Hem Sethi

Concordance Between Urinary Cotinine Levels and Self-Reported Tobacco Use Among Drug-Dependent Persons: A Pilot Study

Self-reported drug use is a principle measure in the evaluation of treatment outcome. As there have been concerns about the accuracy of self-reporting, it is necessary to establish its validity by an objective method. The aim of the study was to examine the concordance between urinary cotinine concentrations and self-reported tobacco use among drug dependents seeking treatment at National Drug Dependence Treatment Centre, AIIMS, New Delhi, India. Eighty consecutive male drug addicts attending the OPD at National Drug Dependence Treatment Centre were interviewed by the clinician. Their tobacco as well as drug use history was recorded, and thereafter their urine sample was analyzed for drug testing. Mean age of the subjects was found to be 33 years (SD: 10). Urinalysis showed high concentration of cotinine (mean ± SD: 586.40 ± 222.15 ng/ml) in 95% of the subjects. High concordance was observed between self-report of tobacco use and urinary cotinine. The quantity of tobacco consumption and FTND scores were also correlated with the urinary cotinine levels. Urinalysis also showed misuse of opioids, benzodiazepines and antihistaminics. The treatment for tobacco use has been given low priority in the de-addiction centers. Tobacco is highly prevalent among the drug abusers. The effectiveness of the treatment program may be increased by using the combination of urine analysis along with self-report.

A 24‐week outcome following buprenorphine maintenance among opiate users in India

Aims: To evaluate the outcome at 24 weeks following a community‐based treatment programme using buprenorphine maintenance among male opiate users in Dimapur, Nagaland ( India). Design: Quasi‐experimental prospective follow‐up study. Participants: Fifty‐four male current opiate users were recruited following fulfilment of inclusion criteria from a community. All users seeking treatment met the DSM III‐R criteria for opioid dependence. Methods: All subjects received buprenorphine (1.2–1.8 mg sublingually per day) from a community clinic and attended psychosocial sessions. Measurements included an assessment of demographic and clinical variables, Addiction Severity Index (ASI), retention in treatment, drug use at baseline and follow‐up at 24 weeks. Findings: The mean age of sample was 26.3±4.1 years, with a mean duration of opioid use of 4.0±3.8 years. The retention rate was 81.5% at 24 weeks. Scores on the Addiction Severity Index decreased and injecting use reduced. No adverse events were reported. Conclusion: Buprenorphine was found to be effective with greater retention rates and less opioid use. Results support the theory that community‐based setting to provide maintenance treatment with very low staff investment from a community clinic can be initiated and replicated safely and effectively in India. However, future work on evaluation of higher doses is recommended.

A Retrospective Chart Review of Treatment Seeking Middle Aged Individuals at a Tertiary Care Substance Use Disorder Treatment Centre in North Part of India over Five Successive Years: Findings from Drug Abuse Monitoring System

Adolescents and young adults continue to remain the main focus of attention with regards to substance use related problems. There has been a limited focus on illicit substance use among middle aged and elderly population. The current study explored the changing trends of substance use among treatment seeking middle aged individuals (aged 40–60 years) at a tertiary level drug dependence treatment centre. The questionnaire used to gather information for the study is a 19-item structured questionnaire. It includes information on various sociodemographic variables, “current,” and “ever” use of substance. Information is also collected on variables related to high risk injecting drug use and HIV status of the individuals. There has been consistent increase in the population of treatment seekers over five years. Over the five-year period, the absolute percentage increase in treatment seeking population is approximately 21%. Polysubstance use was found to increase significantly over five-study years (P Trend = 0.007).

Slow-release oral morphine as a maintenance agent in opioid dependence syndrome: an exploratory study from India

Aim: Slow-release oral morphine (SROM) as agonist maintenance agent was introduced recently in India while buprenorphine is available for the past two decades. In this study, the drug use and psychosocial status of opioid-dependent patients who were maintained on buprenorphine and subsequently shifted to SROM were assessed. Design: This is an observational study. Procedure: This study was carried out in a community-based drug treatment clinic in New Delhi. Thirty-nine opioid-dependent males maintained on sublingual buprenorphine (for at least 1 month) were included in this study. Due to difficulty in buprenorphine procurement for some period, 34 patients were shifted to SROM after informed consent. Assessments were made prior to the switch-over and after 4 weeks of stabilisation on SROM. Results: All patients initiated on SROM continued to remain in the treatment during the 4-week period. The low scores on measures of opioid withdrawal symptoms, craving and high scores on quality of life observed while on buprenorphine continued even after 4 weeks of SROM treatment. Patients on SROM reported mild adverse effects. Conclusion: SROM is as effective as buprenorphine in controlling withdrawal, craving and quality of life on short-term follow-up.

