2. 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

3. 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.inwww.naco.nic.in

4. 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

5. Objectives  Medicines used for detoxification and maintenance  Effect of maintenance on retention & relapse  Pricing of medicines  Source of medicines  Availability of medicines

6. 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

7. Result Summary  Alcohol abuse (26%), injecting opioid abuse (4%) AlcoholOpioid DetoxificationDiazepam (88%) Clonidine (94%) Naltrexone maintenance 18%42% Maintenance cost Rs. 280 / $ 6 / week Non-retention / Relapse 76%98%

8. 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)

9. 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

10. 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

11. Research Agenda  Pilot study with oral methadone in injecting opioid abuse  Objective: Retention and health consequences, i.e., HIV  Outcome measures: 1.Retention in program 2.Reduction in needle use 3.Seroconversion