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Thursday, 17 Dec 2009

Special Report No. 64 of Comptroller and Auditor General: Drug Addiction Treatment and Rehabilitation (Resumed).

Mr. John Buckley (An tArd Reachtaire Cúntas agus Ciste) called and examined.

Ms Kathleen Stack(Assistant Secretary, National Drugs Strategy, Department of Community, Rural and Gaeltacht Affairs) called and examined.

I draw everyone's attention to the fact that while members of the committee enjoy absolute privilege, the same privilege does not apply to witnesses appearing before the committee. The committee cannot guarantee any level of privilege to witnesses appearing before it. I remind members of the long-standing parliamentary practice to the effect that members should not comment on, criticise or make charges against a person outside the House or an official, either by name or in such a way as to make him or her identifiable. Members are also reminded of the provisions within Standing Order No. 158, that the committee shall also refrain from inquiring into the merits of a policy or policies of the Government or a Minister of the Government or the merits of the objectives of such policies.

I welcome Ms Kathleen Stack, Assistant Secretary, national drugs strategy, of the Department of Community, Rural and Gaeltacht Affairs. Ms Stack, please introduce your officials.

Ms Kathleen Stack

I am accompanied by Mr. Michael Conroy, principal officer in the drugs unit in the Department.

I welcome Dr. Jean Long, head of alcohol and drugs research unit, Health Research Board. Dr. Long, please introduce yourself.

Dr. Jean Long

I am on my own.

I welcome Ms Alice O'Flynn, assistant national director social inclusion, HSE. Ms O'Flynn, please introduce your officials.

Ms Alice O’Flynn

I am accompanied by Mr. Liam Keane, national specialist for social inclusion with the HSE and Mr. Joseph Doyle, national rehabilitation co-ordinator.

I also welcome an official from the Department of Finance.

Mr. John Conlon

I am a principal officer in the sectoral policy division.

Mr. Buckley, please introduce Special Report No. 64 on drug addiction treatment and rehabilitation.

Mr. John Buckley

We are dealing with Special Report No. 64 — drug addiction treatment and rehabilitation. The focus of that report was on examining progress over the period 2001-2008 looking particularly at whether required treatment was being made available in a timely way; the arrangements in place for evaluating treatment effectiveness and how well the services were co-ordinated.

The report identified gaps in provision, care planning and co-ordination which I outlined in two previous sessions. The first meeting in July 2009 reviewed the role of the HSE and the co-ordinating role of the Department of Community Rural and Gaeltacht Affairs. The second meeting in September 2009 considered drug treatment and rehabilitation in the criminal justice system.

In the meantime, a new drugs strategy, National Drugs Strategy 2009-2016 was published on 10 September of this year. I would like to touch on one particular matter on this occasion. A recurring theme throughout the report and more generally is the need for better information. Gaps in knowledge include the extent to which illicit drug taking develops into problem drug use, the number of persons who use drugs but do not seek treatment, the actual demand for treatment and the time people are waiting to be assessed for that treatment, treatment completion rates and outcomes for individual clients and the costs of the various treatment services.

Clearly, more people use drugs than seek treatment. However, from the viewpoint of information the collection and analysis of accurate data on treatment would be a good starting point. In that area there are two existing information sources. First, a statutory register of all patients receiving methadone is maintained — this is known as the central treatment list. Second, the national drug treatment reporting system which is a database maintained by the Health Research Board based on information provided by drug treatment service providers. However, the capacity of the national drug treatment reporting system to provide information, which would be useful for both service planning and evaluation of effectiveness, is limited in particular since the database in its current form is not a reliable basis for estimating the numbers receiving treatment, the type of treatment provided or the outcome of the treatment in individual cases. By comparison, the use of a unique identifier in other jurisdictions allows for the collection and analysis of that type of information. As well as this, information gaps arose due to the fact that some service providers did not make returns to the national drug treatment reporting system and there were differences between service providers in how data was recorded. The new National Drugs Strategy 2009 — 2016 signals that consideration will be given to the adoption of a unique identifier and acknowledges the need to record the outcomes of treatment and provide information in a timely way. I am sure the Department and the Health Research Board will provide updates of plans and progress in that regard.

Thank you, Mr. Buckley. Would Ms Stack like to make her opening statement?

Ms Kathleen Stack

Thank you, Chairman. I welcome the opportunity to bring the committee up to date on three recent developments since last July: First , as the Comptroller and Auditor General outlined, the National Drugs Strategy 2009 – 2016 was launched in early September. Its overall strategic objective is to continue to tackle the harm caused to individuals and society through a concerted focus on the five pillars of supply reduction, prevention, treatment, rehabilitation and research. The strategy sets out a range of actions across its five pillars to be delivered over the next eight years by Departments and agencies. As the Comptroller and Auditor General outlined, the strategy was launched in early September and its overall strategic objective is to continue to tackle the harm caused to individuals and society through a concerted focus on the five pillars of supply reduction, prevention, treatment, rehabilitation and research. The strategy sets out a range of actions across its five pillars to be delivered over the next eight years by Departments and agencies. It also provides for the establishment of the office of the Minister for drugs the functions of which will include facilitating the co-ordination of the implementation of the strategy across statutory, community and voluntary sectors. Each Department and agency involved is currently preparing a progress report and implementation plan for their actions under the strategy and these will be reviewed in January by the Oversight Forum on Drugs, which is chaired by the Minister of State, Deputy Curran. The primary role of the forum will be the high level monitoring of progress during the lifetime of the strategy.

The second development is the national substance misuse strategy. The development of a broader substance misuse strategy, capturing both alcohol and drug misuse, also comes within the ambit of the drugs strategy. A new steering group, jointly chaired by the Department of Health and Children and the Department of Community, Rural and Gaeltacht Affairs and comprising representatives of the key statutory, community, voluntary and industry sectors, has been established to address this policy alignment and development. A public consultation process is now under way and interested parties are being invited to submit their views on the content of the integrated strategy by Friday, 22 January 2010.

The third development is the prevalence of opiate use. With regard to its prevalence, the general consensus is that while heroin use has been relatively stable in the Dublin area during the past number of years, its usage has become more widespread across the country. The rate of new entrants to treatment has dropped significantly, by approximately 20% in the period between 2001-02 and 2006-07, and the average age of those in treatment has increased from 28 to 33 in the same period; the experience of service providers bear this out.

