Treatment of a Chronic Illness: Opiate Addiction A Test of a Community Health Center to Promote Heal

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Treatment of a Chronic Illness Opiate
AddictionA Test of a Community Health Center
to Promote Health Presented byDr. L. Doupe
MD DIH DOHSSupporting People, Protecting Society
June 20, 2007
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INTEGRATING THE SOCIAL DETERMINANTS OF HEALTH
INTO PATIENT CARE HEALTH a complete state of
physical, mental and social well-being, and not
merely the absence of disease or infirmity.
(WHO 1946)

• unemployment
• social support
• Friendships and social support
• addiction
• healthy food
• transport policy
• exercise

• social gradient
• Occupational class difference
• stress
• early life
• social exclusion
• Unemployed, disabled, prisoners, refugees,
  homeless,
• working conditions
• Control over work

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Present System Complex Incoherent
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Priorities of Local LHIN

• Promotion and Prevention reduce workplace
  injury and disease
• Coordinate services for Children and Youth
• Assist Persons to Live Independently In the
  Community
• Mental Health and Addictions
• Improve Quality of Care at end of Life
• Specialized Services for Frail Elderly
• Integrated Information Communication Technology

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Methadone Program

• Treatment of Opiate Addiction
• Methadone mu synthetic opioid agonist
• Good oral bioavailability and long duration of
  action
• Used in addiction and in pain management
• Managed by College of Physicians and Surgeons on
  behalf of MOH
• In cooperation with College of Pharmacy
• In cooperation CAMH
• A best practice program - Guidelines
• Audited q 3 years
• High Administrative demands

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Chronic Illness Addiction

• Focus on Treatment and Functioning
• Response rates
• Success rates similar to other chronic illnesses
• Drug and alcohol treatment
• 40-60 abstinent at 1 year varies with drug
• Outcomes optimized in Methadone Program and with
  ongoing support Groups
• Diabetes, Hypertension, Asthma
• 40-60 compliance rate
• lt30 adherence with diet and risk reduction
• 50 require medical intervention within 1 yr

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Effectiveness of Methadone Level 1 evidence

• Reduces morbidity mortality associated with
  heroin use
• Direct 7 yr mortality rate 11x
• Indirect
• Increases program retention and suppression of
  heroin usage
• Treatment retention with Methadone 56
• Treatment retention without Methadone 2
• Reduces illicit drug use and other drug use
• IVDU d 81 -gt 42-gt29
• Treatment retention is associated with reduction
  of crime
• Improvement in employability 12/17 addicts
  employed yr 2

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Effectiveness of opiate treatment increased

• Methadone Maintenance Program
• Harm reduction philosophy
• Adequate dosing
• Contingency management
• Principles of Addiction Treatment
• Education
• Monitoring urines (LFT, behaviors)
• Counselling (Group and Individual)
• Relapse Prevention Programs

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The Program

• Criterion for Admission (DSM IV)
• Pregnancy and Adolescents
• Assessment Signing of Agreements
• Initiation / Pharmacy
• Methadone Dosing issues (50-120 mg)
• Treatment Phases
• Early (0-1 week)
• Late (2-6 Weeks)
• Maintenance Phases (6 weeks )
• Termination Phase

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General Health CareBlood work q 3- 6 months

• Birth Control
• Hepatitis B screening and immunization
• Hepatitis C
• Screening and monitoring
• HIV screening
• STD screening
• Dental care
• Health Promotion
• Health Screening

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Issues at weekly visit

• Goal Abstinence vs harm reduction
• General Health complaints Mental and Physical
• Monitoring of urines
• Honesty (cross checking of written answers to
  urines)
• Treatment and Referral
• Prescription
• Contingency management - Carry privileges
• Goals for improved functioning (social
  determinants)

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Key Challenge

• Trauma Care - Golden Hour Versus
• Addictions Golden Moment

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• CASE HISTORY

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Functioning Case KS- Self Report Step 1 Treat
Patient Addiction, Physician Impatience
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Step 2 Engagement in Recovery
General Health Care
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Step 3 Housing
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SummaryFrom Crack House
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To Home and Family
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