FILE NO:

SUBJECT:

AG1507

DIRECTOR GENERAL; METHADONE PROGRAMME BRIEFING PAPERS.

Please find enclosed for the Director General, Methadone Programme.

details of the Prison

For further information please contact Stephen Wale, A/Methadone Co-ordinator on 289 1253.

I would of course be available to answer further inquiries and recommend that the Director of the Prison Medical Service Dr Frank McLeod be present were the Director General to request such a meeting.

. APR 1989

Angus Graham, Director General.

w~_._. Stephen Wale A/Methadone Co- ordinator Methadone Unit 6th April 1989 .

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BRIEFING PAPER

PRISON METHADONE PROGRAMME

CONTENTS

MEMO AG1507

CONTENTS

INTRODUCTION

GENERAL INFORMATION

HISTORY

POLICY

*Prison Methadone Programme *National Methadone Guidelines

PERSONNEL

ASSESSMENT CRITERIA

ASSESSMENT PROCESS

DISPENSING

URINALYSIS

BLACK MARKETS

WEEKLY STATES

EVALUATION

PAROLE BOARD STATEMENT

ft .. S.W. ()£PIOf" CORRECTIVE SERVlCES LleRA~V

C00888

+

BRIEFING PAPER

PRISON METHADONE PROGRAMME

INTRODUCTION

The New South Wales Prison Methadone Programme is a recently implemented initiative currently financed by the Commonwealth government through the National Campaign Against Drug Abuse. It is the result of close and continuing co-operation between the Department of Corrective Services, the Department of Health and Prison Medical Service.

Policy

The programme is guided in its operation by two policy papers; the "Policy Paper, Pilot Methadone Programme" (March 1986) and the "New South Wales Prison Methadone Programme, Statement on Policy and Procedure" the later incorporating the former. The Pilot Programme was just that and was exclusivly a pre-release programme aimed at reducing the use of heroin and of drug related criminal activity in gaol and after release. The current Prison Methadone Programme is more inclusive (not solely pre-release) and has as a major aim a reduction in the transmission of the AIDS, and Hepatitis B virus. Both policy papers were the result of extensive liaison between the Department of Corrective Services and the Department of Health and were endorsed by both Ministers.

Aims.

This programme aims to reduce the harmful impact of the use of heroin in New South Wales prisons.

Objectives.

The objectives are:

to reduce the incidence of intravenous heroin use by prisoners;

to reduce the spread of HIV and Hepatitis B virus;

to continue methadone maintenance treatment of prisoners incarcerated whilst in treatment;

to commence methadone maintenance treatment with individual prisoners who satisfy the agreed assessment criteria;

to break the cycle of criminal activity associated with drug use;

to provide access to a range of counselling services.

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• Implementation

The Pilot Pre-release Methadone Programme operated in three institutions; Bathurst X-wing, Mulawa and Parramatta with a staff of three (Co-ordinator, Assessor and Evaluator) catering for approximately seventy inmates prior to release at anyone time. Upon release the clients could be transferred to one of three Methadone Management Units; Rankin Court, Blacktown and Liverpool.

Presently the Methadone Unit is comprised of eight staff; Co-ordinator, Clerk, four Assessors, a Sessional Worker and an Evaluator. With this staffing the Prison Methadone Programme is currently available to over two hundred and fifty inmates at anyone time at a total of eleven institutions (Bathurst, Cessnock, Goulburn, Hospital, C.I.P. M.T.C., M.R.P., Maitland, Mulawa, Parramatta and Parklea). There are now seven Methadone Management Units in the community to which inmates can be transferred upon release (Blacktown, Canterbury, Chatswood, Liverpool, Manly, Rankin Court and Sutherland).

The Prison Methadone Programme also depends on the dispense services of the Prison Medical Services clinic nurses and of course the dispensing rights of the Prison Medical Services authorised prescribers.

Planning.

It was the Commission's intention to make this service available to inmates throughout New South Wales as far as practical. Most major institutions are currently catered for.

Expanded implementation of the Methadone Programme will proceed as adequate staffing enables the Methadone Unit to do so responsibly. Co-operation between the Department of Corrective Services, Prison Medical Service and the Department of Health continues as the Prison Methadone Programme moves toward achieving the programmes aims.

The following pages contain material which supports and details the above and deals with other matters related to the Prison Methadone Programme.

IN0788.

.. . .

.. I' 1

.....

BRIEFING PAPER

PRISON METHADONE PROGRAMME

GENERAL INFORMATION

Attached is a "General Information" sheet which is produced and regularly updated by the Methadone Unit and used to answer general enquiries.

BPGI0788

METHADONE UNIT PERSONNEL

TITLE

METHADONE CO-ORDINATOR;

METHADONE CLERK;

METHADONE ASSISTANT

METHADONE KEY-BOARD OPERATOR

METHADONE ASSESSORS;

METHADONE EVALUATOR;

SESSIONAL WORKERS;

PRESCRIBERS;

LOCATION;

POSTAL ADDRESS;

TELEPHONE;

FAX;

NAME LOCATION 'PHONE

Stephen Wale RCH Level 17 289-1253

Margaret Webb RCH Level 17 289-1253

Priscilla Mitchell RCH Level 17 289-1254

Doris Rattos

Jillian Coucill

Julie Hacker

Michael Guy

Judi Fortuin

Michelle Santo

Sarah Hume

Hospital L/Bay

RCH Level 17

RCH Level 17

RCH Level 17

RCH Level 17

RCH Level 17

Station House Level 5

289-2970

289-1254

289-1254

289-1254

289-1254

289-1254

289-1540

Janet Mulholland Cessnock *0736 (049) 90 2800

Dr Frank McLeod Hospital 289-2970 Long Bay

Dr Pooba Govender Hospital 289-2987 Long Bay

Dr Alan Melman Hospital 289-2987 Long Bay

Dr Hugh Jolly Bathurst 957 2344 (063) 313 847

Dr Paul Collins Long Bay 289 2987

METHADONE UNIT Department of Corrective Services Level 17 ' Roden Cutler House 24 Campbell Street SYDNEY 2000

METHADONE UNIT Department of Corrective Services Level 17 Roden Cutler House P.O. Box 31 SYDNEY 2001

289 1253/4

289 1267, 289 1010 MUP0189

BRIEFING PAPER

PRISON METHADONE PROGRAMME

ASSESSMENT CRITERIA

The National Methadone Guidelines contain a section on "Use of methadone in prisons" in which it is stated that " ..• criteria used to assess prisoners for treatment programmes incorporating methadone may differ from that used in community programmes." (p8).

Pilot Pre-Release Methadone Programme.

Acknowledging that the prison population is different from the community in terms of physical dependence, the following are the pre-requisites for admission to the Methadone Programme:

a) propensity to use ·opioids

b) psychological dependence

c) health aspects.

Given that it was a Pre-Release Programme, only inmates who, within the first four months of commencement of the pilot programme were:-

(i) within 12-16 weeeks of release.

