Document 149643

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Recent restructuring in the government
AOD sector and changes to funding have
raised concerns about the availability of
appropriate AOD services in Queensland.
‘A range of app
ropriate, specialised ser
vices should be available to
anyone with a drug-­‐rela
ted problem, irresp
ecBve of personal histor
y.’ [2] Ministerial Council on Drug Strategy 2011:10 70
•  Aboriginal people who inject
drugs were less likely to
currently be in drug treatment
•  There is unmet need for
treatment amongst PWID in
Queensland
•  PWID believe access to
treatment services has become
more difficult in the last 12
months
•  The top three services/people
nominated as being of the most
assistance to reduce or stop
drug use were OST program,
GP, and partner/family member.
60
50
%
with n
o
B
a
c
ifi
x
o
t
e
d
h
t
o
‘B
nted ie
r
-­‐o
e
c
n
e
n
B
s
b
a
t
n
e
subsequ
Bon u
t
B
s
b
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s
d
n
a
t
n
e
m
t
trea
t are n
e
m
t
a
e
r
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c
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a
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t
main
f an o
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t
n
e
n
o
p
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o
c
l a
B
essen
m for e
t
s
y
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a
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effecB
people with opioid dependence.’ IDS A
N
U
/
C
D
O
N
U
/
O
H
[1] W
2004: 8 40
30
20
10
•  High propor
9on of depende
nt use among people w
available to tho
ho inject drugs se who would lik
(PWID): 77% am
e to access them. ong recent opio
id •  Diffic
users, and 41% ul9es include ac
among recent curately s9mulant users
a
s
sessing need fo
[3]. r a health condi9
•  Drug depe
on not easily iden9
ndence has seve
fied because of re health illi
the and social conse
cit nature of sub
quences to the stance use; individual as we
p
r
o
v
iding service co
ll as a wider imp
verage for PWID
act on the commun
n
ot living in inner
ity together wit
city areas, for h a substan9al finan
w
h
at is a rela9vely
cial cost [4]. rare condi9on i
•  Benefits of
n the general pop
treatment go b
u
la9on; and PWID
eyond reduc9on in use
’s s
c
e
p9cism about th
and abs9nence
e efficacy of [5,6,7,8]. treatment. •  Types of tr
•  Common b
eatment availab
arriers to PWID
le
include: brief in
a
c
c
e
s
s
in
g
treatment in Au
terven9ons, stralia assessment, cas
have been iden
e-­‐work support
9fied as lack of , counselling, det
available places
oxifica9on servic
, long wai9ng lis
es, ts, residen9al reha
and treatment e
bilita9on, and th
ntry requiremen
e administra9on o
ts [
9
]
. f opioid pharmacothera
•  Nega9ve e
pies. ffects of wai9ng
•  However, th
lists are well documente
ese different tre
d, par9cularly th
atment approaches ma
e reduced chance
y not be readily
of the PWID entering treatm
ent [10,11].
0
N=887
n=151
n=100
n=150
n=107
n=100
n=88
n=91
n=100
National
NSW
ACT
VIC
TAS
SA
WA
NT
QLD
Currently in drug treatment
Turned away and/or asked to wait more than one week
Current perceived access to drug treatment Very difficult Difficult Easy Very easy (n=53)
% 38 25 30 8 * ‘don’t know’ responses were excluded from this analysis. Change in perceived availability of drug
treatment services in previous six months. •  Data from Queensland sample (n = 100) of National Illicit
Drug Reporting System survey in 2013.
•  Participants were people over 16 years of age who
regularly inject drugs.
More difficult Stable Easier Fluctuates (n=46)
% 46 46 7 2 “The waiting
lists are too
long.”
“The problem is
getting into
treatment.”
* ‘don’t know’ responses were excluded from this analysis. Currently in
treatment 44 46 Not in
treatment 56 54 % Any crime (n=35) % No crime (n=65) 40 48 60 52 % Aboriginal (n=15) % Non-Aboriginal (n=85) 20* 49 80* 51 % Female (n=32) % Male (n=68) 47 35 No one 1 to 2 people 3 to 5 people 6 or more people 53 75 PWID responses to who would most
help to reduce or stop their drug use.
