Making Recovery Real: the public health future

Report
MEDICATIONS IN RECOVERY: RE-ORIENTATING
DRUG DEPENDENCE TREATMENT
HOW CAN WE MAKE SHARED-CARE IN
WANDSWORTH MORE RECOVERY ORIENTATED?
Hannah Lindsell
Public Health England
In a nutshell…
The group’s final report
A lot done.
A lot more to do!
Key principles
• Everyone can recover, but not everyone
will
• We don’t know who will
• Give everyone the best chance for long
term recovery
• Make leaving treatment and sustained
recovery a hope for all from the beginning
Drug treatment has been a big success story
• Lives saved, harms reduced
• HIV rates amongst IV drug users are
down
• Injecting rates amongst drug users are
down
• Drug related deaths are down
• Crime has been much reduced
The problem
2010 drug strategy:
“Substitute prescribing continues to
have a role to play in the treatment
of heroin dependence, both in
stabilising drug use and supporting
detoxification. Medically-assisted
recovery can, and does, happen…
However, for too many people
currently on a substitute
prescription, what should be the
first step on the journey to
recovery risks ending there. This
must change.”
The group’s final report – July 2012
 High-quality treatment system
that substantially improves health
 Heroin is sticky
 Leaving treatment is important
but it isn’t recovery
 Lots of people haven’t recovered
 Done right, OST is effective but a
platform for recovery
 Don’t end it too early
 Some people recover fast, some
don’t – all need recovery support
Avoid unintended consequences
Let’s be clear:
 This is about increasing recovery-oriented
ambition and progress for individuals and in
systems where there is not currently enough of it
 It is not about destabilising - to the point of
unacceptable risk - individuals who are deriving
benefit from OST.
Key to success
 A shared vision of recovery, and leadership
 Organisations & staff able to support and sustain change
 Staff who believe in the treatment they are delivering
 A structured programme with clear treatment goals
 Availability and range of OST medications
 Range and quality of psychosocial interventions
 Active referral to self help and mutual aid
 Links to recovery orientated community organisations
The evidence ...
 ... is good that OST:
 Retains people in treatment
 Suppresses illicit use of heroin
 Reduces crime
 Reduces the risk of BBV
 Reduces risk of death.
 ... is less persuasive that OST:
 Suppresses other drug use
 Improves physical and mental health
 Improves social reintegration of marginalised heroin users
 Promotes abstinence from all drugs.
What should services do?
 Do more, and review more frequently
 Do it quickly for those new in treatment, and purposefully
for all
 Review those in long term treatment to check that they are
still benefitting. If not, adjust treatment
 But avoid unintended consequences (exiting too soon and
returning)
What shared care looks like in Wandsworth
•
Nurse practitioner model
•
GP Prescribing/Pharmacological interventions-325
•
48/325 = Non-Opiate
•
277/325 = Opiate
•
Total number in treatment = 860
•
325/860 = 38% (LONDON average = 37%)
•
Percentage of GP prescribing patients that successfully complete = 6%
(LONDON average = 5%)
•
Length of GP prescribing/Pharmacological intervention:
•
0-1yrs-76%
•
2-5 yrs- 24%
•
6+ years-0%
Recovery support-what does it look like in
Wandsworth?
 Peer-role models and peer support
 Employment support
 Family and social networks
 Housing support
 Mutual Aid-NA, CA, AA, Smart Recovery?
What are the challenges for Wandsworth Shared
care?
• 15/42 practices engaged-expand? How? What are the
barriers?
• Opportunity to review model/outcomes every year when
you review the LES?
• How recovery orientated does the shared care system
feel?
• Care Plan Audit of Shared Care clients?
• How often are Care Plan Review carried out with the
Nurse practitioner, the client, the Pharmacist, the GP?
Further challenges?
Low dose for 2-5yrs? Abstinence a realistic option? Is it
offered?
Greenwich model-brought in a Psychologist to work with this
client group
Is there an opportunity to segment the shared care
population?
Any questions?
?
[email protected]
07795 036 473

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