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Accessibility and Implications of Medicines for Substance Abuse Treatment in Northeastern India

This study examines the restricted availability of medicines for treating substance abuse in Sikkim, Northeastern India, a region with high prevalence rates. It highlights the consequences of limited treatment options, including limited access to vital medications like buprenorphine and methadone, leading to ineffective maintenance therapy. The study emphasizes the importance of creating better supply chains, reducing medication costs, and increasing insurance recognition to improve the quality of care for individuals suffering from substance abuse and to effectively address related health issues, such as HIV.

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Accessibility and Implications of Medicines for Substance Abuse Treatment in Northeastern India

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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 • Medicines used for detoxification and maintenance • Effect of maintenance on retention & relapse • Pricing of medicines • Source of medicines • Availability of medicines

  5. Study Design • Single hospital based, retrospective, no control group • From April 2001 to September 2003 • Patients for detoxification / maintenance • 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 • 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 1 manufacturer for naltrexone • Only 2 manufacturers for 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 • Pilot study with oral methadone in injecting opioid abuse • Objective: Retention and health consequences, i.e., HIV • Outcome measures: • Retention in program • Reduction in needle use • Seroconversion

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