This document discusses opioid substitution therapy (OST) models of program design and implementation. It covers:
1. OST can be delivered in various settings like specialized clinics, hospitals, primary care, and communities. Delivery models include low threshold services to reduce barriers.
2. OST provides benefits as both a drug treatment for opioid dependence as well as for HIV prevention by reducing risky injection behaviors. Evidence shows methadone and buprenorphine maintenance therapy reduces opioid use and HIV transmission.
3. Integrating OST into HIV care improves adherence to antiretroviral therapy and engagement in care, while decreasing opioid use. Studies demonstrate the effectiveness of OST, especially methadone, in reducing HIV incidence.
Opioid substitution treatment involves replacing illicit, unsafe opioids like heroin with legal, safer long-acting opioid agonists like buprenorphine along with psychosocial support. This treatment reduces drug use and risky behaviors, lowers overdose risk and crime, and decreases HIV transmission. However, patients remain chemically dependent and access can be limited. Harm reduction strategies aim to minimize health risks at each level of drug use from prevention to safe injection practices. Opioid substitution therapy and needle syringe exchange programs are effective harm reduction strategies.
Consultation and liaison psychiatry meاحمد البحيري
Consultation-liaison psychiatry involves psychiatrists consulting on patients in medical settings to address intersections between physical and mental health. Issues include capacity to consent, conflicts with medical teams, and patients reporting physical symptoms due to underlying mental disorders. The consultant evaluates patients for suspected psychiatric disorders, agitation, suicidal/homicidal thoughts, and high psychiatric risk factors. Common reasons for consultations include psychiatric symptoms, lack of organic cause for symptoms, and non-compliance.
The document provides guidelines for assessing and evaluating disabilities in India. It describes the following:
1. Authorities in India that are responsible for providing disability certificates according to the Persons with Disabilities Act of 1995.
2. The Indian Disability Evaluation and Assessment Scale (IDEAS) which was developed to measure and quantify disability in mental disorders.
3. How the IDEAS evaluates four areas - self-care, interpersonal activities, communication and understanding, and work - to determine the level of global disability on a scale from 0-100%.
The document defines psychotherapy as a treatment method that involves developing an intimate therapeutic relationship between a client and therapist to explore and modify client behavior in a satisfying direction. It further describes psychotherapy as a process where a person seeks to resolve problems or issues by interacting with a psychotherapist in a prescribed way.
Generalized Anxiety Disorder is a common condition affecting 3-8% of the population annually. It involves excessive, uncontrollable worry about everyday life events. Biological factors like the GABA and serotonin systems are involved. Treatment involves psychotherapy, pharmacotherapy like SSRIs, and lifestyle changes. The disorder commonly co-occurs with other conditions like depression and is more prevalent in women. Medical conditions can also cause anxiety disorder-like symptoms.
Paranoid schizophrenia is characterized by predominantly positive symptoms of schizophrenia, including delusions and hallucinations. These debilitating symptoms blur the line between what is real and what isn't, making it difficult for the person to lead a typical life.
This document defines and describes delusional disorder. It is characterized by non-bizarre delusions that have persisted for at least one month without significant impairment in functioning. There are several proposed causes including biological and psychosocial factors. Various subtypes are identified based on the predominant delusional theme, such as erotomanic, grandiose, jealous, persecutory, and somatic delusions. The diagnostic criteria require non-bizarre delusions for at least one month without symptoms meeting criteria for schizophrenia.
Opioid substitution treatment involves replacing illicit, unsafe opioids like heroin with legal, safer long-acting opioid agonists like buprenorphine along with psychosocial support. This treatment reduces drug use and risky behaviors, lowers overdose risk and crime, and decreases HIV transmission. However, patients remain chemically dependent and access can be limited. Harm reduction strategies aim to minimize health risks at each level of drug use from prevention to safe injection practices. Opioid substitution therapy and needle syringe exchange programs are effective harm reduction strategies.
Consultation and liaison psychiatry meاحمد البحيري
Consultation-liaison psychiatry involves psychiatrists consulting on patients in medical settings to address intersections between physical and mental health. Issues include capacity to consent, conflicts with medical teams, and patients reporting physical symptoms due to underlying mental disorders. The consultant evaluates patients for suspected psychiatric disorders, agitation, suicidal/homicidal thoughts, and high psychiatric risk factors. Common reasons for consultations include psychiatric symptoms, lack of organic cause for symptoms, and non-compliance.
The document provides guidelines for assessing and evaluating disabilities in India. It describes the following:
1. Authorities in India that are responsible for providing disability certificates according to the Persons with Disabilities Act of 1995.
2. The Indian Disability Evaluation and Assessment Scale (IDEAS) which was developed to measure and quantify disability in mental disorders.
3. How the IDEAS evaluates four areas - self-care, interpersonal activities, communication and understanding, and work - to determine the level of global disability on a scale from 0-100%.
The document defines psychotherapy as a treatment method that involves developing an intimate therapeutic relationship between a client and therapist to explore and modify client behavior in a satisfying direction. It further describes psychotherapy as a process where a person seeks to resolve problems or issues by interacting with a psychotherapist in a prescribed way.
Generalized Anxiety Disorder is a common condition affecting 3-8% of the population annually. It involves excessive, uncontrollable worry about everyday life events. Biological factors like the GABA and serotonin systems are involved. Treatment involves psychotherapy, pharmacotherapy like SSRIs, and lifestyle changes. The disorder commonly co-occurs with other conditions like depression and is more prevalent in women. Medical conditions can also cause anxiety disorder-like symptoms.
Paranoid schizophrenia is characterized by predominantly positive symptoms of schizophrenia, including delusions and hallucinations. These debilitating symptoms blur the line between what is real and what isn't, making it difficult for the person to lead a typical life.
This document defines and describes delusional disorder. It is characterized by non-bizarre delusions that have persisted for at least one month without significant impairment in functioning. There are several proposed causes including biological and psychosocial factors. Various subtypes are identified based on the predominant delusional theme, such as erotomanic, grandiose, jealous, persecutory, and somatic delusions. The diagnostic criteria require non-bizarre delusions for at least one month without symptoms meeting criteria for schizophrenia.
Kurt Schneider was a German psychiatrist known for his work on schizophrenia diagnosis and classification. He identified first-rank symptoms (FRS) that he believed were pathognomonic of schizophrenia. The FRS included experiences like hearing voices commenting on one's actions, feeling controlled by external forces, thought withdrawal or insertion. Schneider's conceptualization of FRS was influential but also criticized for lacking statistical evidence. Later authors refined definitions of FRS and debated their specificity to schizophrenia.
- Neurocognitive disorders include delirium, disorders due to Lewy bodies, Alzheimer's disease, frontotemporal disorders, vascular disorders, and traumatic brain injuries.
- Delirium involves an acute change in consciousness and cognition that fluctuates in severity. It is often caused by medical issues, medications, or substance withdrawal. Treatment focuses on resolving the underlying cause.
- Disorders like those due to Lewy bodies, Alzheimer's disease, and frontotemporal disorders cause progressive cognitive decline due to brain changes. Symptoms and severity vary by type. Management includes medications, environmental modifications, and supportive care.