(ii) and had a supervised parole or after care probation period of not less than six months;

would be interviewed by the assessment team with a view to methadone management as a treatment option.

~

The assessment criteria for suitability for admission to the Pilot Pre­Release Methadone Programme were as follows;

8.1. The inmate is at least 18 years of age.

8.2. The inmate, prior to incarceration, has an established history of heroin or other narcotic addiction, as the drug of primary use; a user well entrenched in the illegal drug sub-culture.

8.3. A history of recidivist drug related criminal activity.

8.4. The viablitity of methadone as a part of the management plan for each inmate considering past history, criminal history and future prospects.

8.5. Demonstrated social and motivational factors indicating a willingness to change his/her lifestyle. Involvement in some rehabilitative alternative such as treatment centres, out-patients counselling, detoxification, etc.

8.6. The availability of a position in the community based programme which depends on residential address.

8.7. A supervised parole or after-care probation period of not less than six months. ( To enable some evaluation of the programme).

8.8. The inmate prior to admission to the programme will provide written permission for the collection of urine specimens by the Department of Health and subsequent disclosure of results to the Department of Corrective Services. The withdrawal of permission at any time will lead to automatic withdrawal from the programme.

With the introduction of the "New South Wales Prison Methadone Programme, Statement on Policy and Procedures" (October 1987), the assessment criteria were revised. These revisions resulted in a more encompassing progra~me that enabled the Prison Methadone Programme to be responsible for most inmates who were taking methadone whilst in gaol. This Policy also introduced the move to contain the spread of HIV and Hepatits B virus.

Four catoegories of prisoners were defined for the purpose of assessment.

1. Persons on methadone at the time of incarceration.

2. Persons who are physically dependent at the time of incarceration or using in gaol in a manner that constitutes significant risk of harm.

3. Prisoners eligible for release where there is a reasonable expectation that heroin use will continue or recommence on release.

4. Patients positive for HIV or Hepatitis B.

,

This policy incorporates the Pilot Pre-Release Methadone Programme so where they are not inconsistant the criteria of the pre-release programmme are still in effect. An applicant for the Prison Methadone Programme need not be within 12-16 weeks of release nor have a parole or after-care probation period.

If an inmate is breached and withdrawn from the the Programme they are ineligible to apply for reassessment months of completed withdrawal.

Prison Methadone until after three

Those inmates who are released on the Prison Methadone Programme and return to gaol are eligible to apply for assessment but that assessment will of course look carefully at the factors contributing to that persons recidivision.

AS0788.

• BRIEFING PAPER

Application

N.S.W. DEPT. Of'coRREcnVE SERVtCES LIBRARY

PRISON METHADONE PROGRAMME

ASSESSMENT PROCESS

Inmates wishing to apply for the Methadone Programme should fill out a blue "Prisoner's Application or Statement" stating why they wish to be assessed for the programme and providing details as to age, expected date of release, expected release address and any information about previous treatment programmes, especially if it was with a methadone programme. This form should be sent to the clinic from where it is forwarded to the Methadone Unit. Inmates may also be referred by other professional staff working in the gaols, usually via the 'telephone'.

For recently incarcerated inmates who enter gaol already on a Methadone Programme, the Prison Medical Service notifies the Methadone Unit in writing. This letter of notification is considered an application to be reassessed and is treated as per other applications excepting that in this case the reassessment Programme.

is given priorty over applicants not already on a Methadone

When applications for assessment are received by the Methadone Unit the applicant is sent a form letter acknowledging receipt of their application (copy attached). The application is registered and the applicant placed on a waiting list at the relevent institution. The length of wait varies between institutions from a couple of weeks to over a few months. This is determined in part by the ceiling on the number of inmates taking methadone at that institution and the nature of the gaols, especially with respect to movements. The date on which the application is received by the Methadone Unit determines the position on the waiting list and whilst simple, results in a fair, straightforward and accepted approach particularly when applicants are transferred to institutions with different waiting periods.

The applications are allocated to the relevent Methadone Assessor who is resposible for the particular institution.

To be eligible for assessment the inmate must:-

* be at least 18 years of age, * have an established history of heroin or other opioid addiction, * have a history of drug related criminal activity, * have attempted alternative treatment programmes such as treatment

centres, counselling, detoxification etc., * indicate a willingness to change his/her lifestyle, * be willing to sign a "Methadone Agreement" form outlining the conditions

of the Methadone programme, * live within reasonable travelling distance of a community Methadone

Management Unit upon release if toward the end of their sentence.

If the inmate fulfils all of these criteria they are eligible to be assessed for the Methadone Programme. In the assessment interview the Methadone Assessor offers information about methadone, the rehabilitative process and the Programme. The inmates goals are examined and alternative programmes considered. As part of the assessment, two forms are completed (copies of both are attached) a "Methadone Agreement", form on which they acknowledge that methadone has side effects, that they know the rules of the programme and are aware that breach of these rules will lead to withdrawal from the programme (copy attached). The assessment by the Methadone Assessor may not be completed after one interview as, where relevant, the Assessor consults with other agencies such as Drug & Alcohol Workers, Clinic Nurses, Psychologists, Probation and Parole Officers and previous community Methadone Unit staff, where relevant.

If the applicant is assessed as suitable for the programme by the Methadone Assessor, they are then referred to a doctor who is authorised to prescribe methadone who assesses them on medical grounds. If the doctor also considers them suitable he may then prescribe methadone for the inmate. Those assessed as unsuitable will be seen by the Assessor who will explain why they were so assessed. (For details on dosing please refer to Briefing Paper "Dispensing").

Four weeks after commencement on the Methadone Programme the inmate is again seen by the Methadone Assessor with whom they complete a "Follow Up Questionnaire" (copy attached). This questionnaire raises issues such as side effects, the degree to which expectations have been met by the programme and any changes to the inmates craving, behaviour and fitness. The follow up interview is conducted soon enough after commencement so that changes to the dose (or withdrawal) are possible and long enough after initial dosing so that the inmate has had adequate time to experience being on the Methadone Programme.

Inmates on the Methadone Programme are of course at liberty to request dosage alterations and to withdraw. Reduction and withdrawal requests need to be addressed only to the clinic nurse who can implement such. Requests for a dosage increase above 60mgs are usually subject to a blood level serum test . The inmate is of course encouraged to seek support from the Methadone Assessor in matters of dosage alteration as well as any other matters related to progress on the Methadone Programme.

Prior to inmates, release to the community they are again seen by a Methadone Assessor for a 'release interview'. At this interview the Assessor completes a "Letter of Introduction" (copy attached) which details personal, release and dose information and a "Release Assessment Summary" (copy attached) which is a brief account of the client's progress on the whilst on the Methadone Programme. These two documents accompanied by a copy of of the clients "Treatment Sheet" (which provides dosage details) and a photograph are sent to the Methadone Management Unit in the community to which the inmate is to be transferred on release.

BPAP0888 .

