LAPORAN PELAKSANAAN PROGRAM RAWATAN TERAPI

CURE & CARE
1 MALAYSIA CLINIC
TOWARDS AN INTEGRATED TREATMENT
AND REHABILITATION FOR PEOPLE WHO
USE DRUGS
By :
DR.SANGEETH KAUR
NATIONAL ANTIDRUGS AGENCY
MINISTRY OF HOME AFFAIRS
BACKGROUND
 The Cure & Care 1Malaysia Clinic was
officially launched on 1st July 2010 at the
Anti-Narcotics Rehabilitation Centre in
Sungai Besi, Kuala Lumpur.
This clinic provides open access services
to drug abusers, drug users, their families,
employers and individuals with drug
problems.
Inpatient
Outpatient
Seven
components of Medical detoxification
the client’s
Day care
placement
services are : Short term services
Drug substitution therapy
Referral and advocacy
CORE SERVICES
4 main core services are
provided for clients:-
 Registration
 Placement
 Evaluation
 Intervention
Program
A client can have access to these services
through:
1
2
3
Walk-in
Referral by
family,
employers
or hospitals
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Outreach by
NADA
officers or
NGO’s
3 principles of the services provided:-
Voluntarism
(Confidential)
Non- conditional
No legal
implications
TREATMENT PROCESS
DISCHARGED – COMPLETED
DISMISSED
DROP-OUT
PROGRAMS
INPATIENT OR
OUTPATIENT
ADMISSION
PHYSICAL,
MEDICAL &
PSYCHIATRIC
A.S.S.I.S.T
U.R.I.C.A
CLINICAL ASSESSMENT
PSYCHOSOCIAL
ASSESSMENT
SERVICES PROVIDED
The Cure & Care 1Malaysia Clinic provides a broad range of
services such as :
Guidance and
counseling
TEXT
Religious and spiritual
education
Relapse prevention
Pre & Post HIV
Testing (vct)
Dental
Saringan TB/Hep
B/Hep C
Clinical and
psychiatric evaluation
TEXT
Alcohol
Withdrawal
Management
Health Education
MMT
Hep B Vaccine
Community Service
Re-entryContinued
supervision and
Aftercare
Support groups (family,
employers etc)
Psychiatric
Management
Medical
Detoxification
INH prophylaxis
for latent TB
OPD
ARV
TEXT
Referral and
advocacy
TEXT
Vocational
skills, education
and training
Job placement
C & C 1 MALAYSIA CLINIC
REGISTRATION
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PSYCHOSOCIAL
EVALUATION
CURE & CARE 1 MALAYSIA CLINIC SG. BESI
Registration at Clinic OPD
CURE & CARE 1 MALAYSIA
CLINICSG. BESI
Outpatient treatment by
Medical Assistant
CURE & CARE 1 MALAYSIA CLINIC SG. BESI
Medical Detoxification Ward
CURE & CARE 1CLINIC MALAYSIA SG. BESI
Daily Observation and Withdrawal
Chart Monitoring
CURE & CARE 1 MALAYSIA CLINIC SG. BESI
Early Intervention by
councilor
KLINIK CURE & CARE 1
MALAYSIA SG. BESI
Medication dispensed by
pharmacist (DOT)
KLINIK CURE & CARE 1 MALAYSIA SG.
BESI
Methadone Patients awaiting
dosing
DOT METHADONE
BY PHARMACIST
MEDICAL EVALUATION BY MEDICAL
OFFICER
ACHIEVEMENTS
• Since its launch on 1st July 2010 the C & C 1Malaysia
Clinic has received commendable response.
• As of October 2010, 9000 clients have visited and
received various services at the C & C 1Malaysia Clinic.
•Currently there are 900 clients registered in the
Methadone Maintenance Therapy at Clinic C&Cs and
1400 clients registered at Cure and Care Service Centres
•Voluntary based HIV screening is conducted
•Mental Health screening conducted and seen by
psychiatrist.
STATISTICS
No. Accumulative Clients at Cure & Care Clinics
3091
1729
1649
942
561
402
566
101
No of Clients and Drug of Choice
1249
861
452
302
270
37
61
48
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37
No of Clinic Visits
5000
4533
4500
4138
4000
3667
3500
3184
3000
2672
2500
2181
2000
1677
1291
1500
938
1000
500
1821
601
337
0
Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11
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Jul-11 Aug-11 Sep-11
HIV Screening
No of Test
No HIV positive
64
60
57
24
15
8
Oct'10
21
13
12
10
5
Nov'10
20
0 0
0
Dec'10
Jan'11
Feb'11
Mac'11
13
7
5
1
0
Apr'11
May'11
Jun'11
5
0
0
Jul'11
Aug'11
No of patients started on ARV
No of patients started on ARV
27
27
13
8
4
Oct'10
13
13
13
14
16
14
Sept'11
35
31
31
29
29
32
35
32
23
23
16
8
4
Nov'10 Nov'10
Dec'10 Dec'10
Jan'11Jan'11
Feb'11
Oct'10
Feb'11Mac'11
Mac'11 Apr'11
Apr'11 May'11
May'11
Jun'11
Jun'11
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2
Jul'11 Aug'11
Aug'11
Sept'11
Jul'11
Sept'11
National HIV Notification among
IVDU
 percentage of notified HIV
cases through injecting drug
has decreased from 66% in
2005 to 47.6% in 2010
Percentage
80
70
Drug Abuse Statistic, Malaysia, 2001 2010
69
67
60
67
66
69
65
61
62
20
33
20
10
0
10
1
10
1
23
10
1
17 15
17
16
1
1
23
79.6
74.2
71.0
69.7
66.0
53.6
57.3
57.2
55.2
47.6
36
IVDU
Source : MoH Malaysia
YEAR
23
14
16
1
74.7
50
40
22
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
54
50
30
Percentage of Notified HIV Cases by Risk Factor, Malaysia,
2000 - 2010
4
15
11
2
13
8
5
1
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year
Opiate
Stimulan
Marijuana
Others
Opiate addiction has shown
decreasing trend, from 67% in
2005 to 50% in 2010.
