Illegal Drug Use: Discussion

I welcome our visitors to the meeting. This one of our meetings where we are dealing with the problem of illegal drug use. From the Rutland Centre, we have Dr. John O'Connor and Dr. Fiona Weldon; from Merchant's Quay, we have Mr. Tony Geoghegan and Ms Denise Casement; and from The Base, we have Ms Sharan Kelly, Ms Amel Yacef and Mr. James Hurley. Also in the gallery, we have Maris Clifford, Chris O'Rourke, Elaine Gray, Nicola O'Leary, Phillip Cullen, Jason Power and Daryl Moss. I welcome all our visitors, in particular, the young people who are here. It is good to have a group of young people speaking to the committee on such an important issue.

Before we commence, I remind visitors that they are protected by absolute privilege in respect of the evidence they are to give to the joint committee. However, if they are directed by the committee to cease giving evidence in relation to a particular matter and they continue to do so, they are entitled thereafter only to qualified privilege in respect of that evidence. Visitors are reminded that only evidence connected with the subject matter of these proceedings is to be given and are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against any person or persons or entity by name or in such a way as to make him, her or it identifiable. Members are reminded of the long-standing parliamentary practice that they should not comment on, criticise or make charges against a person or persons outside the House or an official either by name or in such as a way as to make him or her identifiable.

I thank the visitors for coming in and I invite Dr. O'Connor to make his opening statement.

Dr. John O’Connor

I am a consultant psychiatrist and medical director of the Rutland Centre. We are pleased to have the opportunity to address the committee on how we can assist its important work in reviewing drug misuse, emerging trends and related matters. I am joined by the clinical director of the Rutland Centre, Dr. Fiona Weldon, who has extensive expertise in this area, and my fellow board member, Ms Maura Russell.

To help focus discussion and in the interest of assisting the work of the committee, this statement comprises the following three elements: an overview of the Rutland Centre and its work; our views on emerging drug trends; and comments on related public policy issues. Dr. Weldon will make the presentation on our behalf. While the presentation will be brief in nature, members can rest assured that we are happy to expand on any points of interest or matters which may assist them in their deliberations.

Dr. Fiona Weldon

The Rutland Centre is a 25-bed residential treatment centre for addictions to alcohol, drugs, compulsive gambling, sex addiction and eating disorders. It is situated in Knocklyon, Dublin 16, and is a registered charity with a board of directors. The Rutland Centre is widely regarded as a leader in the field of addiction treatment. We offer a full range of services, including assessment service; pre-treatment; a five-week residential programme incorporating group and individual therapy; family support and intervention groups; a relapse prevention programme; continuing care programmes of at least one year; a ten-week general outpatient programme; and a 12-week dual diagnosis outpatient programme.

Our programme is unique in that it is abstinence based, focusing on client-centred treatment without the use of mood altering substances throughout residential care. Our services are delivered by a multidisciplinary team of skilled professionals including addiction counsellors, psychotherapists, nurses, a GP, a consultant psychiatrist and clinical psychologists. We work through group and individual therapy and a significant part of the recovery process involves the completion of a specific recovery and relapse prevention plan tailored to individuals' needs. Independent research found that 79% of those addicted to alcohol and drugs were abstinent one year after completion of our residential and aftercare programme. Higher levels of quality of life were found in all participants who were abstinent for at least one year following completion of the programme. Since its establishment over 6,000 individuals have completed a Rutland Centre programme and many thousands of families have also benefited from our services. Approximately 200 individuals pass through our doors per year.

In regard to emerging trends, we draw the attention of the committee to issues arising on three fronts, namely, misuse of prescription drugs, polydrug use and cannabis addiction. The centre has seen a significant rise in addiction to prescription medications. When polysubstance addiction is taken into account this figure rises significantly. Approximately one third of those addicted to alcohol are also abusing prescriptive medications. It is cause for concern that many individuals are taking these medications for the treatment of anxiety or sleep problems without ever having had access to psychological therapy for treating these conditions through primary care. We are also seeing an increase in individuals with chronic pain conditions who have become psychologically and physically dependent on their opiate pain medications. These trends indicate a need to integrate pharmacological intervention with psychological treatments in order to minimise reliance on medication as a single primary intervention for psychologically treatable conditions.

We have also seen an increase in those presenting with complex needs as a result of polydrug use, including alcohol. Cognitive impairment as a result of chronic drug or alcohol use requires assessment and treatment needs to be informed by this process. Underlying depression or anxiety conditions may be present before addiction or may be as a result of addiction.

