The Netherlands Drug Situation 2010 - Trimbos-instituut

the programming of (often long-term) care for addicted patients with complex problems.The guideline presents suggestions for a target-group analysis when different types ofcare are considered for patients with complex problems. The basic subjects for such ananalysis are patient needs, access to patients, and linking a care program to these needs.The use of this guideline is considered to be improved by a brief additional training ofprofessionals.Chapter one of the guideline contains four subjects:1. a description of the usefulness of patient profiles: how to increase the response rate,how to reduce drop-out rates, and how to increase the effectiveness of treatment orcare;2. steps to be taken toward such a profile: management support within the organisation,sketching the context, data collection, determining the need of care, constructing apatient profile, organizing feedback, and a specified description of the best fit of caresupply;3. information on target group analysis: by a multidisciplinary working group inside anorganization, if necessary supplemented by external expertise; and4. reflections on the time and man power needed to realise this analysis: 10-30 days for2-3 professionals, working group time some six months.In the second chapter of the guideline the constituent steps are described for theanalysis of the target group. Working schemes and elaborated examples are described inthe last part of the guideline.11.2.7 Pharmacological treatment for drug dependence among prisonersThe guideline for pharmacological treatment among prisoners was issued by the Ministryof Security and Justice and the Institute for Quality in Health Care (CBO). The guidelinewas supported by a consensus working group with members from different professionaldepartments: 1) professionals from the forensic medical, psychological and psychiatriccircuit; 2) nurses and medical specialists in prisons; 3) pharmacists, and 4) physicians,specialized in addiction. The initial target was to construct a guideline for methadonetreatment in prisons, but the target population very often has more problems besidessubstance use. These other problems (e.g. comorbidity) forced the working group to castthe net much wider, including other medical interventions. Still, the impetus of thisguideline lies on opiates dependence.The Department of Judicial Institutions (DJI) of the Ministry of Security and Justiceendorses the following explicit points of departure or principles. Prisoners should receiveefficient health care with comparable quality as in general health care, they should alsobe treated with the same evidence-based interventions as people outside prison, andcontinuity of care should be guaranteed when addicted prisoners need it.The guideline consists of ten chapters, covering the following issues: the effectivenessof pharmacological treatments for substance dependent prisoners; epidemiological dataon drug dependence in prisons, the state of the art of pharmacological treatment ofopiate dependence in general; criteria for the eligibility of prisoners for methadonetreatment, suggestions to cope with comorbid problems among prisoners when they receivepharmacological treatment (e.g. infectious diseases, somatic disorders, psychiatricdisorders, pregnancy), criteria for decision making concerning the use of benzodiazepinesamong opiate dependents in prison, decision making criteria targeting the use of othermedication by target group members (e.g. naltrexone, tranquilizers), the organization of165