Medicine scarcity leaves Ukhrul OST centre on brink of closure

Imphal, Mar 20
With hardly a couple of day’s medicines left for dispensing to its 450 plus clients coupled with various forms of threats received from the clients for not dispensing OST (Opioid Substitution Therapy) medicines at the desired quantity, the OST centre located inside Ukhrul District Hospital has no other option left but to close down the centre, said CoNE.
In a statement today, the Community Network for Empowerment (CoNE) said the scarcity of OST medicines in Ukhrul OST centre has been lingering on since November 2020. With little option left, the staff of the centre have been changing the medicine doses after due discussion and consent of the clients enrolled. However, since the scarcity has continued for over 3 months now, the clients are “fed up” with the explanations they receive from the officials of the centre. “Some of them even went to the extent of almost physically abusing the OST staff with an axe,” said CoNE.
The tense situation came to light when volunteers of CoNE went for an inspection visit at the Ukhrul OST centre on March 18 after receiving specific information that the centre was running out of medicine stock for quite some time and that the clients have been deprived of their daily doses of OST.
When the volunteers visited, the data manager informed them that the centre has been facing shortage of the medicines since November 2020.
“There are two satellite OST centres in Ukhrul in addition to this centre. For these OST centres, 50,000 Buprenorphine tablets are required on a monthly basis. However, a very less amount is being sent on a monthly basis since November 2020. As such, we are compelled to compromise on the medicine doses provided to every client and this is where we fear that the clients might relapse and the whole purpose of setting up OST centre could turn out to be meaningless,” said the data manager.
The data manager further informed that at present there are 500 clients enrolled at the centre out of which 435 are currently on OST.
Treating these huge numbers of clients is not an easy job with only two staff presently looking after the centre. “We have written to the District AIDS Prevention and Control Unit (DAPCU) informing that considering the clientload there should be a minimum of 3 nurses, a counsellor and a doctor, but no response has been received till today. We are most concerned with the wellbeing of the clients coming here to take the medicines. However, due to medicine shortage, doses have been changed and at the same time absence of a counsellor has put all counselling services to the clients at halt,” the data manager added.
Meanwhile, a drug user from Ukhrul, Apengring Shimray (name changed) informed the visiting team of CoNE that a number of drug users, mainly youths from Ukhrul have even started injecting Buprenorphine tablets supplied at the OST centre which are meant to be used orally.
“This practice has become a habit among the young drug users as they feel that injecting Buprenorphine gives them the desired kick and put them high for a longer period of time. The negative implication of such practice seen currently is that their veins get blocked after a single shot and ultimately they suffer from abscess,” Apengring said.
Another drug user Leishipem Kashung (name changed) also informed that even alcoholics and other non-injecting drug users are taking/misusing Buprenorphine tablets supplied at the OST centre which are meant for dispensing to the injecting drug users so as to help them abstain from drug use and decrease spread of HIV.
“This trend was mostly visible during the peak of the COVID-19 outbreak where there was complete lockdown imposed in the district. The few staff present at the OST do not take the drug injecting history of any of the persons coming to get enrolled at the centre and dispensed the medicine whenever demanded. This drift could be one of the main reasons for the huge rise in the number of people taking OST services in the centre,” Leishipem said.
Meanwhile, CoNE president RK Nalinikanta informed that according to the sentinel surveillance report of National AIDS Control Society (NACO), the prevalence rate of HIV among injecting drug users in Manipur is 7.2% and 0.36 among the general population. Considering the fact that HIV transmission from drug users community is very high, NACO under its harm reduction approach started OST program around a decade back to substantially reduce spread of HIV among this community. The program was also taken up to reduce criminal activities among the drug users community and deaths related to drug overdose.
“This very useful program has also been implemented in the State and now we have over 24 OST centres across the State and few satellite OST centres. However, it is very sad to see that the OST programme is being implemented in the State for namesake only with lack of staff and shortage of medicines in many of the centres,” Nalinikanta said.
He stated that the situation at the OST centre located at Ukhrul district hospital is “pathetic”.
“Out of the total of 600 people enrolled at the centre, 450 of them are currently on OST. The 450 people are being monitored by a nurse and a data manager only. There are also stock issues in the centre and as such the doses of the clients are being intentionally tempered with to cover all the clients. This not only causes withdrawal issues to the clients but also could be a reason to compel the drug users to return to their drug injecting habit thereby increasing the possibility of contracting and spreading HIV among themselves and others,” he said.
He further stated that if this situation is allowed to continue, the OST centre could be compelled to close down following lack of staff and shortage of OST medicines which will be very unfortunate for the injecting drug users in particular and the society as a whole. Moreover, the entire effort of the authority concerned in taking up harm reduction program in fighting HIV will be rendered meaningless.
There is an urgent need to identify the gap and look at the visible error in the supply chain management to find out whether it is from the part of NACO or is it the negligence of Manipur State AIDS Control Society, he said and appealed to all concerned to take the issue seriously and take up necessary measures to solve the existing problem once and for all.