In terms of illicit drug use, the continued presentation of young males addicted to cannabis and in particular the stronger form of this, skunk, is a serious concerns. Skunk has a concentration of THC that is two to three times higher than cannabis. In many cases these young males have experienced psychotic episodes, including the development of paranoia, related to their cannabis use. The detoxification time for weed is also significantly longer. We are concerned about the rise in young males addicted to ketamine, a tranquiliser used in veterinary practice which has become widely available on the streets. Increased addictions to opiates have also been noted among females with undiagnosed eating disorders. In many cases, females are using the opiates to control their appetite and anorexia is undiagnosed.

In regard to public policy, it is important to acknowledge the scale of moneys spent by the State in tackling the drugs problem. Well over €250 million - €265 million - is being spent this year, including €30 million for drugs task forces. Our interest is to ensure this investment is spent to best effect and with the best outcomes for those in addiction, their families and the wider community. Certain issues arise within this framework which we wish to briefly address.

Continuum of care versus opiate substitution is a matter of fundamental importance. The Rutland Centre has deep concern about the value and effectiveness of methadone treatment for large numbers in addiction, as opposed to a more thorough integrated programme of care that addresses underlying psychological and other issues. Treating addiction to one substance and targeting services accordingly is not likely to be effective and outcomes will be deceptive and skewed. For example, methadone treatment is often accompanied by abuse of alcohol and other illicit or prescription drugs. It is reported anecdotally that the quality of engagement and support for many on methadone is less than satisfactory, despite significant costs to the State, which spent €14 million in 2007 not including inpatient costs.

The Rutland Centre model of treatment, which places an emphasis on providing equity of access and quality care to public and private clients, is abstinence-based and has a higher success rate because it is focused on multidisciplinary client-centred treatment in a residential setting followed by rigorous and sustained supports for years afterwards. This converges with the National Drugs Strategy 2009-2016, which recommends greater access to alternatives to methadone maintenance. Our experience had been that roughly a quarter of our clients, or 50 annually, were medical card holders. In the current year, however, we have not treated any public patients because of changes in HSE policy. We are concerned that the loss of access to our residential care programmes reduces the chances of successful recovery for many. This constitutes a serious loss of service for public patients, the centre and the wider public good.

We would also like to draw the committee's attention to other policy issues. Addiction to prescription drugs underlines a need to integrate pharmacological intervention with psychological treatments in order to minimise reliance on medication. Mental health issues need to be better addressed by our primary care structures. Multidisciplinary intervention is required to minimise the likelihood of addiction developing or mental health conditions deteriorating. Underlying depression or anxiety conditions may be present before addiction or may arise as a result of addiction. Services to address dual diagnosis conditions by treating them in an integrated care plan are appropriate and have been developed with success at the Rutland Centre. Individuals benefit from being offered access to residential treatment at an earlier point because it creates a higher likelihood of becoming abstinent from opiates and other substances. Consistent with the thrust of the national drugs strategy, treatment for alcohol addiction should qualify for funding under the medical card scheme for individuals who are experiencing alcohol addiction.

The Rutland Centre is proud to have provided treatment for 30 years across the social divide to thousands of individuals in addiction and their families. We have saved lives, families and relationships. We serve the common good and the well-being of individuals and are eager to play our part in meeting the challenges that addiction poses to our society. I thank the committee for the opportunity of contributing to this key area of public policy.

I thank Dr. Weldon for her excellent and thought-provoking submission. I now call Mr. Tony Geoghegan, chief executive of the Merchant's Quay Project, to make his opening presentation.

Mr. Tony Geoghegan

I thank the Chairman and members for the opportunity to address the committee. I noted in our submission that illegal drug use and substance misuse covers a broad issue.

We have, therefore, confined our presentation to our own areas of expertise, namely, harm reduction services and drug treatment. I have prepared a written submission for the committee which I now propose to present in synopsis and I hope we will afterwards be able to engage the matters arising in a question and answer session.

I begin by giving a brief overview of Merchants Quay Ireland and the services we offer. We were founded by the Franciscans and provide a range of services to drug users and homeless people. While we were founded in the city centre as a direct response to drugs and homelessness issues in Dublin, our services have since expanded and we now work in 11 counties. Our services range from crisis contacts, health promotion and needle exchange to a national eviction counselling service on behalf of the Prison Service, with counsellors in each of the country's prisons. Other services offered include a structured day programmes for people on methadone; methadone prescribing services; a three-month residential drug treatment programme, including community assisted detoxification; a three-month residential rehabilitation service based on our working farm model of therapeutic community in County Carlow; reintegration and employment programmes; and training and research services. Homeless services include a food centre that opens at 7 a.m. every day to provide breakfasts to those who are sleeping rough; washing and shower facilities, including clothes washing; and primary health care services, including GP, dentist and podiatric care for homeless people. We also provide transitional housing projects for those who complete our drug free rehabilitation programmes, as well as tenancies for people moving back to mainstream society.

