cure & care. - drug treatment and rehabilitation act 1983 - drug was issued as a security threat...

CURE & CARE

- Drug Treatment and Rehabilitation Act 1983 - Drug was issued as a security threat Ministry of Home Affairs - Facility Pusat Serenti (One Stop Centre) - National Antidrugs Agency Act - Fasiliti Pusat Serenti (rebranded as PUSPEN [Pusat Pemulihan Penagihan Narkotik] in 2009) -Enforcement Division was established in 2007 - Transformation of Treatment and Rehabilitation at AADK - Drug Dependency treated as a chronic relapsing disease (Patient) 1983 2004 -Drugs as a social problem -- Department of Social Welfare - Facility Pusat Insaf Diri -Drugs as a social problem -- Department of Social Welfare - Facility Pusat Insaf Diri 1975 2010 onwards 2 Evolving government policies towards Treatment and Rehabilitation of Drug Dependency

Category of Drug Dependents 20112012DECREASE (%) New Drug Dependents 6,9565,270-24.24 Repeat Drug Dependents 4,2383,745-11.63 Total11,1949015-19.50 Total no of registered drug dependents since 1988 till 2012 are 345,234 individuals COMPARISON STATISTICS OF DRUG DEPENDENTS 2011 AND 2012

Adults, 29.85% Youth, 66.88% Teenagers, 3.29% / 48.3% / 31.3% / 12%

Treatment Scenario in Malaysia Compulsory Treatment Provided for drug dependants since 1983 Drug Rehabilitation Centers (DRC) & Supervision in the Community 22 DRCs capacity of 7,000 residents Supervision - 55,000 estimated in the community How can N.A.D.A take care of the massive numbers in the community?

Success Rate 75% ? 50% ? 20% ? 10% ? Success Rate 75% ? 50% ? 20% ? 10% ? Compulsory Treatment Reluctant & Resistant Clients Problems in the DRCs Compulsory Treatment Reluctant & Resistant Clients Problems in the DRCs Treatment Services Programs in DRCs and those undergoing Supervision Treatment Services Programs in DRCs and those undergoing Supervision Parents, Families Stigmatized Residents criminalized (records) Parents, Families Stigmatized Residents criminalized (records) Changes Impact of New drugs on Clients Need for Clinical Approach Changes Impact of New drugs on Clients Need for Clinical Approach Why NADA needs to Transform? GTP & NKRA Concept of 1Malaysia GTP & NKRA Concept of 1Malaysia Success Rate 75% ? 50% ? 20% ? 10% ? Success Rate 75% ? 50% ? 20% ? 10% ? Compulsory Treatment Reluctant & Resistant Clients Problems in the DRCs Compulsory Treatment Reluctant & Resistant Clients Problems in the DRCs Treatment Services Programs in DRCs and those undergoing Supervision Treatment Services Programs in DRCs and those undergoing Supervision Parents, Families Stigmatized Residents criminalized (records) Parents, Families Stigmatized Residents criminalized (records) Changes Impact of New drugs on Clients Need for Clinical Approach Changes Impact of New drugs on Clients Need for Clinical Approach

OBJECTIVE 2 In response to the growing drug problem and its complexity and realizing that the existing strategies are not achieving the intended effects / targets, NADA has shifted its approach from INSTITUTIONALISED rehabilitation to an open approach, OPEN ACCESS SERVICES, by setting up THE CURE AND CARE 1 MALAYSIA CLINIC or better known as C&C 1MALAYSIA CLINIC. This is a paradigm shift for NADA to transform its treatment and rehabilitation services to all its clients in the country. NADA MALAYSIA

Major Developments since 2010 in terms of the extension of voluntary community based treatment COMPULSORY REHABILITATION OPEN ACCESS AMBULATORY VOLUNTARY CENTRES 19 CURE & CARE REHABILITATION CENTRES 11 CURE & CARE 1MALAYSIA CLINICS

AADK DAERAH 9 AKTA PENAGIH DADAH (RAWATAN DAN PEMULIHAN) 1983 INSTITUTION BASED COMMUNITY BASED

Return of clients as socially funcional individuals Provide a holistic approach in treatment and rehabilitation Treat Drug Dependents as patients 10 Treatment and Rehabilitation Strategy

Treatment Wards Registration Office Sg. Besi Psychiatrist/ Medical Officers

CONCEPT OPEN ACCESS SERVICES Voluntarism or Walk-in Support from parents or family Referral Outreach / Motivate No Legal Implications No Pre-conditions No stigma Private and Confidential Options for clients Community-based Program Clients as patients

