Council Report on Methadone Dispensing in the Parramatta LGA

Council Report on Methadone Dispensing in the Parramatta LGA

1.0 BACKGROUND

Council resolved a Notice of Motion on methadone dispensing in the LGA on the 25^th May 2009. It outlines:

That council staff prepare a report on Methadone dispensing within the Parramatta LGA.

This report should include but not be limited to:

Detail the history of methadone dispensing In NSW & Western Sydney with particular reference to the Parramatta LGA.

Canvass & detail community concerns with regards to methadone dispensing from community pharmacies. The authors should speak to and detail the views of shop owners and community members in those areas with methadone dispensing pharmacies.

Investigate & detail the broader community concerns with regards to instances of anti-social or criminal behaviour that may be associated with methadone dispensing within the Parramatta LGA.

Detail council’s land use controls and authority in this area.

Seek input from Sydney West Area Health Service (SWAHS) at NSW Health

about the methadone dispensing program and regulations in the Parramatta

LGA.

Seek input from Centre for Drug and Alcohol at NSW Health about the policies and procedures related to methadone dispensing.

Seek input from the Parramatta Police Local Area Command.

Establish and list all specific areas & pharmacies where methadone is

dispensed. Where such information is not willingly forthcoming a FOI request is to be raised.

Detail all legislative requirements on the dispensing of methadone, paying particular attention to any specific or necessary procedures and requirements for such dispensing.

Provide any other details that the authors feel relevant to allow councillors to make informed decisions on this issue going forward.

As part of this reporting process, a meeting is to be convened to bring together any interested and relevant parties to provide input and views into this reporting process.

1.2 ACTION TAKEN

· The following actions have been completed to progress the notice of motion:

o Research within Parramatta City Council ( Council or PCC) units, including Community Capacity Building, Development Assessment, Landuse Planning, Health and Regulation)

o Research by internet and phone with key external individuals and organisations including NSW Health (Pharmaceutical Services Branch (PSB), Opioid Treatment and Clinical Policy Branch, Centre for Drug and Alcohol, Sydney West Area Health Service) and the NSW Pharmacy Guild.

o Letter of request to NSW Health for information – see letter and response in Attachment 1

o Held a community ‘think tank’ meeting (30^th July 2009) attended by 23 individuals from organisations including NSW Health, NSW Pharmacy Guild, Local Area Command, private practice, Telopea Chamber of Commerce - see minutes in Attachment 2

1.3 ABOUT METHADONE [1]

What is methadone?

· Methadone belongs to a group of strong pain killing drugs called opioids. They include codeine, morphine, and heroin.

How is methadone used?

· Methadone comes in the form of a syrup and is used to treat heroin-dependent people. In Australia, methadone is only legal within a treatment program. It is available in all states and territories, except the Northern Territory. In some situations, takeaway doses are also available.

Who can receive methadone treatment?

· Generally, a person has to be over 18 years of age and can only go on a methadone treatment program after being assessed by a doctor who is an approved methadone prescriber. Usually people pick up their daily dose at a clinic or pharmacy.

Why is methadone a better alternative to heroin?

· There are a number of reasons why methadone is preferable to being dependent on heroin.

· First, methadone is swallowed. This cuts out the risk of using shared or dirty injecting equipment and becoming infected with hepatitis B or C or HIV.

· Second, methadone can be administered in a controlled way. This means that the drug is dispensed in a clinical environment so there is no risk of it being impure.

· Third, the effects of methadone last up to 24 hours and this means a person only needs one dose a day to control withdrawal. These factors help stabilise a person's lifestyle. It reduces the stress and anxiety over where the next dose of heroin is coming from and encourages people to look after themselves and others better. A person on methadone is also more likely to hold down a job.

· Methadone is also cheaper than heroin and the extra money can further improve the health and lifestyle of a person. Criminal activities to buy illegal drugs are also reduced.

What are the effects of methadone?

· The effects of methadone are similar to heroin. They can include relief from pain, feeling of wellbeing, nausea, and vomiting.

Physical effects

· The pupils of the eye become smaller.

· Body temperature drops.

· Blood pressure and pulse slow down.

Methadone may also affect a person's ability to drive a car or operate heavy machinery.

