Emmet Stagg
Question:8 Mr. Stagg asked the Minister for Health and Children the number of heroin addicts currently receiving treatment and the numbers awaiting treatment for each health board area. [19851/97]
Ceisteanna — Questions. Priority Questions. - Drug Treatment Services.
The Eastern Health Board informed me that the number of addicts currently receiving treatment for heroin abuse is 2,666. Heroin addiction is a problem mainly confined to the Eastern Health Board area and there are no waiting lists in other health boards for treatment services. The waiting list for treatment with the Eastern Health Board is currently at 273. This number relates to those requesting treatment in the health board's addiction centres. The Drug Treatment Centre in Pearse Street works a monthly appointment system whereby persons ringing for an appointment will be seen in the following four weeks. No waiting list is therefore kept at this centre.
The Eastern Health Board has made considerable progress in developing treatment services following the report by the Ministerial Task Force on Measures to Reduce the Demand for Drugs which outlined as a priority the elimination of waiting lists by the end of 1997.
The board has extended its drug services and now has six addiction centres and 15 satellite clinics across the city. In recent months new satellite clinics have come on stream in locations such as Darndale, Dún Laoghaire, Bray and Deansrath, and the mobile clinic is currently being extended to a third location. In addition the board has recruited an additional 40 general practitioners and 55 pharmacies in the community who are now providing methadone treatment service. Other new developments include a telephone help-line which commenced in July and is handling on average 55 calls per week — this service provides information, support, guidance and referral; employment of six education officers as well as teams of outreach workers and counsellors — the board plans to employ another four education officers over the next few months; an anti-heroin campaign in the areas most affected by heroin within the board; the production of a video on the satellite service to provide information to communities where it is proposed to commence such a service; the establishment of an emergency service and assessment at a number of addiction centres.
The board has indicated that as services have increased it has led to a raised awareness of drug treatment options available. Consequently, more clients are making contact with the network of services available.
The board has outlined that further service developments are planned in a number of areas, including locations such as Bray, Cork Street, North and South Inner City, Clondalkin, Dún Laoghaire, Tallaght, Blanchardstown, Finglas, Cabra, Ringsend, Crumlin and Rathfarnham.
The board will continue to monitor developments in relation to the number of persons seeking treatment but it is hoped that these planned new services, together with the developments already in place, will provide adequate places for those coming forward.
The Minister gives a figure of 273 heroin addicts in the Eastern Health Board area. I assume that figure reflects those who requested treatment and for whom treatment is not currently available. Would the Minister agree that that does not reflect the measure of unmet need inasmuch as addicts are reluctant to present themselves unless they are pretty well guaranteed immediate treatment, and that it is of absolute importance that we be in a position to offer immediate treatment to anybody who does present himself or herself to any of the centres to which the Minister refers?
I agree with the Deputy that this does not reflect the unmet need. In the debate on drugs last week we referred to anything up to 8,000 addicts in the Eastern Health Board area. Clearly there are many people addicted to heroin who are not in the system and who may at the moment, because of the nature of their addiction, not have any inclination to deal with the system. We have to encourage and persuade as many of these people as possible to use the system and ensure that it is as responsive and immediate as possible. We are improving the situation gradually. The last Government is to be congratulated on the work it did and we have to build on that. There is a recognition that more needs to be done. We must continue on the commitment and not allow the momentum to stop.
Within what timescale will treatment be provided to the 273 people on the waiting list? Are we talking about one, two, three or four months' wait? Will the Minister acknowledge that there is a difficulty, to which Deputy McDowell referred, in dealing with addicts in that a moment can occur when an addict decides to go for treatment, and if that is not acted upon and there is a wait of two or three months, even if an appointment is given, the addict may not turn up and his perspective and world may have changed substantially in the interim? By what date is the Minister saying the health board will effectively be able to give appointments virtually at the time they are sought by addicts who seek assistance to come off their addiction?
