Sensible Specialist Service Responses to the Methamphetamine “Crisis”

APSAD Conference 2014

Trevor King

The Organisation

• ReGen is an NGO operating in Metro Melbourne (Coburg) for more than 40 years (formerly known as Moreland Hall)

• Providing a comprehensive range of youth and adult AOD services (many in a new partnership with Odyssey House):• Intake and Assessment• Residential and non-residential withdrawal

management programs • Counselling (clients and family members)• Non-residential 6 week group-based psychosocial

treatment programs• Post-treatment support• Transitional housing• RTO-based client education and worker training

The Issues• Patterns of methamphetamine use are changing (% using fairly

stable; increased frequency of use; shift to crystal meth; stronger preparations; affordable and easy to access).

• Emerging evidence of increased harms:• ED presentations• Ambulance call-outs• Police call-outs• Drug treatment presentations

• Media reporting “ice epidemic”, use equates to addiction, psychosis and violence. Treatment unavailable or doesn’t work. Fuelled by uninformed ‘expert’ commentary.

• Pressure on emergency services, AOD specialist services.• Political pressure to respond quickly (in the lead-up to an election)

Specialist Service System Challenges

• Specialist services in Victoria oriented to primarily treating alcohol, heroin, and cannabis dependence

• Lack of confidence, competence to treat this client group (emergency services, primary health care and specialist AOD)

• Despondency about the lack of a ‘methadone equivalent’ medication• A sense that tried and trusted psychosocial treatment strategies may

not work well with this client group• Increasing numbers seeking treatment and reasonable expectations

that the specialist service system could provide it.• Eg. Those presenting to ReGen for methamphetamine related

problems (where meth was the primary drug of choice) increased from 6% of total presentations in 2010 to 20% in 2014. Now 45% list methamphetamines as 1st or 2nd drug of choice (alcohol is most frequently the other).

ReGen Challenges• ReGen has had a range of CBT-MET based (1-1 and group based)

counselling programs for adult and young methamphetamine users in place for many years

• The adequacy of the adult residential withdrawal model came under question in 2012. It had been designed as a semi-structured 7 day (ave) detox primarily for people using alcohol, opioids and cannabis.

• A subsequent clinical practice audit in 2013 found that for methamphetamine users: • Only 48% completed the withdrawal episode• Linkage with post withdrawal treatment was inadequate • Relationships between staff and clients were often hostile –

particularly when low-level program participation was encouraged.• 50% of clients had experienced no decrease or an increase in

withdrawal symptoms at the time of discharge (based on Amphetamine Cessation Symptom Assessment scores)

ReGen Clinical Responses

• Residential withdrawal episode extended to 10 days (ave)• Low stimulus environment and provision of nursing care only for first

3 days (to coincide the the ‘crash’ that some were experiencing).• Retention in the withdrawal program increased from 48 – 60%• A stepped withdrawal support program was introduced in 2014 to

extend the period that clients were engaged in the program to cover the crash, acute and sub-acute withdrawal phases (3-5 weeks).

• The model, which is adapted based on need, includes: • Assessment and initial non-residential (nursing support (GP

liaison as required, withdrawal preparation, motivational interviewing and counselling support, harm reduction and self care education)

• Step-up residential withdrawal management • Step-down non-residential supportive care (including post-

withdrawal treatment and mutual support group linkage)

Clinical Responses …(2)

• The stepped care withdrawal model is currently being evaluated.• Clinical outcome measures were collected on assessment,

residential withdrawal admission, during step-down non residential withdrawal and at 3 months post discharge (from residential unit)

Measures:• Program retention• Withdrawal symptom changes (Amphetamine Cessation

Symptom Assessment)• Mental health (Kessler 10)• Quality of life (WHO QOL Brief)• Severity of Dependence (SDS)

Review outcomes will inform withdrawal management and other treatment and support strategies for this client group.

Other ReGen Responses• In the context of heightened community concern, good

clinical practice is not enough. ReGen has also sought to:• Build the capacity of our own and other workforces (RTO

training: Innovation seminars)• Develop and provide information and client education sessions

(Methamphetamine Personal Education Program; Drug Driving Education)

• Influence policies (informal advice; submissions to Inquiries; advisory committee contributions)

• Support families and carers (single session counselling; support groups - provided by the Self Help Addiction Resource Centre)

• Improve community debate (providing evidence at community forums; challenging unbalanced media reporting; social media presence)

The Future

ReGen will continue to:• Align practice with the available evidence• Innovate and evaluate where the evidence-base is light-on• Tailor treatment responses (client centred and family engaging)• Ensure flexible, persistent client engagement strategies and

assertive treatment and support service linkage • Prepare the specialist and other workforces to respond effectively• Influence policy• Inform community debate

Thank you

tking@regen.org.au

www.regen.org.au