continuation of methadone maintenance therapy in … · that during last 2 years mmt was...

CONTINUATION OF METHADONE CONTINUATION OF METHADONE MAINTENANCE THERAPY IN THE MAINTENANCE THERAPY IN THE CONTEXT OF PROTECTION OF CONTEXT OF PROTECTION OF

PATIENTPATIENT’’S RIGHTS IN POLICE ARREST S RIGHTS IN POLICE ARREST HOUSES OF LITHUANIAHOUSES OF LITHUANIA

KestutisKestutis PetrauskasPetrauskasDeputy Head of the Health Care Service under the Deputy Head of the Health Care Service under the

Ministry of the InteriorMinistry of the InteriorLithuaniaLithuania

2th, 2th, JuneJune 20102010RigaRiga

ContentContent

•• MMT hMMT hiistoricalstorical background background and and

•• MMT MMT needsneeds ir ir policepolice arrestarrest hhouousesses•• International and national legislationInternational and national legislation•• Organisational regulationOrganisational regulation•• CooperationCooperation withwith UNODC UNODC project project officeofficeand supportand support

•• PPracticalractical implementationimplementation andand realisationrealisation ofofnneedseeds

•• ConclusionsConclusions

MMT hMMT historicalistorical background and needsbackground and needs

•• MMT MMT in community has been in community has been implementing implementing since 1995.since 1995.

•• 50 patients in 1995 and 550 patients in 1995 and 51212 patients in 2008patients in 2008 ttook part in ook part in this program.this program.

•• Now figures are Now figures are going togoing to increasincreasee..

•• AboutAbout 80 80 %% ofof allall patientspatients withwith HIV/AIDS HIV/AIDS inin LithuaniaLithuaniaare are usersusers ofof injectinginjecting ((usualyusualy oppioidsoppioids) ) drugsdrugs..

GeographyGeography ofof the pharmacotherapy with the pharmacotherapy with methadone and methadone and buprenorphinebuprenorphine inin 19951995 in in

LLiiththuaniauania

Vilnius

Klaipėda

GeographyGeography ofof the pharmacotherapy with the pharmacotherapy with methadone and methadone and buprenorphinebuprenorphine aboutabout 20022002 in in

LLiitthuaniahuania

Vilnius

Klaipėda

Druskininkai

Kaunas

ŠiauliaiPanevėžys

GeographyGeography ofof the pharmacotherapy with the pharmacotherapy with methadone and methadone and buprenorphinebuprenorphine inin 20092009 in in

LLiitthuaniahuania

Vilnius

Klaipėda

Druskininkai

Kaunas

ŠiauliaiPanevėžys

KėdainiaiŠilutė

Mažeikiai

Telšiai

Visaginas

Number of patients in the pharmacotherapy Number of patients in the pharmacotherapy with methadone and with methadone and buprenorphinebuprenorphine 20052005--20020099

in Lin Lithuaniaithuania (Emilis (Emilis SubataSubata, 2010), 2010)

402381

395

512

562

300

350

400

450

500

550

600

2005 2006 2007 2008 2009

Patients in

pharmacotherapy

MMT MMT needsneeds ir ir policepolice arrestarrest hhouousesses

•• AboutAbout 7171 %%drugdrug addictaddict personspersons havehave experienceexperience ofofdetentiondetention oror inprisonmentinprisonment

•• Drug users health pDrug users health problemsroblems needneed moremore andand moremoreattentionattention ofof medicalmedical andand policepolice staffstaff, , moremore nessesarynessesary timetimeandand effortsefforts

•• Discontinuation of prescribed treatment without patientDiscontinuation of prescribed treatment without patient’’s s concern just because of concern just because of detentiondetention is a great harmis a great harm

•• Violation of patientViolation of patient’’s rights take place: s rights take place: 1 1 ofof 3 3 complaintscomplaintsonon violationviolation ofof patientpatient rightsrights inin policepolice arrestarrest houses deals houses deals with interruption of MMTwith interruption of MMT

•• Health care pHealth care possibilitiesossibilities insideinside policepolice arrestarrest houseshouses are are strict determined andstrict determined and thisthis kindkind ofof care care isis slim slim effectiveeffective

