Academic journal article Australian Health Review

Can Monitoring Consumer Requests for Opioid-Replacement Therapy Improve Access to Treatment?

Academic journal article Australian Health Review

Can Monitoring Consumer Requests for Opioid-Replacement Therapy Improve Access to Treatment?

Article excerpt

Introduction

In 2011, 46 446 people were registered in opioid-replacement therapy (ORT) within Australia.1 Of these, 64.8% were treated through general practitioners (GP), 27.3% were managed by publicly funded clinics, 7.2% were prescribed medication within correctional services and a small proportion (0.7%) were treated through a dual private-public arrangement. The number of people entering ORT treatment has increased rapidly over the past decade, with 30 237 treated in 2000 compared with 46 446 in 2011,1 an increase of >50%. The rise in consumers entering ORT was not linear. Between 2005 and 2006, only 48 consumers entered treatment, whereas during 2010-11 a further 368 consumers were registered in ORT programs.1

It is unclear how many people in the wider community would benefit from ORT to treat their heroin and/or prescription opioid misuse dependency because reporting this information is not a national requirement. Only consumers registered in ORT treat- ment are identified.2 From a 2009 review of Australian ORT services, it was estimated that a further 10 000-30 000 people could benefit from ORT.3 An educated guess on the totality of opioid-dependant Australians is presented at 1 500 000 people,4 and it is likely that a significant proportion are misusing these medications when hospital-related admissions, reports of misuse and the increased prescribing of these medications are considered.5-7

It therefore presents as irregular that in 2005-06 and 2010-11 there was a reduction in the number of people wanting ORT. It is likely this represents a consequence of reduced access to treatment, with ORT providers reaching their treatment capacity and limiting consumer entry.8 This conclusion is supported by a survey conducted on 35 ORT programs within the state of New South Wales, with one in four identified as having a wait for treatment; in some programs the wait list exceeded 50 people.9 In Queensland, a similar situation is presented, with the Drugs of Dependency Unit acknowledging that neither GPs nor public clinics are providing ORT in a timely manner.10 The Drugs of Dependency Unit have initiated a program to give GPs, who are not ORT providers, interim authority to prescribe ORT while a person waits for specialist ORT placement.10 In Victoria, access to drug treatment is a problem and a centralised triage approach is planned for this state to improve the situation.11

National policy on ORT provides limited guidance on man- aging people waiting for treatment with no national triage system established. Clinicians responding to consumer requests for ORT are recommended to determine the consumer's priority status for treatment. Priority consumers are:

* pregnant women

* people with HIV, carriers of hepatitis B and the partners of these people

* people on a drug-diversion program

* people with signi fi cant mental or physical illness

* people recently released from prison, particularly within the past month

* people identi fi ed as Aboriginal or Torres Strait Islander

* people aged under 18 years

* parents with children under 2 years of age.

If the consumer does not meet any of these criteria, the clinician is directed to make a clinical decision based on the consumer's presentation.12

ORT providers unable to offer treatment places are confronted with the options of either turning people away or recording them on a wait list.13 Turning people away is not a desirable option because the consumer may not re-engage with treatment.14-16 Wait lists are also undesirable, although they can enable the person to be recontacted at a later date when ORT is available.13 The wait time for ORT is likely to be reduced with increased resourcing,3 although providers should quantify the number of treatment requests9 and explore opportunities to maximise pro- ductivity using existing assets before additional funding is sought.3,17 Awareness of when consumers seek treatment is central to managing the rostering of clinicians to provide a balanced cost-effective ratio of clinicians to consumers to main- tain a safe environment for treatment delivery. …

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