Long term effects

People who use methadone for a long time may experience increased sweating and constipation. Both men and women may experience sexual problems and a woman's menstrual cycle may be disrupted.

Most of these effects will disappear with dose adjustments and as the person's lifestyle improves.

Withdrawal

Stopping methadone abruptly can lead to withdrawal symptoms. Usually they begin one to three days after the last dose. They can include:

· uneasiness

· yawning

· diarrhoea

· stomach cramps

· runny nose

· sleeping difficulties

· joint pain.

These symptoms reach their peak on the sixth day but some may last for a few weeks.

Can you overdose on methadone?

Overdose can happen when more than the prescribed dose is taken, when methadone is injected or when methadone is taken with other drugs, such as alcohol or minor tranquillisers.

1.4 BENEFITS OF METHADONE FOR INDIVIDUALS AND THE BROADER COMMUNITY

FOR INDIVIDUALS

· Methadone is currently the most common pharmacotherapy used in Australia and is recognised nationally and internationally as an effective method for treating opioid dependence.[2]

· There is consistent evidence from controlled trials, longitudinal studies and program evaluations that methadone substitution treatment for heroin users is associated with reductions in heroin use, criminal activity, deaths due to overdose, and behaviours associated with a high risk of HIV transmission.[3]

· Methadone substitution treatment has been found to be more effective than no treatment, placebo, detoxification alone, and drug free treatment in retaining opioid dependent people in treatment and reducing heroin use.[4]

· For those retained in treatment, daily illicit opioid use reduces from 100% of persons entering treatment to less than 20% of persons within one year. Higher doses of methadone are associated with greater reductions in heroin use than either moderate or low doses.[5]

FOR THE COMMUNITY

· There is a weight of evidence that suggests that methadone maintenance treatment is an effective way of reducing heroin-related crime.

· The NSW Bureau of Crime Statistics and Research, together with the National Drug and Alcohol Research Centre, analysed the court appearance records of 11,126 people on the state’s public methadone program over 12 months. [6]

· The report found a reduction in offending rates for all age groups and both sexes.

· When the reductions in officially recorded offences were adjusted to allow for offences that did not result in prosecution, it was estimated that for every 100 people on methadone for one year, NSW had 12 fewer robberies, 57 fewer break and enters and 56 fewer motor vehicle thefts.

· Figure 3 below shows the estimated reduction in charges for males and females in the under 30 and 30 and over age groups. The figure shows:

o For every 100 males under 30 on the methadone program for one year, there is a reduction of 10 charges of any type and 8 theft charges;

o For every 100 males aged 30 and over on the methadone program for one year, there is a reduction of 20 charges of any type and 11 theft charges;

o For every 100 females under 30 on the methadone program for one year, there is a reduction of 44 charges of any type and 23 theft charges;

o For every 100 females aged 30 and over on the methadone program from one year, there is a reduction of 27 charges of any type and 20 theft charges.

Item 12.4 - Attachment 1

Council Report on Methadone Dispensing in the Parramatta LGA

3.2 METHADONE STATISTICS

3.2.1 AUSTRALIA AND NSW

Summary Statistics for Australia[10]

· At 30 June 2008, there were 41,347 pharmacotherapy clients. Of those clients, around two thirds were male.

· The number of clients in 2008 was about 2,500 more than in each of the previous three years.

· Seven in ten (70%) clients were receiving methadone and the remainder received buprenorphine or buprenorphine/naloxone.

· The number of registered prescribers increased gradually since 2006.

· More than six in ten (65%) clients received treatment from a private prescriber.

· The number of dosing point sites increased slightly since 2006.

· Most (86%) dosing point sites were located in pharmacies.

Summary Statistics for NSW [11]

· At 30 June 2008, there were 17,168 pharmacotherapy clients.

o 81% clients were receiving methadone and the remainder received buprenorphine. This breakdown has remained stable since 2006.

o NSW had the second largest proportion of prescribers (36%), following Victoria (38%).

o The total number of prescribers in NSW was estimated at 495, up slightly from 416 in 2005. Of the 495, 199 prescribed methadone only, 39 buprenorphine only and 257 were authorised to prescribe more than one drug.

o NSW had the highest number of dosing sites (698). The majority (588) were in the pharmacy.

