Opioid dependence is a significant clinical and public health issue in India. Opioid substitution therapy (OST) is the most evidence-based treatment for opioid dependence. Although available in India for about three decades now, Indian research on this treatment modality has not been adequately reviewed so far. We conducted a narrative review of Indian research on OST. We conducted an online search for relevant literature in the peer-reviewed journals as well as the general online search for books and monographs. We present the findings of the review in the form of description of literature according to certain identified themes. Considering that methadone has became available in India, only recently, the Indian research on OST predominantly features buprenorphine as the agent. Effectiveness of OST among Indian opioid-dependent patients has been well established through prospective, experimental designs as well as through naturalistic studies using retrospective, chart-review approach. Naturalistic and observational postmarketing surveillance studies have demonstrated the safety of buprenorphine and methadone when used as OST. There are certain areas in which more research on OST will be beneficial for Indian clinicians as well as policy-makers. However, the quantum of evidence base that exists in India is more than adequate to justify the scale-up of this modality of treatment. A conducive policy environment for scaling-up OST is need of the hour.
Letter to the Editor limiting to only two years, not looking at trends of reporting, and relatively unconstrained definition of a "club drug." The findings suggest that club drugs might become a further health and law enforcement challenge in the times to come. Among the reported substances, cocaine seems to be an important drug that is being seized and reported upon. The previous Drug Abuse Monitoring System (DAMS) data of India, which collects information of patterns of substances from different treatment centers, had reported cocaine infrequently among the treatment seekers. 6 The rates of seizure of cocaine, mephedrone, and methamphetamine would mean that healthcare services need to be cognizant of the potentially increasing use of stimulants. The findings complement the findings in the World Drug Report, which suggests that India may be an emerging origin, transit, or destination for drugs like ecstasy, cocaine, and amphetamines. 7 Law enforcement also should be better sensitized, enabling the officials to take necessary actions for detection and prosecuting wherever necessary. It has been observed that stimulants have gradually become an important substance of abuse and cause of mortality in South East Asia, 8,9 but not yet in South Asia. A careful watch is required to prevent it from becoming a greater challenge. It would need attention from mental health professionals and psychiatrists when patients with abuse of these substances seek treatment either for the addictive disorders or comorbid psychiatric disorders.
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