I will now provide a brief overview of the extent of the drug problem in Ireland. The most up-to-date prevalence data from O'Kelly et al. in 2009 estimate the number of opiate users nationwide at between 18,000 and 23,500. These figures are based on a scientifically ratified modality of capture and recapture using different sources, including hospital admissions, Garda interventions and treatment presentations. It is a source of concern that the estimate is a significant increase on the previous study conducted in 2004, which estimated 14,500 heroin users nationally. Approximately 10,000 people are currently engaged in methadone treatments nationally, an increase from 1,861 in 1996. Taking the median of the current estimate indicates there are approximately 20,000 opiate users in the country, which implies that 50% of active opiate users are not receiving drug treatment.

The key point we want to make in terms of addressing the drug problem is that drug treatment works. It has practical benefits for the individuals concerned and their families, communities and wider society. When I say treatment works, I am speaking practically about economics rather than simply personal development or warm and fuzzy feelings. My submission outlines various research findings in Ireland and abroad which emphasise this point. The Garda research unit has found significant reductions in crime levels among those involved in treatment. In Britain, a detailed study produced by the UK Home Office indicated that every £1 spent on drug treatment saved the State £3 in policing and prison costs and when health care, social welfare and family supports were factored in the savings rose to £9 for every £1 invested in treatment. Across all modalities, whether total abstinence, methadone maintenance or counselling, engagement in treatment is associated with improvements in social functioning, well being and health, and reductions in crime levels.

I will now highlight some of the issues that are becoming apparent to us as a treatment provider and outline some of the gaps that exist in services. While I appreciate that some people have problems ideologically with needle exchange because it can be characterised as allowing people to continue using drugs, serious risks are associated with injecting drugs, such as public health issues such as HIV, hepatitis C and other health complaints. It is incumbent on us to engage at the earliest opportunity in the drug using cycle and research conducted in Ireland and internationally has proven that needle exchange acts as a carrot for engaging for people in treatment. Unless we are engaging with people, we have no opportunity to make change possible. As a first step in engagement, it is an outstanding strategy and it also offers clear health benefits in terms of minimising blood borne viruses, the treatment of which poses huge costs to the State in the longer term.

In terms of waiting lists for treatment, I already noted the gap between the median figure of 20,000 opiate users and the 10,000 users who are engaged with treatment. In terms of saving money for the State and minimising harm to individuals and communities, it is important that we engage the remaining 10,000 users. One of our biggest barriers is waiting lists to treatment. Given that members of the committee come from all around the country, they will be familiar with the lengthy waiting lists which are as long as 12 months in some places. As long as we are unable to engage people in treatment, they will continue actively using drugs and facing the attendant harm.

The next barrier is detoxification. In a country with 20,000 drug and opiate users, 10,000 of whom are on methadone, fewer than 50 dedicated inpatient detoxification beds are available for those who want to become drug free. This is a stark example of the level of investment and commitment needed to move people from drug use towards a drug free lifestyle. It remains a critical issue despite being a priority in the current national drugs strategy and its predecessor.

Rehabilitation is an other area which gives rise to concern. As with detoxification, there is a lack of abstinence-based day and residential rehabilitation services. The HSE's own reports on the issue have identified a serious lack of rehabilitation accommodation and estimate that a further 262 beds will be needed to account for the numbers who use drugs.

The other major deficit is a rehabilitation of offenders Act, which would be a cost-neutral intervention.

People who come through drug treatment may often have obtained a criminal conviction as part of their drug-using career. This might have been for a public order offence, possession of drugs or for criminal involvement as a result of their drug use. They then carry that criminal conviction with them for life which is a serious barrier in terms of gaining employment, travel and a range of issues as well as being a continuing stigmatisation for them. It is a budget-free intervention. I understood that in the last Dáil term a Private Members' Bill was due to come before the House on the Rehabilitation of Offenders Act, but I am uncertain of the status of that Bill today.

