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Following a review of the use of Subutex (or
buprenorphine hydrochloride) as a drug to treat opiate dependence, the
Ministry of Home Affairs (MHA) and the Ministry of Health (MOH) have
decided to impose stringent measures to curb the abuse of Subutex: |
(a) From 14 August 2006, buprenorphine, the
active ingredient in Subutex, will be made a Class A Controlled Drug
under the First Schedule of the Misuse of Drugs Act (MDA). The
importation, distribution, possession and consumption of Subutex will
be an offence unless specifically exempted by the relevant
authorities. Penalties for offences under MDA are listed in Annex A.
(b) MOH will implement a Subutex Voluntary
Rehabilitation Programme (SVRP) to help all those currently on Subutex
wean off their dependence and to stay free from opiates. Developed by
a panel of psychiatrists, SVRP consists of a medical component which
would be complemented by counseling, psychosocial therapy and group
support by doctors and counselors to prevent relapse. There will be a
two-week period (14 - 27 August 2006) for Subutex users to sign up for
the SVRP. They can do so through existing doctors managing their
opiate dependence.
(c) From 14 August 2006, doctors will not be
permitted to prescribe and dispense any take-home dosages for existing
patients. All patients who require Subutex will have to consume their
medication under direct visual observation of the pharmacist, doctor
and/or his treatment team on a daily basis1 . Between 14
Aug 2006 to 27 Aug 2006, doctors who are currently treating patients
who sign up for SVRP would be allowed to continue to prescribe and
dispense Subutex to these patients until the day they commence their
first SVRP appointment. From Aug 28, except for those who are enrolled
in the SVRP, no other patient will have access to Subutex. Anyone
caught in possession of Subutex without proper authorization will be
prosecuted. Please refer to Annex B for more details on the SVRP. The
hotline to call for the SVRP is 63258607.
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Background Information on Subutex Abuse
in Singapore |
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Subutex (or buprenorphine hydrochloride) was
approved for use in 2000 by the Ministry of Health and introduced in
2002 as substitution treatment for opiate-dependent (i.e. heroin) drug
abusers. |
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The aim of substitution therapy is to reduce
craving for heroin and facilitate improvement in social functioning such
as employment and personal relationships. |
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However, drug addicts were found abusing
Subutex by mixing it with other drugs and injecting the cocktail into
their body. The intravenous misuse of drugs also gives rise to potential
medical complications such as Hepatitis B and C, and HIV infection, and
limb gangrene. |
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Deaths have also been reported when
addicts inject Subutex intravenously with other drugs. Some
addicts discard the used syringes indiscriminately, causing public
concern about health and safety issues. |
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We saw the emergence of a needle
culture, something which we have not seen in the past, even at the
height of the heroin abuse problem. |
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To tighten control on Subutex
prescription, MOH introduced the Clinical Practice Guidelines (CPG)
on ¡°Treatment of Opiate Dependence¡± in Nov 2005. |
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The CPG describes good clinical
practices and administrative controls to ensure appropriate
prescription of Subutex. |
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MOH also introduced the Central
Addiction Registry for Drugs, Singapore (CARDS) which monitors the
prescription of Subutex by doctors and enables them to identify
patients who obtain additional supplies from different doctors. |
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In addition, MOH requires Subutex-prescribing
doctors to attend a mandatory 8-hour training course. Despite all
the measures taken by MOH, the Subutex abuse situation on the
ground persisted. |
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The Central Narcotics Bureau (CNB), in
investigating into reports on the abuse of Subutex, discovered
that the drug supply came primarily from licit sources. |
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There was no known illicit supply of
Subutex as there was no demand for it. Subutex could be obtained
lawfully from General Practitioners. |
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As Subutex is a licensed drug under
the Medicines Act, CNB could not take action against the abusers
of Subutex. |
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Any effort to make Subutex a
controlled drug must be accompanied by measures to tightly control
its administration as a treatment regime. The alternative is to
completely regulate and prohibit the distribution, possession and
consumption of Subutex. |
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Singapore¡¯s Zero Tolerance Policy |
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Our national strategy against drug
abuse is based on a holistic framework with a multi-pronged
approach of preventive education, tough enforcement to arrest
addicts and traffickers swiftly, treatment2 and
rehabilitation to reform the addicts, and aftercare to reintegrate
reformed addicts back into society. |
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In addition, we have introduced long
term imprisonment and caning for recalcitrant addicts. This
approach has proven successful, with addicts being clean upon
release from the Drug Rehabilitation Centres. |
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There is no easy solution to the
problem of drug addiction. Beyond what the authorities can do, the
individual has the responsibility of avoiding drugs knowing that
it can only bring misery. Those who are addicted must be committed
and determined to kick their habit. |
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In deciding on the approach to deal
with the Subutex abuse problem, MHA and MOH have to ensure that
current users/abusers of Subutex receive support and assistance to
wean off their dependence on the drug. |
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We have decided to take a holistic
approach and make buprenorphine, the active ingredient in Subutex,
a Class A Controlled Drug. |
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It will be an offence to import,
distribute, possess or consume Subutex unless specifically
exempted by the relevant authorities. |
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At the end of the SVRP, Subutex will
only be available under very restrictive conditions; namely,
buprenorphine will only be allowed to be used by medical
specialists approved by the Director of Medical Service under
stringent indications. |
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We strongly encourage all existing
Subutex users to enroll for the SVRP with their existing doctors
managing their opiate dependence. |
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We urge families and friends of
Subutex users to encourage them to sign up for the SVRP early and
support them as they seek to re-integrate into society and lead a
drug-free life. |
MINISTRY OF HEALTH
MINISTRY OF HOME AFFAIRS
CENTRAL NARCOTICS BUREAU
10 AUGUST 2006 |
Footnote:
1If the clinic is closed during weekends or public
holidays, patients will be provided with a private prescription
for direct observed treatment with Subutex at designated
pharmacies.
2Notably, treatment within the Drug Rehabilitation
Centres has not relied on the use of any substitute drugs. |
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More..... (Annexes) |
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Source:
www.mha.gov.sg Press Release
10 Aug 2006 |
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Related Article: |
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-
Update On Subutex Voluntary Rehabilitation Programme |
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Subutex to be classified as a controlled drug |
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