Today, 10 th October, is World Mental Health Day and this year's theme is dedicated to "Investing in mental health". In light of this, our story draws attention to opioid dependence as a complex health condition that requires long term treatment. It also highlights that Opioid Substitution Therapy (OST) can help in the treatment and rehabilitation of individuals who are opioid dependents.

South Asia: Opioid Substitution Therapy - mapping the way forward

The harmful use of psychoactive substances, or simply 'drugs', leads to a number of physical and psychosocial problems in an individual's life. The repeated use of drugs can lead to a 'dependence' syndrome, commonly referred to as 'addiction'. According to the World Drug Report 2011, the third most widely used group of substances globally, after cannabis and amphetamine type stimulants (ATS), are opioids [1], with estimates ranging from 24 to 35 million people, equivalent to a prevalence rate of 0.5% - 0.8% of the population aged 15 - 64. Commonly known opioids include morphine, codeine, heroin, buprenorphine etc. The most problematic opioids at the global level, as reflected in treatment demand, are the opiates, i.e. the various psychoactive substances derived from the opium poppy plant, notably opium and heroin [2].

Opioid dependence has severe consequences on the drug using individual and society, resulting in unemployment, homelessness, family disruption, loss of economic productivity, social instability and crime. Injection of opioids leads to increased risk of blood borne infections such as HIV and hepatitis B and C. Hence, drug dependence treatment is vital to improve well-being and social functioning of people with opioid dependence. As with other health conditions such as hypertension, diabetes and heart disease, people with opioid dependence can stabilize their condition through appropriate use of medication and psychosocial support.

In this context, Opioid Substitution Treatment (OST) has proven effective to treat opioid dependence and prevent transmission of HIV - in terms of retention in treatment, reduction of drug use, improvement of psychological and social functioning, and reduction of high risk injecting and sexual behaviors. OST involves the administration of an opioid medication (like methadone or buprenorphine) to an opioid dependent drug user under medical supervision, along with psychosocial support, which helps the client in weaning off drugs. In case of opioid dependent individuals who are already living with HIV, OST contributes to minimize the risk of further transmission of the virus and stabilizes their condition.

In South Asia, UNODC works with governments, civil society partners, bilateral/multilateral agencies and other stakeholders to include OST in the national response for treatment of/ HIV prevention amongst drug users. UNODC is supporting the implementation of OST interventions in most South Asian countries, using both buprenorphine and methadone as medicines for substitution treatment, and in line with the existing legal and policy frameworks of the countries. The purpose of the OST interventions supported by UNODC in the region is:

  • To test the effectiveness of methadone/buprenorphine as a medication for long term treatment of opioid dependence
  • To study the feasibility of implementing OST and develop action plans for rolling out  the same on a long term basis
  • To develop practice guidelines, and
  • To build capacities of service providers for OST implementation and scale-up

To further augment these efforts and consolidate the experiences from OST interventions across South Asia, the World Bank in partnership with UNODC, organized a regional OST workshop from September 7 to 9, 2011 in the Maldives. The workshop was well timed, since most countries in the regional have been recently reviewing their national AIDS programmes, including possible scale-up plans of OST. Most countries are currently at advanced stages of implementing pilot OST interventions, which aim at creating the evidence base for scaling up OST in countries.

The objectives of the workshop included:

  • Identifying factors that contribute to effective and sustainable OST programs
  • Increasing understanding about the importance of design and impact evaluation of OST programs and raising commitment to increase and improve monitoring & evaluation of OST programs, and
  • Increasing country commitment to scale up best practices to raise the coverage of OST as an integral component of comprehensive harm reduction

The workshop brought together key stakeholders from the countries of Afghanistan, Bangladesh, India, Maldives, Nepal and Pakistan including government representatives (i.e. ministries of health and home affairs/drug control), technical experts, NGOs and development partners involved with the implementation of  OST programmes in their respective country. The participants were able to learn from each other's experiences and draw lessons from across the region. At the end of the workshop, stakeholders acknowledged the usefulness of such an event, which for many was the first of its kind. Each country delegation also agreed upon a 100 - day action plan with the next steps to be taken for further scale-up of OST in their respective home country.

Click here to see the Lessons learned from the Opioid Substitution Therapy (OST) Workshop in the Maldives on the World Bank website

Click here to read WHO/UNODC/UNAIDS position paper on Opioid Substitution Therapy

Click here to read Opioid Substitution - Buprenorphine in India, a study report

[1] Opioid is a generic term applied to alkaloids from opium poppy, their synthetic analogues, and compounds synthesized in the body. In general, a distinction is made between 'opiates' (that is, the various products derived from the opium poppy plant) and synthetic opioids.