Medical Detoxification MAT with Methadone/Suboxone Psychiatric Management HIV/HEP/TB/STI Management Inhalan Management Alcohol and Nikotin Management Immunisation Infectious Disease Screening INH Prophylaxis Medical Detoxification MAT with Methadone/Suboxone Psychiatric Management HIV/HEP/TB/STI Management Inhalan Management Alcohol and Nikotin Management Immunisation Infectious Disease Screening INH Prophylaxis CLINICAL SERVICES 22 VOCATIONAL TRAINING AND JOB PLACEMENT 33 Skill Training Business Job Placement Skill Training Business Job Placement Early Recovery Relapse Prevention Sosial Support Family Development Spiritual and Religious programmes Counseling Self Management Outing/Excursion Sports and Recreational Activities Early Recovery Relapse Prevention Sosial Support Family Development Spiritual and Religious programmes Counseling Self Management Outing/Excursion Sports and Recreational Activities PSYCHOSOCIAL 11 13 PROGRAMME PROVIDED

Bkt. Mertajam 15/10/10 Bkt. Mertajam 15/10/10 Kota Bharu 15/10/10 Kota Bharu 15/10/10 Papar 01/11/10 Papar 01/11/10 Tampin 04/04/11 Tampin 04/04/11 Sg. Besi 01/07/10 Kuching 15/10/10 Tampoi 15/10/10 Tampoi 15/10/10 Jerantut 01/07/11 Jerantut 01/07/11 Karangan 01/05/12 Karangan 01/05/12 Bachok 1/8/12 Bachok 1/8/12 TOTAL NO OF CURE & CARE CLINICS - 11 CLINICS TOTAL NO OF MINI C&C : 4 CLINICS (BESUT, KINTA, MIRI & KENINGAU) : INPATIENT 479 CLIENTS : OUTPATIENT 525 CLIENTS : OPERATIONAL SINCE 15 NOV 2011 TOTAL NO OF MINI C&C : 4 CLINICS (BESUT, KINTA, MIRI & KENINGAU) : INPATIENT 479 CLIENTS : OUTPATIENT 525 CLIENTS : OPERATIONAL SINCE 15 NOV 2011 Tampin 04/04/11 Tampin 04/04/11 Dengkil 07/01/13 Dengkil 07/01/13 (TILL April 2013) Distribution

C&C CLINICCAPACITY CLIENT REFERRAL & ADVOCACY TOTAL INPATIENTOUTPATIENT SG.BESI150135747216 KOTA BHARU50 4213105 BKT MERTAJAM403551894 TAMPOI100612164 KUCHING30197026 PAPAR40203225 TAMPIN755492111257 JERANTUT100774586 KARANGAN100 590159 BACHOK201516031 DENGKIL1002514039 CURRENT NO ( 30 Apr 2013) 5913641471102 ACCUMULATIVE JAN - APR 2013 1449127822484975 ACCUMULATIVE 2012 50433854386912766 ACCUMULATIVE 2011 3028225940809367 ACCUMULATIVE 2010 6667721171555 ACCUMULATIVE 2010-2013 1018681631031428663 PERCENTAGE OF INCREASE OF CLIENTS FROM 2011 TO 2012 } INPATIENT : 66% OUTPATIENT : 71 % 15 STATISTIC OF CLIENTS

DRC VS. C&C CLINIC DRUG REHAB. CENTERS C&C CLINIC Compulsory Treatment & Admission through the Law; Criminal Records; Stigma Open Access Services Voluntary Admission; Considered as Patients Focus on medical, psychiatric & clinical treatment Treatment-based services only Treatment for opiate-based addicts; all males and separate for women Treatment for all substance abusers (opiate, ATS, inhalant) males, females & adolescent are separated Treatment Duration 2 years Treatment duration 1-3 months (inpatient), 4-6 months (outpatient) Capacity for residents in DRCs 7,350 Number of clients that accessed services at 8 C&C Clinics 9,041 Cost of food RM8.00 x 30 days x 12 months /person = RM 2,880 Cost of food RM8.00 x 30 x 3 months = RM720.00 Loss of Property caused by violence, arsonNo incidence of violence or arson

FUN, EFFECTIVE & EASY TO IMPLEMENT APPROACH

YEAR TYPE OF SERVICE TOTAL NO OF CLIENTS DISCHAR GED CLIENT STATUS ENTRY TO COMPULSORY CENTRE UNDERGO REHABILITATION IN COMMUNITY PRISONCOMPLIANT NOT ABLE TO BE TRACED* 2010 Inpatient560 30.54%152.68%30.54%45581.25%8114.46% Outpatient294 00.00%51.70%10.34%27894.56%103.40% 2011 Inpatient2590 361.39%2037.84%271.04%181970.23%45517.57% Outpatient1600 110.69%1298.06%80.50%95959.94%50431.50% 2012 Inpatient3230 491.52%2718.39%491.52%215366.66%88527.40% Outpatient2527 240.95%50720.06%50.20%136754.10%63225.01% TOTAL10,8011231.14% 113010.46% 930.86%703165.10%256723.77% OUTCOME RESULTS OF CLIENTS DISCHARGED FROM CURE & CARE CLINICS (2010-2012)

