Characteristics of the drug treatment population in New South Wales - - PowerPoint PPT Presentation

November 2019 – APSAD Conference, Hobart, Tasmania Emma Black1,2,3, Rachel Deacon1,2, Llewellyn Mills1,2, Adrian J Dunlop4,5, Nadine Ezard3,6,7, Raimondo Bruno3,8, Anthony Shakeshaft3, Michael Farrell3, Jennifer Holmes9, Michelle Cretikos9, Mark Montebello2,3,10, David Reid11,13, Steven Childs12, Krista Siefried6,7, Kristie Mammen1 and Nicholas Lintzeris1,2,13

1 Drug and Alcohol (D&A) Services, South Eastern Sydney Local Health District (LHD), Sydney, Australia, 2 Discipline of Addiction Medicine,

Sydney University, Sydney, Australia, 3 Faculty of Medicine, University of NSW, Sydney, Australia, 4 D&A Clinical Services, Hunter New England LHD, Newcastle, Australia, 5 School of Medicine and Public Health, University of Newcastle, Newcastle, Australia, 6 D&A Services, St Vincent’s Hospital, Sydney, Australia, 7 National Centre for Clinical Research into Emerging Drugs, Sydney, Australia, 8 School of Medicine, University of Tasmania, Hobart, Australia, 9 Centre for Population Health, NSW Ministry of Health, Sydney, Australia, 10 D&A Services, North Sydney LHD, Sydney, Australia, 11 D&A Services, Illawarra and Shoalhaven LHD, Wollongong, Australia, 12 D&A Services, Central Coast LHD, Gosford, Australia, 13 NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN)

Characteristics of the drug treatment population in New South Wales – focus on amphetamine type substances (ATS)

A COQI Project

Acknowledgements

• Clients of participating treatment services
• Staff across participating NSW Local Health Districts (LHDs),

including:

• Directors and Managers of Drug and Alcohol Services,
• Data Managers and Custodians
• Clinicians
• Project Officers, Research Officers & Administrative Staff
• Research Governance and Ethics teams
• The funder: NCCRED
• The COQI and MA Data Project Teams

Credit: cliparting.com

Background – what makes this project unique?

• ~2016 Introduction of EMR to AODTS: CHOC
• Presents a new research opportunity to inform treatment
• Enables us to ↑ understanding of real-life large-scale

clinical data

• across client populations
• at a point in time, and
• over time
• Focus on public outpatient treatment
• excludes detox, NGOs, private providers

CHOC data includes

• Pre-existing NSW MDS-DATS, such as
• age
• sex (binary)
• principal drug of concern (main drug people are seeking treatment for)
• main treatment type (e.g. counselling, case management, OST)
• Addition of Australian Treatment Outcomes Profile (ATOP)

Ryan et al. 2014–past 28 day

• substance use (alcohol, heroin, other opioids, cannabis, amphetamines,

cocaine, benzodiazepines, tobacco, injecting)

• life situation & stressors (days work/study, homelessness/risk of eviction,

caring for/living with children, arrest, violence to self/others)

• health and wellbeing (self rated psychological wellbeing, physical

wellbeing, overall quality of life)

Background – why amphetamine-type substances?

• 2nd most common drug of concern in AOD services, after

alcohol AIHW, 2018

• However, limited understanding of these clients as a group Bartu et al, 2004;

McKetin et al., 2018

• Gaps in population level knowledge:
• characteristics of people who use ATS in AOD services
• their participation in health services
• AOD treatment outcomes
• Topic of ongoing media and political interest
• we need evidence to inform these discussions!
• Improving our understanding of this important and

diverse group of people will enable us to better meet their treatment needs.

Today’s aims:

• 1. Provide preliminary example of the type of work that

can be done

• 2. Describe characteristics of people who use ATS in the

NSW public outpatient AOD treatment population

• Currently gathering data that includes follow ups – will enable us

to look at outcomes Specific question:

Is there a difference in the health and wellbeing of clients who have recently used ATS at entry to treatment compared to clients who have not?

Wellbeing at treatment entry

N=3,031 outpatient clients across 4 NSW Local Health Districts, Jan-Dec 2017 Wellbeing: self-ratings of physical health, psychological health & quality of life (good/poor)

Image credit: www.bandt.com.au

Client descriptors (N=3,031, calendar year 2017)

Not used ATS in past 28d N=2,388 Used ATS in past 28d N=643 Sig. Total clients N=3,031 Demographics Age: mean years (SD) 39 (12.3) 35 (9.7) p<0.001 38 (11.9) % Male 68% 69% ns 68% Principal Drug of Concern Alcohol 53% 11% p<0.001 44% ATS 8% 49% 16% Cannabis 17% 11% 16% Opioids 22% 29% 24%

Client descriptors (N=3,031, calendar year 2017)

Not used ATS in past 28d N=2,388 Used ATS in past 28d N=643 Sig. Total clients N=3,031 Demographics Age: mean years (SD) 39 (12.3) 35 (9.7) p<0.001 38 (11.9) % Male 68% 69% ns 68% Principal Drug of Concern Alcohol 53% 11% p<0.001 44% ATS 8% 49% 16% Cannabis 17% 11% 16% Opioids 22% 29% 24%