As mentioned by our colleagues from the Rutland Centre, the use of prescription drugs is a phenomenon that has grown significantly in the past decade. Most drug users are now poly drug users. They tend not to use just heroin but to use heroin including benzodiazepines, cocaine, cannabis and alcohol. Therefore, a range of drugs is being used of which prescription drugs form a significant part. It is important that people are aware of that.

Our recommendations follow the gaps we have highlighted. First, we recommend that needle exchange services should be expanded to cover all areas affected by drug use. It is important to emphasise that there are swathes of the country with no access to needle exchange. We have a very busy needle exchange in Dublin and we provide needle exchange services in the midlands. However, people are travelling from Cork, Sligo and the west to access needle exchange here in Dublin. That is a significant gap in access to treatment.

Waiting lists for access to drug treatment should be reduced to bring down waiting time to a maximum of four weeks. That was a commitment in the previous drugs strategy and is a commitment in the new one, but remains to be achieved. It is a significant barrier to reducing the harm that drugs cause to individuals and communities.

There needs to be an immediate increase in the number of dedicated detoxification beds available to those seeking to become drug free. That juxtaposition of fewer than 50 detoxification beds for an estimated 20,000 opiate users in the country is a serious indictment on us all. That increase in beds needs to be reflected geographically and should not all be located in Dublin. The drug problem is no longer concentrated in Dublin, but is spread throughout the country and access to detoxification needs to reflect that spread. We need an immediate increase in the number of dedicated rehabilitation places again with a regional spread.

I mentioned the Rehabilitation of Offenders Act, which is a budget-neutral intervention and would make a big difference in terms of aiding those in recovery from drug use. Our final recommendation is to develop measures to ensure increased awareness of problematic use of prescription drugs and poly-drug use.

I reiterate the thrust of our submission which is basically that drug treatment works. It has been shown by both research in Ireland and research internationally that drug treatment works, and shows measurable benefits for individuals, their families, local communities and society as a whole. Not only does it work on health and well being levels, but it also works on a public finance level. Investment in drug treatment will save the Exchequer money in the longer term by saving on criminal justice costs, health care costs, social welfare costs etc.

I thank Mr. Geoghegan for an excellent presentation. I am sure the questioning will focus on what he has said. I welcome members of the third group of witnesses who come from The Base, Ballyfermot Youth Centre and Childcare Facility. I invite Ms Sharan Kelly to make a presentation.

Ms Sharan Kelly

I thank the members of the committee for the opportunity to speak to them. Ms Amel Yacef will present and we also have James Hurley, a young person, who also wants to give a presentation.

Mr. Hurley is more than welcome to come forward; the members will not bite. They may look cross but are not really. It is heartening to see a young man appearing before the committee and prepared to make a presentation. I believe Mr. Hurley is one of the youngest witnesses to appear before a committee and he is very welcome.

Mr. James Hurley

I thank the Chairman.

Ms Sharan Kelly

The Base operates in Ballyfermot and we have been there for a number of years working with children and young people. We provide a range of programmes and services under the one roof. We are a very privileged organisation to have our own facility and we are privileged to be here speaking on behalf of the young people on this issue.

Our presentation is on the screen and we have supplied a submission that is more detailed. We want to summarise the main issues today. In terms of setting the context, we have acknowledged the benefit of prevention and education. Rather than going into that too much we would like to discuss some other strategies that would be useful in terms of the members' decisions in proposing policy changes. One of the big issues we have found is with the accessibility of services for high-need and high risk people. This includes drug-related services, mental health services and even some of the community and voluntary services for young people who may have issues with substance abuse. We would like to recommend policy change involving more co-operation and capacity building in terms of those services learning how to be more youth friendly. The issue of accessing services, engaging with services and retaining services for young people has been a major issue for us in terms of being able to provide the relevant services to young people in the right way. We will talk about the importance of prevention education and harm reduction and intervention. A very big part of that would be involving young people and families in that process.

I will outline the profile of our experience on the ground in Ballyfermot which would be very similar in other communities across the country. The issue is predominantly among males from low social economical background. There are low levels of education attainment, poor levels of physical and mental health and a generational history among the young people.

Trends we have observed show that 14 to 15 year olds are using socially and recreationally, but it is becoming the norm. It is a time when they will start to get involved in crime. There may be addiction, mental health and poverty issues at home influencing their behaviours. Their behaviour is coming to the notice of the Garda resulting in some minor possession and holding charges.

Among 16 to 17 year olds, the problem escalates very quickly and within three or four years the issues and drug use become more serious. There is more involvement in crime-related behaviour and activities. Between 18 and 25 it becomes very much a crisis point. This is when most young people tend to use our services. Ms Yacef will talk more about our role in engaging the statutory and community services along with our own in terms of a response for young people at that stage.

