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Home / News / India /  To ease burden on rehabilitation centres, govt to give free OPD access to addicts

NEW DELHI : Indians with alcohol and drug dependency will be entitled to free out patient department (OPD) services, according to a government directive that seeks to introduce global best practices to the outdated one-size-fits-all system of isolating everyone with addiction.

The departure from the past, health authorities hope, will help avoid treatment costs associated with rehabilitation centres and bring down the rising burden of drug and alcohol addiction in India.

At present, the Centre provides the funding needed to keep rehabilitation centres going, through the ministry of social justice and empowerment under its scheme called the prevention of alcoholism and substance (drugs) abuse. Health being a state subject, the money goes to all Integrated Rehabilitation Centres for Addicts (IRCAs), which provide indoor treatment facilities.

The ministry has now written to project coordinators of IRCAs to start free OPD services, saying there is a huge gap between the number of beds in IRCAs and the number of patients requiring treatment.

“The existing number of treatment centres in the country is not enough to cater to the large population in need of treatment for substance use disorders. With an inpatient-only approach, it has not been possible to provide treatment services to more than 100,000 patients per year through the existing IRCA model," said undersecretary Devendra Singh in a letter to IRCAs reviewed by Mint.

“The understanding of addiction treatment has evolved drastically in the last few decades. The earlier understanding that substance use disorder can be treated only by placing a patient in restrictive care has now changed. It is now clear that a large proportion of patients with substance use disorder can be managed on an outpatient basis, while few would require inpatient treatment of varying duration," Singh said.

According to a February 2019 report on substance use in India by the ministry of social justice and empowerment, 5.2% of Indians, or more than 57 million people are affected by harmful or dependent alcohol use. In other words, every third alcohol user in India needs help for alcohol-related problems. Another 0.66% of Indians (7.2 million people) need help for cannabis use problems. India also has an estimated 8.5 lakh people who inject drugs (PWID).

The report revealed that over 1.08% of 10-75 year-olds (11.8 million people) are users of sedatives (non-medical, non-prescription use).

Singh’s letter indicates a wide treatment gap. Meanwhile, aiming to strengthen OPD treatment of all substance use disorders in IRCAs, the ministry has asked these centres to initiate outpatient-based assessment and diagnosis of all such patients. OPDs will cater to the needs of both those in short-term substance-related withdrawals (OPD-based detoxification), as well as long-term treatment for management of substance use disorder.

“While IRCAs do have resources for providing inpatient care to the patients seeking treatment from them, there are inadequate provisions for maintaining follow-up following discharge from the IRCA. Substance use disorders are known to be chronic, relapsing conditions that require a long-term engagement with the treatment providers for a successful outcome," the letter stated.

The government has realized that in the existing scheme, the capacities of service providers at IRCA are limited, thereby hindering the provision of long-term outpatient treatment and follow-up. Currently, more than 400 IRCAs are supported by ministry of social justice and empowerment across states and Union Territories. Most IRCAs have 15 beds, while a few have up to 30. The usual length of stay in these centres is about one month, though the stay can be extended for up to three months.

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