Addiction Treatment and a Comprehensive Monitoring System

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Addiction Treatment and a Comprehensive
Monitoring System

• David C Marsh MD CCSAM

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Addiction Treatment and Monitoring System

• Strengths
• Supply of treatment
• Some measure of match to demand
• Substances which precipitate treatment related to
  level of use in community
• Systems often in place to collect data
• Weaknesses
• Variability across jurisdictions in data
  collection
• Lack of availability may blunt demand (treatment
  options or treatment effectiveness limited)
• Outcomes

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Minimum Reporting Requirements

• Will set BC standard
• Tied to HA funded
• Standard Criteria have been finalized
• Process and Timelines for reporting to be
  determined
• Will only capture services funded by Health
  Authorities
• Private Facilities, Fee-For-Service Physician
  Services and FNIHB funded services will not be
  captured

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Options in Treatment

• Harm Reduction, Prevention and Outreach
• Withdrawal Management
• Outpatient Counseling
• Intensive Day Treatment
• Intensive Residential Treatment
• Short-Term Residential Transitional Treatment
• Long-Term Residential Treatment
• Supportive Housing
• Pharmacotherapy

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Northern Health Authority

• Service Locations
• Quesnel, Prince George, Vanderhoof, Burns Lake,
  Fort St. James, Mackenzie, Houston, Hazelton,
  Smithers, Dease Lake, Terrace, Queen Charlotte
  Islands, Prince Rupert, Kitimat, Chetywnd,
  Tumbler Ridge, Fort St. John, Dawson Creek, Fort
  Nelson
• Service Types
• Withdrawal Management, Short-term Residential
  Treatment, Support-Recovery, Concurrent
  Disorders, Counseling, Day-Treatment, MMT

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NHA Service Volumes

• Residential Treatment
• 10 adult beds (mixed gender) - 53 clients
• 6 Youth beds (mixed gender) - 39 clients
• Withdrawal Management
• 21 beds - 1560 clients
• Intensive Day Treatment
• 496 clients
• Concurrent Disorders Specific
• 59 clients
• Counseling
• 3900 clients

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Interior Health Authority

• Service Locations
• Kelowna - Crossroads (Adult), ARC (Youth)
• Kamloops - Phoenix Centre
• Service Types
• Withdrawal Management, Short-term Residential
  Treatment, Support-Recovery, Concurrent
  Disorders, Counseling, Day-Treatment, MMT

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IHA Service Volumes

• Residential Treatment
• 58 adult beds (35 male, 23 female)
• 6 Youth beds (mixed gender)
• 1147 clients (includes adult, youth and S-R
  breakdown by HSDA avail.)
• Support-Recovery
• 24 beds (21 male 3 female)
• Withdrawal Management
• 20 beds - 1100 clients
• Concurrent Disorders Specific
• 45 clients
• Counseling
• 1050 clients

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IHA Substance Profile
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Fraser Health Authority

• Service Types
• Withdrawal Management, Short-term Residential
  Treatment (redesigned Support-Recovery plus
  intensive residential treatment), Counseling,
  Day-Treatment, MMT

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FHA Service Volumes

• Residential Treatment
• 140 adult beds - 1300 clients
• 3 youth beds
• 131 beds STLR (formerly Support-Recovery) - 970
  clients
• 25 beds Second Stage Housing
• Withdrawal Management
• 40 beds - 1500 clients
• Intensive Day Treatment
• 200 adult and 45 youth clients
• Counseling
• 3200 adult and 1000 youth clients

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FHA Substance Profile
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Vancouver Island Health Authority

• Service Locations
• Victoria, Duncan, Nanaimo, Parksville, Port
  Alberni, Tofino, Meares Island, Comox Valley,
  Campbell River, Port McNeill, Port Hardy
• Service Types
• Withdrawal Management, Support-Recovery,
  Stabilization, Counseling, Day-Treatment,
  Aboriginal Family

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VIHA Service Volumes

• Residential Treatment
• 16 adult beds (35 male, 23 female)
• 13 Youth beds (11 concurrent disorders)
• Support-Recovery
• 29 beds
• Withdrawal Management
• 55 beds

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Vancouver Coastal Health Authority

• Service Locations
• Vancouver, Richmond, North Shore, Sunshine Coast,
  Squamish, Whistler
• Service Types
• Comprehensive continuum of adult and youth
  addiction services
• Long-Term Residential Treatment
• Adult and Youth locations being developed as
  provincial resources in collaboration with other
  HAs

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VC Addiction Services
Youth
Health Promotion Education Early
Intervention School-based Prevention Prevention
Workers (CHC) AD Counseling
1 to 1 Counseling Day Treatment Community
Services Residential Treatment Beds Therapeutic
Community
Education Needle Exchange Alley
Patrols Sobering Safe Ride Peer to
Peer VANDU Crystal Clear Consumers Board
Drop-in /Crisis Intervention YAC, Youth
Hubs Outreach Odyssey II D-Talks
VISU Probation Pilot Chronic Offenders
Pilot Sheway Drug Court Jail Health
Support Recovery Program
Home Detox Residential Detox
Education Needle Exchange Insite Alley
Patrols Sobering Safe Ride Peer to
Peer VANDU Crystal Clear Consumers Board
Access Referral Health Contact Centre Life Skills
Centre
Home/Outpatient Detox Adult Daytox Residential
Social Detox Residential Medical Detox
Support Recovery Program
Community Health Centres Day Treatment Matrix Paci
fica Methadone
Housing First Alcohol and Drug Free
Housing Supported Housing
Adults
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VCH Service Volumes

• Residential Treatment
• 34 adult beds - 398 clients
• 8 Youth beds
• Support-Recovery
• 5 funded facilities
• Withdrawal Management
• 65 beds - 2862 clients in residential options
• 1137 clients in day treatment options
• Intensive Day Treatment
• 500 clients (adult and youth programs)
• Counseling
• 4000 clients

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Clients Demographics (N 1480)

• 2294 referrals were made to VD by ACCESS1 staff
  over one year period
• Unique clients 1480

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SU-Related Variables
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Methadone Maintenance

• Generally outside Specialized Treatment System
• Data from Provincial Colleges
• Availability varies by province
• Dependence vs. Pain Management
• Total number MMT patients
• 8000 BC
• 3000 Vancouver
• 850 VCH

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BC Physician FFS Billing
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Addiction Care in Acute Hospital

• Determining Need for Addiction Consultation
  Support within an Acute Care Hospital
• System of Flagging Charts
• Cost of Illness Methodology

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Impact of Flagged Patients on St Pauls Hospital
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Distribution by Program for Patients with
Conditions Related to Illegal Drugs
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Ideal Data System

• Uniform data on
• Client numbers
• Demographics
• Services Received
• Substance Use
• Medical, Social, Legal and Mental Health
  Complications
• Validated tools (ASI, MAP, GAIN)
• Ability to track unique clients
• Ability to incorporate data from other services