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| UNODC is cosponsor of the Joint United Nations Programme on HIV/AIDS - UNAIDS |
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UNODC's Response for Prevention of HIV Among Drug Users in South Asia Through Opioid Substitution Treatment (OST)
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Concepts of Opioid Substitution Treatment (OST)
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Effects of drug use: Drug use leads to substantial impairment in functioning, high risk behaviour, involvement in illegal activities and is a burden to family as well as an economic loss to society.
What is OST: OST substitutes an illicit drug with a medically safe, long acting agonist licit medication. It is prescribed by a medical doctor and administered under the supervision of a trained nurse or pharmacist. Methadone and Buprenorphine are the most well studied medications used for Oral Substitution Treatment.
Why do Opioid Substitution: The nature of drug dependence is such that it is a 'relapsing medical condition' and abstinence based approaches alone are unable to help the majority of drug users. OST results in significant harm minimization to the IDU, thereby reducing the risk of transmission of HIV and other blood borne viruses. For certain injecting drug users, abstinence can be achieved, if they are self-motivated to do so, by tapering of medication gradually through consultations between the doctor and the client.
How OST works: It results in elimination of craving for the illicit drug. In addition, it blocks the effect of illicit opiate drugs if used by the drug user while he/she is on OST, thereby gradually leading to total abstinence and recovery.
Effectiveness of OST: Five Cochrane reviews on substitution treatment (Clark et al, 2003; Faggiano et al, 2003; Ferri et al, 2003; Mattick, Breen et al, 2003; Mattick, Kimber et al, 2003), which include 52 studies with a total of 12,075 participants have been conducted so far. These examined maintenance treatments on both buprenorphine and methadone, besides other maintenance medications. These have been carried out using rigourous research methodology in USA, Australia, Netherlands, Switzerland, Italy, UK, Austria, China, Thailand, Spain and Sweden.
Overall, these reviews indicate that Buprenorphine and Methadone were effective in retaining patients in treatment and were effective in reducing heroin use among drug users.
OST is known to be effective in not only reducing illicit drug use but also has the following outcomes:
- Reduced high risk behaviour, risk of HIV infection
- Improved physical and mental health
- Reduced mortality
- Improved psychosocial functioning
- Reduced criminality
- Improved employment status
Overall, it stabilizes and normalizes the lives of drug users.
Safety: Buprenorphine and methadone are safe medications when used appropriately under medical prescription and dispensed by trained nurses or pharmacists after imparting adequate training to the staff. |
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