· As at 30 June 2009 there were 18,000 patients in Opioid Treatment in NSW, 80% on methadone and 20% on buprenorphine.[12]

Further statistical data on clients receiving treatment, demographics of clients receiving treatment, prescribers of treatment and pharmacotherapy dosing point sites can be found in the data tables in Attachment 3.

3.2.2 PARRAMATTA LGA

· There are between 500 - 750 patients on methadone in the Parramatta LGA [13]

· Dosing occurs at one public clinic in Fleet Street and at community pharmacies[14]

· There is approximately the same proportion (40%) of community pharmacies dosing methadone in the Parramatta LGA as in NSW.[15]

· NSW Health has advised that they do not wish to provide specific information on which pharmacies dispense methadone or to how many clients, in order to protect the confidentiality and security of both pharmacists and patient.

3.3 LEGAL AND ADMINISTRATIVE REQUIREMENTS RELATED TO METHADONE TREATMENT IN NSW

3.3.1 LEGISLATION

· In NSW methadone is classified as a prohibited drug.

· As a Schedule 8 drug under the Poisons and Therapeutic Goods Act 1966, it is illegal to possess or use methadone unless it is provided under a medical practitioner’s prescription, issued in accordance with relevant State legislation and guidelines, and consumed as per the doctor’s instructions. [16]

· Only doctors authorised by the Director-General of Health can lawfully prescribe methadone. [17]

· NSW legislation restricts the number of patient’s dispensed methadone or burprenorphine at retail pharmacies to 50 patients in total. This includes patients on detoxification regimens, but not those on prescriptions for buprenorphine-naloxone. This restriction has been applied to ensure that disruption to the local amenity is minimised.[18]

· Possession and supply of methadone other than authorised by prescription, and use other than prescribed, is an offence under the Drug Misuse and Trafficking Act 1985 and may be dealt with accordingly as a ‘prohibited drug’ within the meaning of that Act.[19]

· Penalties for the possession, trade, or manufacture of methadone range from $5,000 and / or 2 years in prison to a $500,000 fine and / or life imprisonment.[20]

· People who are on the methadone program are protected against anti-discrimination under the Anti-Discrimination Act 1977 – SECT 49PA – see Attachment 4.

3.3.2 LEGAL AND ADMINISTRATIVE FRAMEWORK

A. The Commonwealth Government Department of Health and Ageing:[21]

· Supplies methadone and buprenorphine to the dosing points (free of charge)

· Pays for services by doctors (Medicare)

· Approves the formulation and registration of products by way of the Therapeutic Goods Administration, which is also responsible for recall of faulty products

· Prepares national policies and guidelines on the use of methadone and buprenorphine

· Prepares national policies and guidelines on training

· Tracks the use of narcotics

B. The NSW State Government [22]

Enabling Legislation

The Poisons and Therapeutic Goods Act 1966 (NSW) and Regulations (2002) provide for:

· The authorisation of medical practitioners and nurse practitioners as prescribers of opioid treatments

· The review, amendment, and cancellation of medical practitioners’ or nurse practitioners’ authorities to prescribe

· Procedure to allow patients who have been diagnosed as drug dependent to have access to treatment

· The licensing of private treatment

· The licensing of private clinics

· The investigation of complaints regarding prescribing and the professional behaviour of prescribers

· Regulation of the labelling, packing, storage, prescription and supply of products

· Record-keeping on the use of drugs of addition.

Mental Health and Drug & Alcohol Office (MHDAO):

· Is the NSW Department of Health policy and administrative unit for drug and alcohol services

· Undertake statewide planning for service development

· Promulgates clinical guidelines for the Opioid Treatment Program

· Formulates policies to assist in the recruitment of pharmacy dosing points

· Develops accreditation standards for opioid treatment clinics

· Oversees the accreditation of clinics

· Develops policies for the improved care of incarcerated patients and their continuity of care post-release

· Liaises with local councils, police and community groups to handle issues of amenity in the vicinity of public private clinics

· Organise training for medical practitioners/nurse practitioners and accreditation of prescribers

· Supports the Pharmacotherapy Credentialing Subcommittee, which provides expert clinical advice to the Director-General of the Department regarding authorisation, review and conditions on the authorities of prescribers

· Supports a liaison committee involving the Methadone Advice and Complaints Service (MACS), the Health Care Complaints Commission, Justice Health and a consumer group to receive reports on complaints and requests for advice received by MACS and to plan proactive strategies to improve the service.

