Managing Hard-to-Manage Patients Sharon Stancliff, MD Medical Consultant New York State Department...
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Transcript of Managing Hard-to-Manage Patients Sharon Stancliff, MD Medical Consultant New York State Department...
Managing Hard-to-Manage Patients
Sharon Stancliff, MD
Medical Consultant
New York State Department of Health AIDS Institute
New York, NY
Drug Users
IDU directly accounts for 44% ofAIDS case reported by June 2000
Ongoing drug users often perceivedof as hard to engage, poorly adherent, and difficult
Education can help to bridge the gap
Syringe Access
Pharmacy access: those over 18may purchase up to 10 syringes at registered pharmacies
Clinic access: article 28 facilities may register to sell or furnishup to 10 syringes
Syringe exchange programs: 13 in NYS
Goals
Public health: primary and secondary prevention
Health promotion: open the door for honesty and education
Sanitation: promote proper disposal
Drug Treatment
“Do you want to stop or reduce use?”
Treatment alternatives and limitations
— Few treatments have solid track records
— We know little about how people stop abusing drugs
— Users know this on some level
0
20
40
60
80
LTR STR ODF MMTP
PrePost
LTR: long-term resident.ODF: outpatient, drug-free. MMTP: methadone maintenance treatment program.STI: short-term inpatient.Adapted from Hubbard: Overview of 1-year follow-up outcomes in the (DATOS).g
Weekly Cocaine Use Before Treatmentand at Month 12 Follow-Up
Pat
ien
ts (
%)
Methadone Maintenance
Given a high enough dose, the majority will stop heroin use1
At lower doses, risky behavior is reduced with significantly lower risk of seroconversion to HIV positive2
1Ball 1991, Leavitt 2000. 2 Drucker 1998.
MMTPs
Require frequent attendance
Concerns about diversion create an atmosphere of mistrust
Education about true risks and benefits is often lacking
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