Stapleford-Athens 2011 International Addiction Conference Developing a rehab program with NTX as one entry requirement Dr George O’Neil Fresh Start Recovery Programme Perth, Western Australia

Campsite Beach South Perth

Med House

Fresh Start Clinic

Northam Rehab

Use of Rehab 1.To recover from detox symptoms 2.To relieve the upset family 3.To rest (country retreat) following a big detox 4.To relearn new values 5.Length of stay : p.r.n.

Northam Rehab Hospital

City Rehab

10% Methadone Pre Treatment 100% Treatment at Clinic 50% Regular 50% Repair Jobs only Post Treatment

Med House 80% Arrive Untreated 10% Partial Detox Med House 10% Partial Detox at home Medical Clinic Accelerated Detox 6 hrs illness 70% Return Home 30% Overnight I.P. observation 80% Home in days Rehab where an active implant is a prerequisite of admissions Rehab Settings Management O.P. Family Support

Rehab Settings ClinicMed HouseCountry Residence (Northam) City Residence – Return to the community

City Residence

Urine Results Northam Residence

Caplehorn et al 1996 States that the Risk of Death after leaving rehab and jail is 5% in the first year. An implant immediately prior to discharge from a rehab protects against overdose and relapse in the first 6-12 months on returning home. Caplehorn JRM, Dalton MSYN, Haldar F, et al. Methadone maintenance and addicts' risk of fatal heroin overdose. Substance Use Misuse 1996; 31:

Implants Before Admission or Discharge This is the first rehab in the world to use the principle of detox and implant insertion prior to admission so that the patient and rehab is protected from opiate cravings or use. This is also the first rehab in the world where a new implant is inserted routinely in the week before discharge back to the community.

Sannibale et al (2003) Aftercare attendance and post-treatment functioning of severely substance dependent residential treatment clients. Drug and alcohol review, 22, % relapsed in 36 days 23% long term abstinence

Naltrexone Rehab 0.05% positive opiate urine tests (past 9 months) No patient in 10 years with an ongoing opiate problem No overdoses in the first 6 months post discharge Discharge planning implants every 6 months

Northam Patients Protected for 6months+ Estimated duration of therapeutic effect Assuming 4ng/ml, Go Medical = 100 days, Vivitrol 17days Assuming 3ng/ml, Go Medical = 140 days, Vivitrol 21days Assuming 2ng/ml, Go Medical = 200 days, Vivitrol 28days Assuming 1ng/ml, Go Medical = 272 days, Vivitrol 31days

Opiate Pharmacotherapy Treatment in Australia since 1998

Methadone Detox up to 200mg/day Pre 48 – 72 hours – Miss Methadone dose Day 1: IP 2mg – 3mg over 8 hours Buprenorphine + antipsychotics + benzos + 0.2mg Octreotide Day 2: 2mg x 3-4 Doses Day 3: 4mg x 2-3 Doses Day 4 – 11: 16mg Dose Cease Buprenorphine 3 days before implant 14 days later

12 Months Rehab & 12 Months Employment Program 30 years drug use - 2 years since first treated Age 13: Was Drinking and smoking marijuana Age 18: Started using amphetamines + speed Age 18 – 40: Was still using drugs, mainly amphetamine Age 26: Tried to give up drinking and using drugs Age 40: Turned to heroin and morphine Age 44: First naltrexone implant (Has been at Northam for over 2 years and has had 6 implants)

4 Years OP, 9 months Rehab & 9 months Work Program 16 years drug use 8 years in jail First treated 2005 with Naltrexone implant post methadone treatment Returned to Canberra, 5 days post implant 3.5 years opiate free post 1 st implant Relapsed and returned to Perth for treatment and Rehab Good emotional and physical recovery with Rehab

4 Years OP/1 Year IP Age 55 First presented in 2005 Initially had 3 implants over 18 months, but as lifestyle hadn’t changed he returned to using after this time. Reasons for return to use were due to stress from relationships and work, and a belief that he felt that he was better. Currently he has been an outpatient at Northam for 10 months. Rehab has allowed him to reduce his stress Counselling has helped him in his recovery process.

The following is being recognised by our workers Oral Naltrexone has a low success Implant Naltrexone has a high success, but recovery takes 5-10 years support. Reduced Death Rates requires long term continuity of care. 50% recover with one implant Repeat implants every 6-9 months is recommended Methadone patients are detoxed to Buprenorphine for 2 weeks prior to implants

Physiology – changing physiology Physiology – changing physiology Housing “where you know you belong” – The essence of a home is love, joy, peace, patience, gentleness, kindness and self control Housing “where you know you belong” – The essence of a home is love, joy, peace, patience, gentleness, kindness and self control Relationships – self, God, family, community Relationships – self, God, family, community Empowerment Empowerment Education, Employment, Exit from rehab, Entry to Society – occupational therapy, short term employment, career, university/training Education, Employment, Exit from rehab, Entry to Society – occupational therapy, short term employment, career, university/training Follow up- PHREE program

Rehab Program Video

Contact Information Dr George O’Neil Phone –Perth (GMT+8) 6-8am or 7-11pm –London (GMT) 10-12pm or 11am-3pm –New York (GMT-5) 5-7pm or 6-10am –Los Angeles (GMT-8) 2-4pm