The MHDAO is served by other specialised committees, including the Drug Health Council and the Quality in Treatment Committee (QIT).

The Drug Health Council is a forum of drug and alcohol managers from the Area Health Services which meets to coordinate policy and service development on a state-wide basis.

The QIT reports to the Health Council and the MHDAQ on matters relating to improvements in clinical practice and quality of care. It consists of senior clinicians from the Area Health Services with representation from non-government organisations, nursing and allied health professionals.

Pharmaceutical Services Branch (PSB) of NSW Health:

· Maintains the database of authorised prescribers, dosing points and patients

· Issues authorities to allow patients to be treated

· Issues licences for private clinics

· Inspects clinics and community pharmacies

· Liaises with the Commonwealth

· Monitors the labelling, packing, storage, prescription and supply of products.

Justice Health

· Is responsible for methadone or buprenorphine treatment for the prison population and for arranging continuity of care after release.

The Health Care Complaints Commission:

· Provides patient support

· Investigated serious complaints involving professional conduct, prescribing and behaviour

· Refers serious cases to NSW Health or the Medical Board.

The NSW Medical Board:

· Registers medical practitioners

· Undertakes the investigation of serious complaints and implements appropriate training and disciplinary procedures

· Imposes conditions on registration

The NSW Nurses and Midwives Board:

· Registers nurses and authorises nurse practitioners

· Undertakes the investigation of serious complaints and implements appropriate remedial interventions and disciplinary procedures

· Imposes conditions on registration

C. Other bodies [23]

The Methadone Advice and Complaints Service (MACS):

· Provides information to patients on access to prescribers

· Provides information to prescribers on access to dosing points

· Logs complaints and provides support to patients

· Reports to the MHDAO to assist in the resolution of complaints and the development of proactive strategies to address problems of access and quality of care

· Can be contacted on 1800 642 428

NSW Users and AIDS Association (NUAA):

· Is a consumer advocacy group

· Provides support and advice to patients and other interested parties

· Liaises with the MHDAO, MACS, Health Care Complaints Commission and Justice Health to monitor consumer satisfaction and plan ways to improve the system

· Can be contacted on: 1800 644 413

The Coroner’s Court

· Records and investigates unexpected deaths, including drug-related deaths refers matters to the Health Care Complaints Commission for further investigation if appropriate

· Refers matters to NSW Health for consideration with a view to service improvement or further investigation if necessary

D. The Pharmacotherapy Credentialing Subcommittee[24]

· The Pharmacotherapy Credentialing Subcommittee is a subcommittee of the Medical Committee of NSW Health and is established under Section 30A of the Poisons and Therapeutic Goods Act 1966 (NSW).

· The primary role of the Pharmacotherapy Credentialing Subcommittee is to make recommendations to the Director-General on the approval of medical practitioners and nurse practitioners as prescribers of drugs of addiction under the State’s Opioid Treatment Program.

E. Accreditation of prescribing doctors[25]

· Approval to prescribe methadone and buprenorphine is granted by the Director-General of the NSW Department of Health.

· Medical practitioners (and nurse practitioners) are required to successfully complete:

o The Pharmacotherapy Accreditation Course, either through attendance at a workshop or through the web-based course

o An examination

o A workplace assessment (a 2-3 hour clinical placement).

· These requirements and the professional record of the practitioner are assessed by the Pharmacotherapy Credentialing Subcommittee.

3.3.3 LEGAL REQUIREMENTS FOR STARTING METHADONE

The legal requirements for starting methadone are outlined by NSW Health as follows[26]:

· Documented proof of identity of the patient

· Authority to prescribe methadone to the patient from the Pharmaceutical Services Branch of NSW Health. Authority is sought for each patient.

· A current photograph and/or a detailed written description, as well as a valid prescription, must be forwarded to the clinic or pharmacy where dosing will take place.

