Treating opioid and alcohol dependents

Health: The Bhutan Narcotics Control Agency (BNCA) and the United Nations Office on Drugs and Crime (UNODC) will soon begin a treatment for opioid and alcohol use disorders in Bhutan.

The treatment programme will be launched this month as part of the Drug Free Campaign 2015, which Her Majesty Gyalyum Tshering Pem Wangchuck launched on June 26 to commemorate the 60th Birth Anniversary of His Majesty the Fourth King.

Psychiatrist at the military hospital in Thimphu, Dr Sonam Tobgay explained that for opioid drug users, the treatment would use a harm reduction approach through an opioid substitution treatment (OST). Sublingual buprenorphine tablets will be provided as substitution for opioid.

Opioid is opium like compound that binds to one or more of the three opioid receptors of human body. It is a pharmaceutical drug that is abused. A person who is addicted to the drug is called an opioid dependent. In Bhutan most opioids are used as injection and pharmaceutical drugs such as Relipen and Spasmo proxyvon.

Dr Sonam Tobgay said buprenorphine is a partial opioid agonist that has less potential for being abused and does not lead to overdose.

“Once someone is on this treatment, it will suppress craving for other illicit opioids,” he said. “It will help people become functional with improvement in psychological, physical and social wellbeing.”

For the pilot phase, the treatment therapy will be conducted on 50 people with opioid use disorder and another 50 with alcohol use disorder.

In the alcohol use disorder treatment, the clients will be given alcohol withdrawal management service or detoxification based on standardised protocols, management of basic health problems associated with dependent drinking pattern, basic education on alcohol use disorder, psychological support and counselling service.

Making the alcohol dependent ‘abstain from alcohol’ is the main goal here. It is treated with disulfiram, a deterrent drug (tablet) that will help people stay away from alcohol.

In case a person consumes alcohol while on treatment, it would cause nausea, vomiting, headache, palpitation and hypertension among others, Dr Sonam Tobgay said.

“The drug becomes a reminder that the person is one drink away from disaster,” he said.

While drugs for both the treatment can be provided through outpatient service at the hospital, disulfiram tablet for abstaining from alcohol can also be provided through family members on alternative days.

To provide these treatments, BNCA and UNODC have trained about nine officials including medical staff, qualified addiction counsellors and programme officers.

In the region, Bhutan is the fifth country to put the evidence-based intervention in place after India, Maldives, Nepal and Bangladesh.

BNCA’s deputy chief program officer Dorji Tshering said that although there were other methods of treating people with alcohol and drug use disorder, they haven’t been helpful.

A budget constraint did not allow for other types of drugs to be procured for this treatment. The treatment will be implemented at Thimphu referral hospital first and extended to other referral and district hospitals later.

Meanwhile, Dorji Tshering said that there are no recent studies done in the country to determine the drug and alcohol dependence population after the first one was conducted in 2009. A national survey is likely to be conducted sometime next year.

“The survey is developed already and we need electronic devices with GPS service to authenticate the survey and analyse the data immediately,” he said.

By Nirmala Pokhrel

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