A one day consultation with stakeholders on Opiod Substitution Therapy (OST), organised by Nagaland Users Network and NNagaDao, supported by NSACS, PATH, CDC, PEPFAR and CAD Foundation, was held at hotel Japfü, Kohima, on Saturday.
Sharing on the impact of OST in Nagaland, NNagaDAO secreatry, Ketho Angami highlighted insights into the significant impact of the Opioid Substitution Therapy (OST) program in Nagaland, which was launched in 2006 to address the rising cases of HIV among injecting drug users.
Initially rolled out by NGOs in three districts, the program was later expanded due to high demand and demonstrated success, he said.
The primary goals of OST are to transform illicit drug use into licit (legal) practices, shift from injecting drug use to sublingual (under-the-tongue) methods, and increase social acceptance and productivity among users.
This intervention has been highly effective, with OST playing a crucial role in reducing the frequency of injecting episodes and the number of opioid overdose cases.
The OST program follows a structured maintenance protocol with four distinct phases: Induction, Stabilization, Maintenance, and Cessation. Each phase is designed to guide participants through a gradual and sustainable recovery process.
In 2009, the National AIDS Control Organisation (NACO) absorbed the OST centers, signaling a major boost to the program, which also saw the expansion of OST sites into government settings.
By August 2014, Nagaland had established itself as the only state in India with OST centers in every district. At that time, a total of 32 OST centers were operational, including five in NGO-run facilities and 27 in government-run facilities.
These centers collectively served 9,499 key populations (KPs), with 1,322 active in 5 NGO-run centers and 8,177 in 27 government-run centers.
The sustained implementation of OST over the past 18 years has been driven by its ability to prevent the resurgence of drug use, its acceptability among communities, and its evidence-based approach to harm reduction. OST remains a vital tool in mitigating the challenges of problematic drug use in the region.
In parallel with OST services, a series of OST treatment literacy events have been conducted across the state, further raising awareness about the benefits of the program. As Ketho Angami emphasized, “OST remains a pragmatic harm reduction service package to this day.” The program’s long-term success is a testament to its importance in the fight against drug-related health issues in Nagaland, he said.
Addressing the myths and misconceptions about OST, Dr. Sungtimen Jamir, Medical Officer at the OST Center, Naga Hospital Authority Kohima (NHAK), recently addressed common misconceptions surrounding Opioid Substitution Therapy (OST), emphasizing its critical role in managing opioid dependence and reducing the harmful consequences of addiction.
OST is a medically supervised treatment that replaces illicit opioids like heroin with safer, long-acting medications such as buprenorphine. Its primary goal is to reduce harm, stabilize patients, and support their recovery and reintegration into society. However, several myths persist about the therapy, which Dr. Jamir aimed to dispel.
One of the most widespread misconceptions is that OST simply replaces one addiction with another. Dr. Jamir explained that this is not the case. OST works to reduce harm, much like insulin is used for diabetes. It helps stabilize patients, enabling them to engage in therapy and significantly improve their quality of life.
Another myth suggests that patients on OST continue to abuse drugs. In reality, data from the UK, U.S., Australia, and France shows a 40-85% reduction in illicit opioid use within the first year of treatment, proving that OST helps patients regain control over their lives by reducing cravings and withdrawal symptoms.
There is also a belief that OST is only for individuals with severe addiction. Dr. Jamir clarified that OST benefits people with varying levels of opioid dependency, as long as they meet the criteria set by the National AIDS Control Organisation (NACO). Another common myth is that OST leads to long-term dependence.
In fact, OST can be either short-term or long-term, depending on the patient’s recovery goals. The focus is on achieving recovery, not on the duration of treatment. Some patients may taper off under medical supervision, while others may require longer-term care.
Questions about the safety and effectiveness of OST are also common. Dr. Jamir highlighted that OST is endorsed by the World Health Organization (WHO), United Nations (UN), and U.S. Food and Drug Administration (FDA).
It has been shown to reduce overdose deaths and HIV transmission and is listed as an essential medication by the WHO. OST is also approved for use in children over 12 (with parental consent) and is safe for pregnant women, helping to reduce preterm labor and infant mortality.
In addressing common misconceptions, Dr. Jamir noted that OST is specifically for opioid dependence and is not a treatment for other types of substance use disorders such as alcohol or stimulant abuse. He also dispelled the notion that patients on OST cannot lead normal lives. In fact, OST helps individuals return to work, maintain relationships, and reintegrate into society, with numerous success stories proving its effectiveness.
The persistence of these myths, according to Dr. Jamir, is largely due to the stigma surrounding addiction and medication-assisted treatments. A lack of awareness, coupled with misinformation from drug peddlers and misunderstandings within healthcare systems, has contributed to the false narratives around OST.
Finally, Dr. Jamir emphasized the importance of psychosocial support as a part of OST. In addition to medication, patients receive motivational counseling, behavioral therapy, and relapse prevention, which are crucial for long-term recovery.
Highlighting about the substance abuse and the law, Kezhosano Kikhi, advocate and deputy legal aid defense counsel with the Nagaland State Legal Services Authority, provided an in-depth explanation of substance abuse and the legal framework surrounding it under Indian law.
Substance abuse, according to Kikhi, involves the use of illegal drugs or the misuse of prescription, over-the-counter medications, or alcohol for purposes other than their intended use, or in excessive amounts. This not only includes illicit drugs but also the inappropriate use of legal substances like pain medications and alcohol.
Kikhi highlighted the Narcotic Drugs and Psychotropic Substances Act, 1985, which governs substance abuse and related offences in India. Section 27 of the Act outlines the punishment for consuming narcotic drugs or psychotropic substances.
According to the law, anyone found consuming substances like cocaine, morphine, diacetylmorphine, or other narcotics specified by the Central Government can face rigorous imprisonment for up to one year, a fine of up to Rs. 20,000, or both. For substances not specified in this list, the punishment may extend to six months of imprisonment, a fine of up to Rs. 10,000, or both.
The Act also includes provisions for immunity in specific circumstances. Kikhi explained that Section 64 grants the Central or State Government the power to tender immunity from prosecution to individuals who provide full and truthful disclosure of their involvement in a contravention of the Act, whether directly or indirectly.
This immunity can be extended to offences under the Indian Penal Code or any other Central or State Act. However, if it is later determined that the individual concealed information or gave false evidence, the government may withdraw the immunity, and the person could be prosecuted for the original offence.
Furthermore, Section 64A offers immunity from prosecution to addicts who volunteer for treatment. Kikhi elaborated that any addict charged with an offence under Section 27, or for possession of small quantities of narcotics or psychotropic substances, may avoid prosecution if they voluntarily seek treatment for de-addiction from a government-recognized hospital or institution. However, if the individual fails to complete the treatment, the immunity can be withdrawn, and they may face prosecution for their offence.
Earlier, opening remarks were made by joint diector, Prevention, NSACS, Dr Bernice D Thapru, while technical advisor, NUN, Renbonthung shared on the drug scenario in Nagaland.
Open discussion was initiated by president, NNagaDAO, Abou Mere and secretary, NUN, Neiba Kesiezie proposed the vote of thanks.