LAPORAN PELAKSANAAN PROGRAM RAWATAN TERAPI

CURE & CARE 1 MALAYSIA CLINIC TOWARDS AN INTEGRATED TREATMENT AND REHABILITATION FOR PEOPLE WHO

USE DRUGS

By :

DR.SANGEETH KAUR NATIONAL ANTIDRUGS AGENCY

MINISTRY OF HOME AFFAIRS

BACKGROUND The Cure & Care 1Malaysia Clinic was

officially launched on 1st July 2010 at the Anti-Narcotics Rehabilitation Centre in Sungai Besi, Kuala Lumpur.

This clinic provides open access services

to drug abusers, drug users, their families, employers and individuals with drug problems.

Outpatient

Medical detoxification

Day care

Short term services

Drug substitution therapy

Seven components of

the client’s placement

services are :

Referral and advocacy

Inpatient

CORE SERVICES

Placement Intervention Program

Registration Evaluation

4 main core services are provided for clients:-

www.themegallery.com

Walk-in

1

Outreach by NADA

officers or NGO’s

3

Referral by family,

employers or hospitals

2

A client can have access to these services through:

Non- conditional

No legal implications

Voluntarism (Confidential)

3 principles of the services provided:-

TREATMENT PROCESS

PROGRAMS

ADMISSION

CLINICAL ASSESSMENT

PSYCHOSOCIAL ASSESSMENT

DISCHARGED – COMPLETED DISMISSED DROP-OUT

INPATIENT OR OUTPATIENT

PHYSICAL, MEDICAL & PSYCHIATRIC

A.S.S.I.S.T U.R.I.C.A

SERVICES PROVIDED

TEXT

Pre & Post HIV Testing (vct) Saringan TB/Hep B/Hep C Clinical and psychiatric evaluation MMT Psychiatric Management Medical Detoxification TEXT

TEXT TEXT

Guidance and counseling Religious and spiritual education Relapse prevention Community Service Re-entryContinued supervision and Aftercare Support groups (family, employers etc)

Referral and advocacy Vocational skills, education and training Job placement

The Cure & Care 1Malaysia Clinic provides a broad range of services such as :

Dental Alcohol Withdrawal Management Health Education Hep B Vaccine INH prophylaxis for latent TB OPD ARV

C & C 1 MALAYSIA CLINIC

REGISTRATION


PSYCHOSOCIAL EVALUATION

Registration at Clinic OPD

CURE & CARE 1 MALAYSIA CLINIC SG. BESI

Outpatient treatment by Medical Assistant

CURE & CARE 1 MALAYSIA CLINICSG. BESI

Medical Detoxification Ward


Daily Observation and Withdrawal Chart Monitoring

CURE & CARE 1CLINIC MALAYSIA SG. BESI

Early Intervention by councilor


Medication dispensed by pharmacist (DOT)

KLINIK CURE & CARE 1 MALAYSIA SG. BESI

Methadone Patients awaiting dosing

KLINIK CURE & CARE 1 MALAYSIA SG. BESI

DOT METHADONE BY PHARMACIST

MEDICAL EVALUATION BY MEDICAL OFFICER

ACHIEVEMENTS • Since its launch on 1st July 2010 the C & C 1Malaysia Clinic has received commendable response. • As of October 2010, 9000 clients have visited and received various services at the C & C 1Malaysia Clinic. •Currently there are 900 clients registered in the Methadone Maintenance Therapy at Clinic C&Cs and 1400 clients registered at Cure and Care Service Centres •Voluntary based HIV screening is conducted •Mental Health screening conducted and seen by psychiatrist.


3091 1729 1649 942 402 561 566 101

No. Accumulative Clients at Cure & Care Clinics

861

270 37 61

1249

302 48

452

37

No of Clients and Drug of Choice

STATISTICS


0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11

337 601

938 1291

1677 1821 2181

2672

3184

3667

4138 4533

No of Clinic Visits


Oct'10 Nov'10 Dec'10 Jan'11 Feb'11 Mac'11 Apr'11 May'11 Jun'11 Jul'11 Aug'11 Sept'11

60

15

0

57 64

24 21 13

20 13

7 5 8 10

0 0

12 5

1 0 5

0 0 2

HIV Screening No of Test No HIV positive


4 8

13 13 14 16

27 29

23

31 32 35

No of patients started on ARV


4 8

13 13 14 16

27 29

23

31 32 35

No of patients started on ARV

percentage of notified HIV cases through injecting drug has decreased from 66% in 2005 to 47.6% in 2010

74.779.6

74.2 71.0 69.766.0

53.657.3

57.2 55.247.6

0.010.020.030.040.050.060.070.080.0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Percentage of Notified HIV Cases by Risk Factor, Malaysia, 2000 - 2010

IVDUYEAR

National HIV Notification among IVDU

69 67

66 65

67

61 62

69

54 50

10 10 10 17 16 16

11 15

8

36

20 22 23 17 15

23 23 14

33

13

1 1 1 1 1 1 4 2 5 1 0

10

20

30

40

50

60

70

80

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Percentage

Year

Drug Abuse Statistic, Malaysia, 2001 - 2010

Opiate Stimulan Marijuana Others

Opiate addiction has shown decreasing trend, from 67% in 2005 to 50% in 2010.