Item 12.4 - Attachment 1

Council Report on Methadone Dispensing in the Parramatta LGA

3.4 METHADONE DISPENSING PROGRAM POLICIES AND PROCEDURES

3.4.1 POLICY

· In NSW there are 2 relevant documents that govern methadone dispensing:

o National Pharmacotherapy Policy – For people dependent on opioids, January 2007 ( National guidelines from the Commonwealth), and

o NSW Opioid Treatment Program Clinical Guidelines for methadone and buprenorphine treatment of opioid dependence, November 2006 (NSW Department of Health)

· The NSW Opioid Treatment Program Clinical Guidelines for methadone and buprenorphine treatment of opioid dependence (Nov 2006) has been produced by the Mental Health and Drug and Alcohol Office of NSW Department of Health. The guidelines outline best practice for health professionals involved as prescribers and dosers of methadone, and override the National Pharmacotherapy Policy if there are anomalies.

· The clinical guidelines are 173 pages and provide detailed information and instruction to health professionals working in public and private clinics, as well as community pharmacies, on the following areas covering all aspects from the beginning of the patient journey to the end of the patient journey on methadone:

o Opioid dependence and treatment in NSW

o Clinical pharmacology

o Entry into an opioid treatment program

o Commencing treatment

o Continuing maintenance therapy

o Takeaway doses

o Specific clinical situations – e.g. missed doses, vomited doses, over doses, arrangements for travel etc

o Ending methadone or buprenorphine treatment

o Legal and administrative requirements

o Appendices

3.4.2 KEY REQUIREMENTS FOR METHADONE DISPENSING IN COMMUNITY PHARMACIES

· The NSW Opioid Treatment Program Clinical Guidelines for methadone and buprenorphine treatment of opioid dependence (Nov 2006) document the following:[27]

Commencing Treatment

· All patients should commence treatment with methadone or buprenorphine in a well supervised setting. This will usually be a specialist clinic, but can also be community or hospital pharmacies, community or mental health centres and accredited general practitioner/ prescriber surgeries.

· The Pharmaceutical Services Branch of NSW Health must be notified of the dosing location.

· Once stabilised in treatment, most patients should be dosed at retail pharmacies. Normally it takes about three months from starting methadone treatment and one to three months from starting buprenorphine treatment to adequately assess the patient’s suitability for pharmacy dosing. The pharmacist and prescriber or patient’s case worker should communication regularly (at least every three months), and dosing arrangements should be reviewed at least every six months.

3.5 METHADONE DISPENSING PROGRAM MONITORING

This information has been provided directly from NSW Health PSB:

· NSW Health Pharmaceutical Services Branch (PSB) is responsible for the licensing of Opioid Treatment Program (OTP) clinics in NSW. As part of this all OTP clinics are required to be accredited in line with the “NSW Health Accreditation Standards for Opioid Treatment Services in NSW”. These standards are used by approved quality assurance organisations to develop survey instruments and supporting Accreditation programs run over a 3 or 4 year cycle, dependant on the specifications of the approved quality assurance organisation which administers the accreditation program.[28]

· Pharmacies do not require licensing or accreditation as the dispensing of drugs of addiction form part of the normal operation of a pharmacy under the supervision of a registered pharmacist. However, pharmacies receive counselling, advice and information from PSB in relation to the specific needs of patients under an OTP, prior to approval being given for them to become an OTP dosing point. The Pharmacy Guild offers additional support, information, documentation and advice to pharmacies dosing patients under an OTP. Pharmacies are also subject to regular visits by inspectors from the Pharmacy Board of NSW and may be subject to targeted visits and inspections by inspectors from PSB.[29]

Item 12.4 - Attachment 1

Council Report on Methadone Dispensing in the Parramatta LGA

Attachment 2: Minutes of ‘Think Tank’ Community Meeting 30^th July 2009

Methadone ‘Think Tank’ Meeting

MINUTES

Thursday 30 July 2009, 4.00pm to 5.30 pm, Jubilee Hall, Parramatta Town Hall

Chair

Ms Sue Coleman- Group Manager City Services, Parramatta City Council

Attendees:

Councillor Michael McDermott, Parramatta City Council

Councillor Andrew Wilson, Parramatta City Council

Councillor Mark Lacke, Parramatta City Council

Mr Neile Robinson - Senior Project Officer, Parramatta City Council

Ms Megan Dephoff - Manager Social Outcomes, Parramatta City Council

Ms Vikki King - Manager Social and Community Services Unit, Parramatta City Council

Mr John McInerney - Social Policy and Planning Office Parramatta City Council,

Ms Tania Fogarty – Project Support Officer, Parramatta City Council

Mr Dennis Leahy - Pharmacotherapy Manager NSW Pharmacy Guild

Ms Filiz Eminov - Parramatta Drug Court

Mr Stephen Leslie - Tanya Gadiel's Office

Ms Gael Rao - Acting Network Director Drug and Alcohol Cam Nepean NSW Health

Dr Robert Graham - Staff Specialist Drug & Alcohol St Vincent’s and Blacktown Hospitals, NSW Health

Ms Anne Lawrence - Manager Opioid Treatment and Clinical Policy, NSW Health

Acting Inspector Sullivan - Operations Duty Officer, Parramatta Police

Superintendant Frank Hansen - Superintendant Parramatta Police

Sgt Chris Marlow - Crime Coordinator, Parramatta Police

Constable Shane Carne - Crime Prevention Officer, Parramatta Police

Mr Sione Crawford - Policy Advisor, NSW Users and Aids Association

Mr Michael Maughan – Telopea Chamber of Commerce

	AGENDA ITEM	DISCUSSION ISSUES	ACTION
1.	Welcome and Introductions – Sue Coleman	The Chair welcomed all to the meeting and introductions were made by all.
2.	The context for discussion – Councillor McDermott	· The meeting was called to respond to the notice of motion of the 24^th May 2009 requesting Council officers to gather data to assist Council to understand the issues associated with methadone dispensing programs. · Is a chance to learn from professionals and experts in the field, about the facts and history of methadone. It is also a chance to hear about any local issues arising related to methadone. · Some members in the community perceive there are problems in the local community arising in relation to methadone programs. Councillors are advocates for the community and are keen to investigate what the issues are and how they can be solved. · This meeting and notice of motion is a genuine attempt to understand and learn more about methadone, and how such programs can be best managed
3.	History of Methadone Dispensing in NSW – Dennis Leahy	· Dennis Leahy is a resident of Parramatta LGA, a Community Pharmacist and has been dispensing Methadone since 1978, sits on many advisory committees, and is the Vice President of NSW Pharmacy Guild · Methadone was first used in 1960 in New York and there is now 4 decades of history of its use · It is a maintenance treatment to manage heroin dependence · Community pharmacies dispense methadone to people who are clinically stable, have appropriate social functioning, and are free from drugs · In 2007 there were 38,000 people in Australia on the methadone maintenance program (26,700 were dosed in Community Pharmacies) · In NSW there were 17,000 people (8,000 people dosed in Community Pharmacies) · The program has proven to work over a long period of time
4.	Legislative controls and policy and procedures for dispensing. Methadone dispensing programs in the Parramatta LGA. – Anne Lawrence	Anne Lawrence presented on the Regulation, Policy and Procedures for the NSW Opioid Treatment Program - her presentation is attached
5.	Discussion of key local issues – group discussion chaired by Sue Coleman What is working well? What would we need to do better to achieve best practice?	Information arising from the discussion: · There are approximately 600 pharmacies dosing in NSW · Pharmacists are limited to 50 patients per pharmacy, however, there are 7 (under older legislation) that are allowed to dose more – one of which is in the Parramatta local government area · Benefits of treatment are reduced illicit drug use, reduced risk of overdose, reduced risk of HIV and crime · Number of people on treatment is going up. Approximately 400-500 coming to methadone treatment in a month in NSW – approximately 350 of which are coming to treatment again. Approximately 100 per month are new patients. · The Local Police recognise methadone as an essential public health service, which reduces crime, anti-social behaviour and improves the patient’s lifestyles. It is not a silver bullet to fix problems, but it reduces problems. People standing around local dispensing areas can look untidy, but ‘gathering’ or lingering is not against the law. · Local Police identified they would respond to local issues as they arise but they do not keep records on issues related to people ‘gathering’ · Issue raised about the degree of intoxication that people are under on methadone - If the patient is stable and takes only methadone, they are safe to walk, operate machinery etc. · Comment made that it is not the most dangerous drug, and that the dosing is very individual. · Methadone is free from the government. Pharmacists only charge a dispensing fee. Issues Arising from the discussion · Local business owners are reporting to Councillors and other business representatives their concerns about the impact of methadone dispensing on anti-social and criminal behaviours. The police are not receiving the same information from local business owners during their local investigations of the matter. · The local police do not have statistical data indicating antisocial or criminal behaviour linked to methadone dispensing programs in the Parramatta LGA. · Reports of ‘gatherings’ of people around methadone dispensing locations were made, however it could not be confirmed if those gathering were patients on the methadone program or not. · Views expressed that people who congregate in the area around methadone dispensing pharmacies do know who the people are who are being dosed · Some hold the view that those gathering are involved with trading methadone on the black market. · Health professionals differ in their perspectives on what the end goal of methadone treatment should be. Some discussion on the benefits / challenges of rapid detoxification. · There is no legal requirement, or clinical guidelines specifying the need for community pharmacists to dose methadone patients at specific times, to avoid the potential for ‘gathering’ of patients and associated antisocial / criminal behaviour. The Pharmacy Guild can offer suggestions for improvements and support to pharmacists and where issues have arisen. The Guild is quick to work with the police when issues arise.
	Meeting closed by Sue Colemen		Council officers to review information from the meeting, as well as further research, and use this to develop a Council report to respond to the Notice of Motion

