Transcript PPT - health.vic.gov.au

Justice Health
Justice Health and Opioid Substitution
The Justice Response
Presenters: Larissa Strong, Director Justice Health
Scott Drummond, Senior Policy Officer Justice Health
Date:
Thursday 30 May 2013
TRIM ID: CD/13/180885
Justice Health
Background and context
• Justice Health
 Responsibility for prisoner health care
 Sets the policy and standards
 Contract manages health service provider and AOD
treatment provider
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Justice Health
Background and context (cont.)
• Prison population
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Demographics
Entrenched drug using histories
Challenging behaviours
Unwell cohort…
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Justice Health
Health status of Victorian prisoners
Entrants who are current smokers (self report)
88%
Ever diagnosed with diabetes (self report)
6.1%
Tested positive to hepatitis C antibodies
33-52%
Ever diagnosed with asthma (self report)
28.4%
Ever diagnosed with a mental illness (self report)
28%
Alcohol abuse/dependent (AUDIT test)
41%
Entrants with history of injected drug use (self report)
65%
Source: Deloitte Consulting (2003) Victorian Prisoner Health Study. Department of Justice, Victoria.
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Justice Health
Justice Health and drug treatment
• Frameworks
 Victorian Prison Drug Strategy
 guides response to prison drug issues
 Victorian Prison OSTP policy and procedures
 Guides prison pharmacotherapy program
• Drug treatment (counselling)
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Group and individual counselling
Health and criminogenic programs
Harm reduction education
Peer educators
• Drug treatment (OSTP)
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Justice Health
Opioid Substitution Therapy Program (OSTP)
• Prison Pharmacotherapy context
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Background
Rationale
Approx 857 prisoners dosed each day
Approx 16 per cent of prisoners receive OST
90 per cent on methadone; 10 per cent on Suboxone
(0.10% on ‘straight’ buprenorphine).
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Justice Health
OSTP dose data
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Justice Health
Guidelines, Diversion and difficult behaviours
• Guidelines
 Victorian Prison OSTP Clinical and operational Policy and
Procedures (2003)
 Directors Instruction 4.13
 Local Operating Procedures
• Diversion and difficult behaviours
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Security overlay to reduce diversion
Responsibility of Corrections staff, not health staff
Close observation
s2.12. ‘Involuntary withdrawal’
 Failing to treat the health staff with courtesy and respect
 Attempting to trade, sell or divert
 Drug use
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Justice Health
Prison Prescribing
• The experience of prescribing in the prison system
 From the prisoner perspective and the GP
 The continuity of care pre-prison through to post release
 Features of prison OST programs
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Justice Health
Transition to the community
• Discharge planning
 Commences early
 Relationships are key
• Post release subsidy
 30 days post-release
 Reaches approximately 650 prisoners per year
 88 per cent of offenders complete 30 days
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