6.5.1 HistoryThe Western Australian Alcohol and Drug Authority has provided methadone for the treatment of opiate users since 1974. All methadone treatment in Western Australia is now co-ordinated by the William Street Clinic. Agreed National Methadone Guidelines provide the basis for the Authority's policies and procedures.
6.5.2 Current situationThe William Street Clinic assesses client's suitability for methadone treatment, administers methadone to clients, supervises and monitors clients' progress, and provides a range of medical, nursing, social work and psychological casework. The Clinic's staff consists of a manager, medical officers, social workers, nurses, a clinical psychologist, dispensary and pharmacy staff, a phlebotomist/specimen collector, clerical staff and a general attendant.
The majority of clients presenting for assessment are in their mid to late twenties, with a history of heroin use for five or more years. Following assessment over 90% of the clients are considered eligible for methadone treatment. The remainder are encouraged to engage in counselling and undergo outpatient detoxification or seek admission to either a residential detoxification unit or a therapeutic community. Clients are encouraged to book an appointment and there is currently a 4-5 day wait prior to assessment. Treatment is usually commenced the day following assessment.
In general, dependence on an opiate drug is regarded as a pre-requisite for admission to methadone treatment. Priority is given to clients who:
- are pregnant;
- have persistent Hepatitis B antigenemia;
- are HIV or Hepatitis C virus infected.
Methadone consumption is closely supervised and over 55% of all doses are administered at the William Street Clinic. Community pharmacists administer 36% and the remainder are dispensed through the Central Drug Unit, country hospitals and nursing posts. Most clients are expected to attend the William Street Clinic at least one day per week for methadone dosing. Clients attending community chemists during the week return to the William Street Clinic if their chemist is closed on Saturday or Sunday.
Take-away methadone is only provided to clients in exceptional circumstances.
Urine specimens are randomly collected and then analysed by the State Health Laboratory Services. The frequency of collection of specimens varies from three times a week for a client undergoing intensive monitoring to three monthly for a client who has been receiving methadone for a year or more.
Clients are generally encouraged to stay in treatment for at least two years and then gradually detoxify. Some clients elect for a shorter period of treatment. Treatment may be terminated if a client fails to take their prescribed methadone under supervision.
Approximately 50% of the clients receiving methadone treatment are female and each year around 30 give birth. Special obstetric care for women with drug use problems is provided at the King Edward Memorial Hospital.
The Clinic has offered a voluntary HIV antibody testing service to clients since June 1986 and well over 2000 HIV antibody tests have been conducted. The prevalence of HIV infection among the Authority's methadone clients remained between 1% and 2% during 1991/92 and there were 5 HIV infected clients receiving treatment in January 1993.
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6.5.3 StatisticsThe number of clients in the public sector in Western Australia since 1986 are contained in Table 9 below.
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 that the participation rate nearly doubled between 1986 and 1994, from 0.42 persons per thousand in the target population to 0.80 persons.
Several performance indicators were provided in regard to services in 1991/92. These are presented in Table 10 below.
The most pronounced improvements were a reduction (79%) in clients' use of mind-altering substances, as well as improvements in their physical and social status, (50% and 46% of clients respectively).
Table 9: Numbers of clients in WA, 1986 to 1994
Table 10: Performance Indicators, WA Methadone Program, 1991/92Table 10 is presented as text in this HTML version for accessibility reasons. It is presented as a table in the PDF version.
List of outcomes by indicator:
- Cost per dose (Pharmacy) - $1.60
- Cost per client per day (Methadone assessment and counselling) - $3.87
- Proportion of methadone clients showing improvement on physical, psychological and social indicators from initial assessment to termination of contract:
- physical indicators - 50%
- psychological indicators - 15%
- social indicators - 46%
- Reduction in client's harmful use of mind-altering substances from initial assessment to follow-up assessment - 79%