I will outline some of the additional issues happening on the ground. There has been a serious increase in suicide and self-harm associated with the conditions in which young people are living, particularly those at high risk, given their family situation living in poverty. These issues are not new to our young people. They existed in the Celtic tiger years and are still here in recessionary times, but are just getting worse. There is a serious increase in street violence. Many young people will tell us of many things that are happening there and Mr. Hurley will touch on that also. There are many different issues with the community and the Garda. There has been a breakdown between the Garda and the community. We highlight that in terms of how services need to work more collaboratively on this issue.

Our recommendations would be that there needs to be a recognition of the complexity of the issue when it comes to children and young people, living in a socioeconomic environment that facilitates some of the problems we have in society. There needs to be a real understanding, empathy and non-judgmental approach when it comes to policy making. We have seen an enormous increase in problematic substance use from a very young age and it increases very quickly. From our experience we believe it is essential to put the young people and the family at the centre. We need a youth-centred and youth-friendly cohesive approach between ourselves, and our colleagues in the statutory services and in other community and voluntary services.

The youth setting is extremely important for us in terms of engaging the young people. Young people will not traditionally access a mental health or drug-related service. We provide a bridge and fill that gap. We are examining making these more youth friendly to facilitate this process for young people. Ms Amel Yacef will speak about how we have done the groundwork in our youth health programme and our other programmes.

Ms Amel Yacef

I thank the committee for inviting us. I co-ordinate the youth health programme, which is a HSE-based initiative. It is quite visionary and one of the only programmes of its type in the country. The programme was established to respond to the gap between health service providers and young people and their families. Many challenges exist and committee members will be glad to hear we have found more solutions than there are challenges. There is a lack of understanding and awareness on both sides. The health services statutory agencies lack understanding of how we work in a community setting. The belief continues that we are a homework club and there is no recognition of how professional we have become and how much expertise and skill we have. Meanwhile, we do not know how to navigate our way through the statutory structure.

Ms Kelly spoke about the breakdown in the relationship with the Garda Síochána. We cannot emphasise enough the significance of this. We hear very serious reports of gardaí harassing young people, and I do not use the term lightly. Police brutality occurs and they beat up people. It has been completely normalised, which is extremely concerning. I recognise we work very well with some members of the Garda and they have been very supportive. We can work well with the Garda but only if the will is there.

Our structures and the statutory structures are rigid and this needs to change. Organisations in the sector are normally funded on a yearly basis, which means that at the end of the year we must show quantity rather than quality, for example, that we have worked with 1,000 young people. We must explain how much progress we have made in that year and what we have achieved. However, anyone who knows what it is to work in a caring profession knows it is all about relationships. Sometimes it can take two, three or four years to build up a relationship with one young person and this makes it difficult to account for the outcomes on a yearly basis. Frontline workers in mental health services or addiction services can be tuned into how we work and are willing to work with us but they are extremely limited by their structures. In all of this, the voices of young people are lost.

These structures must be reviewed when it comes to policies and national strategies. Capacity must be built on both sides. An example of what we do is to provide training to statutory agencies to familiarise them with how we work. This makes referrals easier and enables them to trust us. Those in the youth and community sectors must be skilled to improve their capacity to understand how the statutory agencies work and how to navigate them.

Young people in areas such as Ballyfermot hit problematic drug use from the age of 14 or 15. This does not require education or prevention; it requires intervention. Young people suffer from mental health issues, polydrug use, bingeing and overdosing. No six-week drugs awareness programme will mean anything to such young people. However, the specialist services are very restricted and many of them do not deal with those aged under 18. Therefore, a serious gap exists.

One can be surprised with what young people can do when they are given respect and Mr. Hurley is living proof of this. We believe in building the capacity of young people to be able to advocate for themselves and to learn how to navigate the statutory structure so that they know their rights and how to speak to a GP if they do not agree with him or her.

Youth work is all about building relationships. We cannot underestimate the importance and significance of our relationship with young people because it is how we will get young people to acknowledge a problem exists and to do something about it. Our programmes and services include crisis counselling, alternative therapies, media, arts and other ways to build the capacity of young people to respond to the issues they face. They are youth friendly and they mean something to the young people.

We must have interagency partnership. One agency cannot respond to all of the issues being faced by young people. Family and community involvement is necessary because no matter how much we do in schools or youth centres, if the message we try to communicate is destroyed at home, is not followed up and there is no sustainability it will not work. We must tackle it in every area.

