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Dáil Éireann debate -
Tuesday, 16 Feb 1999

Vol. 500 No. 4

Adjournment Debate. - Drug Treatment Services.

The important matter I am raising tonight is one which every Member of this House considers to be of huge concern but too often it does not receive the attention it deserves. Today, anyone with an ounce of humanity would have been horrified at the picture which appeared in The Irish Times of a heroin addict whose arms are covered in abscesses because of continuous injecting. It was reported that this man cannot get treatment to help ease his drug habit. We can assume his addiction will accelerate and that his health will suffer more as he waits on the increasing waiting list for drug treatment.

More horrific was the story of a young mother who sat in her livingroom on a winter evening waiting for the onset of cold turkey. In the morning she would go to the post office and collect her social welfare payment, giving her the means to feed her habit for another day. I am not suggesting we should go back to the methadone protocol which was implemented in an attempt to manage our drug rehabilitation services better. However, in implementing this protocol there have been some problems in the effort to comply with the starting dates. Since doctors stopped prescribing methadone to addicts last October, many have been referred to treatment centres and due to the insufficient number of centres, they have had to join waiting lists. This in turn has pushed many people back into the dark and despairing world of heroin abuse.

I am concerned about what is happening to people who are making some inroads in tackling their addiction but are now without any treat ment since the implementation of this protocol. What is happening to those who, rightly or wrongly, were obtaining methadone from a secondary source, perhaps from another addict attending a GP?

Last week in this House the Minister for Tourism, Sport and Recreation gave me assurances that the money allocated to the resourcing of the local drugs task forces would be spent. In spending this money, I would be the first to assert the need to consult with local communities on the establishment of treatment centres. Residents have a right to know the impact a centre would have on their area and it is their right to have an input into how it should be developed. The experience of many communities of treatment centres has been bad. However, some communities have had good experiences and these have come about through direct community input.

I urge the Government, once community endorsement is given for the establishment of a centre, to undertake that work as a matter of urgency. The drug treatment centre in Cork Street is proving to be a success and is operating in a way which respects the wishes of the local community. However, it has yet to secure the full complement of the services planned for it, including counselling and a crèche facility. The money is there and should be released to complete this work.

There are communities throughout this country which continue to be devastated by drugs; death through addiction, children left without parents because of addiction and children born already addicted or infected with the HIV virus are realities which must be faced up to. The people in the most deprived areas carry the burden of our drugs problem and we have the resources to deal with this head on. People who want treatment should not have to wait and I hope action will be taken to ensure waiting is unnecessary.

I thank Deputy Moynihan-Cronin for raising this important matter. As the Deputy will be aware, the provision of treatment for drug misusers is a matter for health boards in the first instance. The report of the review group on methadone treatment services, which became available in January 1998, recommended, inter alia, that strict controls should be introduced on the prescribing and dispensing of methadone.

The review group comprised representatives of the Irish College of General Practitioners, the Pharmaceutical Society of Ireland, the Eastern Health Board and the Department of Health and Children. In arriving at its conclusions the group took into account policy statements issued by the Irish College of General Practitioners and the Pharmaceutical Society of Ireland in relation to the prescribing and dispensing of methadone.

In accordance with the recommendations of the review group, only general practitioners with appropriate training would be allowed to prescribe methadone for opiate misusers and, in addition, the numbers attending any individual general practitioner or pharmacist would be strictly controlled. This would ensure that the prospect of large numbers of patients congregating around individual general practitioners' and pharmacists' premises would be avoided.

The Eastern Health Board, in whose area the vast majority of opiate misusers reside, has also appointed liaison general practitioners and pharmacists in order to recruit general practitioners and pharmacists into the new scheme to ensure an even spread in each local area where a service is required.

The Misuse of Drugs (Supervision of Prescription and Supply of Methadone) Regulations, 1998, were introduced to give effect to the recommendations of the review group. The regulations came into effect in two phases. The first phase, from 16 July 1998, introduced a standardised prescription form for methadone, which allowed for monitoring of these prescriptions to ensure that patients were not obtaining physeptone or methadone from more than one source.

During the period between July and October 1998 when phase 2 of the regulations came into effect, it became clear to the Eastern Health Board that there was a small number of general practitioners who were prescribing methadone to a large number of drug misusers and that, in some instances, patients' details had not been notified to the central methadone treatment list. The challenge faced by the board was, therefore, to find treatment places for a large number of drug misusers in their own locality in a short space of time.

To its credit, the board managed to find places for a significant number of people through a combination of opening new centres or through the recruitment of additional general practitioners and pharmacists into the protocol. Unfortunately, it was not possible to accommodate all those presenting for treatment and the board is continually attempting to expand its treatment facilities with the aim of being in a position to offer treatment to anybody who needs it.

The Eastern Health Board is aware of the need to offer treatment on a priority basis to particular groups and individuals and has not had any problems with this policy to date. I would suggest, therefore, that if the Deputy is aware of any such priority cases she should contact the health board on their behalf or me and we will do all in our power to assist her.

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