Opioid Substitution Treatment (OST) is provided to substitute illicit drugs with a medically safe, long acting agonist licit medication. It is prescribed by a medical doctor and administered under the supervision of a trained nurse or pharmacist. Methadone and Buprenorphine are the most well studied medications used for OST.

The nature of drug dependence is such that it is a 'relapsing medical condition' and abstinence based approaches alone are unable to help the majority of drug users. OST results in significant harm minimization to the IDU, thereby reducing the risk of transmission of HIV and other blood borne viruses. For certain injecting drug users, abstinence can be achieved, if they are self-motivated to do so, by tapering of medication gradually through consultations between the doctor and the client.


OST results in elimination of craving for the illicit drug. In addition, it blocks the effect of illicit opiate drugs if used by the drug user while he/she is on OST, thereby gradually leading to total abstinence and recovery.


Five Cochrane reviews on substitution treatment (Clark et al, 2003; Faggiano et al, 2003; Ferri et al, 2003; Mattick, Breen et al, 2003; Mattick, Kimber et al, 2003), which include 52 studies with a total of 12,075 participants have been conducted so far. These examined maintenance treatments on both buprenorphine and methadone, besides other maintenance medications. These have been carried out using rigourous research methodology in USA, Australia, Netherlands, Switzerland, Italy, UK, Austria, China, Thailand, Spain and Sweden.


Overall, these reviews indicate that Buprenorphine and Methadone were effective in retaining patients in treatment and were effective in reducing heroin use among drug users.


OST is known to be effective in not only reducing illicit drug use but also has the following outcomes:


• Reduce the spread of infectious diseases associated with injecting drug use, especially hepatitis B and C and HIV/AIDS.
• Assist individuals to achieve a successful withdrawal from non-prescribed opioids.
• Reduce crime associated with opioid use.
• Reduced criminality associated with drug users.
• Overall, it stabilizes and normalizes the lives of drug users.


Benefits of OST for an Individual:

• Possibility for causal treatment of HIV, Hepatistis B and C; 

•  Reduced overdose mortality;

•  Improved physical and mental health


Benefits of OST for the community:

• Significant reduction in criminal activities of the patient; no need to find money for drugs.

• Reduced risks of hemocontact infections for the society in general – Hepatitis B and C, HIV –as the patients decrease or avoid injecting practices.

• Reduced levels of promiscuity and sex work among drug using women.

Buprenorphine and methadone (used for OST) are safe medications when used appropriately under medical prescription and dispensed by trained nurses or pharmacists after imparting adequate training to the staff.

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