It sounds like common sense and an obvious point to make to suggest that we must respect and listen to young people and their families but it does not happen. Families and young people are not respected or listened to in the overall structure. Speaking of listening to young people, Mr. Hurley will now address the committee. A number of young people have made their own submission, which is a four-minute clip on DVD. I hope committee members will take the time to watch it and listen to what they have to say. They make very interesting points. Mr. Hurley took photographs in Ballyfermot of the spots that mean something to him and these photographs will form part of his presentation. The first photograph is of his school. I will ask Mr. Hurley to speak about his experience of school and education.

Mr. James Hurley

The last school I attended let me down. The photograph is of St. John's College and going there was the worst choice I ever made.

Ms Amel Yacef

How old were you when you left?

Mr. James Hurley

I was 17. I then went to Ballyfermot Youthreach. The school was a dump.

The next photograph is of a park in Ballyfermot. It looks like a nice park but behind the bushes there are glass bottles, burnt wheelie bins, chairs and tablets such as Valium and Solpadol, which has codeine in it. Young people are taking these.

Ms Amel Yacef

What do you call them?

Mr. James Hurley

We call them "blueys" because they are blue.

Ms Amel Yacef

You have told me that everybody is using them.

Mr. James Hurley

They are like Smarties. Everybody just takes them. There are more pictures of rubbish around Ballyfermot.

Ms Amel Yacef

Burnt bikes.

Mr. James Hurley

Yes. And Johnny wrappers.

Ms Amel Yacef

Mr. Hurley and I discussed a story about condoms and young people who are off their heads.

Mr. James Hurley

Half the girls in Ballyfermot are pregnant. There must be something in the water. At least they are using protection.

Ms Amel Yacef

I asked Mr. Hurley why these pictures were chosen. He took them. The last one is artistic. The pictures are about representing how creative and smart these people are, and their potential.

Mr. James Hurley

This is a photograph of Ballyfermot Youthreach, the best thing I have ever done. Its teachers listen to and work beside their pupils. In secondary school, teachers bark orders at pupils, which gets them nowhere. I thank Ms Marie Clifford and Mr. Chris O'Rourke for taking me in.

Ms Amel Yacef

Does Mr. Hurley wish to mention the Garda?

Mr. James Hurley

The gardaí in Ballyfermot are a bunch of scumbags.

It is a little bit early for that.

Mr. James Hurley

I am sorry.

Just to be careful and not to get into trouble with the Garda.

Mr. James Hurley

The gardaí do not respect us. Why should we show them respect when they look down on us as if we are a bunch of dogs?

Ms Amel Yacef

Does Mr. Hurley feel safe in Ballyfermot?

Mr. James Hurley

No.

Ms Amel Yacef

I will pass over to my colleague Ms Kelly.

Ms Sharan Kelly

The members can see how passionate we are about our work. Ms Yacef and I feel a great responsibility to communicate to the committee the issues that are important to young people. As those who influence policy and the decision makers, we want to tell members that taking these issues on board is an important task. On behalf of the young people with whom we work, we cannot stress enough how it is not only a moral obligation, but also a legal one. I thank Mr. Hurley and those who contributed to the DVD.

The situation is stark and problematic use is serious. It goes from one extreme to another in a short period. The youth friendly model of working with young people - the collectivity of working together in a cohesive way - is important. Great strides have been made in Ballyfermot thanks to Ms Yacef's programme and the way in which the rest of The Base works with the HSE and the area's drugs and counselling services. We want this approach to be at the centre of how we work with young people on these issues. We acknowledge the representatives of the services who are also in attendance and the difference they have made. It is a question of an inter-agency approach.

The Government could make short-term decisions to save money now, but it is important to consider the long-term and the problems that will arise if we and our colleagues do not continue to receive funding. We are not looking for anything extra, only what we already have. Our last slide says it all. We see it as a different way of working, not a different budget. Members should be conscious of this when making cuts. Please, do not make them in our area.

I thank the witnesses for their interesting presentations. To be fair, good work is being done in Ballyfermot and not all the gardaí look down on people. I thank the witnesses for giving their opinions and having the courage to attend. Committee members will listen to witnesses and will only shout and bark at one another.

I thank the deputations for their presentations. They are in attendance to outline their work.

Before Deputy Kelleher proceeds, Dr. O'Connor must leave at 12.45 p.m. If members have questions for the Rutland Centre, we might take them together.

