Transcript Victorian Pharmacotherapy Review, Department of Health

Mental Health, Drugs and Regions Division:
Local Government Drug Issues Forum
11 August 2011
Current context for treatment, harm reduction
& pharmacotherapy services
A moment in time....
• The Government has identified a need for greater cohesion
and coordination in relation to alcohol & other drug policy
and services
• Committed to the development of a whole of government
Victorian Alcohol & Drug Prevention & Treatment
Strategy that will ensure those in need of services are given
every opportunity to get their lives back on track and access
treatment when needed
• Reinforced by observations in the VAGO report for the
reform of the AOD treatment system
• 2011/12 budget commitments signal change and seed
reform
Budget Commitments – Across Pharmacotherapy, Harm
Reduction & Treatment Services
188 million over 4 years for Alcohol & other Drug Services
Including $163.6m for core alcohol & drug treatment services
$39m per annum inherited shortfall – funded
$23.7 million over four years for new initiatives to respond to
alcohol and other drug abuse in Victoria.
• $9m to establish new CCCC services in growth areas
• $11m to expand pharmacotherapy prescribing and dispensing
services
• $3.7m to expand to 24 hours the needle and syringe program in
South and Western
Budget Commitments - Strategy
Whole-of-government Alcohol and Drug strategy:
• Inter-departmental Committee
• Expert Advisory Group
Likely priorities:
• An Integrated Prevention Plan
• AOD service system reform
• Measurable outcomes and accountabilities
Engage with and learn from Stakeholders
Opioid Replacement Therapy (ORT) aka Pharmacotherpay
• In Australia, ORT is the most commonly provided
treatment for heroin and other opioid dependence.
• The Victorian ORT system offers quality services in
accordance with a strong evidence base. It is mostly
community based with general practitioners (GPs)
prescribing ORT and community pharmacies
dispensing the medications.
Opioid Replacement Therapy (ORT)
• Patients with complex needs can be referred to one of
five Specialist Pharmacotherapy Services located in
Box Hill, Fitzroy, Heidelberg, Elwood, Footscray and
Bendigo.
• Participation in ORT in Victoria has increased by 27%
in the last five years and continues to grow.
• In April 2011, there were 13,666 clients receiving ORT
treatments in Victoria.
This level of participation
compares very well with other jurisdictions.
Opioid Replacement Therapy (ORT)
• As at April 2011, 92.4% (12,631) of pharmacotherapy
clients received their medication at one of 460
community pharmacies.
• ORT services are offered at more than one in three
community pharmacies in Victoria.
• In contrast, fewer than 400 of over 5,000 GPs in Victoria
(less than one in ten) prescribe ORT medications.
• The State Budget has committed an additional $11
million over the next four years to improve support for
Opioid Replacement Therapy (ORT) prescribers and
dispensers and to improve access to ORT for clients
living in rural and regional Victoria.
Victorian Pharmacotherapy Review
NDARC and Turning Point commissioned to review Victorian
ORT system.
Found that the system is sound but specific improvements are
needed.
The Review identified six key overarching issues in the
pharmacotherapy treatment system:
•
Specialist component of the treatment system is inadequate
•
Partnership between specialist and community-based providers is
inadequate
•
Workforce requires further development
•
Treatment places are insufficient to meet the escalating demand
•
Lack of program affordability is a critical problem
•
A range of quality of care issues were identified
Victorian Pharmacotherapy Review
Victorian Pharmacotherapy Review officially launched In July 2011
Additional $11 million over the next four years to improve support for
prescribers and dispensers and to improve access for clients living in rural
and regional Victoria
•
$4.8m to boost Addiction Medicine Specialist (AMS) capacity
•
$600k to create annual scholarships for addiction medicine
•
$2.55m to review and redevelop Specialist Pharmacotherapy Services (SPS)
•
$2.3m to create a support network for GPs
•
$550k to train and develop a stronger network of GPs
•
$200k for training and networking for pharmacists and their staff.
How do we create a system wide response to
pharmacotherapy?
• We need to look at service provision from a client
perspective not from treatment services or government
constructs
• Needs to be seen as part of a spectrum of care based
around motivational cycle
• Closer links with treatment services to ensure we make
the most of opportunities for holistic assessment &
responses
• Wrap around support for GPs and Pharmacies with
appropriate specialist back up
• Need to develop a culture of hopefulness
Harm Reduction – Needle and Syringe Program:
Purpose and Achievements
• Prevent the spread of blood-borne viruses and sexually
transmissible infections among injecting drug users
and on to the broader community
• Major contributor to Australia maintaining among the
lowest HIV infection rates worldwide
• In the decade to 2009, NSPs in Victoria directly averted
more than 5,500 new HIV infections and almost 19,000
new hepatitis C infections
• Investment of $71 million yielded direct healthcare cost
savings of $224 million ($153 million net savings)
NSP delivery
• Outcomes are achieved through:
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the provision of sterile injecting equipment;
sexual health products; and
education/information resources; as well as
safe disposal options; and
referral to other health and welfare services, including
drug treatment services.
• More than 500 sites in Victoria, typically located at
community health services and community pharmacies
After-hours access response
• In regional Victoria, including in Geelong, 24-hour
access to sterile injecting equipment is provided at
more than 20 locations at hospital emergency
departments.
• In metropolitan Melbourne, 24-hour NSP access is
available at Werribee Mercy Hospital and in St Kilda.
• In Bendigo and across metropolitan Melbourne,
however, after-hours access is generally limited to
vehicle-based NSP services, typically operating from
about 7.30pm to 11.30pm from four to seven nights a
week.
Extending NSP access from Footscray and
Frankston
• The 2011-12 budget includes $3.74 million over four
years in new funding to secure 24-hour NSP access
from Footscray and Frankston.
• Footscray and Frankston are both in areas adjoining
growth corridors associated with established and
emerging drug issues and existing services straining to
meet growing demand.
Web Links
• http://docs.health.vic.gov.au/docs/doc/VictorianPharmacotherapy-Review
• http://docs.health.vic.gov.au/docs/doc/Whole-ofgovernment-Victorian-alcohol-and-drug-strategy--Community-Consultation