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Accessibility and Impact of Restricted Medicine Availability for Substance Abuse Treatment in Sikkim

This study examines the accessibility and implications of available medicines for treating substance abuse in a tertiary healthcare center in North Eastern India, specifically Sikkim. Given the high prevalence of substance abuse and its correlation with HIV among users, the research identifies medications used for detoxification and maintenance, analyzes the impact of these treatments on retention and relapse, and highlights factors affecting medicine availability, such as pricing and sourcing. The findings underscore the urgent need for better treatment options, education for providers, and improved medicine supply systems.

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Accessibility and Impact of Restricted Medicine Availability for Substance Abuse Treatment in Sikkim

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  1. Accessibility, Pattern of Use and Implications of Restricted Availability of Medicines for Treatment of Substance Abuse in a Tertiary Level Health Care Center in North Eastern India Amit Chakrabarti

  2. Introduction I • Sikkim is a province in North Eastern India • Substance abuse is more prevalent in North Eastern India • Substance abusers are a significant source of HIV • 8 of the 13 sentinel sites on substance abusers are in North Eastern India Source: www.naco.nic.in

  3. Introduction II • Effective treatment is key to limiting health related consequences • Effective treatment depends on availability of options • Commonest available option is medicines • Medicines can be used for detoxification and maintenance

  4. Objectives • To identify medicines used for detoxification and maintenance • To find out effect of maintenance on retention & relapse • To describe factors determining treatment with medicines, viz., • Availability of medicines • Pricing of medicines • Source of medicines

  5. Study Design • Single hospital based, retrospective, no control group • From April 2001 to September 2003 • Patients for detoxification / maintenance included • Alcohol & injecting opioid (IDU) abuse • Hospital records • SPSS 8.0 used for analysis

  6. Result Summary • Alcohol abuse (26%), injecting opioid abuse (4%)

  7. Lessons I • No effective maintenance therapy • Reluctance of treatment provider • Non-availability: • Oral buprenorphine not used • Methadone not available • Source: • Private pharmacies • No supply through National Mental Health Program (NMHP)

  8. Lessons II • Pricing: • High • Patient reluctance to maintenance • Naltrexone 50 mg, 1 tab – Rs. 40 / $ 1 • Only 2 manufacturers for naltrexone and oral buprenorphine • Treatment not covered by insurance agencies

  9. Implications • Education of treatment providers • Availability of effective maintenance • Availability of newer medicines • Affordability through price control • Supply through NMHP • Encourage to manufacture • Insurance recognition

  10. Research Agenda • Hypotheses: • Reverse Gateway effect • Stopping needle use • Modalities: • Rapid assessment of treatment options • Baseline study on prevalence of abuse • Baseline study on high risk behavior • Pilot study with oral methadone in IDU • Objective: Retention and HIV • Outcome measures: • Retention in program • Reduction in needle use • Seroconversion

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