The deputations want to make their case in the context of the continual provision of funding so that they might plan ahead. This is a difficulty for many organisations working with youth services and drug treatment programmes, in that they do not have ongoing unguaranteed budgets with which they can plan in advance.

Turning to the question of necessary supports, Mr. Geoghegan mentioned the fact that treatment works. Most international surveys and statistics support this. The earlier the intervention, the more likely it is to succeed. Given Mr. Hurley's intervention, the breakdown appears to be between the schools and the other services, namely, the HSE, An Garda Síochána, the juvenile liaison officers, etc. All the evidence suggests that people who have passed beyond recreational use into regular use spend a great deal of time absent from or not interacting with school. There is a case to be made for school attendance officers and other groups to work together at an earlier stage instead of picking people up after they have reached the point of being prosecuted.

Let us be clear - we will have limited resources. It would be too easy for me in opposition to tell the deputations that they should get everything. I will advocate as best I can, but we must be realistic. All services will face significant challenges. We must determine where we can intervene at the earliest stage to eliminate the drift into serious criminality and victimhood that isolates people from all services. The schools must play a more proactive role in organising interactions between organisations and individuals at risk. The statutory agencies should do more in this respect and more resources should be invested to ensure people do not end up attending Merchants Quay with long-term addiction problems.

Mr. Hurley referred to the issue of teenage pregnancy. Is a system in place to ensure pregnant girls who are on drugs and are on waiting lists are put on the programme as quickly as possible? It is clear evidence of the intergenerational drug abuse to which we referred.

Gardaí need to be involved and trained to view the issue not only from a criminal point of view, but also from a societal point of view. One Garda division might have a number of excellent community gardaí whereas they would be absent from another. Some time ago, I recommended that an assistant Garda commissioner be designated primarily to handle juvenile policing. For many gardaí, community work is not the greatest career path because it isolates them from the normal progression path within the Garda. More resources and emphasis should be placed on community policing. Many gardaí have referred this issue to me.

I hate rushing these presentations, but I am conscious that many other members wish to contribute.

And some people must go at 12.45 p.m.

In terms of prevention, we mentioned making resources available to young people, listening to them and giving them access to sports and recreational facilities, but some of the greatest difficulties with drug abuse, even in my constituency, are found just outside the front doors of those facilities or down the road from the community centre, GAA pitch or soccer pitch. Where can an agency bring these people back into the youth services? They are not interacting at all. They are removed from all local, community and voluntary organisations, most of which they do not trust. They are afraid to attend them because they believe they might be criminalised or information might be given to the Garda.

What role can any agency play? What agency should take the lead role in terms of encouraging children back into school or to get involved with youth services, soccer and GAA clubs and so on? Are we in this regard dependent on voluntary organisations or schools? These children are falling between agencies. I believe the school should take a more proactive role in addressing the difficulties caused by the progression of young people from recreational to sustained drug abuse.

I join with the Chairman in welcoming the representatives from the Rutland Centre, Merchants Quay Project and The Base and thank them for their written submissions and contributions to the joint committee this morning.

The Rutland Centre has played a hugely important role in providing residential programmes and in pioneering in terms of some the services its provides, as outlined on pages 3 and 4 of its submission. I have a question for all three groups. How in their experience is the recession impacting in terms of the problem of drugs misuse? I am speaking in this regard not of the impact of cutbacks in their area of work but in terms of society.

On page 5 of its submission the Rutland Centre indicates that the treatment available to medical cardholders has dropped in terms of throughput from 47 in 2005 to zero so far in 2011. Yet, as indicated in the submission, it is receiving on average 15 calls per week from medical cardholders. Has the HSE stated it will no longer fund the treatment of medical cardholders and, if so, when did it do so? Perhaps the agency could elaborated on that point as it is something about which we should all be concerned.

I note with concern from page 7 that funding is not available under the medical card scheme for individuals experiencing alcohol addiction. It is important that the joint committee takes note of all that is being said. There are some things we can act upon. I go further and propose that the joint committee press the Minister to intervene and not allow this neglect to continue. I ask that the Chairman and clerk take note of that proposal.

Mr. Geoghegan of the Merchant's Quay Project hit the nail on the head in his contribution. I speak in this context of mental health. People have down through the years always held the notion that people with mental health illness cannot get better. However, they can. There are treatments available and people do recover. The phrase "drug treatment works" is an excellent punchline which everyone needs to take up.

