Delivery models of opioid agonist maintenance treatment in South Asia: a good beginning.

Perspectives An estimated 6.5 to 13.2 million people with opioid dependence, representing more than half of the world's estimated number, live in Asia. 1 Although most people in Asia who are opioid dependent use heroin or opium, the use of pharmaceutical opioids, mainly through the injecting route, has raised concern in recent years. and Sri Lanka – the estimated number of people who inject drugs illicitly ranges from 434 000 to 726 500. Of these people, from 34 500 to 135 500 are infected with the human immunodeficiency virus (HIV). 3 Three countries in South Asia – Bangladesh, India and Nepal – have large numbers of people who inject drugs, many of whom are infected with HIV. In the Maldives, the population of people who inject drugs is also large. 4 In response to the large burden of opioid injection, Bangladesh, India and Nepal have established needle and syringe programmes. In Bangladesh and India these programmes have been rapidly scaled up. 2,5 However, this cannot be said for the use of opioid agonist maintenance treatment (alternatively known in South Asia as " opioid substitution therapy "), which is lagging far behind. This form of treatment for opioid dependence has been recognized as effective in preventing infection with HIV and in increasing adherence to antiretroviral treatment (ART); accordingly , it has been endorsed by different United Nations agencies, including the United Nations Office on Drugs and Crime (UNODC) and the World Health Organization (WHO). 6–9 The two opioid agonists most commonly used to treat opioid dependence, buprenorphine and methadone, are on WHO's model list of essential medicines. 10 A WHO collaborative multi-country study has established the effectiveness of opioid agonist maintenance treatment in developing countries. 11 Different delivery models have been implemented across the world, and studies have several positive outcomes, including reductions in drug use, injecting behaviour, incidence of HIV infection, criminality and drug overdose. Opioid agonist maintenance treatment has not yet been integrated into routine health care in South Asia, a term used in this paper to refer to the six countries represented by the UNODC's Regional Office for South Asia: Bangla-desh, Bhutan, India, the Maldives, Nepal and Sri Lanka. A global review in 2010 showed that opioid agonist maintenance treatment is available in India, the Maldives and Nepal. 5 Bangladesh also initiated opioid agonist maintenance treatment in 2010. In our experience while working closely with these six South …