Vol. 441 No. 3
5 Mr. Gregory asked the Minister for Health the number of drug users on the waiting list for treatment at the City Clinic, Amiens Street, Dublin 1; and the steps, if any, he will take to eliminate the list and provide treatment on demand.
15 Mr. Crowley asked the Minister for Health whether he has satisfied himself with the resources available in relation to methadone treatment; if he has satisfied himself with the success of the programme to date; and if he will make a statement on the matter.
62 Mr. Deenihan asked the Minister for Health his views on the success to date of drug treatment methods in this country, with particular reference to the need to meet increased demands; and if he will make a statement on the matter.
86 Mr. McGrath asked the Minister for Health if his attention has been drawn to the recent report from the National Drugs Treatment Centre with particular reference to drug and substance abuse; if he has satisfied himself that sufficient resources are available to combat such abuses at present; and if he will make a statement on the matter.
93 Mr. Currie asked the Minister for Health whether he has satisfied himself that sufficient prevention methods and techniques are used in the fight against drug abuse; and if he will make a statement on the matter.
137 Mr. Durkan asked the Minister for Health if his attention has been drawn to the recent report from the National Drugs Treatment Centre with particular reference to drug and substance abuse; if he has satisfied himself that sufficient resources are available to combat such abuses at the present time; and if he will make a statement on the matter.
It is proposed to take Questions Nos. 5, 15, 62, 86, 93 and 137 together.
My Department's policy in the area of drug misuse is based on the national strategy to prevent drug misuse. This strategy, which has been accepted by the Government, is based on the recommendations of the national co-ordinating committee on drug abuse which included representatives of the voluntary and statutory agencies involved in the drug prevention and treatment fields. The strategy recognises the validity of a multi-faceted approach to drug treatment and prevention including drug-free harm reduction, maintenance and rehabilitation programmes. The strategy, while recognising the multiplicity of treatment and prevention programmes, advocated a drug-free lifestyle as the ideal.
It is acknowledged however that a drug-free lifestyle is not an option for many drug abusers, at least in the initial stages of treatment. Consequently, my Department has sponsored the introduction of methadone maintenance programmes as a means of stabilising the behaviour of drug abusers and a means of preventing the spread of the HIV virus through contaminated needles.
As Deputies will be aware, intravenous drug misuse is the principal mode of transmission of the HIV virus in this country. At present 57 per cent of all HIV positive cases are drug-use related. Accordingly, the strategies for dealing with drug abuse and HIV-AIDS are closely interlinked. Since 1992 substantial funding has been allocated to these areas, particularly in the greater Dublin area where the majority of drug abusers reside. This funding has allowed for the development of extensive prevention and treatment services by the Eastern Health Board, which, together with the drug treatment centre and voluntary organisations, provides a comprehensive treatment network for drug abusers. It is intended to further develop these services during 1994 and the Minister has allocated specific funding for this purposes.
The national co-ordinating committee on drug abuse, which is chaired by me meets on a regular basis to review developments in this area.
In accordance with the Government's strategies on HIV-AIDS and drug abuse, methadone maintenance, i.e. an artificial drug provided as a heroin substitute, is made available by the Eastern Health Board and also by the Drug Treatment Centre. The rationale is that by availing themselves of this free "safe" drug, addicts are less likely to indulge in high risk needle-sharing and other anti-social behaviour. This helps prevent the spread of HIV and other infectious diseases as well as bringing addicts into contact with the range of services, treatment and otherwise, available for them. It is important to point out that once the addict's behaviour is stabilised a range of treatment options is offered including assistance towards a drug-free lifestyle.
Approximately 600 persons are now availing of methadone programmes in the Dublin area and there is also a substantial waiting list in the region of 400 persons: because of the particular circumstances of this group, however, it is very difficult to be definitive about this figure.
With regard to Deputy Gregory's question about the City Clinic, Amiens Street there is currently a waiting list of 200 persons who reside in the catchment area of the clinic.
Further measures are planned by the Eastern Health Board to involve more persons in the treatment services and thus reduce the waiting list at the existing clinics. Towards this end funding has been made available this year to allow the board to open two additional satellite clinics as well as establishing another community drug team to identify and liaise with drug abusers in particular areas.
In this regard, another development currently under active discussion is an increase in the numbers of persons on methadone maintenance programmes by the involvement of general practitioners in the community. The report of the expert group on the Protocol for the prescribing of methadone will form the basis for the involvement of these general practitioners. It is intended to circulate the report to general practitioners shortly with other relevant information about support services available in satellite clinics.
I am satisfied that there is a comprehensive framework of prevention and treatment services for drug abusers. I will continue to work to ensure that these services are expanded and developed as necessary and in line with our requirements in relation to the prevention of drug abuse and the treatment and rehabilitation of drug abusers.
Does the Minister agree that it is not acceptable to have 204 drug users on a waiting list in one city clinic, all from the local areas of the north inner city? There are twice the number of addicts on the waiting list for that clinic as those receiving treatment. The crisis is worsening every week with new addicts calling to the clinic and being turned away. Left to the mercy of drug dealers, many turn to violent crime and others end up in prison.
I want to assist the Deputy, but we must proceed by way of supplementary question, not a speech or statement.
Is the Minister aware that many of the people on the waiting list end up in prison? We saw the tragic consequences yesterday, a fatal overdose by a prisoner in Mountjoy who, perhaps, was on the waiting list. Does the Minister agree that if an adequate service was provided, which should be available by right, the drug dealers would be all but out of business and violent crime dramatically reduced in this city?