In this context, the National Advisory Committee on Drugs published the outcome of a study on opiate use last Friday based on data from 2006. The study indicates there were 11,800 known opiate users in Ireland in that year. The NACD also sought to tentatively quantify additional opiate users in the study. In that context it is important to state that there is considerable doubt over the estimate produced of a further 9,000 users who did not come into contact with any of the services. The NACD study shows a number of trends which are also of note: the rate of opiate use among females and males aged 15 to 24 decreased, indicating a significant reduction in the number of young people commencing heroin use; an increase in opiate use outside Dublin and a higher proportion of opiate users in treatment in Dublin than elsewhere, reflecting the more recent spread of opiate use outside Dublin and the later development of treatment services. I hope this brief overview is of help to the committee in its deliberations.

I thank Ms Stack for that. May we publish her report?

Ms Kathleen Stack


I invite Ms Alice O'Flynn to make her opening statement. I apologise as some members have to leave as a vote has been called in the Dáil.

Ms Alice O’Flynn

The HSE similarly welcomes the opportunity to update the committee on issues raised in the Comptroller and Auditor General's report and subsequently when the HSE appeared before the committee in July. I will give an update on five issues. First, in regard to case management and key working in addiction services, the national rehabilitation co-ordinator on my left, Mr. Joe Doyle, has undertaken an analysis in the four regions of the HSE, Dublin mid-Leinster, Dublin north east, the HSE south and the HSE west, to identify where formal case management key working approaches are in place in the addiction services. This analysis showed that a key working system is in place in the majority of addiction services in three of the four regions. Formal case management systems are not a commonly utilised tool in the health services. This is a useful baseline for the national rehabilitation co-ordinator who, as part and chair of the National Rehabilitation Implementation Committee, is due to deliver a national framework for rehabilitation early in 2010, which will address the issue of case management and key working in the addiction services.

Second, in regard to Suboxone, an expert group set up by the Department of Health and Children to examine the use of Suboxone recommended the introduction, in the short term and as a feasibility study, of the prescribing and dispensing of Suboxone in specialist addiction clinics with pharmacies and supervised dispensing on site and in a selected number of community settings, namely, level 2 GPs and community pharmacists. The study would run for a year and prescribing and dispensing at the study sites would be evaluated before a decision was made on whether to extend prescribing and dispensing to the entire community. Pharmacists and GPs have been recruited to be part of the study spread across different addiction services. The study will be evaluated in February or March 2010. The numbers of clients active in the study currently is 43. The study commenced in June.

In regard to needle exchange services, the report of the NACD-NDST working group on needle exchange provision in Ireland in November 2008 assessed the role of needle exchange in harm reduction and the extent of provision in Ireland. The report stated that worldwide, "A substantial number of drug injectors have been attracted to these programmes and have been provided with a range of services which cannot be suitably offered by other health services". It showed how needle exchange provision in Ireland reflected the areas where most injecting took place and estimated 44,663 exchanges in 2007 predominately in the Dublin area. The report also pointed out the lack of needle exchange services in the north east, the south east, the west, the south and the north west. The Comptroller and Auditor General's report had also identified the north east and south east as two areas which had no needle exchange services. The NACD-NDST report recommended piloting the provision of needle exchange services through community based pharmacists. Following discussions between the HSE and the Irish Pharmacy Union, 65 needle exchange services will be put in place in rural towns in 24 counties through a pathway of rural pharmacists, co-ordinated and led by a national liaison pharmacist.

This initiative has secured funding from the Elton John AIDS Foundation which has been active in Ireland for several years with small projects to prevent the spread of blood borne illness. The pharmacists will be trained in February 2010 and the programme will be rolled out during the course of next year. Pharmacists will advise injectors on their general health needs and the health consequences of injecting and they will encourage injectors to take up treatment. This will be done on a one-to-one basis.

In regard to providing additional treatment services to respond to the increase in heroin use outside of Dublin, additional facilities and clinics are required in the south east, the south, the north east and the midlands and reconfiguration of the facilities in the mid-west is also needed. The provision of additional clinics requires new facilities or the upgrading of existing facilities, recruiting additional level 2 GPs with the back-up of nursing and counselling staff, which is essential, and proactive engagement with local communities. It is a significant challenge to put in place additional services through the reframing of existing services and resources, nevertheless, plans are in place to develop service capacity in Gorey, Wexford, Waterford, Cork, Tralee, Limerick, Dundalk and Drogheda throughout next year. We also intend to develop capacity in Mullingar and Portlaoise, which may require capital funding.

With regard to the national overdose prevention strategy, a group is currently meeting and is finalising its recommendations on best practice in regard overdose prevention. This will draw on international literature and use the reports of the national drug related deaths index as background materials. Once the recommendations are agreed and published, engagement will take place with wider stakeholder groups, including the HSE drugs services, community and voluntary sectors, local and regional drugs task forces, the Garda Síochána, ambulance services, the Family Support Network and representatives of services users. This engagement will take place with a view to maximising the chances of the recommendations being implemented. I hope this is helpful to the committee.

Can we publish that statement?

Ms Alice O’Flynn


I call Deputy Broughan to begin with his questions.

I welcome all our colleagues and thank them for attending the committee. I wish to ask Ms Stack about one or two recent changes made in the area of drug prevention and rehabilitation. Was the Department consulted by the Department of Education and Science on the major cut in the resources for the rehabilitation and support programme, or RASP as it is known in my constituency? She might have heard a representative of a programme in Ballyfermot in west Dublin on "Morning Ireland" yesterday complain bitterly that the programme's funding for drug rehabilitation will be cut by a third in 2010 and eliminated in 2011. I know at first hand of the work of RASP in north Coolock and I have seen what it has done for vulnerable people coming out of addiction. I appreciate this is a policy issue, but will Ms Stack indicate if the Department was consulted in any way about this major cut in that key service? Ms Stack said the strategy is built on five pillars. One of them is rehabilitation. Now it appears that a core rehabilitation programme is being devastated.

Ms Kathleen Stack

No, the office of the Minister of State with responsibility for drugs was not consulted. I am aware of what the Deputy is talking about. It relates to a number of what were originally local drugs task force projects that were mainstreamed in 2001. We were not consulted in advance. It was a policy decision by the Department of Education and Science.

A former member of this committee, the Minister of State, Deputy John Curran, is responsible for the public policy role in this area with regard to the Department. Rehabilitation is one of the five pillars and it is clearly important for people who are making heroic efforts to get out of addiction and stabilise their lives. Should it not be a core pillar?

Ms Kathleen Stack

It is a policy decision by the Department of Education and Science, and I cannot comment on that. Obviously, however, the office would be very concerned that this substantial cut is being applied in 2010 and the projects are being phased out in 2011. It is something the Minister, Deputy Curran, and the officials in the Department will be discussing with the Department of Education and Science to see what can be done about it.