•• Police should pay attention to the needs of patients, but Police should pay attention to the needs of patients, but do not perform itdo not perform it

MMT MMT needsneeds ir ir policepolice arrestarrest hhouousesses((otherother circumstancescircumstances))

•• Necessary medical care in police arrest houses is within Necessary medical care in police arrest houses is within the competence of the nursethe competence of the nurse

•• The procedures of medicines acceptance in different The procedures of medicines acceptance in different arrest houses are too free, grounded on different points of arrest houses are too free, grounded on different points of viewview

•• The efforts to have well run MMT implementation are The efforts to have well run MMT implementation are differently valuated and interpreted by police officers, differently valuated and interpreted by police officers, authorities and medical staffauthorities and medical staff

•• UNODC UNODC projectproject officeoffice moment questionnaire revealed moment questionnaire revealed that during last 2 years MMT was interrupted for 42 that during last 2 years MMT was interrupted for 42 patienspatiens because of police arrestbecause of police arrest, , from them infrom them in VilniuVilniuss ––16, 16, in in KlaipKlaipeeddaa –– 1212

•• At the same time there is no problems with MMT in arrest At the same time there is no problems with MMT in arrest houses of houses of KaunKaunas and other 5 smaller townsas and other 5 smaller towns

HEALTH DATA OF PERSONS IN ARREST HOUSES HEALTH DATA OF PERSONS IN ARREST HOUSES OF LITHUANIAOF LITHUANIA

(2007(2007--2009)2009)

45,545,531,131,138,638,6Index on Index on 1000 1000 personspersons

13061306818818969969Mental and Mental and behaviourbehaviour disorders misusedisorders misuse opioidsopioids

(F11) ((F11) (absabs. . numbernumber) )


660660763763659659Mental and Mental and behaviourbehaviour disorders misusedisorders misuse alalcoholcohol(F10) ((F10) (absabs. . numbernumber) )


274627462105210519621962Mental and Mental and behaviourbehaviour disorders disorders (F00(F00--F99) (F99) (absabs. . numbernumber) )


625362534887488743584358Registered diseases and health disordersRegistered diseases and health disorders (A00(A00--T98)T98)

((absabs. . numbernumber))

200920082007INDEX NAME

DATA ON HEALTH CARE OF ARRESTED DATA ON HEALTH CARE OF ARRESTED PERSONS OUTSIDE ARREST HOUSESPERSONS OUTSIDE ARREST HOUSES

(ABS. (ABS. NUMBERSNUMBERS 20072007--2009)2009)

474728283939for mental and for mental and behaviourbehaviour disorders misusedisorders misuse alalcoholcohol

156156131131154154misusemisuse alalcoholcohol

445511for mental and for mental and behaviourbehaviour disorders misusedisorders misuse opioidsopioids

595957574444Hospitalizes to inHospitalizes to in--patient clinicspatient clinics

From themFrom them::

266266183183238238misusemisuse opioidsopioids

473473389389497497Ambulance callsAmbulance calls for mental and for mental and behaviourbehaviourdisorders disorders


989819192222misusemisuse opioidsopioids

494948482020misusemisuse alalcoholcohol

16016069696868Consulted in territorialConsulted in territorial health care institutionshealth care institutions

for mental and for mental and behaviourbehaviour disorders disorders


200920082007INDEX NAME

UniversalUniversal definitiondefinition

Continuous treatmentContinuous treatmentmeans completeness of means completeness of organisationalorganisational measures and practical measures and practical actions, grounded on integrated justice actions, grounded on integrated justice reglamentationreglamentation, that , that realize condition of realize condition of uninterrupteduninterrupted treatment of patient, that treatment of patient, that

is inside penal institution because of trial proceedingis inside penal institution because of trial proceeding

Tools of continuous MMT Tools of continuous MMT organisationorganisation

•• InternationalInternational guidelinesguidelines, , recomrecommmendationsendations andand nationalnational lawslaws

•• RulesRules andand regulationsregulations ofof subjectsubject

•• ProceduresProcedures andand actionsactions forfor contincontinuuousous MMTMMT

•• PositivePositive wiewwiew, , positionposition, , jointjoint andand integratedintegrated activityactivity ofof policepolice officersofficers andandnursenursess..