New South Wales Govemment <0"

Department of Corrective Services

(NAME) (ADDRESS)

Dear (SALUTATION)

Roden Cutler House 24 Campbell Street Sydney 2000 Phone: 289 1333 Telex: 176658 CORSEV Facsimile: 281 2751 DX: 22

Our reference:

Your reference:

Your application to be assessed for the Methadone Programme dated (DATE) which you sent from (GAOL) has been received by the Methadone Unit.

You have been brought to the attention of the Methadone Assessors and have been placed on a waiting list. Placement on this list is determined by factors including when you applied, the closeness of your release date and whether or not you are currently on a reduction regimen.

However, it is the policy of the Methadone Unit not to assess inmates on remand, therefore if you are still on remand and you do receive a prison sentence please inform the Methadone Unit of your change of circumstance. The application the Methadone Unit receives while you are on remand determines your place on the waiting list.

You will be seen a Methadone Assessor as soon as it is practically possible. Please bear in mind that there are others in your situation.

If you are transferred to a different Correctional Centre before you are seen by an Assessor please inform the Methadone Unit, either via a "Prisoner Application Statement" form, a letter to the Methadone Unit C/O Department of Corrective Services or via a message left with the Clinic Staff.

Thank you.

Yours sincerely

for; Stephen Wale A/Methadone Co-ordinator Methadone Unit. 10 April 1989

RA0189.

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CONFIDENTIAL

INFORMATION COLLECTION FORN FOR USE IN ASSESSMENT OF METHP~NE PROGRAMME

(SUPPLEMENTARY FORM)

3. Name ...... . ........ . ........................... .

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11.

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(a) ~h~!_y~E~!i~£~!_!!~i£i£g:

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( a ) Patient's Parents: -----------------

( b ) If both Parents Alive: ---------------------

1. 15 or under 2. 16 3. 17 4. 18 and over

1. None 2. Started but dropped out 3. Started and still going 4. Completed

1. Parent(s) 2. Husband/wife/de "facto 3. Other relatives 4 . 5 • 6 .

l. 2 • 3 • 4 . 5.

Friends Alone Other (specify) eo . · • • • • • • •

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4. Forgeg prescriptions (Forging, possessing, uttering)

5. Selling/pushing/importing drugs 6. Smoking/poss~ssing Indian Hemp 7. Other (speci fy) ••••••.••..••....•

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26. (a) What is Patient's strength of Habit (weights per day) .................... .

26. (b) y.lhat is Patient's strength of Habit: (dollars a day on average) ........ .