Source : MoH Malaysia

4 5 6 16

38 43 46 49 54 57 59 61

3 4 4 11 11 11 14 15 17 21 23 25 31 40 46 63

76 89

119 138

172

204

239 262

2 2 2 3 3 3 3 3 3 4 4 4 0

50

100

150

200

250

300

OCT 10

NOV 10

DEC 10

JAN 11 FEB 11 MAR 11

APR 11 MAY 11

JUNE 11

JULY 11

AUG 11

SEPT 11

CL

IEN

TS

MONTHS

INFECTIOUS DISEASES SCREENING

HIV

HEP B

HEPC

TIBI

Psychiatric Cases at C&C Clinic Sg. Besi

Retention rates of psychiatric cases in treatment after 1 year is 67%


Drug Induced Psychosis, 74%

Organic Disorder, 15%

Depression, 8% Others, 3%

METHADONE MAINTENANCE THERAPY

2007

•CCSC – 3

2009 •CCSC – 24

2011 •CCSC – 33 •CCRC – 2 •C&C CLINIC– 8

2008 •CCSC – 3

2010 •CCSC – 24 •KLINIK C&C – 2

2011 2009 2008 2007 2010

Example text

MMT ACHIEVEMENTS AT NADA 2007 - 2011

CCSC 11 PUSPEN 0

C&C CLINIC

0

TOTAL 11

CCSC 184 PUSPEN 0

C&C CLINIC

0

TOTAL 184

CCSC 689 PUSPEN 0

C&C CLINIC

0

TOTAL 689

CCSC 1024 PUSPEN 0

Klinik C&C

0

TOTAL 1024

CCSC 1379 PUSPEN 21

C&C CLINIC

900

TOTAL 2300

MMT ACHEIVEMENTS AT NADA 2007 - 2011

2011 MMT WAS EXPANDED TO;

33 CCSC 8 C&C 1Malaysia Clinics 2 PUSPEN

2010 2011 Target Clients 1325 4825

No. Registered Clients

1183 (89.3%)

2300

No of Active Clients 784 1986

No of Non Compliant Clients

79 235

Klien yang bekerja 632 1,330

OVERALL DATA

EMPLOYMENT No of clients that have started working after enrolling in the program has increased

to 1330 klien (67.7%) pada tahun 2011 from 632 (53%) clients in 2010

MMT ACHIEVEMENTS AT NADA 2007 - 2011

(KLINIK C&C) Graph 1 : Retention Rate of outpatient MMT clients at C&C Clinics

Graph 2: Retention Rate in Comparison to WHO Standard

94.9

91.04 90.59

85.3

3 mths 6 mths 9 mths 12 mths

Retention Rate of MMT Clients at C&C Clinics

94.9 91.04 90.59 85.3

75 65 60 55

3 mths 6 mths 9 mths 12 mths

RETENTION RATE IN COMPARISON TO WHO STANDARDS

NADA WHO

22

83 98 123

144

194 225

255 293

350 374

411

17 61 68 80 96

141 153 171 172

200 190 227

0

50

100

150

200

250

300

350

400

450

OCT 10 NOV 10 DEC 10 JAN 11 FEB 11 MAR 11 APR 11 MAY 11 JUNE 11 JULY 11 AUG 11 SEPT 11

CL

IEN

TS

MONTHS

TOTAL NO. REGISTERED METHADONE CLIENTS

REGISTERED

ACTIVE

23% 16%

33%

11% 9%

25% 20% 25% 21% 12%

28% 24%

0% 10% 20% 30% 40%

OCT 10

NOV 10

DEC 10

JAN 11

FEB 11

MAR 11

APR 11

MAY 11

JUNE 11

JULY 11

AUG 11

SEPT 11

%

PERCENTAGE OF URINE POSITIVE METHADONE CLIENTS (OUTPATIENT)

Employment of MMT Clients KLINIK CURE & CARE 1MALAYSIA (KLINIK C&C)

The programme has achieved in reducing unemployment among people who use drugs by providing training and employment opportunities. 151 (84.8%) of the MMT clients have started work after joining the programme.

32%

22%

5% 3%

2%

19%

17%

Employment

Security Guards

Own Business

Driver

Contractor

Catering

Unemployed

Others

FUTURE TREATMENT PROGRAMMES TO BE INTRODUCED

4 Occupation Therapy to be a part of Rehabilitation

3 INH Prophylaxis for Latent TB for HIV Clients

2 Suboxone as an option for Medical Detoxification

1 Introduction of Suboxone for HIV clients on ARV

Cognitive Remediation Therapy

Specialised Programme for Inhalan Abuse among youth

5

6

RECOMMENDATIONS Skills training to be provided by Ministry of Health, Ministry of Women, Welfare Department and Universities.

Medical leave of employees undergoing treatment.

To provide more doctors and psychiatrists in this clinic to ensure continous medical care and mental health care of clients.

CONCLUSION With the transformation in the approach to drug treatment and rehabilitation and the setting up of the Cure & Care 1Malaysia Clinics, NADA has aligned itself as one of the best practices/ evidence-based practice in treatment and health care of drug users.

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LAPORAN PELAKSANAAN PROGRAM RAWATAN TERAPI