I cannot give a precise date, but I can assure the Deputy that resources will be made available on a continuing basis to continue the current rate of improvement. I hope we can be the victims of our own success in that if we can encourage more people to avail of treatment there may continue to be a waiting list, no matter how quickly we try to provide a service. One way of resolving the problem is for all areas where this menace has permeated communities to meet their obligation and make their contribution by accepting treatment and satellite centres in their areas. Those who have provided services for addicts in their areas are carrying a much greater burden than they should reasonably be expected to carry. The board is working in conjunction with communities in an effort to encourage people to allow treatment centres to be established in all the areas to which I referred. When this is done the time delays will be greatly decreased and hopefully a greater number of people will avail of the service in an attempt to end their addiction. We do not have sufficient treatment centres available to increase the number of addicts receiving treatment. A majority of heroin addicts are not part of the treatment service.
What is the time frame for dealing with the 273 people on the waiting list?
The waiting period in the Pearse Street centre is four weeks. I do not have details of waiting lists in other areas. If there are further details available I will send them to the Deputy.
Is the Minister saying the health board will not be in a position to achieve its objective of providing treatment for all those on the waiting list by the end of 1997?
It appears there will be a waiting list on 31 December. However, it will be much shorter than the one which existed two or three years ago. There may be a residual problem but substantial progress has been made in achieving the objective and the problem is not of the same magnitude as it was previously.
I accept that but as long as there is a waiting list new addicts looking for treatment will not be able to receive it when they need it. If addicts are given treatment at the optimum time then there is some hope they will continue counselling, treatment and rehabilitation. However, if they are told to come back in a week then the chances of them doing so are not great. These addicts will continue to use heroin, thus continuing the cycle. I am disappointed the health board has not been able to achieve its objective.
I presume we are referring by and large to methadone when we refer to treatment. Does the Minister have any figures on the number of detoxification facilities available? Is the health board looking at alternative methods of treatment other than simply dispensing methadone to addicts? Some centres provide detoxification facilities together with long-term rehabilitation programmes which can extend to 12 months in some cases. This is the type of treatment needed if young people are to be helped break their addiction. Is the health board considering allocating more funding to this type of treatment? Methadone maintenance programmes are a harm reduction operation and are basically aimed at helping people to stop using heroin.
I agree that methadone should not be seen as the be all and end all in terms of treatment. Under the programme one is basically replacing an illegal opiate with a legal one. Some people involved in methadone maintenance programmes have raised with me the necessity of having a programme which is medically based and which works. Unfortunately, some people have died from methadone overdoses. I have received representations from business people in the Inchicore area who are trying to operate in very difficult circumstances. This is not acceptable and we need to address the issue and to limit the level of dispensing in various locations. I am dealing with this matter.
I take the Deputy's points about detoxification programmes. A contractor has been appointed to carry out the necessary extension to the board's specialised detoxification unit at Cuan Dara. While it was initially planned to have 15 beds in the unit, a review of the plan has allowed the board to increase the number to 17. Work on the project is well advanced and the extended service should be available before the end of the year.
Phoenix Hall in St. Mary's Hospital has been identified as a suitable location for the 20 bed downstream unit. Plans to carry out the necessary renovations are being drawn up at present. The board is fully utilising the downstream beds being operated by the Merchant's Quay Project in High Park, Drumcondra. A proposal has also been received by the board to fund the existing detoxification and aftercare programme at Cuan Mhuire in Athy which has been particularly effective. The proposal is under consideration and I hope to provide some assistance to the programme.
The board is in the process of selecting a suitable premises for the establishment of a 12 bed inpatient stabilisation unit. Working protocols for admission are being drawn up for this facility.
There is also the young person's programme which will provide a medical stabilisation and detoxification service. This programme has been in place in Baggot Street since August last year and there are 38 persons on it.
The approach to the issue is multifaceted. This is a major issue and I am anxious to continue the momentum which has built up. We are starting to achieve success in the criminal justice and treatment areas and we must press ahead.
The Minister understandably confined his reply to the Eastern Health Board area. It is agreed that the only other area where there is a significant heroin problem is in Cork, particularly north Cork. Is the Minister satisfied that sufficient treatment centres and detoxification beds are available in Cork?
I am not aware of waiting lists for treatment in Cork. The Southern Health Board has its own arrangements in the various institutions to meet the demand. There is a partnership area in Cork and it is carrying out its work. It has not been brought to my attention that there is a specific problem in the area.