Heroin Dependence in Anuradhapura District, Sri Lanka: A retrospective Audit

Abstract

Treatment of Opioid dependence varies from one country to the other, with different national policies. Methadone tablets and syrup were available in Sri Lanka in the past. However, its’ use had been discontinued, and currently there’s only symptomatic management available for patients suffering from Opioid Dependence. Symptomatic treatment is sometimes failed due to the severity of withdrawal symptoms. This audit done over 03 months showed treatment dropout of 38 out of 58 patients (65%). Most of the drop out patients had severe withdrawal symptoms on presentation, and had low educational attainment. Sixteen patients (27% of the sample) remained abstinent over 3 months. Rest of the 04 patients used Tramadol 50 mg, Apple (Tramadol 225 mg), Pregabaline and Heroin in lower doses to avoid withdrawal symptoms. Majority of the patients, 56 of 58 (96%), had co morbid substance use (Nicotine, Cannabis, Alcohol). Patients spent a significant proportion of their income for substances. All the patients received pharmacological treatment for withdrawal symptoms. The most distressing withdrawal symptoms were insomnia and body aches. None of the patients had the interest for psychotherapy. The study emphasises that Heroin dependence is a very significant issue in Anuradhapura district, especially among unskilled and semiskilled workers. Availability of Methodone, Buprenorphine or Buprenorphine/ Naloxone combined pills could have a beneficial role in treating Opioid dependence in Sri Lanka. Proper management of substance related conditions and appropriate national policies and laws on drugs will have a major contribution to country’s development.