- Vascular and traumatic brain injury disorders arise from disruptions to the brain's
Obsessive-Compulsive and Related Disorders (DSM-V)Adesh Agrawal
The disorders those characterized by repetitive behavior, are included under this broad chapter in DSM-5. Here we prepared this PPT in which we tried to cover the whole topic in a very comprehensive and concise manner. We hope that this will help you to understand it in an easy way.
your further suggestions will be appreciated.
This document discusses personality disorders. It begins by defining personality and personality traits, then defines personality disorders as inflexible and maladaptive personality traits that interfere with functioning. It describes three clusters of personality disorders - Cluster A which includes odd or eccentric behavior; Cluster B which includes dramatic, emotional or erratic behavior; and Cluster C which includes anxious or fearful behavior. The document then provides more details on specific personality disorders like paranoid, schizoid, schizotypal, antisocial, borderline, histrionic and narcissistic personality disorders. It discusses symptoms, causes, treatment options for each.
This document discusses various types of psychiatric investigations including routine investigations such as complete blood count, urine analysis, renal and liver function tests, electrolytes, blood glucose, thyroid function, ECG, HIV and VDRL testing. It also discusses electrophysiological tests like EEG and polysomnography, brain imaging tests like CT and MRI scans, and neuroendocrine tests like the dexamethasone suppression test and measurements of prolactin, corticosteroids and melatonin levels. Genetic testing is also mentioned. The investigations are useful for detecting medical disorders causing psychiatric symptoms and alterations in biological functions.
This document provides an overview of the phenomenology of schizophrenia, including a historical perspective on how it has been conceptualized over time. It describes the clinical manifestations and thought disorders commonly seen in schizophrenia, such as formal thought disorders involving disorganized thinking, disorders of thought flow/tempo, disorders of thought possession, and disorders involving delusional thinking. It also briefly discusses misidentification syndromes that can occur.
1) Psychosis refers to impaired reality testing, such as believing events that are not real occurred. Psychotic disorders include schizophrenia, schizoaffective disorder, and delusional disorder.
2) Schizophrenia affects about 1% of the population and is characterized by hallucinations, delusions, and disorganized thinking. It has both positive symptoms like hallucinations and negative symptoms like lack of emotion.
3) Schizoaffective disorder involves symptoms of both schizophrenia and a mood disorder at the same time. Delusional disorder involves nonbizarre delusions not caused by other conditions.
Diagnosis and management of major depressive disorderNeurologyKota
This document provides information on major depressive disorder and dysthymic disorder, including their symptoms, classifications, prevalence, risk factors, pathophysiology, diagnostic criteria, sleep abnormalities seen in depression, and treatment options. It discusses antidepressant medications like TCAs, MAOIs, SSRIs, SNRIs, augmentation therapies, psychosocial therapies, and ECT in the treatment of depressive disorders.
This document discusses integrating mental health services into primary care. It notes that hundreds of millions suffer from mental disorders that create enormous suffering if left untreated. Integrating mental health into primary care is the most viable way to close the treatment gap and ensure people receive needed care. The document outlines strategies for primary care mental health services, including early identification and management of common disorders like depression and psychosis. It provides assessment and treatment guidelines for various mental health conditions suitable for primary care management. The goal is to enable stable psychiatric patients to receive optimal treatment in primary care to prevent relapse.
Obsessive-compulsive disorder (OCD) is an type of anxiety disorder , represented by a diverse group of symptoms that include intrusive thoughts, rituals, preoccupations, and compulsions.
Substance abuse disorders are now classified as mental disorders according to the DSM-5. Addiction changes the brain in fundamental ways and causes compulsive drug-seeking behaviors that override the ability to control impulses. Approximately 21.5 million Americans had a substance use disorder in the past year, including alcohol and illicit drugs. Co-occurring mental health and substance use disorders are common, with 7.9 million people having both in the past year. Integrated treatment that addresses both disorders together is most effective for those with co-occurring disorders.
Conduct Disorder and Oppositional Defiant Disorder are disruptive behavioral disorders characterized by antisocial or hostile behavior. Conduct Disorder involves violating the rights of others through aggression, destruction of property, deceitfulness or theft. Oppositional Defiant Disorder involves a recurrent pattern of negativistic, defiant, disobedient and hostile behavior. The disorders are prevalent in 3-16% of children and adolescents. Risk factors include genetics, early life experiences such as abuse or neglect, environmental stressors like poverty, and influences like peer relationships. Treatment involves parental training, family therapy, and in some cases medication, with the goal of improving behavior and relationships. Untreated, the disorders often persist and in severe early-onset cases may lead
This document provides an overview of personality disorders, including definitions, types, causes, and treatment approaches. It defines a personality disorder as an enduring pattern of inner experiences and behaviors that deviate significantly from cultural expectations and cause distress or impairment. Five classical types are described in detail: schizoid, paranoid, antisocial, histrionic, and obsessive-compulsive personality disorders. Personality disorders are influenced by biological, social, and psychological factors. Treatment involves psychotherapy tailored to the individual, as well as medication for any concurrent disorders or uncontrollable behaviors. The overall goal is to improve social and vocational functioning.
Epidemiological studies in psychiatry in IndiaSujit Kumar Kar
Epidemiological studies in psychiatry have been conducted in India for over 60 years, starting with Dr. K.C. Dube's 1961 study in Agra. Initial studies found wide variation in prevalence rates of psychiatric disorders from 9.5 to 370 per 1000 population. Landmark international studies provided more standardized approaches. However, Indian studies were inadequate to assess non-psychotic disorders. Substance use epidemiological studies included the National Household Survey and Drug Abuse Monitoring System. The National Mental Health Survey was the largest nationwide survey and found treatment gaps of 73-85% for mental disorders. Ongoing national surveys continue to inform mental healthcare in India.
Schizoaffective Disorder - A Diagnostic Conundrum.pdfMohamed Sedky
This document discusses the diagnostic criteria and challenges of schizoaffective disorder. It notes that schizoaffective disorder involves a combination of schizophrenia and mood disorder symptoms. However, the diagnostic criteria have varied between classifications and the disorder has very low inter-rater reliability. Differential diagnosis is also difficult given similarities to other psychotic and mood disorders. In summary, schizoaffective disorder remains a controversial and diagnostically complex condition.
This document provides an overview of Acute and Transient Psychotic Disorder (ATPD). It discusses the history and evolution of ATPD from early descriptions in the late 19th century to its inclusion as a diagnostic category in ICD-10 in 1992. The document outlines the ICD-10 diagnostic criteria for ATPD and reviews several landmark studies that helped establish ATPD as a separate diagnostic category from schizophrenia and affective disorders. It also discusses cultural variants of brief psychotic episodes and debates around classifying certain culture-bound syndromes as ATPD.
This document summarizes research on the course and outcome of schizophrenia. It discusses several landmark studies including the International Pilot Study of Schizophrenia, Determinants of Outcome of Severe Mental Disorder study, and International Study of Schizophrenia. Overall, the studies found that outcomes tended to be better in developing countries compared to developed countries. Within developing countries, outcomes were particularly good in India, with studies in Agra and Chandigarh finding high rates of remission. Acute onset, good premorbid adjustment, younger age, and shorter duration of initial psychotic episode predicted better long-term prognosis.