Chairman, I can give an example of the impact of this. I will read from a letter sent to me by Mr. John Curry, a community leader in north Coolock. He said the RASP project has been a mainstream project since 2000 and has funding of €200,000 per annum. Following cutbacks it will be reduced to €134,000 in 2010 with no funding in 2011, which will result in the closure of our project. Mr. Curry has gone on to state:

Communities such as ours already struggle on a daily basis with a very high level of drug and alcohol misuse and these cuts will leave the community at the mercy of drug dealers and all that entails. Clients who already avail of this service will most likely return to prison at a cost to the already over-burdened taxpayer.

I put this on the record because I believe it is how many people in similar projects feel.

Did anybody in the Department of Finance contact the Department about the major cuts in excise duty? Did anybody ask the Department to do a cost-benefit analysis of those cuts? In the last few days a number of doctors have vigorously criticised these cuts, given the impact with regard to deaths from alcohol.

Ms Kathleen Stack

At official level neither I nor my colleagues had any discussions. It might have been discussed at ministerial level but I cannot comment on that as I do not know.

How many projects throughout the country have been affected by these cuts?

Ms Kathleen Stack

Some 38 projects.

Does that mean that all 38, according to the current plan, will cease to exist 2011?

Ms Kathleen Stack

That is my understanding from what the Department of Education and Science has told us.

It is a policy matter, Chairman, but if we regard it as one of the pillars——

That will be the fall-out from the policy, rather than being the policy.

There is the issue of whether there are cost-benefit analyses being conducted continuously about policy changes.

I welcome the representative of the Health Research Board and the opening contribution. With regard to the extent and breadth of the drug programme, there is a key figure in the board's research series which was helpfully provided by our staff. The figure, which the witness appears to debunk, shows that there were almost 9,000 opiate users in 2006 who had not come into contact with any drug treatment services. That is in the board's study on the estimated rise in the number of opiate users in Ireland. Second, there appears to be an average figure of drug misuse for up to five years before anybody goes to seek treatment. What is the situation in that regard? The extent of the problem appears to continue to rise. New cases presenting were 800 in 2002, rising to 1,100 in 2007. Is it the case that the demand for treatment continues to rise and that this is still a major social problem?

Dr. Jean Long

First, the report to which the Deputy referred is a report from the national advisory committee on drugs, not a report of the Health Research Board. However, I am a member of the national advisory committee on drugs and I was on the research advisory committee for that report, so I can comment on it. It is true the estimate we provided is that between 8,000 and 9,000 people appear not to be known to the services. However, we know that estimate is an over-estimate because we have had much success in getting people into treatment and out of police custody. The overlap, therefore, between treatment and police custody is very small. The technical process used to calculate the estimate, and it is only an estimate, needs a good overlap. The statistician who did the estimate had reservations about publishing it and has made it very clear that it is an over-estimate and that the likely estimate would be smaller. However, he cannot say by how much.

In 2006, the national advisory committee, of which Dr. Long is a member, put the figure at just under 12,000 opiate users. I read elsewhere in the papers provided to us that the figure could be up to 20,000, which seems to incorporate the 9,000 I mentioned. How many known opiate users are there today? What is the estimate of the likely overall number of users in the Republic?

Dr. Jean Long

The estimate of the known opiate users is approximately 12,000.

Has Dr. Long any more recent figures than those for 2006?

Dr. Jean Long

Yes, we have figures for 2007 for the number of known opiate users in treatment. In 2007, there were 11,538 opiate cases, which is slightly different from individuals. As we do not have a unique identifier some of those people would come back more than once to treatment. In 2009, there are 11,657 cases in treatment.

Dr. Long said the statistician was unhappy about the other figure. Has there been any attempt to examine that figure? From where, for example, did the figure of 9,000 emerge? Was it voluntary agencies or the HSE? Who gave that figure?

Dr. Jean Long

The figure of 9,000 comes from a statistical exercise using a statistical method known as capture-recapture. One uses a number of data sources to estimate this number. What one is looking at is the overlap between the data sources — how many people appear in more than one data source and how many people appear in all the data sources. The more overlap there is, the more reliable is the estimate at the end. Unfortunately, in this case our overlap was very small so our estimate of unknown users was very large. The reason our overlap was very small was that, in truth, we are victims of our own success in that we now have too many people in treatment and too few people in police custody. That is a major problem in doing a statistical exercise. It is very good for the patients but not very good for the statistics.

Since the Comptroller and Auditor General did the report on the performance of drug treatment services, this is our third meeting with the different agencies and this issue, the fact that we do not have a unique identifier, has arisen repeatedly. When will we come to grips with this? We cannot follow the individual through from the start to, hopefully, rehabilitation and return to normal life. When will we have a unique identifier?

Dr. Jean Long

As a researcher, my biggest interest is in having a unique identifier. The most powerful studies are longitudinal studies, which a reporting system like this could provide if it had a unique identifier. The Department of Health and Children is currently drafting Part 2 of the health information Bill. This Bill will provide a framework for a unique identifier. The Bill is fairly well progressed at this stage. I hope that next year we will have legislation that will allow us to introduce a unique identifier, not only to the drug treatment databases but, more importantly, to all our health service databases so that they can all talk to one another, and we can have more reliable estimates of what is going on in our communities.

I wanted to ask Dr. Long about one or two other points, but would the Department or the HSE care to comment on that? Clearly, this is a major problem in evaluating the performance and cost of the treatment.

Ms Kathleen Stack

It has been an ongoing issue in terms of the unique identifier. The Department of Health and Children has told us that the health (information) Bill, to which Dr.Long referred, will be published in March or April and is expected to be enacted by next summer. That will progress things concerning that issue. It is tied up with data protection and privacy issues, which are difficult to grapple with. It is something that we are certainly very keen to advance because it would be a huge step forward in tracking individuals.

To return to the research board, another obvious sad and tragic indicator of the prevalence of drugs in society and the havoc it wreaks in people's lives, is the National Drugs Advisory Board's figures on deaths from drug use. The majority appear to be male and in the 30-44 age bracket. What general picture emerges from the research undertaken by the HRB? For example, in recent years, how many people suffering from addiction died tragically and prematurely?

Dr. Jean Long

Between 1998 and 2005 there were 2,442 drug-related deaths. The majority of these deaths, 64%, occurred due to poisoning. The remaining deaths occurred due to medical or traumatic causes. The main causes of poisoning are opiate-related deaths. Heroin is an opiate, but there are other opiates that cause people to die. The non-poisoning deaths were mainly due to medical causes, such as liver disease, respiratory disease or blood-borne viruses. The traumatic causes were mainly due to hanging, drowning, shooting and other violent types of death.

I also noticed from one of the papers to which Dr. Long referred, that alcohol was present in about two-thirds of these cases, with cannabis being the most commonly found illegal drug. Perhaps Dr. Long could comment on that. Is that basically the picture?

