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Dáil Éireann debate -
Thursday, 5 Feb 1998

Vol. 486 No. 5

Written Answers. - Prescription of Methadone.

Jim Mitchell

Question:

64 Mr. J. Mitchell asked the Minister for Health and Children the steps, if any, he proposes to take to restrict the dispensing of methadone to addicts who are resident in the area in relation to a chemist shop (details supplied) in Dublin 8; the steps, if any, he proposes to regulate the prescribing of methadone by doctors; if so, if this restriction will include doctors only prescribing for bona fide residents of the area in which they practice; and other controls, if any, considered; and when these new regulations and controls will be in place. [2912/98]

I am aware of ongoing problems in regard to numbers presenting with prescriptions for methadone in the area mentioned by the Deputy.

My Department set up a methadone treatment service review group in January 1997. Its brief was to assess the use of methadone in the treatment of opiate dependence. The group's report examines the protocols for good practice in the prescribing and dispensing of methadone and points to appropriate controls which might be put in place. It also sets out the basis on which methadone treatment should continue to be developed and recommends a concise framework for the future operation of the scheme.

The report specifically includes recommendations that general practitioners and pharmacies should, wherever possible, dispense methadone to patients from the immediate locality.

A copy of the report has been sent to every general practitioner and pharmacist in the county. The Eastern Health Board is actively recruiting additional general practitioners and pharmacists in each community in Dublin affected by the heroin problem and my officials are in continuous contact with the board regarding drug treatment service developments in the Dublin 8 area. So far, satellite clinics have been established at Fatima Mansions, Dolphin House and Merchants Quay.

As new doctors and pharmacists come into the methadone scheme, it is expected that this will reduce the number of drug misusers who visit any individual general practitioner's surgery or pharmacy and thus relieve the problems associated with high numbers.

Only one type of methadone will be available under the terms of the scheme. Under these terms any person in receipt of methadone must be registered with the central treatment list, must have a treatment card with a named general practitioner and a named pharmacy and may only receive methadone from that pharmacy. This will lead to restricted numbers attending pharmacies participating in the scheme and should lead to a reduction in social problems associated with large numbers of drug misusers attending one location.

Other recommendations outlined in the report include: support to general practitioners and pharmacists through the appointment of general practitioner and pharmacist facilitators including close liaison and communication arrangements with health board services in the event of a patient destabilising; contractual arrangements with general practitioners, pharmacists, etc.; the provision for supervised administration of methadone in cases where a general practitioner specifies the need for this; the introduction of regulations to require that the prescription and supply of methadone be restricted to official prescription forms specifically designed for the purpose; specific training and information for general practitioners and pharmacists on the treatment of opiate dependent persons and methadone monitoring to be placed on a statutory basis by regulation under the Misuse of Drugs Act.
A committee, comprised of representatives from the Eastern Health Board, the Irish College of General Practitioners, the Pharmaceutical Society of Ireland, the General Medical Services (Payments) Board and the Department of Health and Children has been established with responsibility for implementing the recommendations contained in the report. The committee's main objective will be to ensure that all general practitioners and pharmacists providing methadone treatment do so in accordance with the arrangements in the report.
I am confident that the implementation of the recommendations in the group's report will result in strict control on the prescribing and dispensing of methadone in the treatment of opiate misuse and will allow for the more even distribution of treatment, thus relieving the problems associated with the area mentioned by the Deputy.
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