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.c.,' _

~~~-~£~Y-r~£i2g~-£f-~2~~i~~~E~_~£~_~£~i~~~_g£~_~irr£~_~~E2~i~s ~~~i£~~~_~£_QEi~~~~: (Exclude any of 2 days or less)

l. None 2. One 3 . Two 4- Three 5. Four 6. Five +

.!f_£~~_2£_t!~£~: What Was the Lonaest Period of Abstinence: 1. Less than 1 week ----------------~------------------------

If One or More: --------------g£~-~~~-!~~-~£~g~~!-~~£i££_~£hi~y~~:

2. 1-2 weeks 3. 3-4 weeks 4. 1-3 months 5. 4-6 months 6. 6 months +

1. Withdrew self 2. Withdrawn in

clinic/hospital 3. Withdrawn in gaol 4. Other (specify)

................................

g£~_f~li~~~_r£~yi£~~!Y_g££_!£~£~~~~~_f££_Q£~S_Q~E~~g~~EY: 1.' Never 2. Once 3. Twi ce 4. Three or more times

'If One or More: 1. Bourke St.Clinic --------------!lh~£~: 2. Wistaria House

3. Caritas Centre 4. Lan9ton Clinic 5. Drug and Alcohol Services, Parramatta. 6. Other State Psychiatric Hospital 7. General Practitioner

~3>. (I:. ') <. Q) I r'lestmount Katoomba

(c)

2. Odyssey 3 h'.H.O. 4 f-iestmead Hospital

8 Other (please specify) • .•...••.•.••..•..•..•..•..••... ,

.!!_£~£~_2£_t!2£~: ~£~_tl~~h£~2~~_t!~i~~~rr~~£~_~~~~:

M.M.U./DOCTOR FROM

1 /19 1

1 119 1

/ /19 1

/ /19 /

TO

l. 2.

119

119

/19

/19

Y~s ( )

No ()

REASON FOR WITHDRAWAL

ASSESSMENT SUMMARY

Name;

D.O.B.;

Address On Release;

Postcode;

Telephone Number;

M.M.U.;

E.D.O.R.;

Previous Maximum Dose;

Partners Administration Point;

Assesssed by;

Date of Assessment;

Institution;

Suitable/Unsuitable;

Comments;

Otfical Use Only;

Register;

MIN Number;

Data Entry by; Date; AS0289

METHADONE AGREEMENT

I, ...•...................••...••.......••..•• Request to be included on the Methadone Programme. In making this request, I acknowledge that Methadone may have side effects most of which are usually short lived.

I will discuss any problems arising from this drug with the Clinic staff.

I will permit Prison Medical Service staff and the Department of Corrective Services staff employed with the Methadone Unit, to inform the Superintendent that I am on the Methadone Programme, and upon release to inform the community unit to which I am transfering of all relevent information

I undertake to keep the rules of the programme and understand that any breach of these rules may lead to the loss of my place on the programme without further discussion.

I agree to;

Not use heroin or other drugs of addiction not prescribed by a medical practioner for me during my time on the programme;

Provide urine samples as requested under whatever supervision is required at the time and to allow those officers of the Department of Corrective Services directly involved in the Methadone Programme to have access to those results;

Use my place on the programme for my own benefit attempt to trade, sell or give away methadone whatsoever;

alone, and not for any reason

Attend regularly and on time to pick up my dose at the place and time decided by the Clinic staff;

Treat the Clinic staff with courtesy and respect and refrain from abusive language in the vicinity of the Clinic;

Attend from time to time, those groups and other activities required by the programme;

Provide a blood sample to be tested for Hepatitis B;

Present my identity card when requested at the clinic in order to receive my daily dose of methadone.

I am/am not facing extradition and am aware that were I to be extradited I would be withdrawn from the Methadone Programme, as the Methadone Unit cannot ensure transfer to a Methadone Programme outside New South Wales.

Further, I freely sign this Agreement to indicate that this document has been read by, or to me and I understand and agree to be bound by its contents.

Signature ............•.•.•............. Wi tness .........•.......•. " ...... .

Da t e ..•...•••••.••...•.......••..•.....

MA0289.

New South Wales Govemment

Department of Corrective Services

TO WHOM IT MAY CONCERN;

qNIT; ______________________ __

This is to introduce;

NAME;

ALIAS;

DATE OF BIRTH;

. PRISON;

HOME ADDRESS;

DISTINGUISING MARKS;

Roden Cutler House 24 Campbell Street Sydney 2000 Phone: 289 1333 Telex: 176658 CORSEV Facsimile: 281 2751 OX: 22

Our reference:

Your reference:

PAROLEE; Yes ( ) No () Officer Office __________________ _

E STIMA TED DATE OF RELEAS E ; ________________________________________ __

ACTUAL DATE OF RELEASE;

PROSPECTIVE PRESCRIBER; DR . Confirmed as willing to

treat the client by ________________ _ {Methadone Unit Personnel)on / /1989.

PRESENT DOSAGE; mg/ Day.

DATE OF FIRST !1ETHADONE DOSE IN COMMUNITY; ____________________________ __

PRESCRIBER/M.M.U. PRIOR TO INCARCERATION;

DATE OF COMMENCEMENT ON METHADONE IN GAOL; ___________________ _

NOTE;

Further inf or mati on may be obtained from t he undersign ed or th e Me thadone Co-ordinator with the Depart me nt of Corr ective Services .

Yours faithfull y

Methadone Ass essor Methadone Unit Date; / /19 39.

LI 0189.

RELEASE ASSESSMENT SUMMARY

NA!-1E;

Df..TE OF BIRTH;

ASSESSED BY;

DATE F.SSESSED;

REASONS FOR SUITABILITY;

BREACHES OF METHADONE AGREEMENT;

HEPATITIS B. TEST; DATE; 1 11989. RESULT;

PREGNANCY TEST;

CONCERNS;

AUTHOR;

SIGNATURE;

DATE; 1 11989.

Please refer to atta~hed treatment sheetls for history of methadone dosing and other current medication.

RA0389.

BRIEFING PAPER

PRISON METHADONE PROGRAMME

DISPENSING

Prescription

The methadone is prescribed for an inmate by a doctor registered with the Pharmaceutical Services Branch, Department of Health as an Authorised Prescriber.

Currently there are four such prescribers;

Dr Frank McLeod, Dr Pooba Govender, Dr Hugh Jolly and Dr Alan Melman.

Dr P. Collins has applied for authority to prescribe methadone.

Methadone is a schedule eight (8) drug.

Staffing

One nurse and at least one other person must be present during dosing. Only one inmate may be present in the clinic at anyone time.

Administration

The inmate is required to present their identity card and there is a check of the participants name, date of birth, and photograph on the treatment sheet. The dosage is calculated in both mgs and mls and the drug register and treatment sheet signed after administration.

Dosage

Inmates are currently commenced on a dose of 20mg (4mls) and increased at a maximum rate of Smg every three days to a level at which the inmate is "comfortable". There is a maximum dosage level in the Prison Methadone Programme of 60mg which can be reviewed through a blood serum level test. There is a maximum dosage of 80mgs in the Community Methadone Management Units.

The maximum rate of withdrawal is 2.Smg every three days. It is recognised that many experience discomfort at about 20-30mgs and that the rate may have to be slowed down to avoid further discomfort.

A dose is considered stable if the same dose has been administered daily to a client for at least four (4)weeks.

Dispensing

The methadone is administered daily. It is dispensed orally as a syrup. The inmate 'sights' the dose to satisfy themselves that it is correct. This dose is then diluted in front of the inmate by the Clinic Sister who adds water to the methadone in the dispensing container. The inmate swallows this diluted dose which is then followed by a cup of liquid. This liquid ensures that the dose has been swallowed, is further diluted and removes the unpleasant taste of methadone syrup from the inmates mouth. Orange juice has been used to follow methadone syrup as contamination with pithy orange juice would foul the use of syringes were it to be diverted. Cordial has been used at some clinics to faciliate contamination and to remove the unpleasant taste.

Some clinics administer the methadone already diluted after the the inmate has sighted the dose.

Within these guidelines there are minor variations in dispense methods between clinics dependent upon nurse and custodial staffing, the physical layout of the clinic and the expertise of the nursing staff.

The client is of course not dosed if there are signs of intoxication. The clinic nurses experience, expertise and clinical judgement is of course invaluable here.

Diversion

The experience and expertise of the clinic nursing staff is invaluable in preventing diversion of the methadone. In addition to the above dispense procedures, implemented to reduce the possiblity of diversion, the inmates are also of course closely observed by the clinic and custodial staff.

Indications of attempted diversion include;-

Holding

not swallowing, swallowing to one side, not talking freely, cheeks looking bulgy, reluctance to wash mouth out with the cup of water/cordial.

In addition to all of the above precautions, where the physical layout of the gaol/clinic enables it, inmates are held after dosing for up to ten minutes before being released back into the gaol community. This ensures that the methadone dose is well digested and contaminated by bodily fluids and also extends the observation time for indications of diversion as listed above.