Dr. Jean Long

Yes. Opiates were the main cause followed by alcohol and some of the pharmaceutical drugs, such as benzodiazepines. Benzodiazepines are most commonly known as Valium and Diazepam itself. They are significant contributors to drug-related deaths.

I note another key finding is that in a number of these 2,500 tragic cases, to which Dr. Long referred, the people concerned were driving at the time of their deaths. They had a positive toxicology with one or more of these drugs. We have the findings of the Medical Research Bureau on that, but — and I have been asking this question in my other role at transport spokesperson for the Labour Party — does that indicate the absolute necessity to work on a roadside-based drugs toxicology test?

Dr. Jean Long


It is a clear finding of this paper on the havoc wrought by drugs.

Dr. Jean Long

Yes, there is no doubt. At the moment there is no reliable roadside test that can be used. There is clear need to develop something like what can be done for alcohol, so that at least one can do some preliminary screening on the roadside to select whom one wants to do more detailed screening on. Until that type of testing is available, there is very little that can done about drug-driving.

Could we say therefore that in any one year, there are about 400 deaths from drugs, excluding gangland killing?

Dr. Jean Long

Some of that is gangland killing, if they have drugs in their system.

So 232 deaths would be from poisoning, 63 are medical and 83 would be suicides and trauma?

Dr. Jean Long

That is right.

Approximately 400 in total.

Dr. Jean Long

Yes, for 2005.

With regard to gangland killings, the Minister for Justice, Equality and Law Reform answered one of my parliamentary questions on this area, as he does frequently for Deputies. Do we have precise knowledge of the horrendous number of deaths in recent years, where opiate use was subsequently discovered?

Dr. Jean Long

Our brief on the drug-related deaths index is to collect data on persons who died, either directly or indirectly due to drug use. They must have some evidence of a history of drug dependence or toxicology in their system to be included in our index. The only people included in our index from the gang violence are those whom we knew were drug users, so it would not be an accurate measure of drug-related violence in the drugs crime scene.

One of the features in recent years has been a fairly significant spread of the problem across the country to other cities, as well as small towns in rural Ireland. How do the tragic 2,442 deaths break down between the Dublin region and outside it? Does Dr. Long have that information?

Dr. Jean Long

Yes, I do. For the 400 that the Deputy talked about in his earlier briefing, some 119 of the poisonings were outside Dublin. Some 40 of the medical and traumatic deaths were outside Dublin. Therefore, 159 of the 400 deaths occurred outside Dublin.

So it is obviously becoming a very serious problem right across the country.

Dr. Jean Long

It is. We know that poisoning is more common outside Dublin, but that is because drug use has not been there as long. One sees the consequences years down the road, which is what we are seeing in Dublin.

To return to the Department, how much has currently been allocated to drug treatment rehabilitation in the past year? In 2010, how much funding will go directly to rehabilitation treatment and how much will be spent in administrative costs?

Dr. Long must leave at 11.30 a.m. so perhaps Deputy O'Brien wishes to come in.

I am happy enough. Many of my questions would be directed towards the Department and the HSE.

If Dr. Long would like to leave now, she may do so.

Dr. Jean Long

Thank you, Chairman.

My question was about total costs.

Ms Kathleen Stack

I do not have the figures on treatment and rehab because that would be a matter for the HSE to comment on. In 2010, the Department will fund the activities of local and regional drugs task forces with a budget of €36.2 million.

How much of that is front-line and how much is administrative? Does Ms Stack have any figures on that?

Ms Kathleen Stack

In terms of the task forces?

Ms Kathleen Stack

I do not, to be honest, but we can probably get the figure. We can do some work on it and revert to the committee.

I have the new drugs strategy to hand. Ms Stack stated the Elton John AIDS Foundation was providing funding for some of the programmes. Is she concerned that we are relying on a charity group, irrespective of how well intentioned it may be, to implement what should be major Government programmes?

Ms Kathleen Stack

Again, it is more appropriate for the HSE to comment on that. It is involved with the foundation.

Ms Alice O’Flynn

When we got into discussions with the Elton John AIDS Foundation, one point we considered very seriously was that the funding it was giving to us, as part of expanding the needle exchange harm reduction programmes, was clearly a once-off sum. It is to be allocated over a three-year period. We intend to ensure that the funding will be sustained over the relevant period and that the situation the Deputy identifies will not materialise.

How can one ensure the funding is sustainable?

Ms Alice O’Flynn

As I said, we are looking at a three-year period. We are all the time considering how the resources we currently spend and the manner in which they are targeted can be maintained to respond as the situation changes. We have a three-year period in which to plan this with the Elton John AIDS Foundation in terms of the expansion of the needle exchange programme and, as I said, bringing in the pharmacists. That involves significant work in regard to the expansion of needle exchange programmes and will, we believe, be a very cost-effective way of expanding the programmes in the future. With those kinds of factors, that is what we would be looking at.

I welcome that comment on needle exchange. Following the expansion of the needle exchange programmes, will there be any significant areas in which there will not be a needle exchange programme? Ms O'Flynn referred to an expansion of the needle exchange programme and the concentration on areas outside the Dublin region. One of the major complaints has been the lack of needle exchange programmes around the country. Can we take it this matter has been addressed for most or much of the country?

Ms Alice O’Flynn

Yes, it would be our intention to address it as extensively as possible. That is why we are targeting those areas that the Comptroller and Auditor General, the NACD and NDST report identified. We would have acknowledged it anyway from our own work on the ground.

How many people are not receiving methadone? How many are waiting for methadone treatment? Ms O'Flynn referred in her contribution to Suboxone and to the beginning of a programme in respect of these substances. What is the position on methadone at present?

Ms Alice O’Flynn

I have figures for the Deputy pertaining to the period to the end of November 2009. The total number of patients who were in treatment at the end of November was 9,062.

One report stated there were 600 people on the HSE waiting list, mainly outside the Dublin region. Is this still the case or have we come to grips with the problem?

Ms Alice O’Flynn

In July, the total number of people waiting was 541. I do not have a more up-to-date figure for the Deputy because, as he will appreciate, the figures change in that there is a cohort of the population that is particularly vulnerable. Young people under 18, pregnant women, and people with HIV status do not wait but go immediately into treatment. The Deputy will also be aware that, in terms of the number waiting, some are on waiting lists in particular areas of the country. We are going to target these areas to address the problem.

Does the HSE have the breakdown? In what areas are the most people waiting?

We were told in July when the HSE was before us that eight new units were to be opened around the country within a matter of months.

