India:  Saving lives through drug overdose management

Drug overdose is a growing public health concern. Among injecting drug users who use opioids, overdose and associated death call for urgent action. In India's north-eastern state of Mizoram, the number of drug overdose cases has been on the rise since November 2012. According to reports from the Department of Health and Family Welfare, Government of Mizoram, 328 cases of overdose and 13 deaths due to overdose have been reported in Mizoram between November 2012 and July 2013.

An overdose occurs when a person takes drugs in quantities that the body cannot handle. As a result, the brain is not able to carry out normal body functions and the person may pass out, stop breathing and in extreme cases, have heart failure or experience convulsions. Overdose can be fatal and is one of the most common causes of death among opioid dependent users. However, opioid overdose is both preventable and treatable through the use of Naloxone. Naloxone revives the person, helps him/her breathe and only has an effect when ingested in the presence of opioid drugs. It is routinely used in emergency medical services and has no potential for abuse.

A number of factors place an individual at risk of opioid overdose including tolerance, purity of the drug used, mixing alcohol and opiates, poor health, depression, drug scarcity etc. In Mizoram, it was found that 65 percent of overdose cases took place at home or at a friend's place. Therefore, it is imperative to educate drug users, their peers and medical staff on overdose prevention and management, thereby easily preventing overdose and its associated harms, including death.

Since the causes to drug overdose problems are multi-factorial, a multi-pronged approach is needed to tackle the situation. Integration and collaboration is needed between all the sections of society and at all levels across government and non-governmental sectors.

To this end UNODC in collaboration with the Department of Health and Family Welfare, Government of Mizoram organized a training for medical officers from government hospitals as well as private institutions on 'Overdose Management and Prevention'.  The training conducted, focused on increasing the capacity of service providers working with drug users. The training  focused not only on imparting knowledge but also on modifying attitudes and enhancing the skills of the participants. It addressed basic issues relating to overdose as well as clinical and programme management issues.

The participants were presented with an overview of commonly used opioids and the symptoms of an overdose. Effective management of opioid overdose was addressed including the administration of Naloxone.  The training also brought out and highlighted four crucial recommendations: (i) physician prescriptions for Naloxone to at-risk patients should be increased, (ii) distribution of Naloxone should be expanded within the current public health system, (iii) Naloxone should be re-labelled as an over-the-counter drug, which would increase its circulation and use and (iv) Naloxone should be available in all health-care facilities that may be called upon to respond to opioid overdose.

In addition, UNODC developed IEC material on drug overdose in the local language and distributed it to all the district government hospitals in Mizoram. Following the training, UNODC will assist in the procurement and distribution of Naloxone to all the eight district hospitals in Mizoram.

In North-East India, UNODC is leading the response to injecting drug use through a number of activities and innovations on key issues. These include gender sensitive programs reaching out to female drug users, expansion of oral substitution treatment and research on injecting drug use and HIV/AIDS to reduce the knowledge gap. These activities are being carried out under the joint UN Programme on HIV in North-East India.

The training was carried out under the joint UN Programme on HIV in North-East India with financial support from World Vision, India. The Joint UN programme on HIV is funded by AusAID.

Click here to view the UNODC short film on Overdose