1. Justice Health Justice Health and Opioid Substitution The Justice Response Presenters:Larissa Strong, Director Justice Health Scott Drummond, Senior Policy Officer Justice Health Date:Thursday 30 May 2013 TRIM ID: CD/13/180885

2. Justice Health Background and context Justice Health  Responsibility for prisoner health care  Sets the policy and standards  Contract manages health service provider and AOD treatment provider

3. Justice Health Background and context (cont.) Prison population  Demographics  Entrenched drug using histories  Challenging behaviours  Unwell cohort…

4. Justice Health Health status of Victorian prisoners Entrants who are current smokers (self report)88% Ever diagnosed with diabetes (self report)6.1% Tested positive to hepatitis C antibodies33-52% Ever diagnosed with asthma (self report)28.4% Ever diagnosed with a mental illness (self report)28% Alcohol abuse/dependent (AUDIT test)41% Entrants with history of injected drug use (self report)65% Source: Deloitte Consulting (2003) Victorian Prisoner Health Study. Department of Justice, Victoria.

5. Justice Health Justice Health and drug treatment Frameworks  Victorian Prison Drug Strategy  guides response to prison drug issues  Victorian Prison OSTP policy and procedures  Guides prison pharmacotherapy program Drug treatment (counselling)  Group and individual counselling  Health and criminogenic programs  Harm reduction education  Peer educators Drug treatment (OSTP)

6. Justice Health Opioid Substitution Therapy Program (OSTP) Prison Pharmacotherapy context  Background  Rationale  Approx 857 prisoners dosed each day  Approx 16 per cent of prisoners receive OST  90 per cent on methadone; 10 per cent on Suboxone (0.10% on ‘straight’ buprenorphine).

7. Justice Health OSTP dose data

8. Justice Health Guidelines, Diversion and difficult behaviours Guidelines  Victorian Prison OSTP Clinical and operational Policy and Procedures (2003)  Directors Instruction 4.13  Local Operating Procedures Diversion and difficult behaviours  Security overlay to reduce diversion  Responsibility of Corrections staff, not health staff  Close observation  s2.12. ‘Involuntary withdrawal’  Failing to treat the health staff with courtesy and respect  Attempting to trade, sell or divert  Drug use

9. Justice Health Prison Prescribing The experience of prescribing in the prison system  From the prisoner perspective and the GP  The continuity of care pre-prison through to post release  Features of prison OST programs

10. Justice Health Transition to the community Discharge planning  Commences early  Relationships are key Post release subsidy  30 days post-release  Reaches approximately 650 prisoners per year  88 per cent of offenders complete 30 days