Mr. Liam Keane

In July, we committed to opening the clinics in various places. There are three stages. First, we must find the new facilities. The second stage is recruiting level-2 GPs and backup staff for the clinics and the third is dealing with local opposition and difficulties of that nature. An ongoing process involves targeting areas where there are waiting lists with a view to providing additional clinics. In July, we had targeted eight and we are now targeting more. We have opened additional clinics, including two in Cork city and one in Dundalk. With regard to the others mentioned in our submission, we secured facilities in most of the areas.

Kerry, Drogheda, Limerick and Enniscorthy.

Mr. Liam Keane

With regard to Enniscorthy, we agreed we would put two clinics into Wexford instead of one. One will be in Gorey in the north of Wexford and the other will be in Wexford town. This will better meet the geographical spread of people who are not only on the waiting list, but also in clinics elsewhere.

The HSE told us previously that in the midlands, including the Chairman's territory, some people were waiting for more than a year. Is that still the case?

Mr. Liam Keane

It is still the case but we are working on it in terms of getting clinics in place. We are targeting specifically the south east, the north east, the midlands and the southern area to achieve a reduction. Our target in the national service plan for 2010 will be to reduce the waiting list so everybody concerned will receive methadone within one month. That will require all the clinics. We are very much in the process of putting them in place.

What is the total cost of keeping patients on methadone and what is the cost per person?

Ms Alice O’Flynn

The cost varies depending on the part of the country. Our estimates are that in Dublin North, the cost of services per person treated was €7,034 per annum. In the south east, the cost per person was €2,769 per annum. On average, we estimate that the cost for last year across the country was €2,500 per annum.

Why is there a huge divergence between Dublin North and the south east?

Mr. Liam Keane

Some of these clinics are high-support units and have many support staff. Some of the others, particularly because of the scale and volume, are scripting clinics. Some incur considerably greater costs than others. Our experience is that the numbers are smaller around the country. The chaotic nature of the clients in some of the Dublin clinics is not evident to the same extent around the country.

With regard to methadone, some of my colleagues felt the duration of methadone treatment is such that it could be argued the drug treatment policy is more about containment than helping people to move beyond addiction and return to normal life and work. What is the position now? The report of the Comptroller and Auditor General states the number of people who went into detoxification was very low compared to the number on methadone, which is approximately 9,000. Has a cost benefit analysis been conducted of detoxification versus methadone maintenance? How will the Department go forward in this regard? The most effective treatment is to encourage people not to depend on drugs or drugs substitutes. Has work been done since on resources for detoxification?

Ms Alice O’Flynn

It is difficult to do a cost benefit analysis of detoxification versus methadone maintenance as detoxification might be something people would do on more than one occasion. For a number of clients of our services who have particularly entrenched addiction issues, relapse, detoxification, reducing dosage, etc. is sometimes a cyclical period they go through. To try to do a cost benefit analysis of that would be problematic. We have not attempted to do that up to now.

We were struck in the Comptroller and Auditor General's report by how few detoxification beds there were and how few opportunities there were, for example, in the prison setting, which the committee dealt with previously. Is there a basis for investing more resources in detoxification?

Mr. Liam Keane

We have established a national residential rehabilitation working group between DCRGA, the probation and welfare service, the HSE and voluntary service providers and we are looking at detoxification as part of that process because we want, in the first case, to work with the voluntary service providers to reconfigure and work on a more integrated approach to our services, which would involve detoxification. As well as that, in HSE south, we have funded four additional detoxification adult beds and in our report we say we are funding two under 18 detoxification beds but we have further developed that in recent months to a detoxification service through the Aisling community in Ballyragget, County Kilkenny, which we will roll out with them in 2010. We are progressing detoxification and we are aware more beds are needed.

During 2008 almost 3,000 people came off methadone, of which 446 finished their treatment. What happened to those who did not? What outcomes were achieved by the two Departments?

Ms Alice O’Flynn

The number of people in treatment runs at approximately two thirds in clinics and one third in the community. From our GPs working in the community and other colleagues in the addiction services, we know the number of people who are in treatment are managing their lives well and, therefore, it is not necessarily the case that they must finish treatment to get on with their lives and do the things we all do all the time. This is important because the picture of people in methadone treatment and the stigma that still attaches to that as a treatment option is something we want to counter as much as possible.

With regard to the rehabilitation work we are undertaking, my colleague, Mr. Doyle, is leading out in it and we will assert that positively in line with what we intend to do but also in line with those who use our services and who are coping in difficult circumstances while they take methadone.

Does the HSE know how many of those on methadone will be on the treatment for the rest of their lives?

Ms Alice O’Flynn

I do not have figures with me on that.

According to figures I have, 9% of clients have been on methadone for more than five years , 5% for more than seven years and 1.3% for more than ten years.

Will that continue to be the case?

Ms Alice O’Flynn

I cannot comment on that. It is not my field of expertise to be able to comment in a confident way on that.

Next year, we also intend to review the methadone protocol in regard to level 1 and level 2 GPs and the number of clients or patients they will have. As part of the review, we will look at the level of detoxification and the variation in dosage of people who are accessing treatment because we believe that is a recurring issue both for people using our services and the GPs and consultants.

I welcome the delegation. I commend the Department, the HSE, Dr. Long and everyone involved. Crucial work is being carried out in drug prevention and treatment. A total of 2,442 have lost their lives as a result of drug abuse and that is a stark reminder of the scale of the problem we are dealing with. I commend the officials and their staff for the work they are doing in tough times regarding budgets.

I refer to the national drugs strategy. Head shops and emporiums are popping up all over the country. I have received advice from the medical profession and research that has been conducted, which says dangerous drugs and herbal substitutes such as herbal ecstasy and BZP, which was recently banned by the Dáil, are sold. What is the view of the Department and the HSE on these shops? One of these shops has opened up over the past year in almost every town in Ireland with a population of more than 20,000. They are a scourge and I raised this in the House with the Minister.

Ms Kathleen Stack

This is an ongoing issue. The number of them around the country and particularly in Dublin has increased in recent times. The problem with them is that unless a drug is scheduled under the Misuse of Drugs Acts, as BZP was recently, they are not selling anything illegal. While the Garda raid them every so often, they are not doing anything illegal. The problem, as we understand it, is that the ingredients in the products they sell can be easily changed and one of the ingredients, therefore, can change the product. It is a difficult area. The Minister of State, Deputy Curran, is bothered about it and he has consulted the Attorney General on it. It is an ongoing process to work out what can be done regarding their regulation. However, there is no easy answer within the confines of the way the legal system works at the moment with the Misuse of Drugs Acts.

What is the view of the HSE on the health risks posed by these products, which are effectively sold as legal highs?