(n=65)
% 46 20 15 19 30
25
20
%
% Heterosexual (n=92) % Non-heterosexual (n=8) Number of people par-cipants know who tried but were unable to access treatment in the previous six months.
% 30 years or less % More than 30 yrs *p<.05 chi-square test.
Drug Dependency
The Dependency Scale is
made up of 5 items, providing
scores ranging from 0-15. A
higher score corresponds to
higher dependency.
Of those who had recently
used an opioid and
commented (n = 87), the
median score was 7.0 (range
1-15), with 74% scoring five or
above (the typical cut-off for
the presence of opioid
dependence).
Of those who had recently
used a stimulant and
commented (n = 53), the
median score was 2.0 (range
0-12), with 36% scoring four
or above (the typical cut-off
for the presence of stimulant
dependence).
27 47 73 53 10
5
‘It’s harder and
harder to get
into rehab.”
Not in treatment Methadone syrup Suboxone (buprenorphinenaloxone) Subutex (buprenorphine) Drug counselling Oxycodone Narcotics Anonymous Naltrexone implants Valium 15
(n=100)
% 55 17 15 6 3 2 1 1 1 0
Better than
they were six
months ago
18%
Worse than
they were six
months ago
34%
Same as they
were six
months ago
48%
[1] WHO/UNODC/UNAIDS (2004). Subs9tu9on maintenance [6] Rieer A & JJ Chalmers (2009) Polygon: The Many Sides to therapy in the management of opioid dependence and HIV/ the Australian Opioid Pharmacotherapy Maintenance System. AIDS preven9on: posi9on paper. Geneva: World Health Canberra: Australian Na9onal Council on Drugs. Organiza9on, United Na9ons Office on Drugs and Crime, Joint [7] Stoes AL, Dodrill CL and TR Kosten (2009). Opioid United Na9ons Programme on HIV/AIDS. Dependence Treatment: Op9ons in Pharmacotherapy. Expert [2] Ministerial Council on Drug Strategy (2011) The Na9onal Opin Pharmacother 10(1):1727-­‐40. Drug Strategy 2010-­‐2015: A framework for ac9on on alcohol, [8] McKe9n R, Dunlop AJ, Holland RM, Sutherland RA, Baker tobacco and other drugs. Canberra: Commonwealth of AL, Salmon AM & SL Hudson (2013). Treatment outcomes for Australia. methamphetamine users receiving outpa9ent counselling from [3] McIlwraith F, Hickey S, & R Ala9 (2013). Queensland Drug the S9mulant Treatment Program in Australia. Drug and Trends 2012: Findings from the Illicit Drug Repor9ng System Alcohol Review 32: 80-­‐87. (IDRS). Australian Drug Trend Series No.99. Sydney: Na9onal [9] Digiusto E & C Treloar (2007). Equity of access to treatment, Drug and Alcohol Research Centre, University of New South and barriers to treatment for illicit drug use in Australia. Wales. AddicBon, 102, 958-­‐969. [4] Collins DJ & HM Lapsley (2008). The cost of tobacco, alcohol [10] Carr CJ, Xu J, Redko C, Lane DT, Rapp RC, Goris J & RG and illicit drug abuse to Australian society in 2004/05. Carlson (2008). Individual and System Influences on Wai9ng Canberra: Department of Health and Ageing. Time for Substance Abuse Treatment. J Subst Abuse Treat 34
[5] Ma`ck RP, Breen C, Kimber J, & M Davoli (2009). (2):192-­‐201. Methadone maintenancetherapy versus no opioid replacement [11] Chun J, Guydish JR, Silber E, & A Gleghorn (2008). Drug therapy. Cochrane Database of SystemaBc Reviews, Issue 3 Art treatment outcomes for persons on wai9ng lists. Am J Drug No. CD002209. Alcohol Abuse 34(5):526-­‐33. 
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