6.4.1 HistoryUp until 1994/95, methadone maintenance services in South Australia were provided solely through the public sector. Recent initiatives have resulted in medical practitioners in the private sector become involved, and they are expected to play an increasing role in the future.
6.4.2 Current situationThe Public Methadone Treatment Program is operated by the Drug and Alcohol Services Council (DASC) and is aimed at the following client groups:
- Clients who wish to engage in formal efforts to reduce their unsanctioned opioid use and are endeavouring to attain stable treatment progress ("Stream B"). These clients are provided with a "high intervention" methadone program which offers a comprehensive range of services to clients. Total unsanctioned opioid abstinence is only one of a range of acceptable treatment goals in this program. However, high intervention programs endeavour to promote and facilitate change in many life areas so that improved health and social functioning may enable clients to "normalise" their general lifestyle. Services provided include a high level of medical and clinicalcasework intervention, welfare advice and support, social skills training and after-care.
- Clients who have demonstrated good treatment progress in a "high intervention" methadone program and are stable ("Stream C"). These clients require little support other than the prescription, administration and medical supervision of their methadone medication. Accordingly, they are offered a "low intervention/low supervision" methadone program but have access to counselling should they feel they require it.
- Clients with minimal treatment goals and/or no demonstrated stability in treatment (i.e. clients who, at this stage, do not wish to engage in formal counselling regarding their unsanctioned opioid use) ("Stream A"). These clients are provided with a "low intervention/high supervision" methadone program. This is essentially a drug substitution program where it is expected that participation in the program will result in associated improvements in health and social functioning and decreased risk of morbidity, mortality and of HIV risk taking. Clients receive no takeaway doses of methadone and do not qualify for community pharmacy collection of their methadone.
Due to lack of resources, DASC has introduced a ceiling of 850 people on the Public Methadone Program. Applicants beyond this number are placed on a waiting list and assessed as numbers drop below this number. The waiting list as at September 1994 was 77 people.
For the dispensing and administration of methadone, DASC locates all suitable clients to community pharmacies for methadone pick-up. As at September 1994, 58 clients collected methadone from the public dispensary, with 789 clients collecting methadone from community pharmacies. Currently, over 230 community pharmacies in South Australia dispense and administer methadone as part of the South Australian methadone program with a further 70 willing to provide these services.
Top of page
The Private Methadone Program is aimed at medical practitioners who wish to become methadone prescribers and at clients who either wish to engage in formal efforts to reduce their unsanctioned opioid use but who have yet to demonstrate stable treatment progress (i.e. Stream B), or who have demonstrated good treatment progress and are stable (i.e. Stream C). The first training program for medical practitioners was conducted in March 1994, and further training programs are planned. Private medical practitioners are expected to commence in the private program from 1994/95 onwards.
It is expected that:
- private prescribers will enable methadone to be provided to more of the target group by accessing members of the heroin-using population who have not previously been reached
- private programs will contribute to a more regional service, particularly useful in country areas where the public methadone program does not provide a service
- numbers on the public methadone program will stabilise
- the public program will continue to receive referrals from the private program of clients who are difficult to handle;
6.4.3 StatisticsThe number of clients in the public sector in South Australia since 1986 are contained in Table 7 below. There were no clients treated in the private sector up to 1993/94.
Expressing these levels of participation as rates per thousand of population aged between 15 and 44 years (the primary age group of opioid dependent persons) results in the following statistics: The data illustrate the increase in the participation rate among the target population, with a rapid increase evident since 1990. From 1986 to 1994, the participation rate nearly tripled from 0.46 persons to 1.33 persons per thousand.
The number of clients in each of the "streams" identified above at the two public clinics in SA is shown in Table 8.
Approximately 74 per cent of clients are under high supervision (i.e. Streams A and B), with 58 per cent of these clients having high levels of intervention (i.e. Stream B). Only 22 per cent of clients are in the low intervention/low supervision stream (Stream C).
Table 7: Numbers of clients in SA, 1986 to 1994
Table 8: Numbers of Public Methadone Clients by Stream and Clinic in SA, 12 September, 1994
|Warinilla (Norwood)||Northern (Elizabeth)||Total|
|Stream A (low intervention/high supervision)|
|Stream B (high intervention/high|
|supervision) Stream C (low intervention/low supervision)|