This document discusses various systems for classifying mental disorders. It describes the ICD-10 classification system from the WHO which organizes disorders into categories. It also describes the DSM-5 system used in the US which previously used a multi-axial system but now combines the axes. The purposes of classification are to aid in diagnosis, communication, research and treatment. The document also briefly outlines an Indian system which broadly divides disorders into categories like psychosis, neurosis and special disorders.
A DSM 5 Update: Substance - Related And Addictive DisordersChat 2 Recovery
Within the next year, most insurance providers will be expecting all claims to include the new DSM-5 nomenclature. It is imperative for all mental health professionals to be comfortable with the new diagnostic criteria and recording procedures. This presentation provides participants with a clear understanding of the revisions made in the category of Substance - Related and Addictive Disorders from the DSM-IV to the DSM-5.
Topics presented by Nick Lessa, CEO of Inter-Care: an addiction treatment program in New York City.
Includes:
Changes in the diagnostic criteria from the DSM–IV to the DSM-5
The distinction between Substance Use Disorders and the Substance - Induced Disorders
Recording procedures for Substance Related Disorders
This document provides an overview of buprenorphine and its use in office-based treatment of opioid dependence. It discusses the pharmacology of buprenorphine, including how it acts as a partial opioid agonist and has a ceiling effect. It also outlines the legislation that allowed qualified physicians to treat opioid addiction with buprenorphine, reviews the induction and maintenance treatment process, and discusses outcomes research showing buprenorphine is effective for both detoxification and long-term maintenance treatment.
This document summarizes a randomized trial that compared extended (12-week) buprenorphine-naloxone treatment to short-term (14-day) detoxification for opioid-addicted youth ages 14 to 21. The trial found that youth in the extended treatment group had significantly lower rates of positive opioid urine tests at months 6, 9 and 12 compared to the detoxification group. It also found that the extended treatment group had higher completion rates and fewer dropouts. The study provides evidence that extended buprenorphine treatment may be more effective than short-term detoxification for opioid-addicted youth.
Kurt Schneider was a German psychiatrist known for his work on schizophrenia diagnosis and classification. He identified first-rank symptoms (FRS) that he believed were pathognomonic of schizophrenia. The FRS included experiences like hearing voices commenting on one's actions, feeling controlled by external forces, thought withdrawal or insertion. Schneider's conceptualization of FRS was influential but also criticized for lacking statistical evidence. Later authors refined definitions of FRS and debated their specificity to schizophrenia.
- Neurocognitive disorders include delirium, disorders due to Lewy bodies, Alzheimer's disease, frontotemporal disorders, vascular disorders, and traumatic brain injuries.
- Delirium involves an acute change in consciousness and cognition that fluctuates in severity. It is often caused by medical issues, medications, or substance withdrawal. Treatment focuses on resolving the underlying cause.
- Disorders like those due to Lewy bodies, Alzheimer's disease, and frontotemporal disorders cause progressive cognitive decline due to brain changes. Symptoms and severity vary by type. Management includes medications, environmental modifications, and supportive care.
- Vascular and traumatic brain injury disorders arise from disruptions to the brain's
Obsessive-Compulsive and Related Disorders (DSM-V)Adesh Agrawal
The disorders those characterized by repetitive behavior, are included under this broad chapter in DSM-5. Here we prepared this PPT in which we tried to cover the whole topic in a very comprehensive and concise manner. We hope that this will help you to understand it in an easy way.
your further suggestions will be appreciated.
This document discusses personality disorders. It begins by defining personality and personality traits, then defines personality disorders as inflexible and maladaptive personality traits that interfere with functioning. It describes three clusters of personality disorders - Cluster A which includes odd or eccentric behavior; Cluster B which includes dramatic, emotional or erratic behavior; and Cluster C which includes anxious or fearful behavior. The document then provides more details on specific personality disorders like paranoid, schizoid, schizotypal, antisocial, borderline, histrionic and narcissistic personality disorders. It discusses symptoms, causes, treatment options for each.
This document discusses various types of psychiatric investigations including routine investigations such as complete blood count, urine analysis, renal and liver function tests, electrolytes, blood glucose, thyroid function, ECG, HIV and VDRL testing. It also discusses electrophysiological tests like EEG and polysomnography, brain imaging tests like CT and MRI scans, and neuroendocrine tests like the dexamethasone suppression test and measurements of prolactin, corticosteroids and melatonin levels. Genetic testing is also mentioned. The investigations are useful for detecting medical disorders causing psychiatric symptoms and alterations in biological functions.
This document provides an overview of the phenomenology of schizophrenia, including a historical perspective on how it has been conceptualized over time. It describes the clinical manifestations and thought disorders commonly seen in schizophrenia, such as formal thought disorders involving disorganized thinking, disorders of thought flow/tempo, disorders of thought possession, and disorders involving delusional thinking. It also briefly discusses misidentification syndromes that can occur.
1) Psychosis refers to impaired reality testing, such as believing events that are not real occurred. Psychotic disorders include schizophrenia, schizoaffective disorder, and delusional disorder.
2) Schizophrenia affects about 1% of the population and is characterized by hallucinations, delusions, and disorganized thinking. It has both positive symptoms like hallucinations and negative symptoms like lack of emotion.
3) Schizoaffective disorder involves symptoms of both schizophrenia and a mood disorder at the same time. Delusional disorder involves nonbizarre delusions not caused by other conditions.
Diagnosis and management of major depressive disorderNeurologyKota
This document provides information on major depressive disorder and dysthymic disorder, including their symptoms, classifications, prevalence, risk factors, pathophysiology, diagnostic criteria, sleep abnormalities seen in depression, and treatment options. It discusses antidepressant medications like TCAs, MAOIs, SSRIs, SNRIs, augmentation therapies, psychosocial therapies, and ECT in the treatment of depressive disorders.
This document discusses integrating mental health services into primary care. It notes that hundreds of millions suffer from mental disorders that create enormous suffering if left untreated. Integrating mental health into primary care is the most viable way to close the treatment gap and ensure people receive needed care. The document outlines strategies for primary care mental health services, including early identification and management of common disorders like depression and psychosis. It provides assessment and treatment guidelines for various mental health conditions suitable for primary care management. The goal is to enable stable psychiatric patients to receive optimal treatment in primary care to prevent relapse.
Obsessive-compulsive disorder (OCD) is an type of anxiety disorder , represented by a diverse group of symptoms that include intrusive thoughts, rituals, preoccupations, and compulsions.
Substance abuse disorders are now classified as mental disorders according to the DSM-5. Addiction changes the brain in fundamental ways and causes compulsive drug-seeking behaviors that override the ability to control impulses. Approximately 21.5 million Americans had a substance use disorder in the past year, including alcohol and illicit drugs. Co-occurring mental health and substance use disorders are common, with 7.9 million people having both in the past year. Integrated treatment that addresses both disorders together is most effective for those with co-occurring disorders.
