But I don t have a drug problem Engaging With Consumers Affected By Medication Misuse How many people reported misusing a medication in the past year? What percentage of people who misuse medication are aged 50 or older? 1 in 2 1 in 8 1 in 10 1 in 20 13% 45% 56% 68% What percentage of people who misuse opioids, report misusing an over-thecounter codeine? 5% 25% 50% 75% Rates of opioid prescribing 2002-2008 SOURCE: Roxburgh et al, 2011 OXYCODONE Fig 1: Rates of PBS Scripts for Opioids in Australia 2010 2015 (Monheit et al, 2016) Overdose in Victoria 2016 2017 Road Toll 291 255 Deaths by OD 492 523 Deaths by OD due to pharmaceuticals 381 (77.4%) 414 (79.2%) Deaths by OD due to Illicit 263 (53.5%) 271 (51.8%) Who is at risk of misusing pharmaceuticals? People who report misusing pharmaceuticals are more likely to be: Unable to participate in the workforce Living in remote/regional areas Experiencing health problems and chronic pain Aboriginal or Torres Strait Islander Older adults (over 55 years) BUT it can happen to anyone Coroner s Court of Victoria, 2016 Coroner s Court of Victoria, 2018, COR 2016 2730 National Drug and Alcohol Research Centre, 2018 Australian Institute of Health & Welfare, 2017 1
Stigma Health Professional I don t see that type of patient It takes the pain away, what s wrong with that? Community Addicts only have themselves to blame All addicts are dangerous They are bums Self-generated It s only medicine. I don t have a drug problem I only use it help me sleep It was given to me by doctor, so it can t be unsafe Analgesics Anxiolytics Stimulants Other Psychiatric Medication Opioid pain killers Paracetamol Anti-inflammatory drugs Sleeping tablets Benzodiazepines Sedatives Ritalin Modafinil Dexamphetamines Anti-depressants Anti-psychotics Mood stabilisers Signs of problematic use Signs of problematic use Psychosocial problems as a result of use Medical/health problems as a result of use Using larger amounts or more often than intended Hiding use from others or lying about medication use Feeling unable to cope without using medication Mood swings, irritability or anger Difficulty cutting down or stopping Withdrawal symptoms when reduced/stopped Needing to take more and more Spending a lot of time/money on medications Relying on the medication to manage sleep/emotions Doctor shopping or pharmacy shopping Signs of withdrawal SafeScript Anxiety Muscle aches Pain Increased tearing Insomnia Runny nose Sweating Yawning Abdominal cramping Diarrhea Dilated pupils Goose bumps Nausea Vomiting Real-time prescription monitoring system commencing 1 st October 2018 (full roll-out across Victoria by 2019 2020) 2
What is the Medication Support and Recovery Service? Medication Support & Recovery Service A new addiction treatment service specialising in helping people who use prescription and over-the-counter medications A unique FREE service in Victoria based in community health, providing specialised pharmaceutical treatment services We support anyone who is dependent on or misusing medications, and their families Clients can access our service regardless of age or postcode Self-referrals are accepted No Medicare Card or Mental Health Treatment Plan or Chronic Disease Management Plan is needed Locations Access Health and Community Hawthorn Doncaster East Link Health and Community Glen Waverley Clayton Carrington Health Box Hill Inspiro Community Health Lilydale Healesville Belgrave Banyule Community Health West Heidelberg Greensborough Epping Our Services Wrap-around approach within primary health Therapeutic counselling Brief intervention Nursing and withdrawal support Nurse practitioners (withdrawal and prescribing) Peer support Referrals to specialist services (e.g. Addiction Medicine) Referrals to other health & community services Support to access pharmacotherapy Education and training programs Easily accessible Other drugs, n.e.c. 5% Amphetamines 3% Clients can access our service regardless of age or postcode Self-referrals are accepted via phone or website GPs and health professionals can refer via Medical Director/Best Practice, phone or website No Medicare card, Mental Health Treatment Plan or Chronic Disease Management Plan is needed Codeine 24% Opioid analgesics, n.f.d. 35% 1800 931 101 Benzodiazepines 33% 3
Outcomes 0.60 Average Number of Self-Reported Overdoses Not answered 0.55 7% Abstinence 19% 0.50 No change but reduced risk 16% 0.40 0.30 0.20 Reduction 29% 0.10 0.12 No Change 29% 0.00 Three Months prior to MSRS DURING Episode of Care Average Number of Self-reported ED/Hospital/Ambulance Presentations Kate 0.70 0.60 0.50 0.40 0.30 0.20 0.67 0.22 51yo Fractured wrist approx. 3 years ago GP prescribed Endone and made a referral to specialist clinic Engaged with MSRS Has seen a counsellor, nurse and engaged with peer support Referred to physiotherapist and dietician 0.10 0.00 Three Months PRIOR to MSRS DURING Episode of Care Margot George 60yo Referred by emergency services Misuse of opioids and Valium to manage physical health and anxiety Six ED presentations in 12 months Engaged with MSRS Has seen a counsellor, and nurse Referred to allied health including physiotherapy, occupational therapy and podiatry Referred to mental health nurse Collaboration with family in assessment, treatment and planning 53yo Procedure approx. six years ago: Post-op Endone GP prescribed Panadeine, and Panadeine Extra (320mg) Developed alcohol dependence Client tried to stop but had withdrawal symptoms Called MSRS after hearing about the service on the radio prior to 1 st Feb I don t know what I would have done if I didn t hear the radio that day Working with the nurse on a reduction plan 4
Sean 81yo Stomach pain approx. 1 year ago GP prescribed high doses of pain killers Procedure resolved pain but Sean continued to take over the counter codeine Sean tried to withdraw from medications but had the shakes and couldn t stop using Called the MSRS for help after finding the website Working with the nurse on a reduction plan How do I refer to MSRS? Questions? Clients can self-refer or be referred by a GP or health professional Refer via email, telephone or online (website) Contact us for more information 1800 931 101 msrs.intake@accesshc.org.au Julius Ting Project Co-Ordinator Julius.ting@accesshc.org.au Dr. Tamsin Short Senior Manager of Mental Health & AOD Tamsin.short@accesshc.org.au 5