTS The prevalence of tapentadol abuse or dependence was 25% among the pharmaceutical opioid users. Concurrent use of other opioids was seen in >80% of participants of both the arms. Major sources of tapentadol were chemists (without a prescription) (53%) and doctors (prescriptions) (40%). Patients in the tapentadol dependence group had a significantly higher dose, duration, and pharmaceutical opioid use. CONCLUSION India needs awareness promotion, training, availability restriction, and provision of treatment for tapentadol abuse or dependence.
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Affiliation(s)
- Debasish Basu
- Department of Psychiatry, Drug De-Addiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tathagata Mahintamini
- Department of Psychiatry, Drug De-Addiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Abhishek Ghosh
- Department of Psychiatry, Drug De-Addiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Fazle Roub
- Department of Psychiatry, Drug De-Addiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - B N Subodh
- Department of Psychiatry, Drug De-Addiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S K Mattoo
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Parmar A, Rina K, Padhy SK. COVID-19 Pandemic and People Who Use Opioids in India: Opportunities and Evolutions. Indian J Psychol Med 2020; 42:566-568. [PMID: 33354084 PMCID: PMC7735229 DOI: 10.1177/0253717620965882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Arpit Parmar
- Dept. of Psychiatry and Drug De-Addiction and Treatment Centre, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Kumari Rina
- Dept. of Psychiatry and Drug De-Addiction and Treatment Centre, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Susanta Kumar Padhy
- Dept. of Psychiatry and Drug De-Addiction and Treatment Centre, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Kermode M, Choudhurimayum RS, Rajkumar LS, Haregu T, Armstrong G. Retention and outcomes for clients attending a methadone clinic in a resource-constrained setting: a mixed methods prospective cohort study in Imphal, Northeast India. Harm Reduct J 2020; 17:68. [PMID: 32993646 PMCID: PMC7523306 DOI: 10.1186/s12954-020-00413-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 09/10/2020] [Indexed: 11/22/2022] Open
Abstract
Background Opioid substitution therapy (OST) with buprenorphine has been widely available in India since 2007, but the introduction of methadone occurred much later in 2012, and availability remains limited. Illicit injecting drug use is a long-standing public health problem in Manipur, a state in Northeast India characterised by major resource constraints and political unrest. We investigated retention and outcomes for clients attending a methadone-based OST program in Manipur with the aim of strengthening the evidence base for development of relevant policies and programs. Methods All clients enrolling in the methadone clinic over a 1 year period were invited to be part of a prospective cohort study, which followed up and surveyed both retained and defaulting clients for 12 months post-enrollment to assess retention as well as social, behavioural and mental health outcomes. Additionally, we conducted semi-structured qualitative interviews to supplement quantitative information and identify factors contributing to retention and drop-out. Results Of the 74 clients enrolled, 21 had dropped out and three had died (all defaulters) by 12 months post-enrollment, leaving 67.6% still in the program. Using an intention-to-treat analysis, meaningful and statistically significant gains were observed for all social, behavioural and mental health variables. Between baseline and 12 months there were reductions in needle sharing, drug use, property crime, anxiety, depression and suicidal thoughts; and improvements in physical health, mental health, quality of family relationships, employment and hopefulness. Factors contributing to retention and drop-out were identified, including the centrality of family, and general lack of awareness of and misunderstanding about methadone. Conclusion Even in parts of India where resources are constrained, methadone is an effective treatment for opioid dependence. Scaling up the availability of methadone elsewhere in Manipur and in other areas of India experiencing problematic opioid dependence is indicated.
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Affiliation(s)
- Michelle Kermode
- Nossal Institute for Global Health, University of Melbourne, Level 5/333 Exhibition St, Melbourne, VIC, 3010, Australia.