•• CommunicationsCommunications andand coocooperationperation ofof partnerspartners ofof MMT MMT withwith psychiatricpsychiatricinstitutions, arrest houses, prisons, family members, interestedinstitutions, arrest houses, prisons, family members, interested NGONGO

International legislationInternational legislation

EuropeanEuropean prisonprison rulesrulesCouncilCouncil ofof EuropeEurope

CommitteeCommittee ofof MinistersMinisters

RecomendationRecomendation No. R (87)3No. R (87)3

•• 26.1 ... 26.1 ... TheThe medicalmedical servicesservices should be organised in closerelation with general health administration of thecommunity or nation..

•• 100.3. ... 100.3. ... TheThe medicalmedical oror psychiatricpsychiatric serviceservice ofof thethe penalpenal

institutionsinstitutions shallshall provideprovide forfor thethe psychiatricpsychiatric treatmenttreatment


CouncilCouncil ofof EuropeEurope



OF THE COMMITTEE OF MINISTERS TO MEMBER STATES OF THE COMMITTEE OF MINISTERS TO MEMBER STATES CONSERNING PRISON AND CRIMINOLOGICAL ASPECTS CONSERNING PRISON AND CRIMINOLOGICAL ASPECTS

OF THE CONTROL OF TRANSMISIBLE DISEASES OF THE CONTROL OF TRANSMISIBLE DISEASES INCLUDING AIDS AND RELATED HEALTH PROBLEMS IN INCLUDING AIDS AND RELATED HEALTH PROBLEMS IN

PRISONPRISON

GeneralGeneral principlesprinciples

•• SuchSuch a a policypolicy shouldshould be be developeddeveloped inin closeclose collaborationcollaboration withwithnationalnational healthhealth authoritiesauthorities andand be be incorporatedincorporated inin widerwider policypolicy forforcombatingcombating transmisibletransmisible diseasesdiseases inin prisonprison..

•• ProtectionProtection ofof discriminationdiscrimination

SpecialSpecial measuresmeasures..

• Drug addicts shoud be encouraged to follow such treatmentprogrames. .


CouncilCouncil ofof EuropeEurope



OF THE COMMITTEE IF MINISTERS TO MEMBERS STATES OF THE COMMITTEE IF MINISTERS TO MEMBERS STATES CONSERNING THE ETHICAL AND ORGANISATIONAL CONSERNING THE ETHICAL AND ORGANISATIONAL

ASPECTS OF HEALTH CARE IN PRISONASPECTS OF HEALTH CARE IN PRISON

•• eequivalencequivalence of careof care..

• health policy in custody should be integrated into, and compatible with, national health policy..

•• necessary to offer sufficient training to medical and prison pernecessary to offer sufficient training to medical and prison personnelsonnel;;

• to improve co-operation whith external counselling services, in order to ensure continuing follow-up therapy on discharge to the community; ;

National legislationNational legislation

Law Law onon arrestarrest prosecutionprosecution

Quality and quantity of arrestees health care must be Quality and quantity of arrestees health care must be

guarranteedguarranteed as well as in communityas well as in community

LawLaw onon narcologicalnarcological carecare

Persons in prisons, police arrest houses have the right Persons in prisons, police arrest houses have the right

to equivalent to equivalent narcologicalnarcological health carehealth care as well as in as well as in

communitycommunity

National legislationNational legislation

Law on the rights of patients and compensation of the Law on the rights of patients and compensation of the damage to their healthdamage to their health

•• The rights of patients may not be restricted in health care The rights of patients may not be restricted in health care institutions because of gender, age, race, nationality, institutions because of gender, age, race, nationality, language, social status, faith, beliefs or convictions thereof;language, social status, faith, beliefs or convictions thereof;

•• Patients must be accorded qualified healthPatients must be accorded qualified health carecare

LawLaw onon nursingnursing practicepractice

• Within the competence provide health care service

• Respect and do not violate patient’s rights

Organisational regulationOrganisational regulation

Lithuanian medical standardLithuanian medical standard MN 57:1998MN 57:1998

„„Community nurse.Community nurse. FuncFunctionstions, , duties, rights, competence duties, rights, competence and responsibilitiesand responsibilities””

confirmed by the order minister of healthconfirmed by the order minister of health

