TRANSFORMATION JOURNEY OF TREATMENT AND REHABILITATION

PROGRAMS IN MALAYSIA:COMPULSORY OPEN ACCESS SERVICES

CURE & CAREDR. SANGEETH KAUR

NATIONAL ANTI DRUGS AGENCYMINISTRY OF HOME AFFAIRS

MALAYSIA

- 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

1975

2010 onwards

2

Evolving government policies towards Treatment and Rehabilitation of Drug Dependency

Category of Drug Dependents 2011 2012 DECREASE (%)

New Drug Dependents 6,956 5,270 -24.24

Repeat Drug Dependents 4,238 3,745 -11.63

Total 11,194 9015 -19.50

Total no of registered drug dependents since 1988 till 2012 are 345,234 individuals

COMPARISON STATISTICS OF DRUG DEPENDENTS 2011 AND 2012

PROFILE OF DRUG DEPENDENTS 2012

0

1,500

3,000

4,500 4,354

2,820

3 3 5689

311,090

6 13 1

Type of Drug

Num

ber

78%Malay

9%

12%

0%0% 1% MELAYUCINAINDIAPRIBUMI SABAHPRIBUMI SARAWAKLAIN-LAIN

< 13 TAHUN13-15 TAHUN16-18 TAHUN19-24 TAHUN25-29 TAHUN30-34 TAHUN35-39 TAHUN40-44 TAHUN45-49 TAHUN≥ 50 TAHUN

0 200 400 600 800 1,000 1,200 1,400 1,600 1,800

024

2711,506

1,5771,611

1,317964

744974

No of drug dependents

Age

whe

n de

tect

ed

Adults, 29.85%

Youth,

66.88%

Teenagers, 3.29%

98 % DRUG DEPENDENTS ARE MALE

77.4% BETWEEN THE AGES OF 18-44

91.6% USE TRADITIONAL DRUGS LIKE HEROIN/ MORPHINE/ MARIJUANA

/ 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% ?

Compulsory Treatment

Reluctant & Resistant Clients Problems in the

DRCs

Treatment Services

Programs in DRCs and those

undergoing Supervision

Parents, Families

StigmatizedResidents – criminalized

(records)

Changes Impact of New

drugs on ClientsNeed for Clinical

Approach

Why NADA needs to Transform?

Stakeholders

GTP & NKRAConcept of 1Malaysia

Success Rate 75% ?50% ?20% ?10% ?

Compulsory Treatment

Reluctant & Resistant Clients Problems in the

DRCs

Treatment Services

Programs in DRCs and those

undergoing Supervision

Parents, Families

StigmatizedResidents – criminalized

(records)

Changes Impact of New

drugs on ClientsNeed 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

AADKDAERAH

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

TRANSFORMASI

Treatment Wards

Registration Office– Sg. Besi

Psychiatrist/ Medical Officers

CONCEPTOPEN 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

CLINICAL SERVICES2 VOCATIONAL

TRAINING AND JOB PLACEMENT 3

• 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

PSYCHOSOCIAL1

13

PROGRAMME PROVIDED

Bkt. Mertajam 15/10/10

Kota Bharu15/10/10 Papar

01/11/10

Tampin 04/04/11

Sg. Besi 01/07/10

Kuching 15/10/10

Tampoi 15/10/10

Jerantut 01/07/11

Karangan01/05/12

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

Tampin 04/04/11

Dengkil07/01/13

(TILL April 2013)

Distribution

C&C CLINIC CAPACITYCLIENT REFERRAL

& ADVOCACY

TOTALINPATIENT OUTPATIENT

SG.BESI 150 135 74 7 216KOTA BHARU 50 50 42 13 105

BKT MERTAJAM 40 35 51 8 94TAMPOI 100 61 2 1 64

KUCHING 30 19 7 0 26PAPAR 40 20 3 2 25TAMPIN 75 54 92 111 257

JERANTUT 100 77 4 5 86KARANGAN 100 100 59 0 159

BACHOK 20 15 16 0 31DENGKIL 100 25 14 0 39

CURRENT NO ( 30 Apr 2013) 591 364 147 1102ACCUMULATIVE JAN - APR 2013 1449 1278 2248 4975

ACCUMULATIVE 2012 5043 3854 3869 12766ACCUMULATIVE 2011 3028 2259 4080 9367ACCUMULATIVE 2010 666 772 117 1555

ACCUMULATIVE 2010-2013 10186 8163 10314 28663

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, arson No incidence of violence or arson

