India Takes Up Overdose Prevention

by Nandini Pillai

Manipur, in Northeast India, has long battled an injection driven HIV epidemic, but took early steps to address it.  The state was among the first places in the country to adopt harm reduction measures, first "bleach and teach” programs before needle and syringe programs (NSPs) were considered acceptable, and then NSPs starting in 1994.  Manipuris were among the first to accept OST and run community based OST programs (1999-2002 and then again in 2006 continuing today).  Manipur was the first state in India to develop an HIV policy based in harm reduction principles in 1996, a policy that was later used as the basis of the national AIDS policy.  

Despite this forward thinking, naloxone isn’t currently available in state funded drop-in centers (DICs).  It is available for purchase in pharmacies in the cities, but it is often inaccessible because pharmacists know that people only buy naloxone in emergency situations and inflate the prices, sometimes to as much as 3000 rupees (about USD 50). In a place where harm reduction has been embraced for decades, it is sad to see that overdose prevention hasn’t been more of a priority.  

The good news is overdose awareness and advocacy for naloxone availability is on the agenda.  NGOs operating under Project ORCHID, the Bill & Melinda Gates funded HIV prevention program in Manipur and Nagaland, have stocked naloxone in DICs and trained staff to promote overdose awareness since 2009.  The Northeast India Knowledge Network Project has documented this program in a new publication, In Time: Drug overdose management in Manipur and Nagaland.    

The success of this program, as well as advocacy efforts from user groups and other service providers have helped to highlight overdose awareness at state and national levels.  The two main hospitals in Imphal now stock naloxone in their emergency departments, so patients' friends or relatives no longer have to negotiate with pharmacists outside the hospital.  Recently, the National AIDS Control Program included overdose management in their plans, meaning that even state funded DICs will stock naloxone.  Once integrated into government funded DICs, overdose will also be tracked as part of the central information management system which I hope will help us better understand overdose trends, and respond to them more effectively.

For more information about HIV prevention programs in Northeast India, please visit the Northeast India Knowledge Network webpage.

Nandini Pillai is a Project Officer with the Australian International Health Institute in New Delhi, India.

Getting naloxone into the hands of people who use drugs in Thailand

by Karyn Kaplan, Thai AIDS Treatment Action Group (TTAG)

“Is it legal?” “What if you inject it in a vein?” “Does it work on a benzo OD?” ”Can you buy it in a pharmacy?” “Does it lead to more drug use?”

These were some of the many questions about naloxone posed by 40 harm reduction project staff and people who inject drugs (PWID) from 14 drop-in centers and NGOs across Thailand, at our first National Overdose Prevention and Management TOT in Bangkok (July 13-14, 2011). We had just distributed over 800 doses to the participants, along w/3mL syringes and 24G/1” needles. Most of them had never seen, let alone heard of, this miraculous drug.

Thailand, despite having roughly 50% IDU HIV prevalence for the past 20 years (HCV prevalence is even higher), does not embrace harm reduction, has no official policy to support it, and has just started “piloting” evidence-based HIV prevention interventions for PWID with Round 8 Global Fund money. Given that Thailand has known only violent government-endorsed drug crackdowns and stigmatizing anti-drug campaigns, it is no wonder our trainees were concerned about being seen as “promoting drug use” or being arrested for implementing a pioneering intervention that promotes the health and rights of people who use drugs.