| | | | - Lenin Singh Rajkumar
- Department of Psychiatry, Regional Institute of Medical Science, Imphal, Manipur, India
| | - Tilahun Haregu
- Nossal Institute for Global Health, University of Melbourne, Level 5/333 Exhibition St, Melbourne, VIC, 3010, Australia
| | - Greg Armstrong
- Nossal Institute for Global Health, University of Melbourne, Level 5/333 Exhibition St, Melbourne, VIC, 3010, Australia
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Rao R, Kedia Gupta S, Swaminathan P, Gupta V, Dhawan A, Agrawal A, Ambekar A. Predictors of long-term retention on opioid agonist treatment with buprenorphine: a 6-year, community-based retrospective cohort study in India. JOURNAL OF SUBSTANCE USE 2020. [DOI: 10.1080/14659891.2020.1736666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Ravindra Rao
- National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Swati Kedia Gupta
- National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
- Department of Psychology, Holy Family Hospital, New Delhi, India
| | - Prashanth Swaminathan
- National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
- Department of Psychiatry, SUNY Downstate Medical Center, New York, New York, USA
| | - Vivek Gupta
- National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Anju Dhawan
- National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Agrawal
- National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Ambekar
- National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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Sarkar S, Thakur A, Sood E, Mandal P. Barriers and Facilitators of Addiction Treatment: a Qualitative Study. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00394-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Pahuja E, Kumar S, Kumar A, Uzzafar F, Sarkar S, Manjunatha N, Balhara YPS, Kumar CN, Math SB. Collaborative Video Consultations from Tertiary Care Based Telepsychiatrist to a Remote Primary Care Doctor to Manage Opioid Substitution Therapy Clinic. J Neurosci Rural Pract 2020; 11:498-501. [PMID: 32753823 PMCID: PMC7394635 DOI: 10.1055/s-0040-1713293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Opioid use is a major problem in India and has high morbidity and mortality with a prevalence of 2.06%. There is a huge treatment gap for opioid use disorders (OUDs). Due to limited mental health resources and limited psychiatric training of medical practitioners in OUDs, a significant proportion of patients do not receive appropriate medical intervention. This article demonstrates how a primary care doctor working in a remote opioid substitution therapy (OST) clinic received assistance from the optional opioid module of clinical schedule for primary care psychiatry (CSP) and collaborative video consultation (CVC) module to address specific difficulties of patients already on Buprenorphine OST and improve the quality of care, thereby reducing chances of relapses. CVC module is a part of one-year digitally driven primary care psychiatry program designed by National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru. The opioid module was designed by NIMHANS, Bengaluru in collaboration with the All India Institute of Medical Sciences (AIIMS), New Delhi These observations warrant replication of this approach across diverse settings and at a larger scale to explore and evaluate its impact and effectiveness.
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Affiliation(s)
- Erika Pahuja
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Santosh Kumar
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Ajay Kumar
- District Hospital, Haridwar, Uttarakhand, India
| | - Fareed Uzzafar
- Non Communicable Disease Cell, National Health Mission,Uttarakhand, India
| | - Siddharth Sarkar
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Narayana Manjunatha
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - C Naveen Kumar
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Suresh Bada Math
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Mattoo SK, Ghosh A, Subodh BN, Basu D, Satapathy A, Prasad S, Sharma MP. Sexual dysfunction in men on buprenorphine - naloxone-based substitution therapy. Indian J Psychiatry 2020; 62:66-72. [PMID: 32001933 PMCID: PMC6964450 DOI: 10.4103/psychiatry.indianjpsychiatry_195_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 10/06/2019] [Accepted: 12/05/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The literature on sexual dysfunction in patients on buprenorphine-naloxone (BNX) substitution is limited. MATERIALS AND METHODS This research aimed to study the prevalence and correlates of sexual dysfunction in men on BNX substitution therapy. We recruited consecutive forty men from BNX clinic, who had received BNX for at least 6 months, who were free from any recent illicit drug use (confirmed by urine chromatographic immune assay), and who were either married or had a stable sexual partner. Men with other psychiatric and substance use disorders (except tobacco) were excluded from the study. Data for the control group were obtained from a published study (with similar selection criteria) from our center. We assessed sexual dysfunction with two cross-culturally validated instruments: Arizona Sexual Experience Scale (ASEX) and International Index of Erectile Function. RESULTS The sample had a mean age of 31.6 (±8) years; the mean duration of BNX treatment was 9 (±4.2) months and the mean BNX dose was 4.5 (±1.6) mg. ASEX showed the prevalence of sexual dysfunction to be 40%. The IIEF demonstrated intercourse dissatisfaction (95%) and hypoactive sexual desire (92.5%) as almost universal, while 77.5% of the participants reported erectile dysfunction. In comparison to the published data, these figures were significantly more than among the controls. We found no correlation of sexual dysfunction with marital status, age, duration or dose of BNX, duration of illicit opioid use, the severity of opioid dependence, and tobacco dependence. CONCLUSION All men on BNX maintenance therapy must be screened for sexual dysfunction. With the rapid scaling up of office-based BNX substitution, assessment and management of sexual dysfunction ought to be incorporated in the training curriculum.