Conduct Disorder and Oppositional Defiant Disorder are disruptive behavioral disorders characterized by antisocial or hostile behavior. Conduct Disorder involves violating the rights of others through aggression, destruction of property, deceitfulness or theft. Oppositional Defiant Disorder involves a recurrent pattern of negativistic, defiant, disobedient and hostile behavior. The disorders are prevalent in 3-16% of children and adolescents. Risk factors include genetics, early life experiences such as abuse or neglect, environmental stressors like poverty, and influences like peer relationships. Treatment involves parental training, family therapy, and in some cases medication, with the goal of improving behavior and relationships. Untreated, the disorders often persist and in severe early-onset cases may lead
This document provides an overview of personality disorders, including definitions, types, causes, and treatment approaches. It defines a personality disorder as an enduring pattern of inner experiences and behaviors that deviate significantly from cultural expectations and cause distress or impairment. Five classical types are described in detail: schizoid, paranoid, antisocial, histrionic, and obsessive-compulsive personality disorders. Personality disorders are influenced by biological, social, and psychological factors. Treatment involves psychotherapy tailored to the individual, as well as medication for any concurrent disorders or uncontrollable behaviors. The overall goal is to improve social and vocational functioning.
Epidemiological studies in psychiatry in IndiaSujit Kumar Kar
Epidemiological studies in psychiatry have been conducted in India for over 60 years, starting with Dr. K.C. Dube's 1961 study in Agra. Initial studies found wide variation in prevalence rates of psychiatric disorders from 9.5 to 370 per 1000 population. Landmark international studies provided more standardized approaches. However, Indian studies were inadequate to assess non-psychotic disorders. Substance use epidemiological studies included the National Household Survey and Drug Abuse Monitoring System. The National Mental Health Survey was the largest nationwide survey and found treatment gaps of 73-85% for mental disorders. Ongoing national surveys continue to inform mental healthcare in India.
Schizoaffective Disorder - A Diagnostic Conundrum.pdfMohamed Sedky
This document discusses the diagnostic criteria and challenges of schizoaffective disorder. It notes that schizoaffective disorder involves a combination of schizophrenia and mood disorder symptoms. However, the diagnostic criteria have varied between classifications and the disorder has very low inter-rater reliability. Differential diagnosis is also difficult given similarities to other psychotic and mood disorders. In summary, schizoaffective disorder remains a controversial and diagnostically complex condition.
This document provides an overview of Acute and Transient Psychotic Disorder (ATPD). It discusses the history and evolution of ATPD from early descriptions in the late 19th century to its inclusion as a diagnostic category in ICD-10 in 1992. The document outlines the ICD-10 diagnostic criteria for ATPD and reviews several landmark studies that helped establish ATPD as a separate diagnostic category from schizophrenia and affective disorders. It also discusses cultural variants of brief psychotic episodes and debates around classifying certain culture-bound syndromes as ATPD.
This document summarizes research on the course and outcome of schizophrenia. It discusses several landmark studies including the International Pilot Study of Schizophrenia, Determinants of Outcome of Severe Mental Disorder study, and International Study of Schizophrenia. Overall, the studies found that outcomes tended to be better in developing countries compared to developed countries. Within developing countries, outcomes were particularly good in India, with studies in Agra and Chandigarh finding high rates of remission. Acute onset, good premorbid adjustment, younger age, and shorter duration of initial psychotic episode predicted better long-term prognosis.
This document discusses various systems for classifying mental disorders. It describes the ICD-10 classification system from the WHO which organizes disorders into categories. It also describes the DSM-5 system used in the US which previously used a multi-axial system but now combines the axes. The purposes of classification are to aid in diagnosis, communication, research and treatment. The document also briefly outlines an Indian system which broadly divides disorders into categories like psychosis, neurosis and special disorders.
A DSM 5 Update: Substance - Related And Addictive DisordersChat 2 Recovery
Within the next year, most insurance providers will be expecting all claims to include the new DSM-5 nomenclature. It is imperative for all mental health professionals to be comfortable with the new diagnostic criteria and recording procedures. This presentation provides participants with a clear understanding of the revisions made in the category of Substance - Related and Addictive Disorders from the DSM-IV to the DSM-5.
Topics presented by Nick Lessa, CEO of Inter-Care: an addiction treatment program in New York City.
Includes:
Changes in the diagnostic criteria from the DSM–IV to the DSM-5
The distinction between Substance Use Disorders and the Substance - Induced Disorders
Recording procedures for Substance Related Disorders
This document provides an overview of buprenorphine and its use in office-based treatment of opioid dependence. It discusses the pharmacology of buprenorphine, including how it acts as a partial opioid agonist and has a ceiling effect. It also outlines the legislation that allowed qualified physicians to treat opioid addiction with buprenorphine, reviews the induction and maintenance treatment process, and discusses outcomes research showing buprenorphine is effective for both detoxification and long-term maintenance treatment.
This document summarizes a randomized trial that compared extended (12-week) buprenorphine-naloxone treatment to short-term (14-day) detoxification for opioid-addicted youth ages 14 to 21. The trial found that youth in the extended treatment group had significantly lower rates of positive opioid urine tests at months 6, 9 and 12 compared to the detoxification group. It also found that the extended treatment group had higher completion rates and fewer dropouts. The study provides evidence that extended buprenorphine treatment may be more effective than short-term detoxification for opioid-addicted youth.
Dr. Rick Sponaugle: Chronic Pain And AddictionRobert Lee
This document discusses chronic pain and addiction. It summarizes that opioid pain medications can reduce pain signals but also reduce activity in brain regions related to pleasure, dopamine, and serotonin. This can lead to depression and increased pain sensitivity over time. The document also notes that opioid use can suppress hormone production over time, including testosterone and thyroid hormones, worsening associated health issues. Detoxification is presented as a method to correct these issues by preventing adrenaline surges that normally occur with opioid withdrawal.
In this webinar, clinicians from two Ryan White clinics with successful buprenorphine programs describe what buprenorphine is, how it works, what opioids do to the brain, how buprenorphine differs from methadone, important drug-drug interactions, the concept of precipitated withdrawal and how to recognize it, how to determine patient eligibility, and clinical aspects of working with opiod-addicted people living with HIV.
Presenters Pamela Vergara-Rodriguez, MD, (CORE Center in Chicago), and Jacqueline Tulsky, MD (University of California at San Francisco and San Francisco General Hospital), also describe the challenges and successes of the SPNS buprenorphine projects at their institutions.
Visit the Integrating HIV Innovative Practices webpage to learn more about integrating buprenorphine into HIV primary care settings and to access additional training materials.
This document provides an overview of the pharmacologic treatment of opiate dependence, including:
- A historical perspective on approaches to treatment such as methadone maintenance and more recent developments like buprenorphine.
- An explanation of how opioid agonists like methadone and buprenorphine work in the brain and body to reduce withdrawal symptoms and cravings while blocking the effects of other opioids.
- Guidance on patient selection criteria for buprenorphine treatment and considerations around its use as a replacement therapy in office-based settings to expand treatment access.
II Inc. offers drug testing services including instant testing with results, DOT testing, teen screening, pre-employment testing, court ordered testing, and positive confirmation. Their tests provide legally admissible results reviewed by a medical officer and maintaining a chain of custody. Customers can save time and money by bringing their drug testing card to visits.
This document provides an overview of addiction and pregnancy, including:
- Rates of drug and alcohol use during pregnancy range from 12-24% and pose risks to fetal development.