Ms Alice O’Flynn

The HSE shares the Deputy's concern regarding the products that are sold. This concern is also very much shared by colleagues in accident and emergency departments and those providing a range of addiction services. We look forward to whatever might be able to be done in bringing this to the attention of the public and this will be part of the campaign on drug information for next year. Head shops will be part of the information and awareness campaign.

I am pleased to hear that. I know this is a very complex area for the Department and the HSE because each drug has to be scheduled. Jersey, which is part of Great Britain, is the only jurisdiction that has been successful in banning head shops. No other country in the world has been successful in banning them. One aspect that greatly concerns me is that there is no age limit on the sale of these products. Strictly speaking, a ten-year old could legally buy herbal ecstasy and all the legal highs these shops sell, a raft of drugs. It is an area of great concern to me and to members from all parties. It is not coincidental that many of these shops have opened up close to secondary schools and this seems to be prevalent in my constituency. The medical profession has been very strong on this issue. If these shops cannot be banned outright then the local authorities might have a way under their development plans such as under the category of zoning to define and ban these head shops. This would mean they would not be permitted to open up in commercial, residential or green belt areas — whatever it takes to stop them. Then it would be a case of dealing with their presence on the Internet. I have made suggestions to the Minister. The advice of the Garda Commissioner and the Attorney General has been sought but the local authorities might be the way to deal with them so that they are banned in every zoning category. I am convinced this phenomenon will grow out of all proportion and we are a soft touch for them at the moment.

Ms Alice O’Flynn

My colleague has reminded me that the name of the campaign for next year is Dispelling the Myths. It is targeting exactly what the Deputy is talking about.

Has Mr. Doyle any information he wishes to add?

Mr. Joseph Doyle

In line with best practice, a marketing campaign on the subject of cocaine was held last year, so they are keeping the same approach around dispelling myths and this campaign will be rolled out in partnership with the local and regional drug task forces, as identified in the national drugs strategy. There is currently an information paper being developed in the south east and it is envisaged this will be rolled out.

I return to the question of methadone treatment. At our meeting last July the members raised a number of points such as whether it is a case of containment as opposed to treatment. This is a serious issue and there is a stigma attached to methadone treatment. While the treatment is not a cure it helps people maintain a normal life, in many cases. We all have direct constituency experience of methadone treatment. A figure of 1.3% of people still on treatment over ten years, was mentioned. Even taking the figure given to the committee today of just over 9,000 people on treatment, that is not a cumulative ten-year figure. If someone is on the treatment for three or four years, drops off the treatment programme and then returns, are they counted as beginning again at square one? A figure of 1.3% would be an exceptionally good result and would mean only 90 people out of the 9,000 have been on the treatment for ten years. I ask the delegates to explain those figures further.

Mr. Liam Keane

Because we do not have a unique identifier and we are unable to trace people through. Those figures relate to people who were given a treatment number and continued on that treatment number. Those figures relate to people continuously on treatment for that period but as the Deputy observes, there are people who go off treatment and come back on for different periods. We are just not in a position to collate that information without a unique identifier.

This must be a major problem for the Department in that there is not a unique identifier and this issue has been raised on many occasions. Dr. Long referred to the health information Bill due to be introduced next year. On foot of this meeting I will ask the Government when it is scheduled. Has the Department been given any advice as to when that Bill will be scheduled?

Ms Kathleen Stack

We have been informed it will be published in March or April and will be enacted by the summer.

How much lead-in time will be required to implement this unique identifier for patients? Has any background work been undertaken on how this can be introduced?

Ms Kathleen Stack

I understand it will take some time, that it will not happen the day after the Bill is enacted or anything like that. There will be a lead-in time before the unique identifier will be put in place.

Deputy Broughan asked about the recent study which showed that 9,000 people had never been in treatment. I suppose statistics can show trends but they are not statistics in the real sense as to what is happening on drug treatment and rehabilitation, because of the absence of this unique identifier. How precise are the figures?

Ms Kathleen Stack

The NACD showed that 11,800 people are known to the treatment services. That is a realistic estimate. Where there is considerable doubt is the other 9,000, approximately, who are not known to any of the services and this is the figure the Department disputes because it suggests that of those 9,000, about 5,500 are in Dublin. Given the expansion in treatment services and in Garda activity, it is difficult to imagine there are 5,500 people who have not come in contact with any of those services in recent years.

I too find that difficult to understand. I wonder how that figure was arrived at. Dr. Long mentioned that the statistician had reservations about publishing it but it is published now. It is a case of perception, that there are 9,000 people out there with nowhere to go and who are not being treated. I do not understand how this figure was compiled.

Ms Kathleen Stack

I cannot give the Deputy an answer because it is a statistical exercise. Even when one reads the report it is difficult to understand that. As Dr. Long said, it has to do with the overlaps between the three different data sources. In an ideal situation when doing a capture-recapture report, the overlap would be quite big between the three sources. In this case the numbers in treatment and the numbers coming to Garda attention are quite high whereas the numbers coming to hospital attention is quite low. The overlap does not work in that normal sense, I suppose, that one would need for the capture-recapture methodology to apply.

One could say it is probably quite unhelpful, to put it mildly, that this figure was ever published.

Ms Kathleen Stack

It is an over-estimate.

People have a perception of the service being provided by the HSE and the Department and yet here is a figure of nearly 9,000 people. I am surprised that a report such as this was published containing information that does not stack up. I am being told today it does not stack up. These are the type of figures that get headlines and give a negative image of the service being delivered. Did the national advisory committee on drugs show these results to anyone first?

Ms Kathleen Stack

The advisory committee operates under the auspices of the Department but it is an independent body; it is the research arm of the strategy. It would obviously have consulted the Minister and the office of the Minister of State with responsibility for drugs before publishing the report. The figure I would concentrate on is the 11,800 who are the known opiate users rather than the 20,000.

I agree completely. I do not wish to dwell on this point. However, when an official report is published and is in the public domain and Ms Stack is saying that 8,983 opiate users have not come into contact with any drug treatment services, hospital inpatient services or the Garda, it makes the mind boggle that this could happen. I am getting the sense today that those figures do not stack up. I cannot understand how it would have published the report. I know it was not Ms Stack's decision, but a draft report would have gone to the Department and to the Minister and would have been published. We probably need to talk to the Minister.

Ms Kathleen Stack

It is important to say that we are required under the EU to publish prevalent estimates of opiate use. There is an EU requirement that we do that. I am not disagreeing with what the Deputy said.

I shall finish on this point. The numbers appear to have doubled approximately. If Ms Stack is saying there are more than 11,000 people who are known and in treatment and approximately 9,000 who are not known to anyone, immediately the scale of the drug problem nearly doubles on the basis of figures, which while not plucked out of the air no one is willing to stand over.

