Report on the first government-funded opioid substitution programme for heroin users in the Western Cape Province, South Africa

Abstract

Background. Although pharmacological opioid substitution treatment (OST) is a well-established treatment modality for heroin addiction, it is a relatively recent introduction in low-and middle-income countries. Objective. To report on a pilot OST programme initiated in 2013 that was the only public-funded programme in South Africa (SA) at the time. Participants were offered standard care only (n=68) or, for the OST group (n=67), standard care plus Suboxone (Reckitt Benckiser), a synthetic partial opioid agonist, in a 12-week clinician-monitored programme. Methods. Clinical records of 135 participants in the rehabilitation programme at Sultan Bahu Rehabilitation Centre in Mitchell's Plain, Cape Town, SA, from 1 January to 31 December 2014 were reviewed. Data collected included demographics and duration in treatment (retention) as well as number of urine samples provided, positive tests or self-reported use events and dates of first positive/negative tests. Results. Significantly more participants in the OST group (65.7%) than controls (44.1%) completed the treatment (p=0.019). Among the non-completers, retention was higher in the OST group than in the standard care group (48.2 v. 30.1 days; p=0.001). The groups did not differ in respect of number of missed appointments and time to first positive test. However, the proportion of participants testing positive was higher in the OST group (80.6%) than in the standard care group (61.8%), although the former were tested nearly three times (18.3 v. 6.6 times) more. Consequently, the positive rate (proportion of positive tests) was substantially lower in the OST group (16.8%) than in the standard care group (23.3%).Conclusions. The results demonstrate modest success of this pilot OST programme in terms of completion and retention and should argue for a move to increase availability of and accessibility to OSTs for the management of opioid use disorder.

Six-month retention and changes in quality of life and substance use from a low-threshold methadone maintenance therapy programme in Durban, South Africa

“…The cost of a gram of heroin in South Africa fell threefold from 2004 to 2014 [27]. To date, the country has relied almost exclusively on abstinence based residential treatment or out-patient services with very low 'success' rates, usually measured in terms of abstinence [28,29].…”

“…The first community-based opioid agonist treatment programme was started in 2014 by a civil society organisation with local government funding. The project provided buprenorphine-naloxone for 3 months to non-injecting opioid users using a high threshold approach with 66% (44/67) completing the project [29]. The limited access to opioid agonist treatment has been partly due to concerns around limited acceptance of the intervention by key stakeholders [31], safety concerns [36], and the impact on the health system and prohibitive costs [28].…”

Factors predicting 6-month retention among people with opioid use disorders accessing outpatient methadone maintenance therapy in Tshwane, South Africa

“…[13,[15][16][17] A study of a pilot programme in Western Cape Province, using time-limited (3 months) buprenorphine-naloxone v. no buprenorphine-naloxone, showed that patients receiving the former were more likely to be retained in a substance use treatment programme than those not on the medication. [18] The aim of this research was to determine selected sociodemographic and substance use treatment factors associated with retention for at least 6 months among participants receiving methadone as part of OST in COSUP.…”

International comparison of mitigation strategies for addressing opioid misuse: A systematic review

“…28 The need for data that describe the use of OST in South Africa inspired a study that reported the nation's first public-funded OST program for heroin users. 29 This study aimed to assess the retention and completion of participants receiving standard care only (which followed the Matrix Model for outpatient detoxification) compared with those who used OST, which included standard care plus buprenorphine-naltrexone. Results showed that more patients in the OST group completed the program than those in the control group.…”

“…In addition, among those who did not complete either treatment, retention rates were higher in the OST group than in the control group. 29…”