As the public body primarily responsible for the provision of treatment and rehabilitation services, the Health Service Executive welcomes the report of the Comptroller and Auditor General on drug addiction treatment and rehabilitation. The key issues identified in the report which are of relevance for the executive are those relating to the setting of targets for waiting times for methadone treatment, the expansion of needle exchange services, and the upgrading of the current national drug treatment reporting system to provide improved information in regard to non-opiate treatment.
The Health Service Executive fulfils its responsibility in regard to the provision of treatment and rehabilitation services through a combination of direct provision by executive staff, significant funding of voluntary agencies to provide services on its behalf, and a broad range of partnerships with community-based groups and agencies. Individuals presenting for treatment for opiate-related issues are provided with a full and comprehensive assessment in terms of both their medical and psycho-social needs. The range of interventions includes assessment, stabilisation, harm reduction measures, care planning, methadone maintenance, counselling, and detoxification within specialist clinics, residential settings and community settings. It should be noted that due to the complexity of this client group, people will enter and re-enter services and may need interventions on more than one occasion. This necessitates focused engagement and flexibility.
The approach adopted by the Health Service Executive has enabled us to exceed the national drugs strategy target of 6,500 places for the provision of methadone treatment, with a 73.3% increase from the 5,032 patients in treatment as at 31 December 2000 to 8,718 as at 31 December 2008. It has also allowed us to develop innovative responses to facilitate the roll-out of needle exchange services throughout the State. We have developed appropriate responses to emerging needs within existing resources. The executive has also commenced the roll-out of the rehabilitation strategy.
As referenced in the Comptroller and Auditor General's report, the funding committed to addiction services has increased year-on-year over the lifetime of the national drugs strategy from 2001 to 2008. In 2008, €101.87 million was spent by the Health Service Executive on specific addiction services provided either directly by the executive or by community and voluntary addiction services funded by it. This represents an increase of more €45.9 million from 2001 levels of funding. In addition, it should be noted that mainstream health services such as accident and emergency, acute hospitals and mental health services address the treatment needs of alcohol and other substance misusers who avail of them. Those services are not included in the figure of €101.87 million.
Notwithstanding current pressures on Health Service Executive finances, the numbers receiving treatment continue to rise and addiction services continue to develop. Provision was made for 3,686 additional methadone treatment places from 2001 to 2008. Needle exchange services have been established in 13 local drug task force areas and five regional drug task force areas, covering the areas most affected by opiate misuse. The establishment of the national addiction training programme, in partnership with Waterford Institute of Technology and the community and voluntary sectors, resulted in the upskilling of 1,645 front-line staff, utilising 17 evidence-based treatment modules. This training has enabled the Health Service Executive addiction service to respond to the changing trends in prevalence, such as polydrug use involving cocaine, alcohol and so on, as well as keeping a focus on opiate abuse.
The Health Service Executive as the lead agency has commenced the implementation of the report of the working group on drugs rehabilitation by establishing the national drugs rehabilitation implementation committee and employing a national senior rehabilitation co-ordinator. This committee is developing a rehabilitation framework for all addiction services, as recommended in the report. The Health Service Executive welcomes recognition in the report of co-ordination arrangements already in place in several areas.
We acknowledge the challenges that exist in regard to waiting times for treatment in certain parts of the State where drug usage has increased significantly in recent years. While there are approximately 600 clients on waiting lists, more than 10,000 clients received methadone treatment in 2008. Furthermore, 454 patients successfully completed treatment and ceased their methadone maintenance programme in 2007, a figure that has been increasing year-on-year since the commencement of the strategy. The fact that clients have commenced and remained on a methadone programme is of immense significance in stabilising the quality of their family life, workplace involvement and social interaction. This is particularly relevant as approximately 35% of patients received methadone services from a local general practitioner.
To address the issue of waiting times, the Health Service Executive, with the assistance of minor capital grants from the Department of Community, Rural and Gaeltacht Affairs, is developing additional methadone clinics in Limerick city, Cork city, the south east, the midlands and the north east this year. The recruitment of additional level one and two GPs and pharmacies to participate in the methadone programme is essential to reducing waiting times for treatment. The Health Service Executive is actively pursuing this through our GP and pharmacy liaison officers. In 2008, 274 GPs and 496 pharmacies participated in the methadone maintenance scheme. An on-line level one GP training module is available through the Irish College of General Practitioners to assist with the recruitment and retention of GPs at community level. This will facilitate the transfer of clients from Health Service Executive clinics to community-based provision. The executive intends to recruit an additional liaison pharmacist to support pharmacies outside the greater Dublin area to participate effectively in the protocol.
While methadone maintenance is the main form of treatment, the Health Service Executive, in collaboration with the Department of Health and Children, is currently undertaking a suboxone feasibility study. We expect to have 80 clients in treatment in both clinic and community-based settings by year end.
The HSE's collaboration with the Irish Pharmacy Union, pharmacy providers and the Elton John AIDS Foundation will see access to harm reduction or needle exchange services available countrywide by year end. It is hoped that this significant public health measure subsequently will have a positive impact on both health and social gain for heroin users and the community at large.
Finally, in regard to updating the national drug treatment reporting system, the HSE acknowledges that it now is time to develop an Internet-based system that will collect data on client access to all addiction services, including counselling, support services and methadone, as well as to client treatment progression; and on service costs aligned to treatment provision. The HSE has commenced this process with the support of the Health Research Board and plans to develop an Internet-based system for the entire country building on local systems that already have been established as pilots. This system will be made possible with the introduction of a unique identifier for clients accessing addiction services.