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Affiliation(s)
- Surendra K Mattoo
- Department of Psychiatry, Drug De-Addiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, Odisha, India
| | - Abhishek Ghosh
- Department of Psychiatry, Drug De-Addiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, Odisha, India
| | - B N Subodh
- Department of Psychiatry, Drug De-Addiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, Odisha, India
| | - Debasish Basu
- Department of Psychiatry, Drug De-Addiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, Odisha, India
| | - Ashirbad Satapathy
- Department of Psychiatry, Government Medical College, Balangir, Odisha, India
| | - Sambhu Prasad
- Department of Psychiatry, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Mahendra Prakash Sharma
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, Odisha, India
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Tikka SK, Singh LK, Mamidipalli SS, Purushotham A, Suchandra KHH. Buprenorphine/naloxone maintenance for "poppy husk" dependence: A retrospective study. Asia Pac Psychiatry 2019; 11:e12358. [PMID: 31050193 DOI: 10.1111/appy.12358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/02/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Despite a significant number of patients dependent on "poppy husk" in India, they are poorly characterized. Moreover, scarce data is available with respect to their treatment. METHODS A cohort of 148 patients with "poppy husk" dependence receiving substitution treatment with buprenorphine/naloxone were followed up for 4 years, using a retrospective chart-based assessment. Baseline demographic and substance-related characteristics were described. Retention rates (operationally redefined as "6 months of uninterrupted contact anytime during their visits") over the next 4 years and their predictors were assessed. RESULTS Mean age of onset of "poppy husk" use was found to be 27.51 years, and mean duration of dependence was 18.25 years. Mean amount of poppy husk consumed per month was 3.7 kg. Commonest reasons for initiating and quitting its use were enhancing work efficiency and lack of availability, respectively. Retention rates were 25%. Significant predictors of retention were age more than 40 years (OR = 2.295; 95%CI = 1.015-5.19) and uninterrupted treatment duration for at least 1 month from first contact (for 1 month (OR = 5.625; 95%CI = 2.28-13.89), for 3 months (OR = 10.96; 95%CI = 4.65-25.85), and for 6 months (OR = 52.8; 95%CI:14.08-197.98). DISCUSSION Factors associated with occupation such as enhancing work efficiency and overcoming fatigue are related to use of "poppy husk." While the amount of intake is considerably large among treatment seekers who are dependent on it, their dependence duration is longer and retention rates lower than those reported for patients with prescription and injectable opioid dependence. Specific strategies to tap patients less than 40 years and to target uninterrupted contact in initial phases of maintenance should be developed.
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Affiliation(s)
- Sai Krishna Tikka
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Raipur, India
| | - Lokesh Kumar Singh
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Raipur, India
| | | | | | - K Hari Hara Suchandra
- Acute Care and Emergency Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
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Does Cannabis Use Influence Opioid Outcomes and Quality of Life Among Buprenorphine Maintained Patients? A Cross-sectional, Comparative Study. J Addict Med 2019. [PMID: 29543612 DOI: 10.1097/adm.0000000000000406] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Use of various psychoactive substances can influence outcomes of patients on opioid agonist treatment (OAT). While use of alcohol and cocaine has shown to adversely affect OAT results, associated cannabis use shows mixed results. This study aimed to assess the pattern of cannabis use among opioid-dependent patients maintained on buprenorphine. Additionally, the study compared the dose of buprenorphine, opioid-related craving and withdrawals, productivity, and also quality of life between those with and without recent (past 90-day) cannabis use. METHODS We collected data on demographic and drug use details in 100 randomly selected adult male patients attending a community drug treatment clinic, who were stabilized on buprenorphine for more than 3 months. Other measures included scores on World Health Organization (WHO)-Alcohol, Smoking and Substance Involvement Screening Tool and WHO-Quality of Life-Brief (WHOQOL-Bref) version. RESULTS The average duration of maintenance treatment with buprenorphine was 96 months, with excellent compliance for buprenorphine (86.92 ± 9.58 days in 90 days). Thirty-five per cent had used cannabis in past 90 days, with lifetime use of cannabis in 77%. Participants using cannabis currently were on lower doses of buprenorphine (mean dose per day: 7.9 mg vs 8.9 mg; P = 0.04). Yet, there was no significant difference in the rates of opioid use or opioid withdrawals and craving between the 2 groups. Compliance to OAT, number of days of employment, daily earning, and WHOQOL-Bref scores in all domains were comparable between those with and without cannabis use. Duration of cannabis use, current use of alcohol, and dose of buprenorphine predicted current cannabis use in multivariable logistic regression analysis. CONCLUSIONS Cannabis use does not negatively influence opioid outcomes among patients receiving buprenorphine maintenance treatment. There is no difference in productivity and quality of life between individuals maintained on buprenorphine with and without current cannabis use.
