Wednesday, March 16, 2011

CADS Meeting Information.

Most of the issues my campaign raised regarding the MMT programme had been proficiently addressed in Robert Steenhuisens letter of 3-12-2010.   His correspondence was very informative and explanatory re: Methadone treatment objectives, expectations and of CADS treatment policy/obligations and expectations.   All of which had given some clarity and understanding of Methadone treatment.   However, my meeting with Robert Steenhuisen, Regional Manager CADS Auckland on 28-2-2011 which my husband and daughter attended as well proved more beneficial and insightful than previously anticipated.   All discussions, questions pertaining to the MMT programme were approached and answered objectively by Mr Steenhuisen.   Hence, new knowledge, information brings clarity and insight.   Mr Steenhuisen has been with the MMT programme for many years and he also chairs two other nationwide Drug Addiction Treatment Committees so his knowledge and expertise in the field of addiction and this treatment programme is extensive.

The following information is the outcome of my meeting and, or correspondence with Robert Steenhuisen.

In 2010 a policy review of the NZ Alcohol & Drug Addiction Act which has been in existence since the 1960s was undertaken.   Therefore, some significant policy changes - nationally and locally - in how the Methadone service delivers its service has also taken place.   Back in the 1970s all Opioid Substitution was provided by GPs, then specialist services were established and GPs weren't allowed to prescribe Opiates for addiction/dependence.   Now there is a move back to a shared care/partnership approach with GPs and specialist services (CADS) regards Opioid Substitution treatment (MMT programme).   All GPs work with and under CADS service guidelines and protocol, and GPs require CADS authorisation to alter a patient's prescribed Methadone dose.   GPs monitor and drug test their MMT patient's and test results are forwarded to CADS area clinic.   All persons accessing and requiring Methadone treatment must come through CADS first, once a Methadone client is stabilized their file is then allocated to a GP.   At this stage, 50% Methadone treatment clients are prescribed by GPs and 50% are prescribed and still being monitored by CADS.   Government driven policy - aim by CADS is to get as many MMT clients as possible to go through a GP.

MMT programme statistics:  In the past year 15,000 persons nationwide have accessed CADS service.   Average age accessing service is rising, suggesting long term maintenance.   CADS Auckland region treats annually 1200 people with Methadone for Opiate dependency over 7 clinics and employees 250 staff.   Over the last 5 years in the Auckland region around 120 withdraw from the programme annually and a similar number of people are admitted.

Methadone treatment policy information:  The objective of Methadone treatment is to provide an opportunity for opiate/drug dependent persons to get their lives in order by offering a legal substitute to replace their illegal drug habit.   It is realized by service providers that taking a dose of Methadone daily does not automatically fix the social, health and psychological problems clients have or face.   Professional counselling is offered and given upon a clients request, but counselling isn't mandatory for those whom don't want or desire it.

Service providers (CADS) supports minimum of 2 years in treatment with an average of 5-7 years, it is quiet acceptable though for clients to remain in treatment for longer or less.   It is largely a client's decision to do so.

Service providers recognises that abstinence from all drugs is not possible or desired by some drug users so abstinence although preferred is not expected.   But service providers will help and support a client achieve an abstinence goal if they so desire.    So drug abuse by clients in MMT treatment is acknowledged and providers do share concern on this matter, especially the rise in prescription medications being abused.

Black market Methadone - treatment clients selling part of their takeaway doses, service providers are aware this does periodically occur.   However, measures are in place and strict guidelines are imposed if illegal trafficking of Methadone by a client is established and proven.   CADS do have a proviso in place for discharging clients from the programme if illegal trafficking is proven.   CADS receives a monthly report from the police departments Drug Enforcement Agency to keep abreast of what illegal drugs are on the street and being abused.   By all accounts black market Methadone isn't a major problem in NZ.

Assessment for Methadone takeaways usually includes urine drug screening showing definite positive for Methadone but negative for other drugs of abuse, especially alcohol, illicit opiates, benzodiazepines unless prescribed and amphetamines.   Urine testing is random and is performed at Medical labs - cost picked up by CADS.   If a client is strongly suspected of illegal trafficking his/her Methadone then frequent random urine testing is done to check Methadone in his/her system.   Serum level (blood) testing is done mainly in the early stages of entry for checking body metabolism to establish correct dose of Methadone has been prescribed, or but rarely when there is genuine concern about accuracy of reported Methadone consumption.

Methadone treatment - recovery/rehabilitation, Robert Steenhuisens correspondence addresses both these matters.   I felt Roberts views, observations as an experienced treatment service provider worthy of including.