- Treatment includes medication-assisted therapy with methadone or buprenorphine, which can improve outcomes compared to untreated addiction.
- Babies exposed to opioids in utero may develop neonatal abstinence syndrome requiring supportive care and sometimes pharmacological treatment.
Treatment Strategies for Women and Families with Substance AbuseErikaAGoyer
NATIONAL PERINATAL ASSOCIATION 2014 CONFERENCE
Treatment Strategies for Women and Families with
Substance Abuse: The participant will be able to:
Interpret the term “opioid use disorder,” explain the
benefits of Methadone Assisted Treatment (MAT) and
identify the characteristics of Neonatal Abstinence
Syndrome.
This document discusses various pharmacological interventions for treating addiction, including agonist therapies like methadone and buprenorphine, antagonist therapies, anti-craving therapies, immunological approaches, and aversive therapies. It describes the advantages and disadvantages of different medications and addresses issues around cognitive impairment and medication use within twelve step programs.
Experiential account experience at a government general hospitalmailrishigupta
The document summarizes the experience of an opioid substitution therapy (OST) center at a government general hospital in Lucknow, India. It describes the center's operations since opening in 2013, including numbers of clients registered and receiving services. It outlines several initial problems in establishing the center, ongoing challenges like staffing issues and funding delays, as well as advantages like opportunities for teaching and research. The conclusion recognizes the challenges of running an OST center but also its benefits, and calls for improved guidelines, rehabilitation services, and addressing budget and funding problems.
The document discusses the structure and function of the nervous system. It describes key parts of the brain including the lobes, cortex, and interior structures like the brain stem, limbic system, and cerebrum. It also discusses neurons, the basic unit of the nervous system, and how they transmit signals via neurotransmitters and electrical impulses. Imaging techniques like EEG, MRI, and PET scans are used to study the living brain.
This document summarizes a presentation on medication-assisted treatment for opioid addiction. It discusses the history of treatment approaches, including the development of methadone and buprenorphine maintenance therapies. Studies show that agonist therapies like methadone and buprenorphine are more effective at retaining patients in treatment and reducing illicit opioid use than non-medication approaches. While both methadone and buprenorphine are effective, buprenorphine has a safer side effect profile but its effectiveness may be limited by lower monitoring and adherence compared to methadone treatment. The document reviews several studies demonstrating the benefits of long-term agonist therapy over detoxification or short-term medication approaches for opioid
Este documento apresenta uma aula introdutória sobre princípios de química medicinal ministrada pelo professor Eliezer J. Barreiro. A disciplina aborda como os fármacos funcionam, são desenvolvidos e projetados, além de listar referências bibliográficas sobre o tema. O professor também discute brevemente a história da química medicinal, citando contribuições pioneiras.
This document discusses methods of tobacco cessation. It begins with an introduction to tobacco use as the leading preventable cause of death globally. It then covers the history of tobacco, forms of tobacco used in India, and the health effects of tobacco use. Barriers to cessation like nicotine addiction and lack of support are examined. The document outlines goals of cessation programs like long term abstinence. It discusses behavioral management, pharmacotherapies, and counseling approaches. India's tobacco control laws aiming to restrict advertising and smoking in public are also summarized.
This document discusses smoking cessation and provides information to help people quit smoking. It discusses the harms of smoking and tactics that tobacco companies use. It also addresses common reasons and excuses for not quitting. The document outlines the physical, emotional, behavioral, social, and cognitive effects of the quitting process. It discusses stages of behavioral change and notes that many people think they can quit smoking at any time when that is often not the case. The document concludes by listing available help options for quitting smoking, including support groups, medications, health professionals, and online resources.
1) O documento descreve os parâmetros e procedimentos para validação de métodos cromatográficos, incluindo especificidade, exatidão, precisão, linearidade, limite de detecção e quantificação.
2) São detalhados os testes, critérios de aceitação e número de determinações necessárias para cada parâmetro de validação de acordo com diretrizes como ANVISA, ICH e FDA.
3) O documento fornece informações sobre como estabelecer a curva de calibração e avaliar sua linearidade para assegurar a
The document summarizes India's National AIDS Control Programme (NACP) which aims to prevent the spread of HIV/AIDS in India. It describes the epidemiology of HIV/AIDS in India, noting stable national prevalence but rising trends in some states. It outlines the early response through NACP I and II, including establishing surveillance, promoting condoms, treating STDs, and targeted interventions. NACP III expanded these efforts and added programs for preventing parent-to-child transmission and increasing access to testing, treatment, and care. Future plans include continuing and strengthening current strategies through NACP IV.
Global Medical Cures™ | Dietary Guidelines for Americans
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Experiential account experience in the prisonmailrishigupta
This document summarizes the rationale and process for implementing an opioid substitution therapy (OST) program in Tihar Prison in New Delhi, India. It notes that 40-80% of prisoners have substance abuse problems. An OST program was launched to provide buprenorphine treatment and psychosocial support to opioid dependent inmates. Prison staff and NGO counselors were trained to deliver the intervention. The program aimed to test OST feasibility and develop prison OST guidelines. Eligible inmates received daily buprenorphine dosing in prison along with group counseling. They could continue treatment after release through partner clinics. Evaluations occurred at regular intervals over 12 months to assess outcomes.
Place of ost among various treatment options for opioid dependence sifting th...mailrishigupta
The document discusses opioid substitution therapy (OST) for treating opioid dependence. It provides an overview of OST, noting that it is endorsed worldwide based on extensive evidence from over 100 randomized controlled studies. OST involves prescribing long-acting opioid agonists like methadone and buprenorphine to reduce drug cravings and withdrawals while enabling patients to stabilize in treatment. The document outlines the debate between abstinence-based versus harm reduction approaches, and argues that OST falls under a harm reduction model aimed at retaining patients in treatment to reduce illicit drug use and associated harms.
Buprenorphine has been used in India for opioid dependence since the early 1990s. Initial experiences found it effective for detoxification and long-term treatment. Over time, higher strength and take-home formulations became available. Research studies conducted in India provided evidence that buprenorphine is superior to clonidine for withdrawal management and blocks the effects of opioids. It was also found to have moderate abuse potential similar to morphine. Sustained release morphine and later buprenorphine-naloxone were explored as additional treatment options. Efforts were made to scale up opioid substitution therapy across India through capacity building, additional treatment centers, and a multi-site effectiveness study.
Methadone maintenance treatment implementation indian experiencemailrishigupta
Methadone maintenance treatment has been implemented in India since 2012 across several government healthcare settings with over 700 clients enrolled. The document discusses the feasibility findings of setting up methadone clinics in India, including obtaining necessary approvals, selecting clinic locations, infrastructure requirements, staffing, licensing, procurement, dispensing, clinical services, quality assurance, and advocacy efforts. Overall, the experience so far demonstrates that methadone maintenance treatment can be successfully implemented in India to benefit opioid dependent clients and communities.
