IDENTIFYING AND RESPONDING TO NEED; MANAGING MULTIPLE COMPLEX INDIVIDUALS ON OPIOID SUBSTITUTION TREATMENT IN RESIDENTIAL CARE AND BEYOND WHOS (WE HELP OURSELVES) OPIOID TREATMENT PROGRAM SERVICES NADA Conference Sydney 2014 Presenter: Carolyn Stubley - WHOS Nurse Manager
WHOS OTP Services WHOS TC services commenced in 1972 In mid 1980 s adopted the Harm Minimisation philosophy The first of WHOS OTP services commenced in 1999 with the Methadone to Abstinence Residential (MTAR) Program In 2009 the Residential Treatment of Opioid Dependence (RTOD) stabilisation program commenced for individuals on OST
Working with clients on OST Both OTP Services commenced in response to identified need of this client group Incorporating a goal of abstinence from problematic drug use and principles of harm reduction Identifying what more we can provide for individuals remaining on OST during the WHOS program and their return to the community
Identifying the Gaps Not all individuals can achieve abstinence without the aid of substitution treatment Acknowledging that not all individuals do well coming off OST within a timeframe Responding to the multiple complex needs of the client group OST clients have less options to support and aftercare in the community Lack of social connectedness within this group Need for skill based training for reintegration in community
Overview of Complex Needs The following has been identified from research and surveys conducted in the OTP programs at WHOS 2009 2012 Findings are across the individuals remaining on OST for the duration of stay at WHOS being the RTOD community
Mental Health Screening Questionnaire (2011,2012 N=120, RTOD =20) During your lifetime have you ever experienced? Lifetime Lifetime RTOD Last 30 days - RTOD Anxiety / Panic symptoms 79% 89% 61% Strong fears (e.g. agoraphobia) 80% 90% 59% Taken psychiatric medication 74% 93.8% 55.6% Depression 81% 94% 38.9% Psychiatric hospital admission 42.9% 76% 6.7% Attempt to kill yourself 43.4 66.6% 5.9% themselves Heard voices / saw objects 34.7 31% 16.7% others couldn t see Nightmares / flashbacks from traumatic events 67.7% 89% 44%
Physical Health Profile Variable Health during past 12 months (%) Excellent Very Good Good Fair Poor Spent time in hospital past 12 months (%) Median no. days spent in hospital (excluding detoxification or rehabilitation) WHOS RTOD (N=75) Total(n=75) Males(n=40) Females(n=35) 1 3 0 7 5 9 24 20 29 35 50 17 32 20 46 53 45 63 7 5.5 16 Overdosed in past 12 months (%) 32 25 40 Median no. overdose past 12 months 1 1 1.5
Criminality Variable WHOS RTOD (N=75) Ever been involved in criminal activity (%) Ever been charged (%) Drug use predate crime (%) Arrested in past 12 months (%) Total(n=75) Males (n=40) Females (n=35) 84 83 86 87 89 86 68 60 77 59 65 51 Median no. arrests in past 12 months* 2 2 3 Committed illegal acts in past 12 months (%)# 59 65 51 Median no. illegal acts in past 12 months* 3.5 3.5 4
Comparisons Clients from WHOS RTOD were more likely to report a higher rate of previous mental health diagnoses (71%, compared to 59% for the drugfree services and 52% for the WHOS MTAR service) More likely to be on prescription medication for mental health problems (63%, compared to 55% in the drug-free services and 48% in the WHOS MTAR service). Much more likely to report that their health was poor when compared to the other services (32%, compared to 11% in both the drug-free services and WHOS MTAR). Much less likely to refer themselves to treatment compared to clients from the drug-free services and WHOS MTAR (17%, compared to 43% in the drug-free services and 52% in the WHOS MTAR service). Just over 40% were living by themselves, compared to 20% in the drugfree service and 11% from the WHOS MTAR service.
Returning to the Community Traditional aftercare e.g. NA, AA etc not always an easy fit for those remaining on OST Returning to clinic environment for dosing Return to social isolation Breaking down barriers in the community starting whilst in the TC
Filling the Gaps MTAR and RTOD Longer stays in the TC services In 2012 WHOS OTP Services secured DATS funding from NSW Ministry of Health to enhance services to OST clients Setting up of OST dispensing onsite, A Day Program in for OST clients in Newcastle Employment Skills, Aftercare and Outreach services, case management, family support Multidisciplinary teams, care planning, liaising with community
Challenges To enable admission into the WHOS OTP Services requires collaboration between community OTP Providers to ensure continuity of care for the clients OST Starting up new services Pursuing avenues for social connectedness Breaking down the barriers around discrimination of this client group There is always more to do
Recognition In 2012 WHOS was given the status of Dual Diagnosis Capable in the 4 th year DDCAT Review In 2012 the WHOS OTP Therapeutic Community Initiatives were awarded Excellence in Treatment and Support at the National Drug and Alcohol Awards.
Client Anecdotes Perhaps I will always be on maintenance treatment for the rest of my life, however very grateful to have the opportunity to be on maintenance and also in a TC rehab, very eager to do this entire program. Male 27 years Methadone 150mg I feel like I have experienced true growth, acceptance and can t wait to see where this journey takes me. Female (ATSI) 33 years Suboxone 24mg When I first arrived here I felt and was reluctant, unsure and withdrawn. Now three months later with the support of my peers and staff I feel that I have changed for the better and have learnt to deal with life s problems rather than run from them. Male 35 years- Methadone 160mg I came in need of help and felt like I had nothing to live for. When the door opened for me I came carrying a big burden of guilt, shame, anger, hurt, fear and a lot of regrets. I came with no expectations but now thanks to this place, my peers and staff I m not living in darkness anymore. My family can t believe the change in me I changed a lot from this place and I now feel that there is hope for me. Female 42yrs Methadone 200mg The page in my life I previously found too heavy to turn now seems a lot lighter Male 39yrs Methadone 170mg
Conclusion Individuals on OST remain a marginalised and often discriminated against group in terms of further treatment options, Most have co morbidities which include psychosocial, mental and physical health issues Addressing social connectedness and support structures post treatment is paramount to maintain gains made whilst in the TC programs Improving services to the OST client is constantly being undertaken by the WHOS organisation to ensure continuity of care from admission to exit planning back into the community and follow up.
Acknowledgement and References Thank you to Garth Popple; Lyn Roberts; Gaye Byron; Jo Lunn; Dr. Peter Kelly and Gabrielle Campbell. Campbell, G; Stubley, C; Darke, S; and Popple, G., (2011). NDARC Technical Report No. 318 - WHOS RTOD Residential Treatment for Opioid Dependence-Stabilisation Program Kelly, P Dr., (2012) Dual Diagnosis Capability in Addiction Treatment (DDCAT) Summary Report Year 4