Drug Substitution Programs

• Pages: 95-97

Contenidos

• The Issue.
• Legal and Policy Considerations.
• Practice Examples.
• References.

Page 95

The Issue

Drug substitution programs have been widely used to treat injecting drug users for their addictions. Drug substitution programs (or substitution maintenance therapies) are among the most effective treatments for opioid dependency. Opioids, including opium, morphine, codeine, and heroin, are commonly injected. Drug substitution programs provide a prescribed psychoactive substance, related to the one producing dependence, under medical supervision. The substitute drug often works by reducing the craving for the illicit drug without providing a "high" or other euphoric effect. Such programs are controversial, as injecting drug users are generally a very stigmatized population. However, evidence demonstrates that these policies can be effective at reducing injecting drug use and therefore the associated transmission of HIV.

Legal and Policy Considerations

Drug substitution therapy has been implemented in various forms in many countries. Some countries have authorized drug substitution programs within more general legislation for illicit drug regulation. Another approach has been to pass legislation or enact policies that specifically authorize drug substitution. These provisions may even dictate specific drugs to be used and detailed procedures for oversight. Many substitution therapy programs are designed using the principles of good medical practice. Evidence-based guidelines include eligibility requirements for the program, contraindications, best practices in clinical management, and relevant government regulations. Regulations can be aimed at improving the quality of treatment, and not be so restrictive as to deny access to individuals who would benefit from treatment. Medical issues such as maximum doses or maximum length of treatments should be determined by a practitioner's clinical judgment, and based on an individualized assessment of a patient. Registering and/or accrediting treatment providers can help to ensure quality of service and reduce the risk of prescribed medicines reaching illicit channels.

Treatment with a drug substitute has been shown to be effective in curtailing drug use as well as reducing the incidence of HIV. Even so, programs for the provision of substitute drugs can be highly contentious. According to a position paper produced jointly by the World Health Organization, United Nations Office on Drugs...