Ost capacity building, monitoring and mentoringmailrishigupta
The document describes the training and quality assurance mechanisms used in India's National AIDS Control Organization (NACO) opioid substitution therapy (OST) programme for injecting drug users. It discusses NACO's 5-day induction training programme for OST staff, which aims to build knowledge, attitudes and skills. It also outlines the quality assurance process, which involves regular visits from OST experts to assess service quality and provide guidance to staff. This includes using a standardized tool and report format. The training manual and quality assurance reference guide provide structure and guidelines to build staff capacity and ensure high-quality OST services.
Clinical practice guidelines for buprenorphine and methadone based ostmailrishigupta
The document outlines guidelines for opioid substitution therapy (OST) using buprenorphine and methadone. It discusses the steps in OST delivery including induction, maintenance, and termination phases. The induction phase focuses on determining the correct drug dose to address withdrawals and cravings. Buprenorphine induction typically lasts 2-3 days while methadone induction takes 2-3 weeks, starting at low doses and increasing slowly. The maintenance phase involves long-term treatment with the stabilized OST drug dose to prevent relapse. Termination marks the decision to discontinue OST medication after a period of treatment.
Experiential account experience as a private practitionermailrishigupta
Dr. Ashwin Mohan has been practicing psychiatry since 2001 and treating opioid dependence through opioid substitution therapy (OST) using buprenorphine. He began with a few patients on OST but scaled up treatment in the 2000s as he saw better results than traditional treatment methods. Over the years, he increased doses and duration of OST based on patient needs. However, a 2014 crackdown on opioids led to thousands seeking treatment without adequate infrastructure. This created diversion issues and negative press around OST. As a result, many psychiatrists stopped OST and treatment options were severely limited, worsening the opioid crisis. Dr. Mohan argues for expanding access to OST and other evidence-based treatments for opioid dependence.
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This document discusses the integration of traditional and complementary medicine into health systems. It provides an overview of the World Health Organization's policies on this issue, including the Beijing Declaration which calls on governments to integrate traditional medicine into their national health care systems. The document also discusses different models of integration, from inclusive systems that recognize but have not fully integrated traditional medicine, to integrative systems where it is officially recognized and incorporated into all areas of health care provision.
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Innovations in ost formulations and programme deliverymailrishigupta
This document summarizes a presentation on innovations in opioid substitution therapy (OST) formulations and program delivery. It discusses issues with existing OST approaches and the need for innovations to balance treatment effectiveness and patient convenience. Potential innovations discussed include new buprenorphine formulations like films, implants, and patches designed to reduce abuse potential and increase adherence. Service delivery innovations explored automatic dispensing, biometric identification, and flexible take-home dosing models. The presentation also examines innovative program designs implemented internationally to enhance OST accessibility and outcomes.
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Opioid substitution therapy (ost) models of programme design and implementation
1. Opioid Substitution Therapy (OST):
Models of programme design and
implementation
Dr. M. Suresh Kumar MD DPM MPH
Consultant Psychiatrist
National CME: “Opioid Substitution Therapy: Policy and Practice”
Organised by NDDTC & AIIMS
New Delhi
April 18 2015Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
2. Outline of presentation
1. OST in various settings and models of OST
2. OST as drug treatment vs OST as HIV prevention
3. Integrated OST services
4. Key gaps in OST program implementation
5. Summary
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
3. 1. OST IN VARIOUS SETTINGS AND
MODELS OF OST
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
4. OST in various settings
OST in specialised exclusive clinics
OST in hospitals
OST in drug dependence treatment clinics
OST in primary care settings
OST in community settings
OST in custodial settings
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
5. OST in various settings
OST in hospitals
Department of Psychiatry
Department of General Medicine
OST in primary care settings
OST in primary health care settings
OST delivery through Pharmacies
OST in community settings
Government sponsored OST Clinics
NGO run OST Clinics
With Outreach Programs
With Peer Support
OST in custodial settings
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
6. “Everyone deserves services
no matter what”
Client centeredness
Low threshold services
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
7. Low threshold OST
Disagreement between professional groups and programs on
definition of ‘low threshold’ OST
Abstinence from opioids and other drugs is not the treatment goal
High involvement of GPs and community health providers
Prescription of buprenorphine or slow release morphine
Reduce barriers for admission
Facilitate treatment retention
Strike et al, Int J Drug Policy 2013; 24(6):e51-6
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
8. Facilitators of OST
Government sponsorship
No dispensing fee
Attractive to poor opioid dependent clients
Mobile units
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
9. MMT in North America
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
10. Methadone: IRAN
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
11. MMT, Specialized clinic: Iran
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
12. MMT, General hospital: Iran
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
13. OST Clinic: Melbourne, Australia
WHO Jakarta
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
15. Community MMT Clinic: China
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
16. MMT Clinics in China
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
17. OST in Asia
Methadone scaling up in:
China, Malaysia, Indonesia
Methadone established in:
Hong Kong, Thailand, Myanmar, Vietnam, Cambodia
Nepal, Bangladesh, Afghanistan, Maldives
Buprenorphine substitution in:
India
Malaysia
Detoxification using buprenorphine in Indonesia, Malaysia, India,
China, Myanmar
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
18. Models of delivery in South Asia
Model Bangladesh India Maldives Nepal
Drug used Methadone Buprenorphine
Methadone
Methadone Methadone
Beneficiaries PWID PWID People with
Opioid
dependence
PWID
Location GO run
hospital
NGO run TIs
GO-NGO
Model
Govt Dept of
Psychiatry,
Medical
College
Urine testing No No Random urine
screen
No
Rao et al, Bull World Health Organ 2013; 91:150-53
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
19. OST in Asia
Country Estimated no. of
PWID
No. of OST sites
in 2008
OST
in prison
Est. no. of PWID
covered by OST in
2008
China 1,800,000–
2,900,000
531 159,439
Indonesia 190,460–247,800 35 4 3300
India 106,518–223,121 47 1 4600
Malaysia 170,000–240,000 68 4 22000
Maldives 400–500 1 45
Myanmar 60,000–90,000 7 500
Nepal 28,000 2 192
Thailand 160,528 147 4000-5000
Viet Nam 135,305 6 1484
Adapted from: Chatterjee & Sharma / International Journal of Drug Policy 21 (2010) 134–136Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
20. OST Scale-up in India (March 2014)
29
104
147
94
32
175
350
250
0
50
100
150
200
250
300
350
400
No of states
with OST
No of Districts
with OST
Services
No of OST
Centres
No of OST
centres with
Govt
Current Status
Targets
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
21. Community based OST Clinic: Chennai
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
