Stapleford-Athens 2011 International Addiction Conference Developing a rehab program with NTX as one...
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Stapleford-Athens 2011 International Addiction Conference Developing a rehab program with NTX as one entry requirement Dr George O’Neil [email protected]
Stapleford-Athens 2011 International Addiction Conference
Developing a rehab program with NTX as one entry requirement Dr
George ONeil [email protected] Fresh Start Recovery Programme
Perth, Western Australia
Use of Rehab 1.To recover from detox symptoms 2.To relieve the
upset family 3.To rest (country retreat) following a big detox 4.To
relearn new values 5.Length of stay : p.r.n.
[email protected]
Slide 8
Northam Rehab Hospital
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City Rehab
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10% Methadone Pre Treatment 100% Treatment at Clinic 50%
Regular 50% Repair Jobs only Post Treatment
[email protected]
Slide 11
Med House 80% Arrive Untreated 10% Partial Detox Med House 10%
Partial Detox at home Medical Clinic Accelerated Detox 6 hrs
illness 70% Return Home 30% Overnight I.P. observation 80% Home in
days Rehab where an active implant is a prerequisite of admissions
Rehab Settings Management O.P. Family Support
[email protected]
Slide 12
Rehab Settings ClinicMed HouseCountry Residence (Northam) City
Residence Return to the community [email protected]
Caplehorn et al 1996 States that the Risk of Death after
leaving rehab and jail is 5% in the first year. An implant
immediately prior to discharge from a rehab protects against
overdose and relapse in the first 6-12 months on returning home.
Caplehorn JRM, Dalton MSYN, Haldar F, et al. Methadone maintenance
and addicts' risk of fatal heroin overdose. Substance Use Misuse
1996; 31: 177- 196. [email protected]
Slide 16
Implants Before Admission or Discharge This is the first rehab
in the world to use the principle of detox and implant insertion
prior to admission so that the patient and rehab is protected from
opiate cravings or use. This is also the first rehab in the world
where a new implant is inserted routinely in the week before
discharge back to the community. [email protected]
Slide 17
Sannibale et al (2003) Aftercare attendance and post-treatment
functioning of severely substance dependent residential treatment
clients. Drug and alcohol review, 22, 181-190
[email protected] 56% relapsed in 36 days 23% long term
abstinence
Slide 18
Naltrexone Rehab 0.05% positive opiate urine tests (past 9
months) No patient in 10 years with an ongoing opiate problem No
overdoses in the first 6 months post discharge Discharge planning
implants every 6 months [email protected]
Slide 19
Northam Patients Protected for 6months+ Estimated duration of
therapeutic effect Assuming 4ng/ml, Go Medical = 100 days, Vivitrol
17days Assuming 3ng/ml, Go Medical = 140 days, Vivitrol 21days
Assuming 2ng/ml, Go Medical = 200 days, Vivitrol 28days Assuming
1ng/ml, Go Medical = 272 days, Vivitrol 31days
[email protected]
Slide 20
Opiate Pharmacotherapy Treatment in Australia since 1998
[email protected]
Slide 21
Methadone Detox up to 200mg/day Pre 48 72 hours Miss Methadone
dose Day 1: IP 2mg 3mg over 8 hours Buprenorphine + antipsychotics
+ benzos + 0.2mg Octreotide Day 2: 2mg x 3-4 Doses Day 3: 4mg x 2-3
Doses Day 4 11: 16mg Dose Cease Buprenorphine 3 days before implant
14 days later [email protected]
Slide 22
Slide 23
12 Months Rehab & 12 Months Employment Program
[email protected] 30 years drug use - 2 years since first
treated Age 13: Was Drinking and smoking marijuana Age 18: Started
using amphetamines + speed Age 18 40: Was still using drugs, mainly
amphetamine Age 26: Tried to give up drinking and using drugs Age
40: Turned to heroin and morphine Age 44: First naltrexone implant
(Has been at Northam for over 2 years and has had 6 implants)
Slide 24
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4 Years OP, 9 months Rehab & 9 months Work Program 16 years
drug use 8 years in jail First treated 2005 with Naltrexone implant
post methadone treatment Returned to Canberra, 5 days post implant
3.5 years opiate free post 1 st implant Relapsed and returned to
Perth for treatment and Rehab Good emotional and physical recovery
with Rehab [email protected]
Slide 26
Slide 27
4 Years OP/1 Year IP Age 55 First presented in 2005 Initially
had 3 implants over 18 months, but as lifestyle hadnt changed he
returned to using after this time. Reasons for return to use were
due to stress from relationships and work, and a belief that he
felt that he was better. Currently he has been an outpatient at
Northam for 10 months. Rehab has allowed him to reduce his stress
Counselling has helped him in his recovery process.
[email protected]
Slide 28
The following is being recognised by our workers Oral
Naltrexone has a low success Implant Naltrexone has a high success,
but recovery takes 5-10 years support. Reduced Death Rates requires
long term continuity of care. 50% recover with one implant Repeat
implants every 6-9 months is recommended Methadone patients are
detoxed to Buprenorphine for 2 weeks prior to implants
[email protected]
Slide 29
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Physiology changing physiology Physiology changing physiology
Housing where you know you belong The essence of a home is love,
joy, peace, patience, gentleness, kindness and self control Housing
where you know you belong The essence of a home is love, joy,
peace, patience, gentleness, kindness and self control
Relationships self, God, family, community Relationships self, God,
family, community Empowerment Empowerment Education, Employment,
Exit from rehab, Entry to Society occupational therapy, short term
employment, career, university/training Education, Employment, Exit
from rehab, Entry to Society occupational therapy, short term
employment, career, university/training Follow up- PHREE
program
Contact Information Dr George ONeil Email:
[email protected]@drgeorgeoneil.com Phone +61 893881991
Perth (GMT+8) 6-8am or 7-11pm London (GMT) 10-12pm or 11am-3pm New
York (GMT-5) 5-7pm or 6-10am Los Angeles (GMT-8) 2-4pm
[email protected]