Characteristics of opioid drug users in an Urban Community Clinic

Background: Community-based treatment program is an approach for the treatment of opioid users that aims to engage, retain, and provide treatment to some of the most marginalized and hardest to reach populations in order to reduce the harms of continued opioid use. Aims: To describe the demographic and clinical characteristics of opioid drug users from a community clinic for opioid drug users in a metropolitan city of India. Methods: Oral substitution treatment with buprenorphine for opioid-dependent drug users was being carried out through a community clinic located in an urban resettlement colony in Delhi. The information on 104 opioid users attending the clinic was gathered by self-report on the drug abuse monitoring system questionnaire and a brief semi-structured proforma. Results: Majority of opioid-dependent (mainly heroin) drug users were male (97.1%) and most were married (58.7%). Around 33% were illiterate, and a large number (42%) were presently unemployed. Heroin was the primary drug of abuse in majority of the patients (97%). The mean age of initiation of opioid use was 20.3 ± 7.3 years and mean duration of opioid use 10.8 ± 8.9 years. Around 67.3% had a history of injecting drug use, while 49% were still injecting drug in the last 1 month. The highest rates of injecting drug use were among those who were between the ages of 18 and 25 years, unmarried, having some education, employed, and living in nuclear families. The significant risk factors for injection drug user (IDU) were being unmarried (odds ratio [OR] = 3.6, confidence interval [CI] = 1.2–10.9) and having sex with sex workers (OR = 2.9, CI = 1.4–7.7). A highly significant linear relationship was found between the number of risk factors and IDU. Conclusions: Studying the characteristics of opioid drug users and injectable drug use among people who use opioids will help to define treatment and preventive interventions.

Time trends of cannabis use among treatment-seeking individuals at government de-addiction centers across India over a period of 7 years

Background: Cannabis continues to be the most commonly used illicit psychoactive substance globally. The National Survey in India conducted in the year 2004 also reported it to be the most commonly used illicit substance in the country. Furthermore, it was reported to be the second most commonly used psychoactive substance by the treatment seekers at de-addiction centers in the country. Objectives: To assess time trends of cannabis use among treatment-seeking individuals at government de-addiction centers across India over a period of 7 years. Materials and Methods: The study utilized data collected through Drug Abuse Monitoring System across India. The data of treatment seekers from de-addiction centers established under the Drug De-addiction Program, Ministry of Health and Family Welfare, Government of India and supported by the Ministry of Social Justice and Empowerment, Government of India (122 in number) across the country were analyzed. Results: A total of 107,469 individuals sought treatment from government de-addiction centers over the 7 years (2007–2013) period. With the exception of an aberration for the year 2012, there has been a steady decline in the proportion of treatment seekers who are not current cannabis users. A significantly greater proportion (Chi-square: 586.30, df: 1, P < 0.001) of individuals with current cannabis use alone or along with tobacco (20.4%) tend to have a co-morbid psychiatric disorder as compared to treatment seekers with current use of substances other than cannabis (6.1%). Conclusions: It is important to focus on cannabis in clinical service delivery and research in the country.

Opioid substitution treatment in Tihar prisons, India: Process of implementation

Sonali Jhanjee *, Suruchi Pant , Narinder Kumar Girdhar , Hem Sethi , R. Gunasekaran Rengaswamy , Raka Jain , Jayadev Sarangi b National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India United Nations Office on Drugs and Crime, Regional Office, South Asia (UNODC, ROSA), New Delhi, India c Tihar Prisons, New Delhi, India

Use of alcohol among treatment seeking illicit drug users in India

Introduction: Concomitant multiple substance use by clients in drug abuse treatment settings has been recognized as an important treatment issue for many years, and remains under-researched in Indian context. Aim: To examine the patterns and prevalence of concomitant alcohol and illicit drug use among the patients seeking treatment for illicit drug use. Materials and Methods: A total of 110 patients attending the National drug dependence treatment centre having multiple drug use were included for the present study. Data was collected by face-to-face structured interview on a semi-structured proforma. Results: It was observed that overall 38.2% of the illicit drug users had concomitant alcohol use. Concomitant use of alcohol was found to be 37.1%, 45.5% and 44.4% among heroin, cannabis users and Doda (opium) users respectively. The maximum quantity of alcohol consumption was reported by patients who used opium (Doda) (mean = 703.13 ml/day). A multinomial logistic regression analysis showed that middle aged males and those with lower educational levels, were at greater risk for concomitant exposure to alcohol and illicit drugs. Conclusion: Many people use alcohol in combination with illicit drugs. Clinicians should warn every patient about alcohol-drug interactions, especially those at high risk for concomitant exposure. These findings have implications for prevention, as well as clinical risk for adverse consequences of concomitant alcohol and illicit drug consumption.