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Program methadone kkm hrpz2
1. Dr Hj Mohd Ariff Mohd Noor
Pakar Perunding Psikiatri
HRPZ II, Kota Bharu
Pusat Latihan Bachok, 26 Mei 2010
2. General :
• To improve the health and quality of
life of persons with opiate
dependence through drug substitution
therapy.
OBJECTIVE
3. Specific:
• To reduce relapse among opiate dependent.
• To improve the physical and mental condition of opioid dependents.
• To reduce spread of infection through IVDU and sharing needles.
(e.g HIV, hepatitis B and C )
• To treat opiate dependents pregnant women.
• To improve psychosocial functioning, including ability to gain or
maintain employment and to improve their social adaptation and
integration into the society.
• To reduce criminal activities amongst opiate dependent.
OBJECTIVES
8. CRITERIA
• Inclusion
- Volunteer
- Drug dependent > 2years
- Proof of identity
- capable of informed
consent
- complication of opiate dependence
• Exclusion
- Age < 19
- Drug dependent <2 years
- Polysubstance abuse
- Abnormal LFT(more than 3x)
- ac. Med/psy disorder (severe/with
complication)
9. CRITERIA…additional inform
• Inclusion
- accept HIV negative
- non IVDU
• Exclusion
- No compromise if it is excluded
- Abn LFT
Allow DOT if ALT >3fold with no
clinical significant finding & repeat LFT
in 2/52
No DOT if ALT>5fold & repeat LFT in
2/52
Exclude if clear clinical significant
finding.
- poor personal information (register but
waiting for include into the program)
- psy disorder with poor
supervision/compliance/
frequent admission/cognition
10. Consent…..inform about
Emphasize on the rule
Terminate if persistent against
the rule such as fraud,
violence toward staff
No compromise on drug
dealing & theft/damage
property
Not by proxy for takeaway
except able to show evidence
such letter from Doctor. Show
other evidence or bring family
if they want temporary
takeaway.
To be taken preferably with
family
Blood taking after consent
11. INITIAL ASSESSMENT
Questionaire
- WHOQOL
- Personal data
- OTI
- W0, W12, W24,W48
- W0 (on the day before DOT)
Physical examination
- sign intox,withdrawal,needle track
- medical problem e.g. liver disease
Blood
- LFT,HIV,Hep B,C
- after consent,3/12 first 1yr, then 6/12
Urine
- weekly 1st
1/12
-2 weekly for next 1/12
- randomly each month
17. INITIAL ASSESSMENT….blood
Blood
- LFT,HIV,Hep B,C
- after consent,3/12 first 1yr,
then 6/12
- HIV,Hep B,C once
assessment if positive
- TO BE TAKEN at least 1/52
before at initial DOT on the
same day (after consent)
- Blood is taken for selected
number of pts from same group
by different day of the week
monthly scheduled.
20. INITIAL ASSESSMENT….urine
Urine
- weekly 1st
1/12
-2 weekly for next 1/12
- randomly each month
- No need
randomly/month if
the individual show poor
behavioral performance.
23. ASSESSMENT BY THE PRESCRIBER
• Induction/stabilisation
– Patients are reviewed every 3
days or 2x a week for 2/52
(e.g.Sunday & Wednesday).
– Review PRN between those
days if withdrawal or
intoxication occur
– Highly supervised setting.
– No take home dose.
24. ASSESSMENT BY THE PRESCRIBER
• Maintenance Phase
– Patient should be seen:
• Weekly for 2 week.
• Fortnightly – 2 months.
• Monthly – after that.
– Allow take away not more
than 3 days
– Preferably with family
supervision.
25. ASSESMENT TAKEAWAY
Takeaway
Not mandatory if urine result
persistent negative
Avoid from giving takeaway
Unlikely involve with gang or
came with outsider
Busy and comitted with work
especially involve with people
Never seen with “hang around”
Don’t empathy/sympathy
26. TAKEAWAY cont…
Takeaway
Suspended if
urine persistently positive
Share with others
Selling to others
Bring the bottle to their friend’s house
Bring back bottle of the similar identity
Strictly warning or suspend takeaway if
repeatedly bring suspicious ‘friend’
29. How to plan…
• Review pt
• Blood specimen
• OTI
• Urine
• Counselling
• ….if possible all plan are systemic,well
organised, time consuming and
predictable
30. APPROACH
• Identify group
MO only looking at clinical aspect. MO came to
review according to their turn because has to
review other activities.
• The committee would arrange time table base
on MMT GUIDELINE FOR
1) review client according the group
2) blood specimen taken /OTI/QOL
3) urine test
• All procedure done before review by MO and
then dispensing by pharmacist
51. Conclusion
• Systematic
• Traceable - personal file
- the procedure schedule &
its defaulter
- result test & its defaulter
• Better time management
• Easy to arrange work plan
• Predictable
• Enforce the rule and be assertive
Although not much is known on the etiology of mental disorders and how the different factors for intervention impact on the outcome, three major factors have shown a consistent relevance.
1 Biological
2 Psychological
3 Social and environmental
Use them as:
a model for « etiology »
a model for treatment
a model for the organisation of mental health care