From my observations the clients in our Methadone programme fall into three categories.   A small group of people who, as soon as they are on the programme, organise their lives again, are working or attend university, look after their famalies, disengage from crime.   As a rule they are pleasant to engage, but want to minimise their contact with our service as much as they can.   They see our programme as an extension of the 'junky world' they are keen to exit.   A second group will make hardly any progress in terms of full recovery, but make some gains in reducing injecting drugs and crime.   While these are modest results, they are important for the families they live with.   There is also the group hardest to manage on the programme with ongoing confrontations between them, our staff and community pharmacy staff.   The third group makes progress to recovery but will also suffer regular set backs due to a range of psychological and environmental factors.

In your information you make the case for stricter management of clients on the programme through discharging those who fail to make progress (a slight misinterpretation of my info I think) and offering more rehabilitation for those who stay on it.   Offering more rehabilitation services to the first two groups is wasteful.   The first group makes ample gains without professional input (other than prescribing methadone), while the second group professional input remains limited to managing anti social behaviour.   The third group is the most promising for a return on more rehabilitation input.

My experience is that once you look at the recovery pathways of individuals they are very diverse.   It is obvious that a person who intends to exit the world of addiction needs to address a wide range of issues.   For some they will find support within The Methadone programme, others will do so elsewhere.   For most the journey to abstinence will be interupted with many set backs.   It is essential they they accept responsibility for their own recovery.   It is not possible that a Methadone programme can force people to recover and avoid making mistakes.

In my discussions with Methadone clients who withdraw from Methadone after many years I always felt they saw the Methadone service with some ambivalence.   On one level it saved them from HIV, Hepatitis and imprisonment, but on the other hand it prolonged their dependence on a chemical 'to feel normal'.   I have not been able to identify in the literature any guidelines on how to manage this dilemma.   The management of Methadone programmes swings between being too permissive and/or too restictive.   Neither is good for the client, or the staff.   I do not think there is an 'ideal' way of running the service, it is a process of regular review and adjustment.

Mr Steenhuisen quoted the NZ MMT programme is fairly rigid compared to some overseas programmes, and he is a strong advocate for more addiction treatment facilities nationwide.

All campaign issues were addressed with the exception of the addictive nature of Methadone and its withdrawal/detoxing problems.   However, this was semi addressed in Mr Steenhuisens observations - recovery pathways sections.   My interpretation is:  if a client desire it, remains stabilized, doesn't actively drug abuse and follows a steady/slow withdrawal regime then Methadone withdrawal/detoxing problems are possibly minimized.   I still feel that this Methadone addictive/withdrawal problem needs to be included in the facts section of CADS website or upon initial contact so clients are aware upon entry.    Sorry post is a bit long, but felt it only fair that readers have the full benefit of this meeting/information and insight into Methadone treatment.

Thursday, March 3, 2011

Love Of Family Triumphs Over Drugs. An End To 'Chasing The Dragon'.

In the early stages of admittance I did have contact with the unit regarding Shane's addiction history, our decision, and his prevailing circumstances.    An update on Shane's status confirmed what I had feared, that he had very little recollection of the days leading up to his admittance, which isn't unusual with the use of certain substances.   But it was concerning because this loss of memory was causing him to be unsettled, confused and depressed about his present situation and reasons for it.   So permission was granted for Shane to contact me to clarify his situation and future circumstances.   Which he done on the third day of his admittance, where all was explained and clarified especially our ultimatum, 'tough love' decision and what it meant for him.   Shane listened intently and was extremely sorry and apologetic for his actions.   He told me he fully understood our decision and why, and would respect it, and said I wasn't to worry about him, that he'd be alright and vowed to clean his life up of drugs.  He ended the phone call promising to keep in touch with me via his mobile phone.   It was a sad, emotional call for both parties, but I felt so very proud of how strong, brave and compassionate Shane was about it all, and without an ounce of animosity expressed.   His strength, compassion and understanding not only showed true grit and the measure of the man, but also of his deep love, respect and appreciation for us and his family.

My heart immediately wanted to retract the decision and bring Shane home, but my gut instinct and knowing the path his drug addiction was now on wouldn't allow it.   Shane had good drug knowledge but a reckless attitude towards his abusing, so the potential for and risk of him possibly overdosing was always there and one of our greatest fears, all of which had increased in recent weeks.   It was probable death or rehab, we knew it and so did Shane, but getting him to acknowledge it was our problem.   Hence, the reason for actioning 'tough love', it was a last resort measure for us and done purely out of despair and desperation, hoping it would prompt Shane to recognize his drug abuse was now very extreme and life threatening, and that a professional facility to end his battle with drugs/Methadone and possibly save his life was required.   My belief was that if Shane's desire for drug freedom was still in tact, then this would be his guiding light for obtaining it.

My first task regarding our 'tough love' decision was to pen a letter to Community Alcohol & Drug Services (CADS) regarding Shane's current situation, to which they would've been informed about but were possibly unaware of the reasons.   So my letter was to explain that and of all matters pertaining to it, plus of our decision, hence Shane's circumstances upon discharge.   Therefore, informing them that I was relinquishing my authority and all responsibility regarding Shane's Methadone and drug addiction.