The time of day at which inmates are dosed varies between institutions and is dictated to a large degree by staffing levels.

Inmates are always dosed on the day of release.

Redosing

Re-dose should only take place when;

1. The fact of vomiting has been witnessed by Clinic or Prison Staff;

2. This has occurred within a short time, i.e. minutes of leaving the clinic;

3. The inmate has to that time proven reliable and cooperative with the programme.

The decision to re-dose is to be made by the Nursing Unit Manager, and the amount should not exceed HALF of the prescribed dose.

Overdosing

The directions in case of overdosing are;

The most important effect of an overdose is RESPIRATORY DEPRESSION which can be fatal. It is easily reversed by the use of Naloxone ("Narcan") given IV or with less dramatic effect, IMI.

This dangerous side effect is made worse by the concomitant use of other non-prescribed depressant drugs, e.g.other narcotics, or tablets such as Serapax, Rohypnol, etc.

DI0888.

BRIEFING PAPER

PRISON METHADONE PROGRAMME

BLACK MARKETS

Methadone

Methadone syrup taken orally by someone who is stable on a Methadone Programme should not produce a 'high' nor a 'stone'. Taken orally by someone who has not developed a tolerance to opioids, methadone will produce virtually no high due to the slow absortion rate but will produce a marked 'stone'. Intravenous injection of methadone syrup is usually described as an unpleasant experience due to local venous irritation and the large volume of methadone injected. These factors reduce the attractiveness of methadone on a possible black market.

The dispensing procedures are designed not only to ensure that all clinical and security requisites are observed but also, to minimise the possibility of diversion of the methadone. The vigilance and expertise of Clinic Nurses and Custodial Officer's in this procedure is relied upon and appreciated. The procedures of looking for indications of oral or bodily secretion, of insisting on a drink after the dose, of holding the inmate after dosing and those procedures governing redosing, all contribute to minimising the possiblility of diverson and are detailed in the "Dispensing" Briefing Paper.

Urine

Given the consquences of providing a 'dirty' urine, the possiblity of a blackmarket in 'clean' urines cannot be ruled out and must be addressed.

The procedures of surveilance, sighting the specimen, temperature testing and randomised days of request all minimise the possiblity of substituting urines thus defeating a blackmarket in 'clean' urines. These procedures are outlined in the Briefing paper "Urinalysis". Given that a clean urine must contain methadone, most inmates (approximately 95% of the male poulation) who are not on the Methadone Programme are prevented from participating in a possible black market.

Evaluation

Study 4, conducted by the Methadone Evaluator, October 1987, provides an indication of the extent to which methadone is diverted (if at all).

Of 390 specimens from 62 inmates taken during a six month period in only 3.3% was no methadone detected and " ... in all but one case, specimens in which no methadone was detected were the first specimens taken from the individuals". (ibid p2). It is reasonable to expect no methadone to be detected in the first urine specimen after the commencement of dosing.

Systematic Urinalysis

The introduction of Systematic Urinalysis may provide the Prison Methadone Programme with information from which an indication of the extent of blackmarketing to inmates not on the Methadone Programme could be ascertained.

Conclusion

No evidence has been placed before the Methadone Unit suggesting the existence of a black market in methadone or urine.

BM0788.

BRIEFING PAPER

PRISON METHADONE PROGRAMME

WEEKLY STATES

The "States: Methadone in Institutions" detail the number of inmates taking methadone for every correctional institution throughout New South Wales each week. There are separate entries for males and females. The percentage of inmates taking methadone compared with the total population is provided for each institution.

The States are compiled every week on Friday morning by the Methadone Clerk who gains the information from the dosing nurses at each clinic. These statistics are thus accurate "to the man" as of each Friday morning. Due to a one month delay in the collection of statistics by the Methadone Statistics Unit, Department of Health the two sets of figures do not always clearly correspond and the Weekly States from the Methadone Unit, Department of Corrective Service should be relied upon.

These Weekly States figures are for all inmates taking methadone in New South Wales gaols. Those taking methadone who are not on the Prison Methadone Programme will be either

i) those who came recently to gaol, already taking methadone and are due for reassessment by the Methadone Unit for the Prison Methadone Programme.

ii) those who came to gaol with (typically) a short incarceration period and for whom their community prescriber is "keeping a place". Thus there is only a change of administration point and not a change of prescriber so they do not need to be assessed for the Prison Methadone Programme.

The Weekly States figures do not include those dosed from Periodic Detention Centres.

The Weekly States are distributed each Monday to:

Mr Angus Graham, Mr Ross Nixon, Dr Frank McLeod, Dr. Glenice Hancock, Mr Bob Hogan, Mr Danny O'Connor, Mr John Caplehorn,

Director General, Corrective Services. Deputy Dircetor General. Director,Prison Medical Service. Consultant. Chairmans Secretariat,Corrective Services. A/Methadone Co-ordinator, Department of Health. Director, Statistics Unit, Department of Health.

Please find attached a "States: Methadone in Institutions" for 16.9.88.

WS0788.

WEEK-ENDING

Institutions

BATHURST

BERRIMA

Broken Hill

Cessnock

Coana

Emu Plains

Glenn Innes

Goulbum

Grafton

Kirk- Connell

LONG BAY CENTRES Hospital

"

C.I.P.

M.R.C.

M.R.P.

/

STATES: MET.HAIX)NE IN INSTITUTIONS

/ 1988.

Sex Nl.ID1ber of inmates on the Methadone Programme

Percentage On Metha­done at institutions

l_f§]gl~ __ l ____________________________ l _________________________ _ : Male

"

"

"

"

"

"

"

"

"

Female ------------------------------------------------------------------Male

"

"

" ---------------------------------------------------------------------------------------

tMTC .". .

-:~~~~~--------------:~;~;~;~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~:~~~~~~~-------------------"

Maitland

Mannus

Mulawa

Nonna Parker

Oberoll

Parramatta

Parklea "

Silverwater

Total Males Total Females

OVERALL TOTAL

: Male

"

"

Female

Female

Male

"

Female ------------------------------------------------------------------Male

Male

NB These numbers do not include any PDC'S

BRIEFING PAPER

PRISON METHADONE PROGRAMME

EVALUATION

It is a condition of the funding body (N.C.A.D.A.) that the Prison Methadone Programme be evaluated. To implement this a Research Officer was employed to work in the Research and Statistics Division and was designated as the Methadone Evaluator. This location was to ensure a degree of objectivity and to provide the Methadone Evaluator with the resources necessary to conduct the evaluation.

The first Methadone Evaluator commenced duty on 20th October 1986, leaving 3rd August 1987 to be followed by the current Evaluator who commenced 9th September 1987.

The approach decided upon was to undertake a series of well defined, self contained studies. This would provide the Methadone Unit with rapid and relevant information with which to guide administrative decisions and an opportunity to address problems as soon as possible. With such out put of studies the Methadone Programme would also be seen to be evaluated. This approach proved to be a wise one when a major change in policy ( with the introduction of the containment of the HIV virus strategy) necessitated a change in research orientation. Thus research could be adapted to this change whereas an all encompassing study would be found wanting with major variables unaccounted for.

Long term studies are important and do provide valuable evaluation, however. This is catered for with studies such as number three (summary attached) which is updated in the proposed study number eight, giving a sizeable longitudinal evaluation of the Prison Methadone Programme.

There has of course also been ongoing and extensive research into Methadone Programmes in the community conducted by other departments and research bodies. Two studies which mention or are relevent to the Prison Methadone programme are;

Reilly,David et. al. Methadone treatment: a profile of clients in a New South Wales Program (New South Wales Drug and Alcohol Authority In-house Report Series; A 87/3) Sydney: N.S.W. Drug & Alcohohl Authority, 1987.

