This procedure relates to working with young people who are on pharmacotherapy treatment.

 

When to use this procedure

When you are providing case management and supervision to a young person who is receiving pharmacotherapy treatment.

 

Practice context and legislation

  • Youth justice is committed to ensuring that responses to drug use are developmentally and age appropriate and in line with community expectations. The literature also highlights that drug and alcohol use by young people has an impact on their development.
  • The overall goal of the Youth justice drug policy and strategy (2007) is to assist young people to stop using drugs.
  • This goal is based on the belief that the use of drugs by young people is often illegal, detrimental to their health and wellbeing, and subsequently harmful to the wider community. This goal is made more complex by the youth justice context, to reach a balance between the goal of abstinence, need for rehabilitation and realistic strategies to keep the young person well and safe.
  • The overriding responsibility of youth justice is to address offending behaviour and reduce the likelihood of recidivism.
  • Helping young people to stop, or reduce, their use of substances, including opiate drugs, helps to meet this responsibility.
  • In addition, young people involved with youth justice are entitled to receive alcohol and other drug treatment equivalent to that offered to other young people in the community, both during their contact with the system and beyond the youth justice order.
  • Pharmacotherapy treatment is often referred to as substitution treatment. It involves the prescription of a drug with similar action, but with a lower degree of risk, to a drug of dependence.
  • There are a range of substitution therapies for opiates (opiates include heroin, morphine and codeine) used across the world. Methadone and buprenorphine are the two that are used most in Victoria and are the only legally available substitution therapies.
  • The National drug strategy (1997) supported the use of methadone and buprenophine substitution therapies to:
    • reduce heroin and other drug use
    • reduce drug-related crime
    • reduce drug-related mortality
    • reduce the transmission of blood-borne viruses
    • enhance social functioning
    • improve general health and wellbeing.
  • Pharmacotherapy can be effective in reducing dependence on heroin.
  • Treating illicit opiate use by substitution therapies can introduce a level of stability into young people's lives so that they are better able to work towards a drug-free lifestyle.
  • Pharmacotherapy medications remain active in the body for longer than opiates. This means a single daily dose is all that is required to prevent physiological cravings. This may allow the person to stabilise their addiction and start looking after themself.
  • Pharmacotherapy can be short term (two weeks or less) to reduce the discomfort of withdrawal from heroin or long term (months or years) to help the person reduce the harms associated with illicit drug use and improve their quality of life.
  • The youth justice pharmacotherapy program has two separate target groups:
    • maintenance – young people who are already engaged in an opiate substitute program when they enter the youth justice system
    • induction – young people who are not on a program on entry into the system, but who would benefit from pharmacotherapy, either because of their dependence on opiates or because there is a significant risk that they may relapse into opiate use.
    • Note: Naltrexone in the form of implants has not been approved or registered as a therapeutic treatment for the management of young people involved with youth justice with opioid dependence.
  • For more information regarding the use of pharmacotherapy in youth justice refer to the 'Use of pharmacotherapy / opioid replacement therapy in Secure Services' policy.
 

Roles and key tasks

Case manager

  • Undertake intake and assessment.
  • Complete referrals to drug and alcohol agencies for assessment of need for pharmacotherapy.
  • Incorporate pharmacotherapy in the client service plan.
  • Facilitate the young person's access to drug and alcohol intervention.
  • Monitor progress and communicate risks and issues to drug and alcohol professionals.
  • Reinforce harm-minimisation strategies during supervision sessions.

Team leader / team manager

  • Provide guidance and consultation on, and endorsement of, case management issues as required.

Assistant Director / Manager Individual and Family Support

  • Provide oversight, direction and monitoring of the area youth justice program.
  • Provide case consultation regarding court recommendations, breaches and young people exhibiting high-risk behaviours.

Youth Justice Senior Practice Advisor

Provide consultation on case management issues, particularly in relation to high-risk young people. This should occur subject to any local area agreements between Assistant Director / Manager Individual and Family Support and the Senior Practice Adviser.

 

The procedure in detail

Assessing drug and alcohol use history

For young people on community based orders, the primary responsibility for assessment and management of their pharmacotherapy treatment usually lies with general practitioners, community health services or specialist alcohol and other drug agencies.

It is not the role of youth justice to manage pharmacotherapy treatment.

A young person commencing their community based order may already be on pharmacotherapy treatment.

