OPIOID SUBSTITUTION THERAPY

2. Philosophy of Opioid Substitution
Drugs of abuse: (e.g.
Heroin)
• An illicit,
• medically
unsafe, short-
acting, more
addictive
• Opioid,
• Taken by
injecting
route…
Is substituted with…
Agonist medications:
(e.g. Buprenorphine)
• …legal, safer,
long-acting
agonist
medication of
known purity
and potency
along with
psychosocial
rehabilitation

3. Opioid Substitution Treatment
Benefits
• Reduces drug consumption, promotes abstinence
• Reduces risky behaviors, risk of HIV transmission
• Reductions in lethal overdose- decrease use and high tolerance
• Reductions in sex work
• Reduction in crime
Limitations
• Patient still chemically dependent on opioids
• Limited availability, due to cost and logistic reasons
• Risk of diversion to unregistered drug users

4. Hierarchy of harm reduction strategy
Drug using status Strategy to be used
Never start using drugs Preventive education to
general community
Even if using drugs, don’t
inject
Education to Drug users
on harms with PWID
If injecting, assistance to
stop injecting drugs
Opioid Substitution
Therapy
If not able to stop injecting,
don’t share
NSEP; educate on safe
injecting
If not able to stop sharing,
ensure new/clean
equipment before every
use
Educate; Provide cleaning
materials

5. Conclusions
Harms associated with drug use can be dealt with in a number of
ways
Harm reduction strategy provides the most practical and flexible
approach to reduce these harms
Focus is on immediate and easily preventable harms rather than
setting unrealistic goals such as complete abstinence
Agonist substitution treatment and NSEPs are the most common
and effective strategies
Combination of strategies and individualization of intervention are
important aspects of a harm reduction approach