J. Greely, W. Gladstone, (Ed) Methadone Programmes in Australia, Policy & Practice Proceedings from the National Methadone Workshop, National Drug & Alcohol Research Centre, Sydney, March 1987.

Please find attached memo SH:GH 86/127; "Status of Methadone Research Studues as at July 1988".

EV0788.

,.:.-.-..-'-'

(

II

"

/

( FILE No. SH:GM 86/127

SUBJECT: Status of Methadone Research Studies as at July, 1988.

A. Completed Studies

Study 1: Profile of those assessed for the pilot pre-release methadone programme.

As at 1st December 1986, 129 inmates had been assessed for their suitability for admission to the programme. This study sought to: provide a profile of the inmates presenting for assessment for the pilot methadone programme; determine in what ways those who were assessed as suitable differed from those considered unsuitable; and to look for characteristics of those who were withdrawn from the programme.

Study 2: Views of inmates participating in the pilot pre-release methadone programme .

. Thirty-six inmates who had been assessed as suitable for the pilot pre-release methadone programme were interviewed in February -Harch and June 1987'to ascertain to what extent the pre-release phase of the programme was functioning in accordance with the guidelines which had been established:

Study 3: Progress report on first 201 assessments.

This study sought to track the progress of those people asse~sed for admission onto the pilot pre-release methadone programme prior to 1st June 1987. Of the 135 inmates assessed as suitable, 105 had been released from gaol onto the programme by 1st July 1987. Records were examined to determine how many of these 105 were still being maintained on methadone in the community and how many had been returned to gaol since their release.

Study 4: Results of gaol urinalyses, January - June 1987

This report presents the results of urinalyses conducted within the gaols for the six month period January - June 1987, pertaining to inmates on the pilot pre-release methadone programme .

. . . /2 ...

r""

('

,i ,\

- 2 -

Study 5: Views of key personnel involved in the administration of the N.S.W. prison methadone programme.

Personnel interviewed included: gaol superintendents, custodial officers, prison nursing staff, staff of community dispensing units, probation and parole liaison officers, prescribing doctors, drug and alcohol staff, methadone assessors, and the methadone co-ordinator. It was felt important to ascertain the views of these people on the operation of the programme in order to benefit from what they have learnt when the programme expands to new areaS.

The interview schedule consisted of questions relating to: perceived aims of the programme, problems with the programme and its operation, perceived benefits and disadvantages of the programme, attitudes towards the expansion of the programme, and suggestions for programme improvement.

B. Study in Progress.

Study 6: Results of community urinalysis.

This study looks at the urinalysis results of those on the community phase of the N.S.W. prison methadone programme over a 4 month period from November, 1987, to February, 1988. These results are compared with a matched sample of clients.who are not participants in the Corrective Services progra~e at the three community methadone units.

This research ascertains to what extent those on the prison programme continue to use drugs, and which drugs they are using. The data have been collected and analysed, a~d,the report is currently being drafted.

C. Studies to be conducted.

S~udy 7: Views of participants following release.

Interviews to be conducted with clients on the Corrective Services methadone programme who are collecting at the community dispensing units. Content of interview schedule to include: clienti' attitudes about services offered by dispensing unit staff and probation and parole liaison officers, dispensing, urinalysis, employment, education status, perceived effects of the programme on their life, expectations of the programme, and suggestions for programme improvement. This study aims both to determine any changes in employment/educational status, etc following being on the programme, and to document perceptions of benefits and problems of the programme and suggestions for improvement, etc .

. . . /3 ...

.)

(1'

l

~

- 3 -

Study 8: Progress Report

This study will seek to update Study 3, following the release of more people on the programme. However, it is hoped that a comparison group can be found, comprised of drug offenders who have been released from gaol but are not on the N.S.W. prison methadone programme. The main variable to be measured in this study is the recidivism rates of both groups.

Study 9: Methadone Literature Review ,

This review .of the methadone research and literature will have a particular focus on studies of methadone treatment of incarcerated offenders,. and probationers and parolees.

METHADONE PROGRAMME

GENERAL INFORMATION

The Department of Corrective Services is committed to the provision of a Methadone Programme for inmates to reduce the harmful impact of the use of heroin in New South Wales prisons. Two major objectives are to reduce the incidence of intravenous heroin use by prisoners and to reduce the spread of HIV and Hepatitis B virus.

From April 1986 to mid 1987 there was a Pilot Methadone Programme for inmates who were about to be released to the community. This programme ran at Parramatta, Mulawa and Bathurst X-Wing and the Methadone Management Units at Blacktown, Darlinghurst and Liverpool.

Since mid 1987 the Methadone Programme has expanded to make it available for more inmates throughout N.S.W. bearing in mind that the number of places at each gaol will necessarily be limited. Not only inmates about to be released but also those with time to serve and those coming into gaol on methadone will be able to apply for the programme.

Inmates wishing to apply for the Methadone Programme should fill out a blue "Prisoner's Application or Statement" stating why they wish to be assessed for the programme and providing details as to age, expected date of release, expected release address and any information about previous treatment programmes, especially if it was a methadone programme. This form should be sent to the clinic from where it will be forwarded to the Methadone Assessors. Inmates may also be referred by other professional staff working in the gaols.

To be eligible the inmate must:-

* be at least 18 years of age. * have an established history of heroin or other opioid addiction, * have an history of drug related criminal activity, * have attempted alternative treatment programmes such as treatment

centres, counselling, detoxification etc., * indicate a willingness to change his/her lifestyle, * be willing to sign a "Methadone Agreement" form outlining conditions

of the Methadone Programme, * live within a reasonable travelling distance of a community Methadone

Management Unit upon release if toward the end of their sentence.

If the inmate fulfils all of these criteria they are eligible to apply to be assessed for the Methadone Programme. In the assessment the Assessor offers information about methadone, the rehabilitative process and the programme. The inmates goals are examined and alternative programmes considered. As part of the assessment, two forms are completed and the inmate asked to sign a "Methadone Agreement" form on which they acknowledge that methadone has side effects, that they know the rules of the programme and are aware that breach of these rules will lead to withdrawal from the programme. The assessment by the Methadone Assessor may not be completed after one interview as, where relevent, the Assessor consults with other agencies such as Drug and Alcohol Workers, Clinic Nurses, Psychologists, Probation and Parole Officers and previous community Methadone Unit Staff, where relevent.

If the applicant is assessed as suitable for the programme by the Methadone Assessor, they are then referred to to a doctor who assesses them on medical grounds. If the doctor also considers them suitable he can then prescribe Methadone for the inmates. Those assessed as unsuitable will be seen by the Assessor who will explain why they were so assessed. The suitable inmate will commence on a low dose and increase steadily over a period of one about month to a stable dosager at which the inmate is 'comfortable', with a maximum dose of 60mg. The inmate must continue to collect their Methadone daily in compliance with clinic procedures and must provide random urine specimens weekly under supervision as requested by the clinic staff.

Upon release inmates will be transferred to one of the Health Department's Methadone Management Units in the community where they will partipate in that units programme and continue to collect their methadone.