Item 12.4 - Attachment 1

Council Report on Methadone Dispensing in the Parramatta LGA

Presentation by Anne Lawrence at Think Tank Meeting

30 July 2009

Attachment 3: Methadone Statistics for Australia and NSW

Clients Receiving Treatment

Numbers of Clients [30]

· Nationally an estimated 41,347 clients were receiving pharmacotherapy treatment in 2008, an increase on 2,504 since 2007.

· From 2004 to 2007 the figure remained relatively stable, after an increase of over 50% from 1998 (24,657 clients) to 2004 (38,741 clients).

Table 1: Total number of pharmacotherapy clients receiving pharmacotherapy treatment on a ‘snapshot/ specified’ day, by state and territory, 1998 – 2008

Types of pharmacotherapy [31]

· In 2008 approximately 70% of clients registered for pharmacotherapy treatment were receiving methadone and the remaining 30% received buprenorphine or the combination product buprenorphone/naloxone.

Figure 1: Total proportion of pharmacotherapy clients receiving pharmacotherapy treatment on a ‘snapshot / specified’ day, by type of pharmacotherapy provided, 2006 – 08.

· The proportions of clients prescribed methadone, buprenorphine or buprenorphine/nalaxone varied across jurisdictions, (Table 2), although over 60% of clients in most jurisdictions were prescribed methadone.

· Methadone was more likely than other drugs to be prescribed in Tasmania, New South Wales and the ACT.

Table 2: Total number of pharmacotherapy clients receiving pharmacotherapy treatment on a ‘snapshot/specified’ day, by type of pharmacotherapy provided and jurisdiction, 2006, 2007 and 2008.

Prescriber Type [32]

· Of the 41,347 estimated clients authorised to receive pharmacotherapy treatment on the snapshot day in June 2008 (Table 3):

o 65% (26,878) received the treatment from a private prescriber

o 27% (11,106) received the treatment from a public prescriber

o 7% (2,899) received the treatment from a practitioner in a correctional facility

Table 3: Estimated number of pharmacotherapy clients by pharmacotherapy drug type and prescriber type on a ‘snapshot/ specified’ day, 2005 – 2008.

Dosing Point Sites [33]

· Dosing point sites are most commonly located in pharmacies (Table 4)

Table 4: Estimated number of pharmacotherapy clients by pharmacotherapy drug type and dosing point site on a ‘snapshot/ specified’ day, 2006 – 2008.

Demographic Profile of clients receiving treatment

Sex [34]

· Of the 41,347 estimated clients authorised to receive pharmacotherapy treatment in June 2008, 26,641 (64%) were male (Table 5). This proportion was similar for clients receiving methadone (63% of clients).