FUN, EFFECTIVE & EASY TO IMPLEMENT APPROACH

YEAR TYPE OF SERVICE

TOTAL NO OF

CLIENTS DISCHARGED

CLIENT STATUS

ENTRY TO COMPULSOR

Y CENTRE

UNDERGO REHABILITATI

ON IN COMMUNITY

PRISON COMPLIANT NOT ABLE TO BE TRACED*

2010Inpatient 560 3 0.54% 15 2.68% 3 0.54% 455 81.25% 81 14.46%

Outpatient 294 0 0.00% 5 1.70% 1 0.34% 278 94.56% 10 3.40%

2011Inpatient 2590 36 1.39% 203 7.84% 27 1.04% 1819 70.23% 455 17.57%

Outpatient 1600 11 0.69% 129 8.06% 8 0.50% 959 59.94% 504 31.50%

2012Inpatient 3230 49 1.52% 271 8.39% 49 1.52% 2153 66.66% 885 27.40%

Outpatient 2527 24 0.95% 507 20.06% 5 0.20% 1367 54.10% 632 25.01%

TOTAL 10,801 123 1.14% 1130 10.46% 93 0.86% 7031 65.10% 2567 23.77%

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 servicesReady to

recommend the clinic to family and friends

OUTCOME STUDY AT C&C CLINIC

Drug use history

Substance30 days

BEFORE first visit to C&C

Past 30 days

Heroin 67.1% 4.8%

Benzos; Dormi, Clona, Valium, Xanax

12% 2.0%

Syabu, Meth, Ice 13.9% 2.1%

Pil Kuda 3.3% 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 accessOUTCOME 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 2nd 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 prisonsOUTCOME 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 trainingKAJIAN KEBERKESANAN PROGRAM KLINIK

C&C OLEH UNIVERSITI MALAYAOUTCOME STUDY AT C&C CLINIC

CRIME HISTORY

Institution BEFORE C&C Since coming to the C&C

Lock-up 3.50 0.57

Prison 1.06 0

PUSPEN 0.61 0

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

Experienced serious depression, sadness, hoplessness, or loss of in-terest

Experienced serious anxiety/tension-uptight, unreasonably worried, inability to feel relaxed?

0

5

10

15

20

25

30

26

22

11 11

30 days before coming to C&C

In the Previous 30 Days

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

1. UNODC (United Nation Office of Drug And Crime)

2. UNAIDS3. WHO4. IDPC (International Drug Policy

Consortium)5. Pengiktirafan daripada Negara Luar

PENGIKTIRAFAN ANTARABANGSA

28

Drug Issues and Priorities for Southeast Asia

24th IFNGO Conference, Kuala Lumpur

Gary LewisRegional Representative, UNODC

8 November 2011

Positive example: Malaysia’s Cure and Care 1 Malaysia Clinics

(Gary Lewis. Regional Representative, UNODC)

Commendation by Mr. Andrew Marshall, Journalist from Al-Jazeera

AFTERCARE SERVICES

AFTERCAREOptions 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

OutpatientCCSC

CCH

CCVC

TransCC

NADA District Offices

NADA

VISIONS AND TARGETS

People TargetsCapacity Building – Training for officers, partners, volunteers

Process TargetsEngaging Strategic Partners and Smart Partners

Strategy TargetsScaling up of Community-based services /programs

Outcome TargetsBetter outcome and success rate in treatment & rehabilitation

Nation’s TargetsHealthier people, drug-free country

By 2015

STRATEGIC PLANNING FOR COMMUNITY-BASED SERVICES / PROGRAMS

CCH / MOBILE UNITSC&C

1MALAYSIA CLINIC

CCSC

What are N.A.D.A’s

Future Plans?

By 2015

STRATEGIC PLAN (2011 – 2015)

No. of Compulsory Rehab. Centers

(CCRC) (4)

No. of CCSC – 98

No. of CCH – 96

2015

CCSC

2015

CCH

2015

C&C 1Malaysia

Clinic

No. of C&C 1Malaysia Clinics

(18)

THANK YOUTERIMA KASIH

We Care, We Serve