What can we learn from the past? 1950’s Advertisement People who use amphetamine-type stimulants and access treatment through CADS Auckland: What we know, what we might expect in the future.   Alistair White Alcohol & Drug practitioner (methamphetamine focus) www.cads.org.nz

Community Alcohol & Drugs Services (CADS) is an Auckland regional service provided by Waitemata District Health Board Mission - Reduce alcohol & other drug (AOD) related harm in the community. Assist people who have concerns about their own, or someone else's substance use. CADS provides services for the whole Auckland region, rural and urban communities, a population of 1.4million and rising. A staff of around 200 provide outpatient counselling and group programmes, withdrawal support, including inpatient detox, opioid substitution treatment and more.

Methamphetamine is the second most used illicit (psychoactive) substance in New Zealand, as it is in Australia. We can make predictions about future treatment demand, by analysis of service data of past clients. What can population trends and estimates of methamphetamine use mean for future demand? We infer from health survey estimates of methamphetamine use. What might we as a service do differently to meet the need of people who use stimulants?

Service demand: Demand for treatment services is represented by presentations to CADS over four years; the period from July 2011 to end June 2015. Data for six month periods were extracted from existing database to track other trends. Earlier data were dis-regarded as the service changed electronic recording systems at the end of 2010. Need: An estimate of service need in the Auckland region was made based on the NZ Ministry of Health Household Health survey (2013-2014) is at 1% of the population or 3% for Maori, and NZ Census data. Need was estimated according to ethnicity. “Unmet need” is the gap - the distance between current service use and estimated population use of amphetamines.

Gap analysis by ethnicity We can see that no ethnic group has engaged in numbers near to this estimate of need. Asian peoples needs appear to be particularly un-met at this point in time. At this rate, it will take many years to meet the needs of people who use methamphetamine. This means a new generation of users is likely to arise and a methamphetamine sub-culture to remain in sections of society. estimated need treatment seeking % of needs met NZ European / Pakeha 6970 1617 23% NZ Maori 4283 781 18% Pacific peoples 1950 257 13% Asian peoples 3072 107 3% Other 156 38 24% other European 923 155 17% Middle Eastern, Latin American, African 249 35 14%

Increasing number of people seen with amphetamine diagnoses We have seen an increase in number of clients seen by the service over time. We had 6079 referrals in the 4 year time period July 2011 to June 2015. This graph shows number of clients who attended the service during each six month period.

Limitations Not all treatment seekers will come to CADS: We do not have data from other services in the Auckland region, such as residential and outpatient services and “Methhelp” nationwide phone line. Our dataset is of a real client population gathered over four years, i.e. it is as accurate as real staff records allow in a working service. The midpoint of the timeframe was when the census was completed, the population trend is continued growth. Our estimate of need is a snapshot - the small sample of the NZ household health survey. We also make the assumption that everyone who uses methamphetamines will need treatment – which is in contradiction with research on natural recovery. Alistair White CADS Auckland NZ ph 263 2000 alistair.white@waitematadhb.govt.nz www.waitematadhb.govt.nz www.cads.org.nz