INFECTIOUS DISEASES SCREENING
300
262
239
250
204
CLIENTS
200
172
150
138
HIV
119
HEP B
HEPC
89
100
76
63
50
31
43 2
40
54 2
46
64 2
1611
3
11
3
49
46
43
38
11
3
14
3
15
3
3
25
23
21
17
4
TIBI
61
59
57
54
4
4
0
OCT NOV
10
10
DEC JAN 11 FEB 11 MAR APR 11 MAY JUNE JULY AUG SEPT
10
11
11
11
11
11
11
MONTHS
Psychiatric Cases at C&C Clinic
Sg. Besi
Depression, 8%
Others, 3%
Organic
Disorder, 15%
Drug Induced
Psychosis, 74%
Retention rates of psychiatric cases in
treatment after 1 year is 67%
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METHADONE MAINTENANCE THERAPY
2007
2008
•CCSC – 3
•CCSC – 3
2009
•CCSC – 24
2010
•CCSC – 24
•KLINIK C&C – 2
2011
•CCSC – 33
•CCRC – 2
•C&C CLINIC– 8
MMT ACHIEVEMENTS AT NADA 2007 - 2011
2007
2008
2009
2010
2011
CCSC
PUSPEN
11
0
CCSC
PUSPEN
184
0
CCSC
PUSPEN
689
0
CCSC
PUSPEN
1024
0
CCSC
PUSPEN
1379
21
C&C
CLINIC
TOTAL
0
C&C
CLINIC
TOTAL
0
C&C
CLINIC
TOTAL
0
Klinik
C&C
TOTAL
0
C&C
CLINIC
TOTAL
900
11
Example text
184
689
1024
2300
MMT ACHEIVEMENTS AT NADA 2007 - 2011
OVERALL DATA
2011 MMT WAS EXPANDED
TO;
 33 CCSC
 8 C&C 1Malaysia Clinics
 2 PUSPEN
2010
2011
Target Clients
1325
4825
No. Registered
Clients
1183
(89.3%)
2300
No of Active Clients
784
1986
No of Non Compliant
Clients
79
235
Klien yang bekerja
632
1,330
EMPLOYMENT
No of clients that have started working after enrolling in the program has increased
to 1330 klien (67.7%) pada tahun 2011 from 632 (53%) clients in 2010
MMT ACHIEVEMENTS AT NADA 2007 - 2011
Graph 1 : Retention Rate of outpatient MMT clients at C&C
Clinics(KLINIK C&C)
Retention Rate of MMT Clients at C&C Clinics
94.9
91.04
90.59
85.3
3 mths
6 mths
9 mths
12 mths
Graph 2: Retention Rate in Comparison to WHO Standard
RETENTION RATE IN COMPARISON TO WHO
STANDARDS
NADA
94.9
91.04
WHO
90.59
85.3
75
3 mths
65
6 mths
60
9 mths
55
12 mths
TOTAL NO. REGISTERED METHADONE CLIENTS
450
411
400
350
374
350
293
CLIENTS
300
255
200
194
200
144
123
150
83
100
50
227
225
250
98
171
172
REGISTERED
ACTIVE
96
80
68
61
141
153
190
22 17
0
OCT 10
NOV 10
DEC 10
JAN 11
FEB 11
MAR 11 APR 11
MONTHS
MAY 11
JUNE 11 JULY 11
AUG 11
SEPT 11
%
PERCENTAGE OF URINE POSITIVE METHADONE
CLIENTS (OUTPATIENT)
40%
30%
20%
10%
0%
33%
25%
23%
16%
11% 9%
20%
25%
28%
21%
24%
12%
OCT NOV DEC JAN FEB MAR APR MAY JUNE JULY AUG SEPT
10
10
10
11
11
11
11
11
11
11
11
11
Employment of MMT Clients
Employment
KLINIK CURE
& CARE 1MALAYSIA (KLINIK
C&C)
17%
32%
Security Guards
Own Business
19%
Driver
Contractor
22%
2%
3%
Catering
Unemployed
Others
5%
The programme has achieved in reducing
unemployment among people who use drugs by
providing training and employment opportunities.
151 (84.8%) of the MMT clients have started work
after joining the programme.
FUTURE TREATMENT PROGRAMMES TO BE
INTRODUCED
1
2
3
4
5
6
Introduction of Suboxone for
HIV clients on ARV
Suboxone as an option for
Medical Detoxification
INH Prophylaxis for Latent TB for HIV
Clients
Occupation Therapy to be a part of
Rehabilitation
Cognitive Remediation Therapy
Specialised Programme for Inhalan Abuse among
youth
RECOMMENDATIONS
Skills training to be provided by Ministry of Health,
Ministry of Women, Welfare Department and Universities.
Medical leave of employees undergoing treatment.
To provide more doctors and psychiatrists in this clinic to
ensure continous medical care and mental health care of
clients.
CONCLUSION
With the transformation in the approach to
drug treatment and rehabilitation and the
setting up of the Cure & Care 1Malaysia
Clinics, NADA has aligned itself as one of the
best practices/ evidence-based practice in
treatment and health care of drug users.