Ms Kathleen Stack

They are an over-estimate.

On counselling and rehabilitation services, most people would agree that counselling is one of the most effective interventions and forms part of the strategy. Some 23 posts are vacant owing to the public sector recruitment embargo. Even with the embargo in place certain individual posts are sanctioned. Has the Department or HSE made an application to the Minister to fill those posts? If so has it been refused or granted?

Ms Alice O’Flynn

The process in terms of vacant posts in the health services is that priorities are given to posts to be filled and those priorities are in line with the priorities around cancer services and around other health services, as the Deputy would know. Regarding the addiction services, the vacant posts are continually put up as a request to prioritise alongside the other posts that are vacant and we will continue to do that.

I would lend my support to that. The waiting lists are obviously expanding because we cannot fill 23 posts that have been identified as being needed. Is Ms O'Flynn saying she is putting in the requests on a regular basis and they are being refused or not prioritised?

Ms Alice O’Flynn

We only have so many posts that we are able to fill at any one time. A judgment needs to be made. It is an impossible judgment in a way in terms of which posts would be filled. I am also saying that we are very conscious about those posts that are vacant in the addiction services. Recently we talked to some of our counsellors who said to us — again this is borne out by evidence internationally — that in terms of people coming into treatment, counselling is a very important stage, not just in terms of people engaging, but in getting people to remain in treatment. Counselling posts are critical for us in terms of the provision of addiction services. We will continue to lobby for those posts to be filled.

I thank Ms O'Flynn.

On rehabilitation and reintegration, the Comptroller and Auditor General spoke about the 1,000 FÁS community employment scheme places for long-term unemployed people who were drug users and mentioned that these 1,000 places have not been utilised. Why have they not been utilised?

Ms Kathleen Stack

Our understanding is that 938 of the 1,000 are being used for drug users.

My copy of the drugs strategy states that it is interim. I know Ms Stack played a big role in bringing it forward. Regarding the first strategy from 2001, our colleagues in the media reported that the European Monitoring Centre for Drugs and Drug Addiction found that Ireland had the fourth highest use of cocaine use among 15 to 24 year olds in Europe. We were among the countries with the highest prevalence of drug-related deaths. We have just heard the number 2,500. We were fifth in Europe with, I believe, 57 drug induced deaths per 1 million of population, behind Luxembourg, Estonia, Norway and Denmark. We have heard from Dr. Luke that Ireland is facing a cocaine epidemic in the next ten years. It also mentions that in eight countries including Ireland, France, Romania and so on, detoxification was available to fewer than half of those who sought it. The European Monitoring Centre for Drugs and Drug Addiction would seem to be suggesting that the 2001 national drugs strategy failed in many respects and that many of the findings of the Comptroller and Auditor General will be very important and relevant in the period up to 2016.

Ms Kathleen Stack

I do not have the data the Deputy has before him. In things like drug-related deaths there would be question marks over the figures used in some countries, particularly countries like France which is down at the bottom of the list. Much of it depends on the data used to calculate the averages. The Deputy will know of the nature of drug misuse from his work on the drugs task forces. It is an ongoing battle in many ways in terms of trying to deal with people who have addiction problems. There were many successes with the first strategy. I suppose it is an ongoing process in terms of rolling out a number of the actions and the pillars have remained the same under the new strategy. So I would not agree with him that it is a failure. It is an ongoing process and we need to continue to focus across the pillars in terms of trying to tackle the problem.

Is Ms Stack concerned about the figures on cocaine? I believe a doctor in the Cathaoirleach's area spoke about the cocaine epidemic. We saw the very tragic death of a prominent young Irish model, Katy French, in the recent past and the issues that arose in that regard. Are we taking the problem sufficiently seriously? The first strategy may have failed to grapple with that problem.

Ms Kathleen Stack

When the first strategy was published in 2001 the nature of the drug problem in Ireland was very different. At that point the focus was very much on the heroin problem in Dublin. In the past seven or eight years the nature of the problem has changed. There is now a much bigger poly-drug use problem and there has also been a rise in cocaine problem. What we are trying to do in partnership with the other agencies like the HSE is to put a comprehensive integrated treatment system in place so that whatever the nature of the problem with which someone presents, they are in a position to deal with it. It is not focused solely on heroin use any more and it is dealing with the broader nature of the poly-drug use problem that is presenting itself.

Regarding the national drug strategy for 2009 to 2016, under the heading of prevention, the Comptroller and Auditor General has asked for black and white performance indicators. One of those is to decrease the number of opiate users in the Dublin area and to stabilise the number of opiate users in the country by 2011. Are we near stabilisation or will the graph keep rising? Is the 2011 target realistic from the work Ms Stack's committee has done to produce the report or is it simply aspirational?

Ms Kathleen Stack

The indication so far is that the problem in Dublin is stabilising and the NACD study last week would show that, as would indications from the service providers themselves. The strategy for 2009 to 2016 acknowledges that the heroin problem is growing outside Dublin and this is an issue that must be addressed. We are working with the likes of the HSE to put treatment facilities in place. The prevention pillar is trying to tackle that problem.

Why was 2011 picked as the year of stabilisation, bearing in mind the work of the delegates, the HSE, the Department of Health and Children and the local task forces?

Ms Kathleen Stack

We are trying to set fairly challenging targets for ourselves. I appreciate 2011 is not far away and that there is a serious amount of work to be done in the meantime. It is a question of focusing on what we are trying to do.

With regard to the performance indicators outlined by Ms Stack, which the committee will return to in the coming few years, she states 100% of problem drug users will be accessing treatment within one month of assessment by 2012? How achievable is this? She stated 100% of problem drug users aged under 18 will be accessing treatment within one week of assessment by 2012. There is to be a 25% increase in residential rehabilitation by 2012 and 25% of hepatitis C cases among drug users are to be treated by 2012. A drugs intervention programme is to be in place by 2012 and it is to incorporate treatment referral — for example, for those who have come to the attention of the Garda probation service. Do these meritorious goals, which respond to the work the committee and the Comptroller and Auditor General have done, comprise realistic performance indicators and targets on which the Department would be happy to be benchmarked over the coming years?

Ms Kathleen Stack

The overall objective in the treatment pillar is to put an integrated and comprehensive system in place. I will have to ask the HSE to comment on the individual performance indicators because it will be responsible for delivering on them.

We will hold the Department responsible also because the Minister is responsible for the strategy.

Ms Kathleen Stack

Yes, but ultimately the HSE will be called on to engage in the operational delivery.

We heard statistics from Dr. Long and the HSE. The submission is a very interesting read. The first chapter is on putting alcohol abuse to the fore, because of its often incredibly dreadful impact, and on the poly-drug culture. Ultimately, the Department is answerable.