At Assessment: days of ATS use, past 28 days

2388 14186 35 43 21 21 14 40 12 8 10 38 2 18 6 17 6 3 1 7 8 2 5 9 6 6 3 75 200 400 600 800 1000 1200 1400 1600 1800 2000 2200 2400

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728 Frequency Number of days used in past 28 No recent ATS use N=2388 Any recent ATS use N=643

All clients at assessment: life situation, stressors & substance use, past 28 days

17% 15% 37% 15% 21% 61% 11% 8% 11% 13% 31% injected non-OST opioid use cannabis use benzo use ATS use alcohol use violence (self/other) arrested living with child <5y housing stress work/study

At Assessment: life situation and stressors, past 28 days

33% 10% 12% 7% 9% 24% 24% 7% 12% 17% work/study housing stress living with child <5y arrested experienced violence (self/other) Not used ATS in past 28d Used ATS in past 28d

**** **** **** **** **** **** p<0.001

At Assessment: substance use & injecting, past 28 days

63% 31% 12% 13% 2% 6% 1% 52% 61% 28% 23% 6% 58% 10%

Alcohol Cannabis Non-OST

• pioids

Benzodiazepines Cocaine Injected Shared equipment

Not used ATS in past 28d Used ATS in past 28d

**** **** **** **** **** **** **** **** p<0.001

At Assessment: Clients reporting poor health & wellbeing

48% 38% 42% 62% 45% 58%

Psychological health Physical health Quality of life

Not used ATS in past 28d Used ATS in past 28d

**** *** **** *** p ≤ 0.001 *** p ≤ 0.0001

Analysis – binary logistic regressions

• Is amphetamine use itself significantly associated with

poorer health and wellbeing at treatment entry?

• or is it better explained by other factors (e.g. age, sex, housing stress,

violence, other substance use)?

• Ran 3 separate binary logistic regressions looking at:

1. Psychological health 2. Physical health 3. Quality of life

• Full multivariate regression
• Sensitivity analyses (backwards & forwards stepwise

regressions) yielded similar results

Factors associated with poor psychological health at treatment entry

1 2 3 4 injected

• pioids

cocaine cannabis benzos ATS alcohol violence (self/other) arrest housing stress live with child under 5y work/study sex (male) age

✱✱✱✱ ✱✱ ✱✱✱✱ ✱✱ ✱

Predictors of poor physical health at treatment entry

1 2 3 4

injected

• pioids

cocaine cannabis benzos ATS alcohol violence (self/other) arrest housing stress live with child under 5y work/study sex (male) age

✱✱✱✱ ✱✱✱✱ ✱ ✱ ✱✱ ✱

Predictors of poor quality of life at treatment entry

1 2 3 4

injected

• pioids

cocaine cannabis benzos ATS alcohol violence (self/other) arrest housing stress live with child under 5y work/study sex (male) age

✱✱✱ ✱✱✱✱ ✱✱✱✱ ✱✱✱✱ ✱✱✱

Regression Summary

Poor psych health Poor physical health Poor quality of life

Older age

**** ***

Sex (male)

****

(women rate more poorly)

****

(womenrate more poorly)

****

(womenrate more poorly)

Work/study

****

(not working= poorer)

Live with child under 5y Housing stress

** ****

Arrest Violence (self/other)

**** * ****

Alcohol use

**** **** ****

ATS use

**** * ***

Benzodiazepine use

**** ** ***

Cannabis use

*

Cocaine use Non-OSTOpioid use

** *

Injected

Take home messages

• Important to consider days of use, not just PDOC
• ↑ ATOP completions  more informed service provision

 hopefully better outcomes for clients!

• Huge potential for use of EMR data to inform services
• See COQI symposium on Wednesday morning for more info
• n this!
• ATS use at entry to treatment is associated with poorer

self-ratings of health and wellbeing at that time, even when other factors accounted for

What next?

Treatment outcomes: do ATS use play a role?

• Similar, but larger, dataset
• 6 LHDs
• People entering AOD treatment mid-2016-mid 2019
• Includes assessment and follow up ATOPs
• Combined dataset in preparation
• Focus on OST
• Large % of Tx population; CHOC inc ATOP now permits us

to look at use of drugs that are not principal drug of concern & outcomes (e.g. change in drug use; health & wellbeing)

Preliminary data: n=544 people entering OST with a follow up (3-9mths later), 3 LHDs

22% 27% 28% 16% 19% 7% 5% 9% 13% 20% 40% 39% 47% 23% 43% 6% 4% 8% 22% 12%

0% 10% 20% 30% 40% 50% poor quality of life poor phys health poor psych health ATS use non-OST opioid use violence (self/other) arrested living with child <5y housing stress work/study

Assessment Follow-up

Thank you

Image: www.freepik.com

Contact: emma.black@health.nsw.gov.au