I thank Deputy Gregory for bringing me up-to-date with the latest figures. I agree it is not acceptable to have a waiting list. It is unfortunate that, because of the way the satellite clinics are structured, half of those waiting are people who are receiving treatment in one satellite clinic.
As to the effect of this programme, Deputy Gregory will be aware that the number of people on treatment in the methadone maintenance programme has expanded dramatically in recent years and we are making further strides in this regard. To alleviate this situation we are in the process of establishing two new satellite clinics. I do not want to tell the House precisely where those clinics will be located because the matter is still under discussion but they will be established very soon. With their establishment there will be a substantial reduction and, it is hoped, a total elimination of the waiting list in the clinic to which Deputy Gregory refers. A further initiative is the methadone maintenance Protocol which will involve general practitioners in prescribing methadone treatment in a controlled way and the establishment of a new drugs team.
We are conscious of the situation and have been spending more money in tackling it. The amount has gone up in 1992, 1993 and 1994 — I can give the Deputy the figures if he wishes. It is hoped that by the summer we will have established the two new satellite clinics and have the methadone maintenance Protocol involving general practitioners in operation which will help to reduce waiting lists, as some of the people will go to their GP instead of to the satellite clinics.
Does the Minister know that a satellite clinic is one which serves the local community and that all the people on the waiting list in the city clinic are from the local community? It, therefore, follows that setting up satellite clinics in other areas of the city will have no impact on the waiting list of the city clinic which serves the north inner city of Dublin. Is the Minister not attempting to mislead me and the House by making irrelevant statements about other clinics that he hopes to establish? Does the Minister not agree that to provide treatment on demand to the people looking for it at that clinic would require twice the staff the clinic currently has and twice the budget allocated to it? Will the Minister answer that question rather than attempting to mislead me by his erroneous statements?
Deputy Gregory will appreciate in retrospect that he accused the Minister of State of deliberately misleading the House which is not in order.
I had no intention of accusing the Minister of deliberately misleading anybody. I am asking him a question. I have put the facts to him and I am interested in his reply. I withdraw my implication that the Minister deliberately misled me.
Deputy Gregory is suffering from the disease of not listening, what Shakespeare called the malady of not marking. He made a point about the location of the clinic serving the local community. I did not say where the new clinics were to be located, but the Deputy can draw an inference from my answer. When deciding on their location we had the Amiens Street waiting list to the forefront of our considerations. I confidently predict that with the establishment of the two new clinics the waiting list in Amiens Street will be substantially reduced. The other initiative, involving general practitioners in the prescribing of methadone, would further reduce the waiting list throughout the city.
Perhaps the Minister will give the House an evaluation of the treatment programme so far, with particular reference to needle exchange etc., and whether the best procedures are now being followed to be effective?
I am satisfied that the best procedures in the development of technology and science are being applied. There is an alternative point of view, what I regard as a more traditional point of view, which advocates a different type of programme——
Cold turkey.
——detoxification followed by abstinence. International experience has proved that the multi-faceted approach is the best. This is what the Government strategy committee and the National AIDS Strategy Committee concluded. It is also reflected in a number of other facts which I do not wish to go into today. We are taking the best approach which is in line with that in every other country trying to combat this problem. Some people have the view that there is one rigid treatment programme to which addicts must adapt themselves. I take the opposite view, that we cannot expect drug addicts to adapt themselves to a particular uniform treatment programme which somebody lays down. A treatment programme must be flexibile. The treatment programme and the treatment providers must adapt themselves to the addicts rather than the other way around.
What is the procedure within prisons? Are all drug addicts offered methadone treatment? Is there a Protocol within prisons in addition to the Protocol outside?
When a drug abuser is sentenced to a term of imprisonment, the treatment there tends to focus on detoxification. There is discussion at the moment in the Departments of Health and Justice, which have not yet been finalised, about whether the methadone maintenance programme should be extended to the prisons.
As the Minister referred to the National Co-ordinating Committee for Drugs Abuse, the work of the Eastern Health Board and his Department and recommended that there should be a multi-faceted approach, does his Department liaise with the Department of Education in respect of a drugs awareness programme? Ten of the 15 primary schools in Dublin which I surveyed last year showed considerable evidence of substance abuse among children. Does his Department liaise with the schools? If such a programme was in place the methadone treatment would not be required.
The liaison to which the Deputy referred was recommended by the National AIDS Strategy Committee and the Government strategy to prevent drug misuse. There is liaison which we hope to strengthen in the coming months.
Will the Minister indicate where he intends to establish the two new satellite clinics? Is he genuinely considering setting up a second clinic to service the community to which I referred? Furthermore, within the time-scale does he intend providing the staff and resources to eliminate the list in Amiens Street of more than 200 people?
As we are in the process of discussion with various local groups in respect of the establishment of the new satellite clinics, I am not prepared to indicate their precise locations. However, I assure the Deputy that we are acutely aware of the position in Amiens Street, the two satellite clinics will be established in the context of present waiting lists and we know where they are. I hope to have the clinics up and running by the summer at the latest.
Are the Minister's conclusions on the effectiveness of the programme based on clinical evidence, medical opinion, debate or a combination of all?
My conclusions are based on a combination of everything, we have obtained substantial medical evidence. Also, the experts to whom I spoke and the reports which I read are practically unanimous about the need for a multi-faceted approach and in agreeing that a methadone maintenance programme is an essential tool in this battle.
