OST, a boon or a disadvantage
- Hueiyen Lanpao Editorial :: December 10 2011 -

Ningombam Pramod from the desk

Oral Substitution Therapy (OST) is a means to give the injecting drug users (IDUs) a medically safe, long acting agonist licit medication. It is to be 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 at present.

In Manipur OST programme was taken up by the Emmanual Hospital Association (EHA) under its project named as Project Orchid. The project was implemented by various NGO's including SASO, MNP+, Care Foundation and DPU. In Manipur, Buprenorphine is being administered to IDUs who are on OST.

The OST programme is reported to be effective to a large extent according to the NGOs who carry out this programme. They are of the opinion, and which is in fact a reality, that OST results in significant harm minimization to the IDU, thereby reducing the risk of transmission of HIV, hep-c 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.

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. 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.

In fact Buprenorphine and Methadone, according to the Five Cochrane reviews on Substitution treatment have proved to be 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 in reducing high risk behaviour, risk of HIV infection, improving physical and mental health, reducing mortality, improving psychosocial functioning, reducing criminality and improving employment status. Overall, it stabilizes and normalizes the lives of drug users.

Considering all these advantages of OST, the state government has officially launched the OST programme in government sectors on the occasion of the World AIDS Day-2011 held at 1st Manipur Rifles. The approach of the government seems to be right at this point, considering all the feedbacks obtained from the various NGO's implementing the OST programme.

But the worst part, which is in fact the ugly truth, is that majority of the IDUs who are dependent on Heroin, locally known as number 4, who are registered on OST, can hardly abstain from the drug and recover totally. The reason being that almost all the IDUs coming to get themselves treated on OST, comes only when they have no money to buy Heroin.

The Buprenorphine acts as a substitute to fill the gap. Once they have enough money to buy Heroin, they abstain from Buprenorphine. There are even some who are taking both the drugs simultaneously, as they give them more kick, compelling them to be dependent on both the drugs and making them a multi drug user.

Looking at this side of the story, the government should come up with a specific policy to monitor the programme on OST. The only problem with Buprenorphine is that there is no mechanism to monitor it and as a result, there is high possibility of IDUs becoming multi drug users.

The oral substitution therapy has proved to be highly successful in other western countries like the USA and Australia because these countries have that monitoring mechanism to identify the use of multi drugs by an IDU. If we are to follow the west, then, we should also leave no stone unturned.

The government should realize that Buprenorphine is a safe medications when used appropriately under medical prescription and dispensed by trained nurses or pharmacists after imparting adequate training to the staff, which, under normal circumstances is hardly practiced in the state so far.

If we are to adopt the OST, lets not make it a disadvantage for the IDUs but rather make it a boon for them as is seen elsewhere in the western world.