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Abstract
Opioid use disorder affects over 26 million individuals worldwide. There are currently three World Health Organization-recommended and US Food and Drug Administration-approved medication treatments for opioid use disorder: the full opioid agonist methadone, the opioid partial agonist buprenorphine, and the opioid receptor antagonist naltrexone. We provide a review of the use of buprenorphine for the treatment of opioid use disorder and discuss the barriers, challenges, risks, and efficacy of buprenorphine treatment vs. other treatments. Although evidence from numerous studies has shown buprenorphine to be effective for the treatment of opioid use disorder, a majority of patients with opioid use disorder do not receive buprenorphine, or any other medical treatment. We review the different formulations of buprenorphine, including newer long-acting injectable formulations that may decrease the risk of diversion and improve adherence.
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"They don't like us….": Barriers to antiretroviral and opioid substitution therapy among homeless HIV positive people who inject drugs in Delhi: A mixed method study. PLoS One 2018; 13:e0203262. [PMID: 30161255 PMCID: PMC6117039 DOI: 10.1371/journal.pone.0203262] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 08/19/2018] [Indexed: 12/02/2022] Open
Abstract
Background Provision of Anti-Retroviral Therapy (ART) and Opioid Substitution Therapy (OST) are important components of the targeted intervention (TI) programme for people who inject drugs (PWID). Homeless HIV positive PWIDs in Delhi is a key population experiencing gaps in uptake of these services, especially the ART uptake which is reportedly far from 90%, UNAIDS’ 90-90-90 target to end the AIDS epidemic. Objective To assess the gaps and barriers in accessing the ART and OST services uptake among HIV positive homeless PWID in Delhi and to explore experiences and perspectives of the PWIDs and service providers. Methodology We used a convergent parallel mixed methods design which included a cross-sectional quantitative survey and a qualitative study. Two hundred thirty five homeless HIV positive PWID were interviewed and in-depth interviews were conducted with five PWIDs and nine health providers. Results While only 12% of PWIDs were on ART, 80% were availing OST services. The top individual, health system related and structural barriers for ART service access were insufficient and incorrect knowledge (63%), long waiting time (86%) and lack of family support (44%) respectively. Inconvenient timings, stringent registration requirements and negative attitude of health providers were expressed as major barriers of accessing ART services during the interviews while these were not a concern in OST services. Homelessness, poverty, stigma were common barriers for both services. Integrated, ‘single window’ service and provision of additional support like nutrition and shelter were suggested as measures to improve access by both health providers and the PWIDs themselves. Conclusion There is an urgent need for structural and health systems changes to improve access to ART and OST services. These include integrated service delivery, flexibility in timing of the centers, accelerated ART initiation, simplification of bureaucratic procedures, nutritional and social support to all homeless HIV positive PWIDs.
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Abstract
Drug dependence syndrome is a medical condition classified as a multifactorial health disorder that often follows the course of a relapsing and remitting chronic disease. Opioid substitution therapy (OST) is one of the established standard treatments for opioid dependence syndrome. OST, a process in which opioid-dependent injecting drug users, is provided with long-acting opioid agonist medications for a long period under medical supervision along with psychosocial interventions. OST service provider may have to deal with issues of license/registration/recognition/permission under various legislations such as the Drugs and Cosmetic Act, 1940; Narcotic Drugs and Psychotropic Substances Act, 1985; Rights of person with disability Act, 2016 and Mental Healthcare Act, 2017 depending on the drug prescribed, type of services provided, procuring, transportation, storage, and prescribing these narcotics and psychotropic medicines. The narcotics and psychotropic drugs are administered through various ministries and departments causing huge confusion, lack of coordination, overlapping roles and responsibilities, and various laws/rules and gives an opportunity for the abdication of the responsibilities. The "public mental health issue," where the number of opioid users in the country is approximately two million and opioid dependence syndrome is approximately 0.5 million. The number of beds in the public governed deaddiction centers is abysmally low, number of psychiatrist, or trained medical practitioners in OST are also few in number to face this humongous challenge. Against this background, this article focuses on the legal issues surrounding the OST.