Participation in the Methadone Programme must be voluntary and should in no way be related to parole consideration. Acceptance onto the Methadone Programme should not preclude the inmate from participating in any other programme, rather they are in fact encouraged to do so. Where possible groups will be run for those inmates on the programme to address other aspects of the rehabilitative process. Currently (June 1988) applicants may be assessed at Bathurst, Cessnock, Goulburn, Hospital, C.I.P., M.T.C., M.R.P, Maitland, Mulawa, Parramatta, and Parklea. As the programme expands inmates will be able to be assessed at more gaols throughout the state. Inmates wishing to be considered for the Methadone Programme should enquire as to its availability from clinic staff or Drug and Alcohol Workers.

For further information contact:

Stephen Wale A/Methadone Co-ordinator Department of Corrective Services Roden Cutler House 24 Campbell Street SYDNEY 2000

G.P.O. Box 31 SYDNEY 2001

289 1333

GI0688.

BRIEFING PAPER

PRISON METHADONE PROGRAMME

HISTORY

The Prison Medical Service has always assumed responsibility for dosing people incarcerated whilst on a Methadone Programme.

In 1985 the Director, Prison Medical Service, aware of an increasing number of inmates coming into gaol already on a Methadone Programme in the community, perceived a need for methadone maintenance and withdrawal programmes in New South Wales correctional institutions. This need was expressed at meetings of the New South Wales Methadone Standing Committee and the Department of Corrective Services also recognised the need. The then Commissioner directed that proposals for a Methadone Programme with-in correctional institutions be drafted which was done, guided by Department of Health Guidelines. The Department of Health indicated that it would make $100,000 available over two years to employ a Department of Corrective Services Methadone Co-ordinator and pay for extras. In 1986 a Methadone Co­ordinator was appointed and the Pilot Pre-Release Methadone Programme Policy Paper drafted. This was endorsed by the Commission, Department of Corrective Services and approved by the Ministers for Health and Corrective Services.

It was recognised that the Methadone Programme should be staffed by people with an expertise in methadone just as in the community there are specialist Methadone Management Units. However, the Methadone Programme was to be one option among others provided by the Drug and Alcohol Programmes. An integrative approach was to be encouraged and inmates offered whatever services were appropriate.

A Methadone Assessor was appointed to work with the Prison Pre-Release Methadone Programme and the first inmate was assessed on 10th May 1986.

The success of the Pilot Pre-Release Methadone Programme led to an expanded programme for 1987-88. A new policy paper was endorsed by both Ministers in October 1987 which made the Methadone Programme available to inmates previously disadvantaged in the Pilot Programme. Notably, those positive for HIV and Hepatitis B virus and those using in gaol in a manner that constitues a significant risk of harm. Concern over reducing the spread of AIDS constituted a significant introduction into the policy of the Methadone Programme.

The provision of a Methadone Programme to inmates always received strong support from the Director, Prison Medical Service and the Department of Health. The Prison Methadone Programme is an initiative of both the Department of Health and Department of Corrective Services and ongoing liaison and co-operation is facilitated by;

the representation of Department of Corrective Services and Prison Medical Service on the Methadone Co-ordinating Committee {formerly the Methadone Standing Committee}, Department of Health.

the representaion of Department of Corrective Service at the Methadone Management Unit's Team Leaders meetings.

the representation of Department of Health on the Drug and Alcohol, Methadone and AIDS Policy Advisory Committee, Department of Corrective Services.

HI0788.

f:~\J .. (C'. :;'~/

N. S. Vl. PRISOI~ ~1ETHADONE PROGRAN

STATEMENT ON POLICY AND PROCEDURE

INTRODUCTION

This paper outlines the policies covering the operation of a met had 0 n e pro 9 ram i n P • S • T'iT • P r i son s. . T his pro g ram \-1. i 11 incorporate the prisoner pre-release methadone program, provide continuing care for prisoners incarcerated whilst on a methadone programme and enable appropriate prisoners to be commenced on methadone in prison.

This policy is intended for the guidance of the staff of both the P. S. H. Depa rtment of Cor recti ve Services and the Department kof Health .N.S.n.

AIMS AND OBJECTIVES.

l\HiS.

Th is programme aims to reduce the ha rmful impact of the use of heroin in l'J.S.T':. prisons, and by making available the appropriate counselling support services to assist methadone recipients to alter their lifestyles.

OBJECTIVES.

The objectives are:

to reduce the incidence of intravenous heroin use by prisoners;

to reduce the spread of HIV and Hepatitis B virus;

to continue methadone maintenance treatment of prisoners incarcerated whilst in treatment;

to commence methadone maintenance treatment with individual prisoners who satisfy the agreed assessment criteria:

to break the cycle of criminal activity associated with drug use:

to provide access to a range of counselling services.

~ 'tiLS,W DEPT. of. CORRECTiVE: SERVICESl Ii UBRAFW ! '!~ •. ,,!.,"'T;~(j';P;'''''?_';;;:ll!'.':l~~~J!"~-I'll~~·'~-

ADIUNISTRATIOH

The programme will be administered by the Department of Corrective Services in consultation with the Department of Health and \/ith all medical decisi"ons made by the Prison Hedical Service (P.t1.S.). O\"ersighting \'li11 be the re::::pon:;;ibility of the Prison I'ledical Services Steering Committee \'lhich includes officers of both Departr.1ents. The Department of Corrective Services Drug &

Alcohol Committee will monit6r the activities of Corrective Services staff, to ensure that the methadone program is consistent with other initiatives and other activities in the AIDS and Drug use area. The Department of Health's Standing Committee" on Itethadone and the Medical Sub-Committee will monitor the activities of the P.B.S. to ensure that the medical and nursing services comply with the appropriate standards.

The Co-ordinator \'lill be employed by the Department of Corrective Services. The Co-ordinator is responsible for the overall administration and co-ordination of the program including arranging assessments, the transfer of prisoners to community programmes upon release, monitoring the total number of prisoners prescribed methadone and other activities to ensure the smooth operation of the service,

ASSESSHENT

Initial assessment of those prisoners who are to be considered for methadone but who are not on methadone \'lhen incarcerated, may be undertaken by Drug and Alcohol workers employed by the Department of Corrective Services.

Corrective Services staff will also undertake casework and supportive counselling for prisoners and probationers on methadone.

Deci~ions concerning the prescribing of methadone rests solely with authorised medical practitioners employed by the P.M.S. Except in exceptional circumstances, and where treatment with methadone is commenced outside of gaol, the prescriber will take into consideration the advice of the assessment staff prior to commencing methadone treatment.

DISPENSING AND URINE COLLECTION

Dispensing of methadone and the collection of urine specimens for screening within this programme is the responsibility of staff of the P.I";. 8.

SIZE OF THE PROGRAHHE.

Funding is consistent \v'ith a total of 500 persons in treatment \.'ith raethaoone in the prison system at any tir.1e. Treatment of r.1ore than 500 persons is subject' to the agreement of both Departments.

PRINCIPLES OF OPERATION.

Both Departments agree that the management of prisoners and probationers will, as far a~ is possible within a correctional system, adhere to the policies and procedures outlined for the operation of community based methadone programmes.

Special. attention shall be given to issues such as confidentiality of neGical records and details collected for medical treatment and assessment.

Each prisoner should provide a signed statement as an indication of informed co~sent.

170 pr isoner should be forced to accept a methadone prosram or be recommended for a methadone programme for custodial reasons.

The decision to commence methadone for a prisoner shoul~ be based on a reasonable e~pectation of a reduction in harm to his/her health and social functioning arising from intravenous drug use by that prisoner.

The decision to continue treatment should similarly be based on the expectation of continuing gains or· continued reduction of harm. Ideally, medical assessment of the individual should be und~rtaken at each time that a prescription is renewed. In continuing treatment the authorised medical practitioner should consider the views of other members of the assessment counselling and treatment team.

