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.

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