s e c i v d r n e a s l t s n n e e e m t u a Q e r n t i s g r u e r s D u g u r d g n i t c e j n i d an , h t i a r w l I e Mc i l r i a F , y e k c i H e i h p o S i t a l A a s o and R d n a l s n e e u Q f o y t i s r e v i n U 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.’  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 u s d n a t n e m t trea t are n e m t a e r t e c n a n e t main f an o s t n e n o p m o c l a B essen m for e t s y s t n e m t a e r t e v eﬀecB people with opioid dependence.’ IDS A N U / C D O N U / O H  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 . 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 . 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%  WHO/UNODC/UNAIDS (2004). Subs9tu9on maintenance  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  Stoes AL, Dodrill CL and TR Kosten (2009). Opioid United Na9ons Programme on HIV/AIDS. Dependence Treatment: Op9ons in Pharmacotherapy. Expert  Ministerial Council on Drug Strategy (2011) The Na9onal Opin Pharmacother 10(1):1727-‐40. Drug Strategy 2010-‐2015: A framework for ac9on on alcohol,  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  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  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.  Collins DJ & HM Lapsley (2008). The cost of tobacco, alcohol  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  Ma`ck RP, Breen C, Kimber J, & M Davoli (2009). (2):192-‐201. Methadone maintenancetherapy versus no opioid replacement  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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