· The proportion of male and female clients have remained stable since 2006.

Table 5: Estimated number of pharmacotherapy clients by pharmacotherapy drug type and sex of the client on a ‘snapshot/.specified’ day, 2006 – 2008.

Age Group[35]

· The largest proportion of clients (38%) is aged 30 – 39 years, about a quarter were aged 20 – 29years and another quarter were aged 40 – 49 years, about one in ten were aged 50 – 59 years and fewer than 1% of clients were aged either 10 – 19 years or 60 years and over ( Table 6).

Table 6: Estimated number of pharmacotherapy clients by pharmacotherapy drug type and age group of the client on a ‘snapshot /specified’ day, 2006 – 2008.

Prescribers of treatment [36]

· Nationally in 2008, 1393 practitioners were authorised to prescribe pharmacotherapy drugs during the financial year. Of these:

o 69% (958) were registered to prescribe more than one drug type

o 27% (371) were registered to prescribe methadone only

o 4% (60) were registered for buprenorphine only

o Less than 1% were registered for b/n only

· Victoria continued to account for the largest proportion of prescribers (38%), followed by NSW (36%).

Table 7: Estimated number of prescribers registered to prescribe pharmacotherapy drugs by drug type and jurisdiction, 2005 – 2008.

Pharmacotherapy dosing point sites [37]

· A pharmacotherapy dosing point site relates to the physical setting in which a pharmacotherapy drug is provided to a client, regardless of whether the drug intake is supervised or the dose is taken away.

· The majority of dosing sites were located in pharmacies.

· NSW has the highest number of dosing point sites (698).

Table 8: Number of pharmacotherapy dosing points sites by jurisdiction, 2005 – 06 to 2007-08.

[1] NSW Health Fact Sheet on Methadone January 2003

[2] Australian Government Intergovernmental Committee on Drugs January 2007

[3] Australian Government Intergovernmental Committee on Drugs January 2007

[4] Australian Government Intergovernmental Committee on Drugs January 2007

[5] Australian Government Intergovernmental Committee on Drugs January 2007

[6] Lind et al. 2004

[7] Australian Government Intergovernmental Committee on Drugs January 2007

[8] Australian Institute of Health and Welfare May 2009

[9] Personal comms, presentation by A Lawrance to PCC 30.07.09

[10] Australian Institute of Health and Welfare May 2009

[11] Australian Institute of Health and Welfare May 2009

[12] Personal comms, presentation by A Lawrance to PCC 30.07.09

[13] Personal comms, presentation by A Lawrence to PCC 30.07.09

[14] Personal comms, presentation by A Lawrence to PCC 30.07.09

[15] Personal comms, D Leahy to PCC 30.07.09

[16] NSW Police Drug and Alcohol Coordination September 2007

[17] NSW Health Factsheet - Methadone 2003

[18] NSW Health, Mental Health and Drug and Alcohol Office 2006

[19] NSW Police Drug and Alcohol Coordination September 2007

[20] NSW Health Factsheet - Methadone 2003

[21] NSW Health, Mental Health and Drug and Alcohol Office 2006

[22] NSW Health, Mental Health and Drug and Alcohol Office 2006

[23] NSW Health, Mental Health and Drug and Alcohol Office 2006

[24] NSW Health, Mental Health and Drug and Alcohol Office 2006

[25] NSW Health, Mental Health and Drug and Alcohol Office 2006

[26] NSW Health, Mental Health and Drug and Alcohol Office 2006

[27] NSW Health, Mental Health and Drug and Alcohol Office 2006

[28] Personal comms. Bruce Battye, Letter from PSB NSW Health, Aug 2009

[29] Personal comms. Bruce Battye, Letter from PSB NSW Health, Aug 2009

[30] Australian Institute of Health and Welfare May 2009

[31] Australian Institute of Health and Welfare May 2009

[32] Australian Institute of Health and Welfare May 2009

[33] Australian Institute of Health and Welfare May 2009

[34] Australian Institute of Health and Welfare May 2009

[35] Australian Institute of Health and Welfare May 2009

[36] Australian Institute of Health and Welfare May 2009

[37] Australian Institute of Health and Welfare May 2009