Community nurseCommunity nurse working in arrest house have working in arrest house have additional duties and responsibilitiesadditional duties and responsibilities


Lithuanian medical standardLithuanian medical standard MN 129:2004MN 129:2004

„„Medical office of arrest house of territorial police institutionMedical office of arrest house of territorial police institution””

confirmed by the order of the minister of healthconfirmed by the order of the minister of health

DutiesDuties, , rightsrights andand responsibilityresponsibility ofof policepolice arrestarrest househouse nursenurse

•• To take part in To take part in organisationorganisation of health care services, which of health care services, which could not be provided by the nursecould not be provided by the nurse

•• Accept medicines prescribed by doctor, register and give Accept medicines prescribed by doctor, register and give them to patients under doctorthem to patients under doctor’’s prescriptions prescription

•• Dispose Dispose NaloxonumNaloxonum hydrochloridumhydrochloridum 0,4 mg 0,4 mg ampamp. . for usefor use ininemergencyemergency cascaseess


Convoy regulation

confirmed by the order of minister of justice and minister of confirmed by the order of minister of justice and minister of interior interior in 2005

If the continuous treatment is prescribed for person under convoIf the continuous treatment is prescribed for person under convoy, officery, officer

on duty of the penal institution passes the medicines to the heaon duty of the penal institution passes the medicines to the heard ofrd of

convoy in order to present these medicines to the point of taskconvoy in order to present these medicines to the point of task

Interior activity rules of police institutions arrest houses

confirmed by the order of general confirmed by the order of general commissioniercommissionier in 2007

•• Quality and quantity of arrestees health care must be Quality and quantity of arrestees health care must be guarranteedguarranteed as as well as in communitywell as in community

•• Arrestees have right to require medicines which are prescribed bArrestees have right to require medicines which are prescribed by y doctor, except necessary health caredoctor, except necessary health care

•• Officers can brink to arrest house only medicines which are presOfficers can brink to arrest house only medicines which are prescribed cribed by doctor for arresteesby doctor for arrestees

CooperationCooperation withwith UNODC UNODC projectproject officeoffice andand

supportsupport

UNODC UNODC projectproject officeoffice::

•• iin 2009 n 2009 elevated actuality of MMT problem extent and elevated actuality of MMT problem extent and indicated thatindicated that situationsituation inin the the policepolice arrestarrest hhouousesses isis notnotclearclear

•• Proposed recommendations and support for Police Proposed recommendations and support for Police department and Health care service under the MIdepartment and Health care service under the MI

•• Organized and contributed 2 training events in which took Organized and contributed 2 training events in which took part 37 policemen and nurses from arrest housespart 37 policemen and nurses from arrest houses

•• Jointed together for cooperation interested police and Jointed together for cooperation interested police and medical institutions, medical institutions, NGONGO’’ss

•• Organized and contributed the conference Organized and contributed the conference ““Arrest and Arrest and addiction diseases. Necessary aid and MMTaddiction diseases. Necessary aid and MMT”” together with together with Medical faculty of VU and cooperation with Police Medical faculty of VU and cooperation with Police department.department.

PPracticalractical implementationimplementation andand realisationrealisation ofof nneedseeds

Health care serviceHealth care service’’s actionss actions•• Got acknowledged with the sense of problem the authority of the Got acknowledged with the sense of problem the authority of the Police departmentPolice department

•• AnalizedAnalized information got during visits to arrest houses in 2007information got during visits to arrest houses in 2007--20092009•• Initiated and prepared on cooperation with the Police departmentInitiated and prepared on cooperation with the Police departmentstandard model of medicines receiving, storage and delivering ovstandard model of medicines receiving, storage and delivering over to er to patientspatients

•• Consulted on this subject chiefs of the arrest houses and medicaConsulted on this subject chiefs of the arrest houses and medical staff l staff and underlined legality of the MMT to doubtful officersand underlined legality of the MMT to doubtful officers

•• Encouraged arrest houses to develop contacts with territorial Encouraged arrest houses to develop contacts with territorial psychiatric institutionspsychiatric institutions

•• Activated medical staff education and foresaw measures in nationActivated medical staff education and foresaw measures in national al program of mental healthprogram of mental health

