CHANDIGARH-Bhagwant Mann Government’s harm-reduction services, a key component‘Yudh Nashean Virudh’, are emerging as an important pillar of the state’s fight against substance abuse.
People suffering from substance use disorder (SUD) can avail harm reduction services through 547 Outpatient Opioid Assisted Treatment (OOAT) centres run by the state’s health department and 47 Opioid Substitution Therapy (OST) centres run by the Punjab State Aids Control Society, along with Targeted Intervention Services.
According to the World Health Organization (WHO), harm reduction encompasses a range of interventions aimed at minimising the negative health and social consequences associated with drug use, including the transmission of HIV. Rather than focusing solely on drug use itself, harm reduction approaches identify and address the various risk factors associated with it to reduce potential harms. Evidence has demonstrated that, when implemented at sufficient scale and coverage, harm reduction interventions can prevent, slow, and even halt HIV epidemics among people who inject drugs. Their benefits also extend to preventing other blood-borne infections, including hepatitis B and C, reducing overdose deaths, lowering criminality, and addressing social exclusion.
Health and Family Welfare Minister Dr Balbir Singh has described harm reduction as an essential component of the government’s comprehensive response to addiction. “We must approach victims with empathy and give them treatment and skills for dignified reintegration, ” Minister Dr Balbir Singh said, underlining the government’s emphasis on bringing affected people back into the mainstream rather than allowing stigma to push them further away from treatment.
The state’s largest harm-reduction intervention is implemented through 500+ OOAT centres where patients can avail counselling and receive medication used to treat opioid use disorder and manage acute or chronic pain through a prescription issued by a government psychiatrist. This outpatient treatment strategy involves the provision of Buprenorphine (BPN) or a combination of BPN and Naloxone, as a medicine which mimics the action of addictive opioid drugs, but which is much safer to use, even for a long duration.
Patients visit an OOAT centre daily to receive their prescribed dosage or, upon meeting a certain criteria, are given home doses for a fixed number of days. According to Dr. Atul Ambekar, Professor at National Drug Dependence Treatment Centre (NDDTC), AIIMS Delhi, “This treatment, called Opioid Substitution Treatment (OST) or Opioid Agonist Treatment is recommended as the first-choice strategy for long-term treatment of opioid dependence.”
Commenting on the nature of the treatment, Dr. Atul Ambekar further clarifies that “since the medicine provided under this treatment may also be addictive in nature, the strategy is often perceived, incorrectly, as substituting one addiction by another. People need to be made aware that many health conditions require taking a medicine every day, for a very long time (running into years and possibly life-long) and simply taking a pill daily, does not make one an ‘addict’.”
The programme focuses on educating drug users about the health risks associated with substance use and encouraging them to seek treatment. For those who continue to inject drugs, health teams provide counselling on safer injection practices, including why not to use syringes that have been used by someone else, and to follow safe injection practices that help reduce the risk of transmission of infections such as HIV and hepatitis.
The state has also been expanding treatment options which include oral substitution therapy, especially treatment through liquid methadone. Six dedicated methadone clinics are now operational in Faridkot, Ludhiana, Patiala, Gurdaspur, Mohali and Jalandhar as an alternative to Buprenorphine. The state is also establishing six more methadone maintenance treatment centres, taking the total number of dedicated facilities to 12.
Health Minister Balbir Singh said, “Methadone maintenance therapy, implemented in accordance with the guidelines of the World Health Organization (WHO) and the National AIDS Control Organisation (NACO), provides an effective treatment option for people with long-term opioid dependence. The comprehensive approach would improve recovery outcomes and help patients successfully reintegrate with their families and society.”