Lessons Learned from the Opioid Substitution Therapy (OST) Workshop in the Maldives
Key messages of the Regional OST workshop:
OST is an effective evidence-based treatment for drug use
OST provides benefits beyond prevention of HIV and improved ART adherence
OST gaps in Asia can be effectively addressed through scale up efforts in both community and custodial settings
The World Bank South Asia regional AIDS team cohosted a regional workshop on Opioid Substitution Therapy with the Government of the Maldives and in collaboration with UNODC. The workshop brought together 50 policymakers, program implementers, researchers and representatives of networks of drug users from South Asian countries where opioid substitution treatment (OST) has been undertaken and/or is planned as part of an overall comprehensive harm reduction program. Participating country teams from Afghanistan, Bangladesh, India, Nepal, Maldives and Pakistan shared their lessons learned and best practices in implementing OST pilots and programs and learned from each other. A field visit was made to the Male Methadone Maintenance Therapy clinic.
The objectives of the workshop were to: identify critical factors that contribute to effective and sustainable OST programs; understand the importance of the design, impact evaluation and commitment to increase and improve M&E of OST programs; and, strengthen commitment to scale up best practices to increase the coverage of OST as an integral component of comprehensive harm reduction.
Opiate dependence is a chronic relapsing disorder. While detoxification may lead people into drug treatment, evidence shows its long term effectiveness is generally very poor while substitution treatment is an effective, safe and cost effective modality for the management of opioid dependence, associated with substantial reductions in illicit opioid use, criminal activity, deaths due to overdose, and behaviors with a high risk of HIV transmission. The marginalization of most drug users makes them difficult to reach and negative attitudes to drug users can make it difficult to mobilize financial, political and community support required for effective programs. In addition, local laws and regulations may prohibit the implementation of specific interventions. As a result, many governments are trying to adopt pragmatic approaches to prevent HIV among people who use drugs, and this consultation brought key stakeholders together to seek multi sector solutions to scale up OST.
The country teams made commitments to a 100 days results agenda. One of the highlights of the workshop was the presentations by a panel of representatives from drug users networks and organizations.
Quotes from Participants regarding ost
“Methadone as maintenence treatment is a magical mirror that allows to see the past, present and future” - Shoihidul Alam, Bangladesh
"Life saving, life changing programme. Methadone works...Worked for many of us” - Anan Pun, Nepal
"Request for support to Afghan Drug User Network” - Abdul Raheem, Afghanistan
"Support to drug user community is vital to provide psychosocial support and to create a demand for OST” - Ketho Angami, India
"On methadone maintenance therapy I saw a different world” - Naxim, Journey, Maldives
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