Additional Director General of Police and chief of the anti-drug Special Task Force (STF) in Punjab Harpreet Singh Sidhu on Friday said that the carry home dose of de-addiction medicine buprenorphine should be increased to 21 days, if not 28 days.
The state government had increased the carry home dose during curfew and lockdown from 7 days to 14 days first, and then 21 days, but recently cut it back to 7 days amid concerns of probable “misuse” of the medicine.
At the dispensing centres, patients are being given doses ranging from 5 to 7 days, an official said.
Punjab Health Minister Balbir Singh Sidhu on Thursday said that the carry home dosage was reduced so that addicts undergoing treatment could be “counseled more frequently” at the Outpatient Opioid Assisted Treatment (OOAT) clinics.
There are 198 government-run OOAT centres and 35 government de-addiction centres. There are 108 privately-run centres.
During the lockdown and curfew in the state, nearly 1.2 lakh addicts taking various opioid drugs enrolled in OOAT centres to get treatment as supply of illegal drugs became scarce.
From March 23 to June 2, the number of patients registered to take the medicine increased from 4.14 lakh to 5.33 lakh. A total 1.93 lakh have registered in government OOAT centres and 3.39 lakh at private centres.
Harpreet Sidhu said, “The carry home dose of buprenorphine should be at least 21 days, if not 28 days. Those who come to take the free medicine from OOAT clinics usually cannot afford to pay for these medicines at private centres. More frequent visits for medicine would mean that they would end up wasting a day or half which could be used for gainful employment. Calling them repeatedly for the medicine also puts a burden on doctors and other staff who are working very hard and also are already overstretched.”
If the carry home dosage is increased, Sidhu said, doctors and staff have more time to attend to new patients in a better way.
The STF chief said there were minimal chances of any “misuse” of buprenorphine. “Its misuse is very minimal. For instance, only the first pill will work and even if someone consumes more pills, these would have no impact due to the ‘ceiling effect’ of the medication and will not cause any harm,” said Sidhu.
He added that in case there is any “diversion”, only that person who is already hooked to some opioid drugs will consume it. “This would mean that an addict would come under the treatment net.”
According to Dr Abhishek Ghosh, assistant professor in PGI psychiatry department and de-addiction and treatment centre, Buprenorphine does not produce a high or euphoria equivalent to other abusive drugs like heroin or other opioid drugs. “It is basically a medicine which can take care of craving, withdrawal symptoms and which can also block the effects of abusive drugs. For example, if a person is on adequate dose of buprenorphine and that person relapses for heroin and even if he/she takes heroin he/she will not get high because of the heroin,” said Dr Ghosh.
Dr Ghosh said that since buprenorphine was being administered in combination with naloxene, risk of abuse was very low. “There is a ceiling effect after a certain dosage,” added Dr Ghosh.
“If a person takes adequate dose of buprenorphine he or she will be able to concentrate on their daily lives and it will help the person recover,” said Dr Ghosh.
Dr Ghosh added that diversion of the medicine was an issue and should not take place. However, he said that the diverted medicine was most likely consumed by addicts of abusive opioid drugs only who experience craving or withdrawal symptoms. He also supported giving medicine for longer duration. “It is perfectly justified to dispense carry home dosage for longer period.” Citing the lockdown, he said, “Earlier, we were dispensing this for two weeks and subsequently we increased it to four weeks.”
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