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Affiliation(s)
| | | | - Naveen C Kumar
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
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Ambekar A, Rao R, Agrawal A, Kathiresan P. Research on opioid substitution therapy in India: A brief, narrative review. Indian J Psychiatry 2018; 60:265-270. [PMID: 30405250 PMCID: PMC6201667 DOI: 10.4103/psychiatry.indianjpsychiatry_385_18] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Opioid dependence is a significant clinical and public health issue in India. Opioid substitution therapy (OST) is the most evidence-based treatment for opioid dependence. Although available in India for about three decades now, Indian research on this treatment modality has not been adequately reviewed so far. We conducted a narrative review of Indian research on OST. We conducted an online search for relevant literature in the peer-reviewed journals as well as the general online search for books and monographs. We present the findings of the review in the form of description of literature according to certain identified themes. Considering that methadone has became available in India, only recently, the Indian research on OST predominantly features buprenorphine as the agent. Effectiveness of OST among Indian opioid-dependent patients has been well established through prospective, experimental designs as well as through naturalistic studies using retrospective, chart-review approach. Naturalistic and observational postmarketing surveillance studies have demonstrated the safety of buprenorphine and methadone when used as OST. There are certain areas in which more research on OST will be beneficial for Indian clinicians as well as policy-makers. However, the quantum of evidence base that exists in India is more than adequate to justify the scale-up of this modality of treatment. A conducive policy environment for scaling-up OST is need of the hour.
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Affiliation(s)
- Atul Ambekar
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra Rao
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Agrawal
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Preethy Kathiresan
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
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Ghosh A, Basu D, Avasthi A. Buprenorphine-based opioid substitution therapy in India: A few observations, thoughts, and opinions. Indian J Psychiatry 2018; 60:361-366. [PMID: 30405267 PMCID: PMC6201663 DOI: 10.4103/psychiatry.indianjpsychiatry_218_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The most evidence-based treatment for opioid dependence is opioid agonist maintenance treatment also known as opioid substitution therapy (OST). However, there are some critical, yet unaddressed issues of buprenorphine-based substitution therapy, especially in the Indian context. These comprise of generalizability of the evidence for OST, especially for natural and pharmaceutical opioids and for all age groups, optimum dose and duration of OST, and mode of treatment delivery including the frequency of dispensing. Notwithstanding the use of buprenorphine-naloxone combination, abuse and diversion are serious but often underreported problems. There is an urgent need for health services research in India on OST, focusing on these aspects. Rather than directly copying from Western models, it is important to try to understand the useful and safe program and policy options likely to be applicable in the Indian setting, with our own assets as well as vulnerabilities.
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Affiliation(s)
- Abhishek Ghosh
- Department of Psychiatry, Drug De-Addiction and Treatment Centre, PGIMER, Chandigarh, India
| | - Debasish Basu
- Department of Psychiatry, Drug De-Addiction and Treatment Centre, PGIMER, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, PGIMER, Chandigarh, India
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Viswanath V, Palat G, Chary S, Broderick A. Challenges of Using Methadone in the Indian Pain and Palliative Care Practice. Indian J Palliat Care 2018; 24:S30-S35. [PMID: 29497252 PMCID: PMC5806303 DOI: 10.4103/ijpc.ijpc_168_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Palliative care providers across India lobbied to gain access to methadone for pain relief and this has finally been achieved. Palliative care activists will count on the numerous strengths for introducing methadone in India, including the various national and state government initiatives that have been introduced recognizing the importance of palliative care as a specialty in addition to improving opioid accessibility and training. Adding to the support are the Non-Governmental Organizations (NGOs), the medical fraternity and the international interactive and innovative programs such as the Project Extension for Community Health Outcome. As compelling as the need for methadone is, many challenges await. This article outlines the challenges of procuring methadone and also discusses the challenges specific to methadone. Balancing the availability and diversion in a setting of opioid phobia, implementing the amended laws to improve availability and accessibility in a country with diverse health-care practices are the major challenges in implementing methadone for relief of pain. The unique pharmacology of the drug requires meticulous patient selection, vigilant monitoring, and excellent communication and collaboration with a multidisciplinary team and caregivers. The psychological acceptance of the patient, the professional training of the team and the place where care is provided are also challenges which need to be overcome. These challenges could well be the catalyst for a more diligent and vigilant approach to opioid prescribing practices. Start low, go slow could well be the way forward with caregiver education to prescribe methadone safely in the Indian palliative care setting.
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Affiliation(s)
- Vidya Viswanath
- Department of Palliative Care, Homi Bhabha Cancer Hospital and Research Centre, A Unit of Tata Memorial Centre, Visakhapatnam, Andhra Pradesh, India
| | - Gayatri Palat
- Consultant, Pain and Palliative Medicine, MNJ Institute of Oncology and RCC, Hyderabad, India
| | - Srini Chary
- Department of Oncology and Family Medicine, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
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