Re: The NACO Oral Substitute Program of North East India

[Guest guest]

Dear Forum

/message/10891

The issue raised by Mike Tonsing is very relevant and important.

In our experience of last one decade or so with OST, we have seen that

providing just the medication (i.e. buprenorphine) as treatment and

overlooking rehabilitation does not work. A healthy mix of psychosocial

interventions along with regular follow-up and dispensing buprenorphine is

essential for a successful recovery.

Additionally, it must be remembered that an adequate duration of treatment is

very important. With a few weeks of stabilization on maintenance dose of

buprenorphine the drug use behavior starts improving however improvement in

social and occupational spheres of life takes much longer.

Thus even six-month duration of OST will not be enough for most clients. In fact

a majority of clients would require OST for at least a year or more.

The issue of " what after OST " is a tricky one. The practice guidelines of NACO

on OST

(http://nacoonline.org/upload/Publication/NGOs%20and%20targetted%20Intervations/\

Bupenorphine_%20Practice_Guidelines.pdf)

do mention that sudden stoppage of buprenorphine is not desirable and may lead

to uncomfortable withdrawals. In fact the decisions - whether to taper, and if

yes, how to taper - should be jointly taken by the doctor and the patient.

I agree with Mike Tonsing's view that a linkage of TIs who are doing OST with

drug treatment centres would be a good idea. A few willing clients can then be

referred and provided help in rehabilitation after OST.

--

Dr. Atul Ambekar, M.D.

Assistant Professor

National Drug Dependence Treatment Centre and Department of Psychiatry

All India Institute of Medical Sciences,

Ansari Nagar,

New Delhi

India - 110029

Phone (O): 91-11-26593236

Phone ®: 91-11-26105757

Mobile: (+91) 9811155682

Fax: 91-11-26588641, 91-11-26588663

Email: atul.ambekar@...

Website:

http://www.aiims.edu/aiims/departments/spcenter/nddtc/nddc_intro.htm

[Guest guest]

Dear FORUM,

/message/10891

This is in response to Mike Tonsing message and suggestion regarding Oral

Substitution Therapy in Churachandpur.It is very unfortunate that such incident

happens to OST client.

In fact, OST is the thought to be the best means for substitution of drug

addiction but it could be very fatal if one mix it with other opiatic drugs.

Also, if OST is stopped without minimizing the dose, one could suffer the

withdrawal symptoms after two-three days, and that person go back to drug using,

especially Heroin No,4, the chance of over-dose is very high.

So, therefore, the best means of stopping the whole OST treatment is dose

minimization or taking it lifetime at the minimum dose possible.

If NACO could introduce such a long-term treatment (not therapy) process, it

could well be the stepping stones to whole recovery of any addict.

However, in the light of the present situationin Churachandpur, OST program is

best implement under direct observation treatment process, it may not be

commendable to follow the model they use in Australia or China, that is making

it available in the pharmacies.

However, it would be best for drug addiction treatment, especially substitution,

if OST could be found in the pharmacies and client able to maintain one dose. It

all depends on one's attitude and mental strength.

For this, it may take another 4-5 years for the Churachandpurian to be able to

adjust with the lifestyles like in Australia or China or the US.

AS a whole, OST however is very good for the time being, that is if one use it

according to the guidelines.

With best regards:

ph Joute, Counselor.

SAHARA Churachandpur.

e-mail: <josephjoute39@...>