Our Christmas festivities were still celebrated but they weren't, as you'd expect full of cheer and excitement.   However, we done the best we could that year under the circumstances.   Knowing Shane was a least safe in the unit and that all Christmas festivities were being bestowed upon him in there brought some solace though.

Shane was discharged from the unit after one week and his no fixed abode lifestyle commenced.   He lived this rough, vagrant lifestyle for about 2 months.   His accommodation and home for this time was a tent in a camp type situation, set up in the bush on the outskirts of the Thames township.   This bush camp/home sight just had the basics and belonged to, and was set up by another vagrant male person whom invited Shane in to share his accommodation.   Even renting a room in the scungiest budget hotel in Thames cost $30.00 a night, which Shane did pay for and do for his first 3 nights upon discharge.   But he couldn't afford to continue staying in the hotel so this male's camp accommodation when offered was gratefully accepted.   Which does go to show that these street people or vagrants whom most of us look down on and also judge, do care, are kind, and look out for others especially those in the same situation.

Because of his no fixed abode lifestyle Shane wasn't permitted to have take away doses of Methadone, which I was very thankful of, as this could've caused problems within his lifestyle, or with those around him   Shane and others on the programme that are in this position are required to attend the pharmacy daily and the hospital on Sundays for their Methadone.

The 'tough love' rule of no personal contact with Shane, although difficult and distressing was adhered to by all in the family for this time, with the exception of his brother, whom veered only slightly by having personal contact with Shane on a weekly basis.   But at these times he never rendered any other personal or financial support to Shane.   This was good though because it gave him and us peace of mind regards our actions and also of how Shane was coping.   By all accounts Shane handled his sudden vagrant lifestyle well and done it with resilience and dignity.   With having only minor slip-ups, re: drug or alcohol over indulgence, and these were in the initial first couple of weeks of his vagrancy.  Shane did abide by his word and promises, he kept safe and in regular contact with me, and also in his vow to clean his life up of drugs.

Within days of being discharged from the unit Shane informed the CADS clinic in Thames of his intentions, and requested entry into a residential rehabilitation facility for his drug addiction and Methadone withdrawal.   Shane being on the Methadone programme meant that CADS were deemed his drug addiction treatment providers.   Therefore, it was CADS responsibility to initiate and action Shane's request for entry into a rehabilitation facility.   Shane couldn't enter himself into a facility which was very unfortunate, because it took CADS nearly 2 months to action his request, by which time Shane had become quite disheartened and despondent.   The wherefores and why regarding their lack of action I wont go into, well not in this post anyway.   We had decided that once Shane's requested entry into a rehabilitation facility had been actioned and confirmed, then he could reside back home with us to await and prepare for his admission date.   Shane was informed of this decision early into the rehabilitation entry process with CADS to encourage, and  to keep his will, spirit and motivation in tact.   But it was also because I knew through my own inquiries of the entry process and admission criteria for such residential rehabilitation facilities, and Shane's no fixed abode lifestyle could cause delays or problems regarding either process.   We imposed a total abstinence rule for Shane though, with the exception to his daily dose of Methadone.   And it was emphasized that if he mucked up or delayed his admission into the centre he would be resuming his vagrant lifestyle.   But this abstinence rule being imposed didn't perturb Shane at all, with living the rough lifestyle he was just ecstatic about the option and chance to come home, to a comfy bed and a hot shower.

By the end of February Shane's entry into Odyssey House, a long term residential addiction rehabilitation facility based in Auckland had been actioned and confirmed so at this point as agreed, his vagrant lifestyle ended and his comfy home lifestyle began.   Shane's two clinical interviews for the entry process were by telephone and completed within the first week of March, but a definite admission date couldn't be given.   The fact that this addiction rehabilitation facility is a highly respected long term programme, up to eighteen months, and also that it is one of the few facilities nationwide that does undertake Methadone withdrawal makes this programme and centre very much sought after.   Shane was advised though that being from the Waikato region and not Auckland, regards allocation of beds could expedite his entry and admission.

The waiting for an available bed began, but as luck would have it not for long.   Towards the end of March Shane received notification and he was admitted into Odyssey House in Auckland on April 2nd 2008, to commence his Methadone withdrawal and drug addiction rehabilitation.   So in the end, the love and importance of family proved more powerful than the love and desire for drugs, well it did for us anyway.   And I thank god for that every day.   Because 'tough love' did work for us, doesn't mean it's a measure I am advising or recommending to others in the same position.   Shane may have been ready to clean his life up of drugs and this action just prompted him to make the attempt, that's all.

I will do a posting on Shane's long journey of recovery at a later date.   My message to all out there is, never give up hope not matter how hopeless it may seem, love until you just can't love anymore, and always have faith in your convictions, decisions and intincts.