•• Performed purposeful questionnaire of medical staffPerformed purposeful questionnaire of medical staffandand

•• Made correction of inadequacies of implementation of standard moMade correction of inadequacies of implementation of standard model del in placesin places


Standard model of medicine’s receiving, storage and delivering over to patients

•• This Standard model includes special chapter for This Standard model includes special chapter for MMTMMT

•• It is due, that if arrestee is a patient on MMT program, the staIt is due, that if arrestee is a patient on MMT program, the staff of the ff of the arrest house informs psychiatric institutionarrest house informs psychiatric institution

•• Coordinates the conditions of receiving and delivering of methadCoordinates the conditions of receiving and delivering of methadone one or or buprenorphinebuprenorphine

•• Health care specialists or other commissioned person, according Health care specialists or other commissioned person, according to to Ministry of Health issued order, already can visit their patientMinistry of Health issued order, already can visit their patients in the s in the arrest house, give them prescribed medicinesarrest house, give them prescribed medicines

•• On the first visit health care specialist or other commissioned On the first visit health care specialist or other commissioned person person must leave in arrest house medical office document of prescriptimust leave in arrest house medical office document of prescription of on of methadone (methadone (buprenorphinebuprenorphine), signed by doctor), signed by doctor


Standard model of medicine’s receiving, storage and delivering over to patients

•• Methadone (Methadone (buprenorphinebuprenorphine) should be ) should be registeredregistered andand taken under taken under arrest housearrest house’’s health care specialist and (or) arrest houses health care specialist and (or) arrest house’’s staff controls staff control

•• Health status of patient and medicineHealth status of patient and medicine’’s consumption are registered in s consumption are registered in his/her medical documentationhis/her medical documentation

•• Health care specialists or other commissioned person Health care specialists or other commissioned person havehave a a possibilitypossibility to to leaveleave somesome dosesdoses ofof methadone (methadone (buprenorphinebuprenorphine))accordingaccording specificspecific situationsituation

•• There is determinate order on patientThere is determinate order on patient’’s release from arrest house and s release from arrest house and for his/her transferring to another penal institutionfor his/her transferring to another penal institution


example

REGISTER OF MEDICINES ACCEPTED FROM PACIENT’S REPRESENTATIVES

6

Pristačiusio asmens duomenys

8754321

Davimo pacientui pagrindas

KiekisPavadinimas, dozuotė

Duomenys apie

likučius

Priėmusio asmens

duomenys

Duomenys apie

pacientą

Duomenys apie vaistinį preparatąPriėmimo data, laikas

PPracticalractical implementationimplementation andand realisationrealisation ofof nneedseeds MMT MMT

MMT ACCEPTABILITY FOR PATIENTS IN POLICE ARREST HOUSES(2007-2010 I quarter)

9,69,63,83,85,55,52,32,3Percent part in Percent part in MMT MMT from all from all opioidsopioidsmisusersmisusers

3333

1515

4545

818818

2008

9191808000Change percent of MMT acceptabilityChange percent of MMT acceptability

3232404000Continued Continued MMT MMT inside arrest house inside arrest house

((absolute number)

353550502222Was on Was on MMT MMT before arrest before arrest ((absolute number)

36336313061306969969Mental and Mental and behaviourbehaviour disorders disorders misusemisuse opioidopioidss (F11) (F11) ((absolute number)

From them:From them:

2010 I quart.

20092007Name of index

ConclusionConclusionAdvantages of continuous MMT in the police arrest houses

• Health policy in the police arrest houses becomes more integrated into national health policy

• This is a condition of equal continuous treatment in the police arrest houses

• This is one step more strengthening patient’s rights in the police arrest houses

• This is protection of trials to incriminate making harm to patients by territorial police institutions

• Presently this is most effective way to solve health problems of part of opioids addicted persons inside police arrest houses, where other possibilities are poor

• Progress of cooperation between local police and community psychiatric institutions, interested NGO’s and their representatives is encouraged and supported

• More trust and community respect to police, police arrest houses and their staff

THANK YOUTHANK YOU

ANDAND

GOOD LUCKGOOD LUCK

continuation of methadone maintenance therapy in … · that during last 2 years mmt was...

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