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Program evaluation, april 1995/2001 |
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Andrej
PIŠEC, Dr. Med., Spec. Psych. |
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SUMMARY |
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Into
the study of the 6-year treatment in the center 570 addicts to prohibited
and thus illegal drugs were included in the period April 1995 – April
2001. Group
A comprises the results of 284 addicts, treated with methadone, while in
the group B the treatment results of
all 570 addicts from our center are handled. The
average age in the group A is 26 years, the average daily dose is 80 g of
methadone. In
the group the following number of addicts is infected with
For
16 persons the results are unknown
(5,6%). The
death cause analysis for this population shows approximately the same
procentual rate (1,4%) of
suicides, overdoses, violent deaths and traffic accidents. At
the moment there are 164 addicts treated by the maintenance methadone
program (VMP). In
the group B (n=570, all the addicts treated) the average age is 24 years,
procentually the infection with HBV, MCV and HIV is smaller than at
addicts, included in VMP. For 109 persons (19%) the result is unknown. The
percentage of co-morbidity is high, it has been diagnosed at 178 patients
(37%); 115 persons have personality problems (20%), 58 addicts (10%) were
diagnosed to have endogenous psychical diseases. |
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KEYWORDS |
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Evaluation
of treatment results, methadone maintenance program, co-morbidity of
addicts, extent of HBV, HCV HIV infection amongst addicts |
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1.INTRODUCTION |
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The
center in Maribor is one of five A centers in our republic, employed in
treating the addiction to prohibited drugs. Additionally to the named ones
there are also B centers, acting in connection with above stated A centers. The
cover institution of the entire republican addiction treatment program is
the detoxication center in Ljubljana, acting as a part of the Clinical
department for mental health, at UKC (University Clinical Center). The activities of our center, which has been actively operating since April 2, 1995, are as follows:
A brief presentation of the rules of the Substitution and maintenance methadone program (VMP) in Slovenia: Into
this program only the patients may be included who are younger than 18
years and have failed to pass two to three (documented) treatments of
addiction and are proved to have been taking hard drugs (heroin) for a
longer period (1 year or more) intravenously. Among
the indications also several laboratory findings (positive to opiates),
auto- and hetero-anamneses are taken into account. Pregnant addicts who
are not able to be witout the illegal drugs, are also entitled to this
program, as well as all addicts, positive to virus HIV – fortunately
there are no such addicts in our country for the time being. Methadone is
distributed every day from 7 a.m. to 2 p.m., dissolved in the fruit juice,
which the addicts have to drink in the dispensary in the presence of the
medical staff. In special cases (stable, settled and employed clients)
exceptions are permitted. Group
work takes place in the afternoons, each of four (4) groups is leaded by
one therapeutist, in two of them there are also two co-therapeutists (education).
At the moment all the group work as well as the therapeutists are
supervised and/or peervised by the center head. For four years 250 addicts
have been vaccinated against hepatitis A, B (3x). During the center
operation (April 1995 to April 2001) there have been 570 addicts treated
in the center. If calculating with the fact that only 10 to 15% of such
patients undergo the medical treatment, we can easily create the
epidemiologic picture of the addictiveness to prohibited drugs in our town
which has about 200.000 inhabitants. There
were 284 addicts attending the methadone program, now there are 164.286
addicts are included in various programs, in the detoxication center, in
the communities of Don Pierino, Patriarche, Syanon, hospital or treated in
the daily center Maribor – Healthy Town. The trend of the first
examinations is still not increase. The program of our center is a low-threshold
one, which means that we try to offer help to every addict who is asking
for it. Of course, many addicts are not able to fulfil even the minimal
requests, therefore the drop-out from the program is considerable. A higher threshold of the work in the center is ensured by the work with parents and addicts in groups. The work results are better and more stimulative than the plain methadone treatment. |
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2. RESULTS |
GROUP A |
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It
comprises 284 addicts, who in the period April 1995-2001 were treated in
the maintenance methadone program (VMP). Today there are 164 of them
included in VMP. The
daily dose of methadone is 80 mg, the average age is 26 years, the
relationship between male and female is 2,6/1
(208/76).
the
percentage of unknown results is 5,6% (16 persons). The
review of death causes gives the following numbers:
The
co-morbidity was diagnosed at 107 addicts (38%), 63 thereof have had
personality problems (22%) and 45 persons psychotic deseases (16%). |
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GROUP B |
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In
this group the results of all the treated patients in the center were
incorporated
(in the period April 1995-2001), additionally to VMP also the
dispensary approach, the pre- and posthospital treatment, psycho-social
rehabilitation etc. The
average age is 24 years, the relationship between male and female is 2,9/1
(427/ 143).
The
percentage of unknown results (many treated patients do not want to make
all necessary tests) is 19% (109 persons). In
the period of 6 years 24 people died: (4,2%)
The
co-morbidity has been diagnosed at 178 addicts (31%), 115 thereof have had
personality problems (20%) and 58 (10%) endogeneous psychosis. The
results of the therapeutic treatment are as follows: 164
addicts (28%) are included in VMP, 47 (8,2%) went to communities, in the
hospital have been treated 50 addicts (8.8%). Inspite of receiving all
kinds of help, about 45% (256) are consuming prohibited psycho active
substances (PAS), 10% (57 persons) are »clean« from PAS. |
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3. CONCLUSIONS |
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In
the conclusion the data from the year 1997 will be compared with the
herein presented ones (year 2001). The
results of the 6-year work with the addicts to prohibited PAS in Maribor
show that the number of the patients on the maintenance methadone program
is increasing, as well as the total number of all addicts treated. Four
years ago (1997) the relationship between the male and female was 3,4/1,
now (2001) it is 2,9/1. Also the average age of the addicts is decreased
from 24,8 to 24 years. In
comparison with the year 1997 the percentual infection with HCV is nearly
for 13% lower, while the infection with HBV remained the same. The results
show the effectiveness of the low-threshold programs (condomats, needle-exchange
programs, health prevention) and of course the awareness and the
informativeness
of the addicts population on possibilities of the stated infections. An
encouraging fact is that among the addicts to prohibited drugs (PAS) there
are no positive carriers of the HIV infection. In the year 1997 the
percentage of unknown results was 26%, this year it is »only« 19%. The
average dose of methadone was 65 mg in the year 1997, today it is 80 mg.
The drop-out of VMP is smaller. When
comparing the number of the dead in the years 1997/01 a significant
increase can be noticed, from 3,7 to 4,3%. The increase is mainly the
result of violent acts and overdose. The
problem of the co-morbidity has not changed significally, in both
comparative periods it amounts to approximately one third of all the
treated ones. Also
the results of the therapeutic (un)successes are similar – in VMP one
third to one quarter of the addicts are included, about 10% go to
communities, a similar percentage is »clean« from drugs. 45
% continue to consume the prohibited PAS. In
the work with the addicts the supportive therapy is also important, as
well as the education of addicts and their relations or partners, work
with them and the psycho-social support. |
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