22. Community based OST Clinic: Delhi,
India
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
23. Implementation of OST within
prison
OST reduces HIV transmission within prisons
It serves as a conduit to care after release from prison
It reduces the adverse consequences of injection drug
use, including overdose both within prison and after
release
Springer, 2010. Addiction, 105, 224–225Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
24. MMT in Prison Malaysia
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
25. OST in prisons: Malaysia
Attitudes of prisoners to MMT
Secondary HIV prevention among prisoners in Malaysia
is crucial to reduce community HIV transmission after
release
Half of the surveyed HIV+ prisoners believed that OST
would be helpful, only a third said they needed it to
prevent relapse after prison release
Those reporting the highest injection risks were more
likely to believe OST would be helpful
Bachireddy et al, Drug and Alcohol Dependence 116 (2011) 151–157Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
26. 2. OST AS DRUG TREATMENT
VS
OST AS HIV PREVENTION
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
27. Opioid Substitution Therapy (OST):
Triple Action
Objective Target population Responsible
sectors, agencies
OST as HIV prevention IDUs Ministry of Health
Prison authorities
NGOs
OST to improve treatment
adherence to ART and TB
DOTS
HIV + IDUs
IDUs with TB
Ministry of Health
ART Centres
Hospitals
Prisons / custodial settings
NGOs
Private Sector
OST as drug dependence
treatment
Opioid dependent persons
(includes both IDUs and
non-injecting drug users)
Ministry of Health
Public Security
Drug treatment and
rehabilitation centres
Prisons / custodial settings
NGOs
Private sector
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
28. COCKRANE REVIEW: MMT
Methadone is an effective maintenance therapy
intervention for the treatment of heroin dependence
It retains patients in treatment and decreases heroin use
better than treatments that do not utilise opioid
replacement therapy
It does not show a statistically significant superior effect
on criminal activity or mortality
Mattick et al, Cochrane Database Syst Rev. 2009 Jul 8;(3)Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
29. Impact of MMT Program, China
In 2008 and 2009, respectively, an
estimated 2969 and 3919 new HIV
infections (excluding secondary
transmission) were prevented
Consumption of heroin was
reduced by 17.0 tons - 22.4 tons
$US939 million - US$1.24 billion in
heroin trade were avoided
MMT program is supported
legislatively and financially by the
central government with multi-
sector cooperation
Incorporation of MMT clinics into
existing medical infrastructure,
which has facilitated delivery of
services
Yin et al, International Journal of Epidemiology 2010;39:ii29–ii37
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
30. MMT Program, China
(128 clinics, 2-year follow-up)
Yin & Wu, 2008:
Presented at 19th International Conference on Harm Reduction,
11-15 May 2008, Barcelona, Spain
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
31. Components of effective methadone
treatment
Flexible but adequate dose of methadone after
stabilisation (usual range 50–150 mg)
Adequate duration of treatment
Goal of maintenance
Rapid and client-centred assessment and induction
Ward et al, 1999. THE LANCET, Vol 353
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
32. Components of effective methadone
treatment
Psychosocial services to deal with social disadvantage
and psychiatric comorbidity
Trained staff with positive attitudes towards MMT and
opioid dependent patients
Affordable - cost of treatment should not exceed ability
to pay
Engagement with clients rather than punishment of
continuing illicit drug use
Ward et al, 1999. THE LANCET, Vol 353
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
33. Buprenorphine and illicit drug
use
Fiellin et al, J Acquir Immune Defic Syndr 2011;56:S33–S38Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
34. OST in HIV settings:
OST as HIV prevention
Injecting
frequency
Injecting
risks
Sex risks HIV
infectivity
HIV
incidence
OST ↓ ↓ x -- ↓
Adapted from: Degenhardt et al, Lancet 2010; 376: 285–301
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
35. Evidence for MMT as HIV
prevention
Metzer et al, J Acquir Immune Defic Syndr. 1993 Sep;6(9):1049-56
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
36. Effectiveness of MMT
MMT is associated with a significant decrease in
injecting drug use and sharing of injecting equipment
MMT is associated with a lower incidence of multiple sex
partners or exchanges of sex for drugs or money, but no
change, or only small decreases, in unprotected sex
Studies of seroconversion, suggest actual reductions in
cases of HIV infection
Farrell et al, International Journal of Drug Policy 16S (2005) S67–S75
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
37. Evidence for OST:
Other benefits in HIV integrated care
BHIVES Collaborative findings
• Established in 10 sites as integrated models of HIV primary care and
substance abuse treatment
• OST with buprenorphine/naloxone potentially effective in improving
health related QOL for HIV-infected patients with concurrent opioid
dependence
• Integration of buprenorphine/naloxone into HIV clinics increases
receipt of high-quality HIV care
• Buprenorphine/naloxone provided in HIV treatment settings also
decreases opioid use
J Acquir Immune Defic Syndr 2011;56Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
38. Evidence for OST as HIV prevention:
Buprenorphine in reducing HIV related
risk behaviours
Sullivan et al, J Subst Abuse Treat. 2008; 35(1): 87–92Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
39. OST medications: Is there a
choice?
Methadone Buprenorphine
Most researched and proven
effectiveness as HIV prevention and
dependence treatment
Relatively less researched; evidence for
HIV prevention and dependence
treatment exists
Cheaper; cost effective option Expensive
Overdose not uncommon ‘Ceiling effect’ – Safety of the drug
Drug interactions with ARVs – need to
adjust doses
No clinically significant drug
interactions with ARVs
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
40. Key findings from WHO
collaborative study on OST and HIV
OST can achieve similar outcomes consistently in a culturally
diverse range of settings in low- and middle-income countries to
those reported widely in high-income countries
It is associated with a substantial reduction in HIV exposure risk
associated with IDU across nearly all the countries
Results support the expansion of opioid substitution treatment
Lawrinson et al, 2008; Addiction, 103, 1484–1492Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
41. Methadone vs Buprenorphine
Methadone clients have more severe substance abuse and
psychiatric and physical problems compared to buprenorphine
clients
Clients on methadone are more likely to remain in treatment
However, those retained on buprenorphine are more likely to
suppress illicit opiate use and achieve detoxification
Buprenorphine may also recruit more individuals such as those
who do not want methadone to treatment
Pinto et al, J Subst Abuse Treat. 2010;39(4):340-52.
The SUMMIT Trial
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
42. Effectiveness of OST with
methadone or buprenorphine
There is strong evidence that OST with methadone or
buprenorphine suppresses illicit opioid use
Both access to and effectiveness of OST contribute to
sustaining adherence to HAART in HIV-infected IDUs
There is also evidence that OST for HIV-positive IDUs is
associated with improved health outcomes
Farrell et al, International Journal of Drug Policy 16S (2005) S67–S75
Roux et al, 2008; Addiction, 103, 1828–1836Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
43. Effectiveness of OST with
methadone or buprenorphine
Buprenorphine is an effective medication in the
maintenance treatment of heroin dependence, retaining
people in treatment at any dose above 2 mg
Compared to methadone, buprenorphine retains fewer
people when doses are flexibly delivered and at low
fixed doses.
If high doses are used, buprenorphine
and methadone appear no different in effectiveness
care.
