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: –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 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.

Pharmacotherapy-Reviewhttp://docs.health.vic.gov.au/docs/doc/Victorian- Pharmacotherapy-Review government-Victorian-alcohol-and-drug-strategy--- Community-Consultationhttp://docs.health.vic.gov.au/docs/doc/Whole-of- government-Victorian-alcohol-and-drug-strategy--- Community-Consultation Web Links