94.4% 90% 61% Reduced by 37.1% Injecting drug use 46% to 8.9% Confident of not using drugs in the near future Clients satisfied with services Ready to recommend the clinic to family and friends OUTCOME STUDY AT C&C CLINIC

Drug use history Substance 30 days BEFORE first visit to C&C Past 30 days Heroin67.1%4.8% Benzos; Dormi, Clona, Valium, Xanax 12%2.0% Syabu, Meth, Ice13.9%2.1% Pil Kuda3.3%2.2% 3 or more substances in the same day 10.8%1.7% OUTCOME STUDY AT C&C CLINIC

In general, how satisfied are you with the medical attention you receive for your health problems (other than drug addiction) at the Cure and Care Clinic? Satisfied 69.3% Very satisfied 23.9% Not very satisfied 5.6% Health status, needs and access OUTCOME STUDY AT C&C CLINIC

Qualitative analysis: Opinions and feedback on C&C program and services. Overall, happy with the C&C concept C&C encourages voluntary and ambulatory care and rehabilitation MMT is seen as a stabilizer giving 2 nd chance Programs offered by C&C were well received Good support from C&C staff, Counselors and Medical Team OUTCOME STUDY AT C&C CLINIC

20112010 Example text METHADONE MAINTENANCE PROGRAMME CCSC 1024 CCRC 0 Klinik C&C 0 Jumlah 1024 CCSC 1380 CCRC 21 Klinik C&C 351 Jumlah 1647 2012 CCSC 1530 CCRC 40 Klinik C&C 1735 Jumlah 3305 936 (67.8%) clients employed in 2012 compared to 543 (53%) clients in 2011. OUTCOME STUDY AT C&C CLINIC

56.3% Helped maintain jobs 42.7% Helped get into government support services 54.3% Continued education 77.6% Improved family relations 72.1% Obtained permanent homes 75.9% Prevented arrest into prisons OUTCOME STUDY AT C&C CLINIC

73.8% Prevented admission into Compulsory DRCs 78.3% Helped family or friends to get treatment and rehabilitation 76.7% Access to medical care 94.9% Very satisfied with the methadone maintenance programme 94.4% Reduced drug cravings 65.4% Obtained skill training KAJIAN KEBERKESANAN PROGRAM KLINIK C&C OLEH UNIVERSITI MALAYA OUTCOME STUDY AT C&C CLINIC

CRIME HISTORY InstitutionBEFORE C&CSince coming to the C&C Lock-up3.500.57 Prison1.060 PUSPEN0.610 Average number of times inpatients and outpatients have been sent to prison, lock up, or PUSPEN KAJIAN KEBERKESANAN PROGRAM KLINIK C&C KOTA BHARU OUTCOME STUDY AT C&C CLINIC

Mental Health KAJIAN KEBERKESANAN PROGRAM KLINIK C&C KOTA BHARU OUTCOME STUDY AT C&C CLINIC

1.UNODC (United Nation Office of Drug And Crime) 2.UNAIDS 3.WHO 4.IDPC (International Drug Policy Consortium) 5.Pengiktirafan daripada Negara Luar 28 Drug Issues and Priorities for Southeast Asia 24 th IFNGO Conference, Kuala Lumpur Gary Lewis Regional Representative, UNODC 8 November 2011 Drug Issues and Priorities for Southeast Asia 24 th IFNGO Conference, Kuala Lumpur Gary Lewis Regional Representative, UNODC 8 November 2011 Positive example: Malaysias Cure and Care 1 Malaysia Clinics (Gary Lewis. Regional Representative, UNODC) Commendation by Mr. Andrew Marshall, Journalist from Al-Jazeera

AFTERCARE SERVICES AFTERCARE Options for Aftercare Services after discharge from C&C Clinic : as outpatient with the same C&C Clinic or other facility; or CCSC (Cure & Care Service Centres); or CCH (Community Caring House) CCVC (Cure & Care Vocational Centre) vocational skills training TransCC Transitional Cure&Care facility Outpatient CCSC CCH CCVC TransCC NADA District Offices

NADA VISIONS AND TARGETS People Targets Capacity Building Training for officers, partners, volunteers Process Targets Engaging Strategic Partners and Smart Partners Strategy Targets Scaling up of Community-based services /programs Outcome Targets Better outcome and success rate in treatment & rehabilitation Nations Targets Healthier people, drug-free country

By 2015 STRATEGIC PLANNING FOR COMMUNITY-BASED SERVICES / PROGRAMS CCH / MOBILE UNITS C&C 1MALAYSIA CLINIC CCSC What are N.A.D.As Future Plans? By 2015

STRATEGIC PLAN (2011 2015) No. of Compulsory Rehab. Centers (CCRC) (4) No. of CCSC 98 No. of CCH 96 2015CCSC 2015CCH 2015 C&C 1Malaysia Clinic No. of C&C 1Malaysia Clinics (18)

We Care, We Serve

cure & care. - drug treatment and rehabilitation act 1983 - drug was issued as a security threat...

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