Methadone is superior to buprenorphine in retaining
people in treatment
Mattick et al, Cochrane Database Syst Rev. 2014 Feb 6;2
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
44. 3. INTEGRATED OST SERVICES
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
45. Integrated Services
Different models of integration
Co-located services
Case management
Referral networks
Role of medical providers in screening and
interventionPresented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
46. Integrated Services
Different models of integration
Clinic site level integration
Same physician delivering addiction and
medical services
Two physicians working together at the
same clinic
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
47. Integrated Services
Psychosocial services
Mental Health Services
Pregnancy and reproductive health services
Infectious diseases care services – HIV, HCV,
TB
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
48. Integrated Services
Potential benefits of providing integrated
substance use and medical care services
Increase drug treatment capacity
Reduce health and administrative costs
Diminish duplication of services
Improve health and drug treatment outcomes
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
49. New Initiatives at Integrated
Services
Integrating the Substance use and HIV
services
Buprenorphine HIV Evaluation and Support
Services (BHIVES)
Integration into community and hospital based
clinics
Weiss et al, J Acquir Immune Defic Syndr Volume 56, Supp 1, March 2011
BHIVES Collaborative
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
50. Evidence for OST:
Positive HIV treatment outcomes
Altice et al, J Acquir Immune Defic Syndr Volume 56, Supp 1, March 2011
BHIVES Collaborative
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
51. Reasons for poor adherence to
OST and ART
Perception of adverse effects
Alcohol consumption
Depression
Roux et al, 2008; Addiction, 103, 1828–1836Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
52. Integration with mental health
services
High prevalence of personality disorders
Depression
Co-morbid substance use disorders
Integrated services
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
53. OST, Pregnancy and
Neonatal abstinence syndrome
Methadone has been the recommended standard of care for
opioid-dependent pregnant women
Buprenorphine is an alternative to methadone for the treatment
of opioid dependency during pregnancy
The benefits of buprenorphine in reducing the severity of NAS
among neonates with this complication suggest that it should
be considered a first-line treatment option in pregnancy
Jones et al, N Engl J Med 2010; 363:2320-31Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
54. How to improve and ensure effective
linkages?
Co-location of services
Collaboration between various departments
Cross training of health professionals
Treatment literacy for IDUs
Other supportive services
mental health, psychosocial support, nutrition
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
55. 4. KEY GAPS IN OST PROGRAM IMPLEMENTATION
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
56. OST adoption
Despite evidence, detoxification is preferred than opioid
substitution therapy by several addiction programs
Leadership qualities critical to OST adoption
Leaders’ training treatment orientation, tenure determine
OST adoption
Leaders less ideologically grounded in abstinence only
approaches
Friedmann et al, J Behav Heal Serv Res 2010, 37(3):322-37Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
57. OST: Key challenges for the
resource poor settings
What is the most effective model for implementing
OST?
How can OST become a fundamental component of
integrated HIV prevention?
How can the quality of the OST programmes be
ensured and evaluated?
Kermode, Crofts, Kumar & Dorabjee, Bull World Health Organ 2011;89:243
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
58. Efficient ways of delivering opioid
substitution medication
Prescription by general practitioners
Community pharmacies
Community based approach to OST
Integration into primary care
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
59. Key obstacles to safe and effective
delivery of opioid substitution medication
Restricted Government funding and support for
OST
Limited patient capacity to pay for OST
Prejudices against OST
A balance between overregulation and laissez-
faire provision
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
60. Advocacy in Islamic Republic of Iran
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
61. Islamic Republic of IRAN
This order is to remind judges at all courts of justice and
prosecutors’ offices throughout the country that, since a major
element of criminal action is verifiable malicious intent, the
aforementioned interventions are clearly void of such intent and,
instead, are motivated by the will to protect society from the
spread of deadly contagious diseases, such as AIDS and hepatitis.
Therefore all judicial authorities must consider the lack of
malicious intent in the interventions of the Ministry of Health and
Medical Education as well as those of other centres and
organizations that are active in this field. They must not accuse
service providers of assisting in the criminal abuse of narcotics
and must not impede the implementation of such needed and
beneficial programmes. Seyed Mahmood Hashemi Sharoudi
Head of the Judiciary
24 January 2005
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
62. Policy and OST
Policy shifts increase coverage of OST
In Vietnam, Malaysia and China, shift from punitive
law enforcement to evidence based treatment has
increased coverage
Policy shift in Ukraine increased OST coverage
Russia’s stand against OST and closing down
access to information on methadone
Degenhart et al, Int J Drug Policy 2014; 25(1):53-60
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
63. Workforce and Training
Limited training and teaching in addiction
medicine during MBBS
Possibility for one day training course for
prescribing buprenorphine
Training of nurses, pharmacists and other
healthcare workers
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
64. MMT in China: Barriers and
facilitators
Barriers to MMT for
clients
Requirement for registration in the police department
Perceived societal stigma; Logistic difficulties;
Side effects; Inappropriate perception of methadone;
Fear of being addicted to another drug;
Lack of additional services; Economic burden
Barriers for Service
Providers in MMT
Financial difficulties; Lack of professional training
Difficulties in pursuit of career; Lack of institutional
support
Concern for personal safety; Low income
Large work load; Misunderstanding by society
Factors associated
with successful MMT
MMT clinics affiliated with local CDCs have more clients,
higher retention rates
Longer operating hours
Incentives for compliant clients
Lin et al, J Subst Abuse Treat. 2010; 38(2): 119.
Lin et al, Int J Drug Policy. 2010; 21(3): 173–178
Lin, 2009. Dissertations & Theses, UCLA
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
65. Factors that maximise
participation in OST programs
Client related Ease of access
Extended opening hours at clinics
Sufficiently high doses
Service Providers
related
Non-judgemental clinicians
Professionally & technically competent to deal with
addiction related issues
High staff morale
Access to allied medical, psychological and welfare
services
Support related Significant peer support
Family support
Support groups
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
66. OST: Key gaps identified
• OST is available for a limited number of IDUs at present in
most countries of South Asia
• Lack of exclusive OST centres for women injecting drug
users
• Effective linkages with other services such as ICTC, ART,
TB DOTS, Drug dependence treatment is a significant
challenge
• Pharmacological options for OST need to be expanded
– Methadone; Buprenorphine; Buprenorphine-Naloxone; Oral morphine
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
67. Evidence for OST as HIV prevention:
Coverage is critical
Country IDU
prevalence
(%)
OST
availability
HIV
incidence
among
IDUs, 2005
HIV
incidence
among
IDUs, 2006
Russian
Federation
Current IDU
1.78
OST not available 72/million 79/million
Ukraine Current IDU
1.16 (1.00, 1.31)
OST mostly
unavailable (~1%)
134/million 153/million
USA Current IDU
0.96 (0.67, 1.34)
OST available
(1998–2004:
15%–25%)
18/million NA
Canada Lifetime IDU
1.3 (1.0, 1.7)
OST available
(2003: ~26%)
7.2/million 7.3/million
EU (27 countries) Current IDU
0.19 (0.16–0.21)
OST available
(2004: ~33%)
6.4/million 5.9/million
Australia Current IDU
1.09 (0.65–1.50)
OST available
(2006: ~50%)
1.6/million 1.4/million
Weissing et al, Am J Public Health 2009; 99:1049–1052.
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
68. Why OST is needed for non-injecting
opioid dependent users?
Strathdee et al, Lancet 2010; 376: 268–84
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
69. 5. CONCLUSION
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi
70. Conclusion
• OST is an effective evidence based drug use treatment for injecting
as well as non-injecting opioid dependent individuals
• OST is evidence based opioid use disorder treatment
• OST in HIV settings is primarily to prevent HIV and improve ART
adherence; often benefits go beyond HIV related issues
• Integrated OST services are essential
• The identified gaps in OST in Asia can be effectively addressed in
future through scaled-up efforts (in community & custodial settings)
and multi-sectoral collaboration
Presented at the national CME "OST: Policy and Practice" on 18th-19th April 2015 at AIIMS, New Delhi