Math Suresh Bada, Mohan Ashwin, Kumar Naveen C
Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India.
Senior Consultant, Chandigarh, India.
Indian J Psychiatry. 2018 Jul-Sep;60(3):271-277. doi: 10.4103/psychiatry.IndianJPsychiatry_391_18.
Drug dependence syndrome is a medical condition classified as a multifactorial health disorder that often follows the course of a relapsing and remitting chronic disease. Opioid substitution therapy (OST) is one of the established standard treatments for opioid dependence syndrome. OST, a process in which opioid-dependent injecting drug users, is provided with long-acting opioid agonist medications for a long period under medical supervision along with psychosocial interventions. OST service provider may have to deal with issues of license/registration/recognition/permission under various legislations such as the Drugs and Cosmetic Act, 1940; Narcotic Drugs and Psychotropic Substances Act, 1985; Rights of person with disability Act, 2016 and Mental Healthcare Act, 2017 depending on the drug prescribed, type of services provided, procuring, transportation, storage, and prescribing these narcotics and psychotropic medicines. The narcotics and psychotropic drugs are administered through various ministries and departments causing huge confusion, lack of coordination, overlapping roles and responsibilities, and various laws/rules and gives an opportunity for the abdication of the responsibilities. The "public mental health issue," where the number of opioid users in the country is approximately two million and opioid dependence syndrome is approximately 0.5 million. The number of beds in the public governed deaddiction centers is abysmally low, number of psychiatrist, or trained medical practitioners in OST are also few in number to face this humongous challenge. Against this background, this article focuses on the legal issues surrounding the OST.
药物依赖综合征是一种被归类为多因素健康障碍的医学状况，通常遵循复发性和缓解性慢性病的病程。阿片类药物替代疗法（OST）是治疗阿片类药物依赖综合征的既定标准疗法之一。OST是一个过程，在此过程中，对阿片类药物依赖的注射吸毒者在医疗监督下长期提供长效阿片类激动剂药物，并辅以心理社会干预措施。根据所开药物、提供的服务类型、采购、运输、储存以及开具这些麻醉药品和精神药品的情况，OST服务提供者可能必须应对各种立法下的许可/注册/认可/许可问题，如1940年《药品和化妆品法》、1985年《麻醉药品和精神药物法》、2016年《残疾人权利法》和2017年《精神保健法》。麻醉药品和精神药物由多个部委和部门管理，导致极大的混乱、缺乏协调、角色和职责重叠以及各种法律法规，并为责任推诿提供了机会。该国存在“公共心理健康问题”，阿片类药物使用者人数约为200万，阿片类药物依赖综合征患者约为50万。公立戒毒中心的床位数量极低，从事OST的精神科医生或经过培训的医疗从业者数量也很少，难以应对这一巨大挑战。在此背景下，本文重点关注围绕OST的法律问题。