Ms Kathleen Stack


Does the HSE want to say anything on the performance indicators suggested in the strategy?

Ms Alice O’Flynn

The performance indicators are very challenging and the bar is quite high. It is very important for us to have high expectations in terms of what we will be able to achieve in line with our colleagues and partners. Most of those under 18, or up to 95%, are able to access services immediately. Certainly, the objective of providing treatment within one month of assessment is a challenge. To achieve the targets, we will need to be realistic and expand our services. That will require posts. We need to juggle the options. I refer to posts such as clinical psychiatrists for the under 18s.

That can be pursued with Professor Brendan Drumm, who will before us in February or March. We can follow up on the appointments if they are not made by then.

When the drugs task forces were set up, we considered prevention. I was a Minister of State responsible for drugs task forces at the time. What preventive programmes are in place at present and what is the link with sports organisations, youth groups and voluntary groups?

Ms Kathleen Stack

The Chairman is correct in saying that a number of the projects that operate at local and regional drugs task force levels focus on prevention. They are complemented by the more mainstream programmes that operate in schools, such as SPHE. It is a partnership approach in that there is particular work on the ground that is supported in the more mainstream settings.

The new prevention strategy continues to focus on early school leaving. It also focuses on the more mainstream programmes, such as SPHE, and on continuing to roll them out. It focuses on supporting teachers in terms of how the programmes are being rolled out and also on prevention programmes in third level colleges. The latter may not have been as much to the fore as we would have liked them to be. There are a number of prevention programmes across the gamut of agencies. Some of the local and regional drugs task forces work with clubs such as sports clubs.

My experience on the ground is that the voluntary groups, sports organisations and youth organisations have been muscled off the field by the statutory bodies. That was never intended initially because it seems the statutory bodies have control of the funding now and the voluntary groups are being squeezed. That is a fatal flaw in the preventive programme. It was never envisaged that way.

Ms Kathleen Stack

Until fairly recently, the Department had responsibility for what is called the young people's facilities and services fund. Certainly, through that, there is considerable engagement with sports and community organisations in terms of putting facilities, youth workers and outreach workers in place to support their activities.

How much money was invested in that this year?

Ms Kathleen Stack

I do not have the figure to hand but can get it for the Chairman.

One of the key areas is the provision of facilities. The capital grants system has been abolished, for example.

Ms Kathleen Stack

Through the Department of Arts, Sport and Tourism.

Yes. That is one area where there has been a major hammer blow to the voluntary groups.

Ms Kathleen Stack

Through the young people's facilities and services fund, there would have been a lot of money invested in facilities since the late 1990s when the fund came into play. We can provide the figures.

I thank Ms Stack.

Dr. Long and Ms Stack mentioned the abuse of prescription drugs, such as valium. How prevalent is the abuse of prescription drugs and what is its extent as a percentage of the overall drug abuse problem?

Ms Alice O’Flynn

I do not have the figures to hand. In terms of trying to get the figures, there is a way of reviewing and assisting GPs who are part of the GMS scheme in regard to the prescriptions they are providing. With my colleagues in the HSE, we have got something in place in regard to that cohort of GPs. Regarding the cohort of GPs who are not part of the GMS, I understand that, within the HSE, we do not have the authority to assist, review or monitor in any way what GPs are prescribing, except through the ICGP, the GP body. It is a recurring issue and our colleagues in the addiction services are significantly concerned about it in terms of services in the accident and emergency departments and in regard to people who are presenting therein.

Would it be safe to say prescription drug abuse forms a serious and substantial part of abuse overall? Am I correct in saying we are not talking about a small percentage? Anecdotally, evidence suggests that over-prescription is apart of the problem. I am not suggesting doctors are prescribing more medication than they believe to be necessary but that the monthly stocks of prescribed drugs already given out by the pharmacies are not being taken into account. This came up as a major issue during last year's discussions with the pharmacists when they mentioned there was over-prescription. Is there monitoring of GPs' prescription patterns in the GMS?

Ms Alice O’Flynn

We have started to look at the prescribing patterns of GPs in the GMS scheme. If a pattern is identified, it may be then helpful to have discussions with GPs about what it shows and support them as much as possible with them.

That is very broad. Has the IMO a view on this? Has this matter been raised with the HSE by the IMO? Identifying prescription patterns is one matter. What happens, however, if the HSE has a concern about a GP's prescription patterns?

Ms Alice O’Flynn

Since this has been put in place and when a pattern has been noticed, a conversation would be had with the GP about what it has shown us and whether the GP was aware of the benzodiazepines issue to which the Deputy referred. It would be brought to their attention in a direct way.

Is that happening?

Ms Alice O’Flynn

Yes, since we have put that system in place.

Are there any figures on the illegal or street trading of methadone?

Ms Alice O’Flynn

I do not have figures for this. I presume it is a matter for the Garda Síochána. The review of the methadone protocol, which I spoke about earlier, will examine this. Ireland, compared with the UK and other European countries, fares favourably in the leakage of methadone. Part of this is to do with how we manage to engage and sustain people in treatment.

Would the Department of Justice, Equality and Law Reform have the figures in this regard? Has research been done into it?

Ms Alice O’Flynn

I would imagine the Department has figures. I am afraid we have not done any research into it.

I just want to explain the absence of committee members to the witnesses. Members were tied up with six divisions in the Chamber today as there are no pairing arrangements in place.

Mr. John Buckley

Obviously, the previous strategy we examined had many actions. One action we welcome in the new strategy is that there is a provision for follow-up which introduces an element of accountability for performance.

I made remarks at the beginning about how important information is in the strategy. I must stress its importance again because it guides allocation and application decisions in regard to resources. As well as that, it positions one to create better strategies and carry out proper evaluations.

The first step with regard to the unique identifier will be to get it on the Statute Book. Thereafter, I imagine it will not be that simple to put into place with many discussions with the interests involved even at implementation stage. On balance, taking all these together, there is certainly a movement towards more accountability in the next phase of the strategy. Hopefully, we will see some progress in this.

I thank the witnesses for attending. The committee has had three sessions so far and the evidence it has taken will be noted. A report will be prepared on drug treatment and rehabilitation.

I wish Mr. Gerry Kearney, Secretary General of the Department of Community, Rural and Gaeltacht Affairs, the committee's best wishes on his retirement next week.

Is it agreed to note the special report No. 64 of the Comptroller and Auditor General, drug addiction treatment and rehabilitation? Agreed.

I wish members and the Comptroller and Auditor General and his staff a happy Christmas.

The witnesses withdrew.

The committee adjourned at 12.15 p.m. until 10 a.m on Thursday, 21 January 2010.