MANAGEMENT OF PROBATIONERS.

As a general rule, on release, probationers and parolees should be referred to public sector methadone units for continuing care except Hhere some probationers and parolees \"1ill be referred bacJ~ to their private prescribers.

Probation and Parole staff will undertake supervision of probatjoners and paroleeG concerning the conditions of their release, provide case\·lorl~ support cJnd liaise \lith the staff of methadone units concerning continuing management.

The continuity of methadone treatment with released prisone~s is the responsibility of treating medical staff, however, these prescribers should consider the assessments of probation and parole staff in deciding to continue or discontinue treatment except where persons have been released without the condition of supervision by the Probation and Parole Service.

Probationers and parolees are subject to th~ normal conditions and rules which apply to other clients in community methadone programmes.

ASSESSMENT CRITERIA.

Four categories of prisoner are distinguished for the purpose of assessment.

1. Persons on methadone at the time of incarceration.

The decision to continue or to terminate methadone rna intenance should be made by the prescribing medical officer utilising information from assessment staff. Dosage, length of prev ious treatment and length of sentence should· (inter alia) be considered at this time. Short term current treatment (e.g. a few days), a long sentence and a remote gaol may be factors indicating inappropriateness for continuing methadone treatment.

2. Persons who are physically dependent at the time of incarceration or using in gaol in a manner that constitutes sicnificant risk of harm.

Prisoners admitted to gaol physically dependent have a right to hUmane treatment of their withdrawal symptoms. However, this may not be an indication for cpntinuing methadone maintenance.

Prison provides an ideal opportunity for some prisoners to discontinue their use of all drugs, consequently consideration of the use of methadone may not be appropriate where a prisoner wishes to abstain or is likely to abstain.

Whereas physical dependence is not an essential requirement for methadone maintenance, in decicing to prescribe methadone the authorised practitioner should be of the opinion that the advantages of using methadone will outweigh the disadvantages for that individual.

Methadone should only be prescribed where ther~ is the reasonable expectation that a reduction in harmful behaviour by the individual concerned vlill fo1101'1.

Prolonged methadone treatment may be considered inappropriate for long term prisoners.

3. Prisoners elicible for release Hhere there is c reasonable expectation that heroin U8e will continue or recom~ence upon release.

The operation of the prisoner pre-release programme is a model for this category of prisoner. Specifically, a history of drug use must be verified and a conviction by assessment staff that harmful heroin use will recommence on release.

4. Patients positive for HIV or Hepatitis B virus.

The containment of HIV and hepatitis B is a primary goal of this programme. Persons who are positive for these viruses should receive special consideration in assessment and in providing access to methadone.

The conce rn is· \d th needle sharing by these pr isone rs. Therefore the prenence of the virus itself is not sufficient reason to prescribe methadone. There must be a reasona bl e expec ta t ion by assessment staff of the danger of needle use and needle sharing.

Persons \li th no previous history of intravenous drug use would not normally be eligible for a methadone programme.

All aroups.

An assessment by Corrective Services staff r:hould prE'ceo'2 the d'2cis·ion by the medical practitioner to prescribe for groups 2, 3 and 4 and for decisions concerning continuing treatment in long term prisoners in group 1.

Although the decisions to prencribe and the responsibility for treatment rests solely ...,ith the prescribing medical officer, these should be made follovling recom~endations made by the assessment staff.

EVALUATION

The evaluation of the programme should be based on measuring the achievement of the"stated objectives.

The funding is currently on a yearly basis and continuing funding should be contingent on a favourable evaluation.

Alterations to this policy should be negotiated between both Departments as necessary.

Prepared by

RICHARD BALmnN Department of Health N.S.W. October 1987.

BRIEFING PAPER

PRISON METHADONE PROGRAMME

URINALYSIS

Urinalysis in the Methadone Programme provides;-

i. a clinical monitoring of the clients medical condition.

ii. a case management tool to detect a need for counselling and intervention, including possibly breaching.

iii. a monitoring tool for the management of possible diversion and black marketing.

The National Methadone Guidelines, 1988 state that " ••. the monitoring of drug taking by random collection and analysis of urine specimens is an important part of treatment programmes incorporating methadone." (pll).

Schedule

In the Prison Methadone Programme at least two urine specimens are taken per week on days determined randomly. The inmate is asked for the specimen prior to dosing and if necessary, dosing is delayed until a specimen can be supplied • Provision of a specimen is a condition of the Methadone Agreement which is signed by the inmate uppn being assessed as suitable for the Methadone Programme.

Analysis

The specimens are collected in non-sterile containers and sent to the Oliver Latham Laboratories for analysis. The Prison Medical Service uses a 'non­evidentiary' procedure.

Cost

The test costs $7.20 ($6.20 without cannabis screening) and the costs are met completely by the Department of Health.

Administration

The results are received two to three weeks after sampling and are recorded in a register. Community Units, Clinic nurses, Methadone Assessors, Director of Nursing and the A/Methadone Co-ordinator are currently designing a system for recording Urinalysis results which is consistent with community practices to be used throughout New South Wales gaols. The results are considered to be medical recqrds and are thus confidential. Methadone Assessors with the Department of Corrective Services are granted access to these records by the inmate when they sign the Methadone Agreement.

Collection

Specimens are collected under supervision. Whether this is done by custodial staff or nurses in the presence of custodial officers varies between institutions due to staffing levels, physical layout of clinic facilities and the sex of the people involved. Community Methadone Management Units utilise television cameras and one-way mirrors to observe clients providing specimens. Whether this is "better" than direct observation is open to debate.

Inmates are required to fill the specimen jar. This is not only to provide the laboratory with a sufficient sample but also to make the secreting of a substitute specimen on the body as difficult as possible.

The specimen is sighted for colour and appearance and its temperature is taken with an electronic thermometer. This last measure has only recently been introduced and is being trialled. All indications are that it is a very good detector of substitution as it is very hard to maintain a substitute specimen between two very specific temperature limits. Community Methadone Management Units do not use a tempreture test other than feeling the container.

Dirty Urines

A 'dirty urine' prescribed for methadone.

is defined as the inmate by

one which shows the presence of a drug not a medical practioner or the absence of

UA0888.

( , ".

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Subject:

Parole Board

METHADONE PROGRAMME - PAROLE BOARD File No.: 88/1 006

JMH:VW

1 The Parole Board recognises that a methadone programme may benefit only so~e peoplei that some inmates may not wish to apply for a methadone programme and that some inmates may be assessed as unsuitable for a methadone programme.

2 The Parole Board may recommend that an inmate request assessment for the methadone programme.

3 The Parole Board cannot recommend that an inmate be accepted on a methadone programme.

4 The Parole Board does not consider an inmates decision not to apply nor the assessment of an inmate as unsuitable for the methadone programme to be an indication not to grant parole.

5 The ~arole Board is looking for a personal commitment by the inmate toward rehabilitation. Participating in a methadone programme is not necessarily evidence of this, as being on a methadone programme may not be a genuine guarantee of personal commitment~

~"-M~ M Hutchinson A TING SECRETARY

.12 August 1988

Forwarded, as directe~ .

IrJ. e--. ~. Mr S Wale A/Methadone Co-ordinator Methadone Unit DEPllRTMENT OF CORRECTIVE SERVICES

RECENEO \ 5 f\UG 1988 . ~tW JD

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