Nelson Alcohol and Other Drug Service

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What do the AOD center do?. Authority appraisal of liquor and other medication disordersComprehensive evaluation and analysis utilizing DSM1V criteriaAddiction drug specialistsUse of particular pharmacotherapyCo-existing issue managementTherapeutic interventionsFamily/whanau supportSpecific Youth serviceDetox serviceOpioid substitution programmeGP Liaison for opioid substitution by means of GPsEducationRes

Presentation Transcript

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´╗┐Nelson Alcohol and Other Drug Service GP CME Presentation March 2009

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What do the AOD facility do? Authority appraisal of liquor and other medication issue Comprehensive evaluation and determination utilizing DSM1V criteria Addiction pharmaceutical experts Use of particular pharmacotherapy Co-existing turmoil administration Therapeutic mediations Family/whanau bolster Specific Youth benefit Detox benefit Opioid substitution program GP Liaison for opioid substitution by means of GPs Education Research

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What medications are most ordinarily utilized? Nicotine Alcohol Cannabis Stimulants Benzodiazepines Opiates Hallucinogens Solvents/gasses

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What is Detox? "Detoxification alludes to the procedure by which the impacts of sedative medications are dispensed with from sedative ward clients in a protected and compelling way, to such an extent that withdrawal manifestations are limited. (WHO 2006)

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" The historical backdrop of the treatment of opiate withdrawal is a long and disreputable one...." Kleber H.D. et.al. The treatment of Narcotic withdrawal: A Historical Review. J Clin Psych. 43:6(Sec 2)- June 1982 Belladonna medications Peptization and water Balance Treatments Bromide rest treatment Lipoid Treatments Endocrine medicines Immunity Treatments Accupunture Vitamin C Abrupt and fast withdrawal Convulsive treatment Hibernation treatment Methadone Phenothiazines Diphenoxylate Propanalol Proxyphene Naloxone encouraged withdrawal

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Opiate Withdrawal Management Buprenorphine v customary 'immediately' Symptomatic help COWS done every day Management of the most hard to manage manifestations. Sleep deprivation, eager legs, disturbance Protracted withdrawal disorder

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Protracted Withdrawal? "While the writing would bolster the continuation of physical and subjective irregularities past the intense withdrawal time of liquor and opiates....protracted withdrawal has not been indisputably exhibited due to methodological confinements" Satel SL et.al. Ought to extended withdrawal from medications be incorporated into DSM IV? AM J Psych. 150:695-704,1993.

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Choice of sedative agonist Both methadone and buprenorphine have been observed to be successful in the treatment of sedative withdrawal however the proof for methadone has a more noteworthy research base There is confirmation that buprenorphine has a shorter time of withdrawal and a more prominent rate of maintenance in treatment. [1] Gowing L, Ali, R, White, J. Buprenorphine for the administration of opioid withdrawal. Cochrane database of orderly audits 2006. Issue 2 [2] Amato et.al. Methadone at decreased dosages for the administration of sedative withdrawal (Review) Cochrane database of orderly audits 2005, issue three .

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Detox Outcomes Smyth et.al. In-patient treatment of sedative reliance: medium term follow-up results. English Journal of Psychiatry. (2005), 187, 360-365. 149 patients admitted to an inpatient Detoxification/singular treatment/assemble treatment 2 after 3 years 5 passed on 54%continuing to utilize unlawful medications 57% on upkeep 25% abstinent inside a month ago Abstinence related with culmination of in-patient program participation at aftercare not utilizing IV nonappearance of family history of utilizing

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Daryle Deering et al. NAC 'Boundaries to Care-A Service Users Perspective' 2008

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Barriers To Transfer Of Clients-Primary Care All 18 administrations recognized obstructions GP accessibility (61%) Stigma (39%) Cost to customers (66%) Clients favoring clinic (39%) Clients not prepared (39%) Service staffing/mentality related (44%) Deering et al 2008

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GP contact for methadone endorsing Criteria for GP recommending Process for exchange Ongoing observing Responsibility of care What happens when the wheels tumble off?

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Criteria for GP recommending No worries re behaviour No uncertain issues re abuse Illicit medication utilize not distinguished in UDS Client has agreed to necessities of O.S.T.P. No current unlawful exercises Client has drawn in with partaking GP Stable measurement of methadone Takeaway courses of action built up

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Process for exchange Contact with customer's G.P. Authorisation by AOD Medical Officer Client's extensive evaluation and recommending points of interest to G.P. Duplicate of medicinal history and hazard calculate appraisal sent to G.P.

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Ongoing checking Client to go to G.P. arrangement once month to month for restoration of medicine. G.P. Contact Clinician to meet with customer in any event every year. AOD will approach customer for 2 pee sedate screens a year G.P. Contact Clinician liaises with customer's G.P. all through treatment.

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Responsibility of care Overall steadiness of customer Injection site(s) examination Hepatitis status Liver capacity tests HIV tests

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What happens when the wheels tumble off? Customers can be come back to Specialist Service G.P. Contact Clinician is accessible Monday to Friday 0830 to 1700 hours Relevant clinical staff accessible if required.

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Who to Contact at AOD Methadone Prescribing: Jude Burgess or Dr Lorraine Balance Detox/withdrawal: Steph Anderson Complex AOD/Pain/Out of hours: Dr Lee Nixon or Dr Marijke Boers Regional Service Manager is Eileen Varley

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