If they are exiting a custodial precinct, the Youth Health and Rehabilitation Service (YHARS) is responsible for:

  • notifying youth justice
  • referring the young person to a community pharmacotherapy provider
  • linking them with a community pharmacy.

The assessment and case planning process may suggest that a young person may benefit from treatment, either because of their dependence on opiates or because there is a significant risk that they may relapse into opiate use.

The role of the youth justice worker is to facilitate the young person's access to specialist alcohol and other drug assessment (for example, through YSAS) so that this decision can be made.

Pharmacotherapy

The pharmacotherapy support program provides support to young people involved with youth justice through the payment of pharmacotherapy dispensing fees.

Under the program, the government reimburses pharmacies for the dispensing costs of methadone and buprenorphine for young people under 19 years of age and who have an existing youth justice order.

This assistance is an encouragement for young people to begin and continue with pharmacotherapy as a replacement for opiate use.

Young people who turn 19 while on a youth justice order will still have access to the program until the completion of their order.

If the general practitioner or community pharmacy has not informed the young person that they are eligible for payment, the youth justice worker may need to fax a statement notifying the Drugs Poisons Regulations Group of the young person’s potential eligibility for the program.

Ensure that the ‘Notification form’ and ‘Informed consent form’ are completed.

Recording involvement in pharmacotherapy

Effective case management practice includes ensuring clear communication about any interventions the young person is currently engaged in.

While the youth justice worker does not have a role in recording clinical information about young people's pharmacotherapy treatment, it should be entered into the client assessment and planning that the young person is engaged in treatment. This aspect of their care may have case management implications.

Pharmacotherapy is part of the offence-related work that youth justice undertakes with young people, and relevant to their case management.

Counselling and social support

Youth justice and YHARS have a role in ongoing support of the young person and liaison, as needed, with community health services.

Youth justice workers, because of their close working relationships with young people, have a significant role in monitoring their progress and communicating with others who are involved in their care as issues emerge.

There is evidence that combining pharmacotherapy with other interventions such as counselling and social support leads to improved outcomes.

Youth justice workers, therefore, can contribute to the success of pharmacotherapy treatment through their own support of the young person and by facilitating their access to other supports needed.

This may be through specialist alcohol and other drug services or, dependent on the need identified, from a range of other agencies.

Signs of intoxication or overdose

When pharmacotherapy medications are used correctly, fatalities are rare.

In fact, an injecting drug user's risk of death from drug overdose is considerably reduced once they are stabilised on pharmacotherapy.

However, methadone and buprenorphine are potentially toxic substances.

Other drugs including alcohol, prescription medications and heroin can interact with methadone or buprenorphine and add to the risk of overdose.

This is a factor during transition to the community as young people may choose to use other substances once they are no longer confined to custody.

Youth justice workers engaged with young people who are on pharmacotherapy medication should be aware of the signs of intoxication which include:

  • slurred speech
  • unsteady movements or dizziness
  • drowsiness
  • pinpoint pupils or red eyes
  • smell of alcohol or cannabis
  • lack of inhibitions.

If a youth justice worker notices any of these signs and has concerns that a young person is substance affected, they should consult with the team leader and contact the drug and alcohol clinical counsellor for secondary consultation or an assessment.

Significant safety concerns

The safety of both the young person and the worker is paramount and actions must be taken to ensure this.

If the worker has significant concerns about the young person's level of intoxication and therefore their ability to keep themselves safe, they should arrange for the young person to be transported to medical care.

Consult with the team leader to determine the safest course of action to transport the young person to a GP or hospital emergency department.

Options include:

  • driven by youth justice in a government vehicle
  • accompanied by youth justice in a taxi
  • by ambulance where the situation appears to require this.

Refer to the procedures for 'Harm prevention and risk management' for more information.

Further information

The following sources can provide further information on pharmacotherapy treatment:

DirectLine – 1800 888 236

DirectLine, through Turning Point Drug and Alcohol Centre, provides 24-hour, seven-day counselling, information and referral to alcohol and drug treatment and support services throughout Victoria. DirectLine's counsellors are experienced in alcohol and drug-related concerns.

Drug and Alcohol Clinical Advisory Service (DACAS) – 1800 812 804

A 24-hour specialist telephone consultancy service for alcohol and drug practitioners and health and welfare workers. DACAS takes calls from doctors, nurses and other health and welfare professionals seeking advice on the clinical management of alcohol and drug issues.

 

Additional information