The Merchant's Quay Project has had a proud history, filling a role that the State had abrogated in abandoning whole communities, since its inception in 1989. I commend the agencies and acknowledge the role they have played in helping to devise strategies nationally based on their respective experiences, which is important. I pose to it also the question in regard to the recession impacting on the problem of drugs misuse. Have Government cutbacks impacted on the work of the Merchant's Quay Project? It is stated on page 6 of its submission that the Health Research Board finds that areas that have the longest waiting lists for methadone treatment are also now experiencing the largest growth in problem drug use. A number of areas around the country are instanced, including Longford-Westmeath, Laois, Offaly, Louth and Waterford. Are other areas affected and does this reflect the spread of heroin outside Dublin? What in the agency's view needs to be done to tackle these waiting lists? As I understand it, the agencies believe there is a correlation here. We need to hear a little more in that regard.

I echo the agency's concern that there are fewer than 50 detox beds. That is scandalous. I commend the recommendations made by the agencies. I suggest to the Chairman that we forward these submissions and recommendations to the Minister, the Department and HSE. I propose that the joint committee undertake that action following today's meeting.

I commend The Base and its focus on young people in particular. In its experience, has the recession impacted in terms of the problem of drugs misuse? Have Government cutbacks impacted on its work? The agency has been generous and fair in terms of its asking that no further funding or services be taken away from it, which is all agencies are asking for. What has been the agency's experience thus far? The cutbacks are bound to have translated into some real hits. Given the agency's particular focus on young people, in its experience are patterns of drugs misuse by young people changing? Perhaps the agency would elaborate on that point.

Without wishing to be in any way patronising, "Well done James".

I apologise to our visitors but a Vote has been called in the Dáil. I propose we suspend and reconvene following the Vote.

Sitting suspended at 12.50 p.m. and resumed at 1.05 p.m.

Deputy Kelleher and Deputy Ó Caoláin had spoken so we will now hear from Deputy Naughten.

I thank each of the three groups which gave presentations today. I am also thankful for the detailed supplementary documentation provided. My first question deals with the misuse of prescription drugs. The point was made that this is not just about medication with regard to people presenting to GPs but also psychological treatment. Is there any indication of the scale of the problem of misuse of prescription drugs, particularly those prescribed to an individual patient as opposed to those prescribed to another family member or third party? As there is no structured approach for the disposal of medication, I presume the drugs are getting back into the system again. What are his thoughts on that?

What consistently comes across is the strong tie between substance abuse, be the substance legal or illegal, and mental health problems. We cannot dissociate one from the other. I found an interesting figure in a European report published last week. Mental health disorders affect 38% of the population each year, but less than a third of those people are receiving treatment. That is a phenomenal figure. Almost four in ten people have some type of mental health disorder each year. This comes back to the traditional problem this country has had in trying to shove the issue of mental health under the carpet and ignoring it.

I refer to the submission made by The Base. Serious allegations have been made about the Garda, specifically the gardaí in Ballyfermot, and police harassment and brutality. In his presentation Mr. Geoghegan made the point that the criminal justice system is critical to the treatment of people with addiction problems and to their full recovery. What efforts have been made to try to deal with this problem, which appears to be specific to Ballyfermot? How have the witnesses tried to address it? Have they spoken with the Garda authorities locally or at Commissioner level? The gardaí are only effective in a community if they have community support. That does not appear to be the case in what was outlined to the committee. It is something that must urgently be clarified and addressed. It surprises me that when the solutions were listed, the witness did not mention the Garda Síochána. Perhaps that was an error in the presentation and I am aware there were time restrictions, but the gardaí are critical to dealing with the issue if there are those specific problems in that area. What steps have been taken to date in that regard?

I will make two final brief points. The first relates to the importance of youth work, which was mentioned. One of the issues in that regard is that there is a huge lack of flexibility in youth work budgets. The money comes down from the Department and one must use one allocation to run a particular centre, another to provide an information service and so forth. Surely it makes far more sense to provide the youth work service in an area with an envelope of funding and audit the service at the end of the year to ensure there is good delivery for the money. It could provide for and support local initiatives that deal with the local challenges.

Finally, Mr. Geoghegan spoke earlier about the impact of the cost-benefit analysis and made the point that, based on UK research, for every euro spent there is a saving of six euro for the health and social welfare services, which have two of the biggest departmental budgets in this country. Has there been an assessment of the impact of drug and substance abuse on the emergency and acute hospital services, either here or in the UK? That is a huge political issue at present. If there were savings and if pressure could be removed from that area, it would make a strong argument for the type of investment he mentioned.

There were three questions. I invite Dr. Weldon, Mr. Geoghegan, Ms Kelly and Ms Yacef to speak on the responses to their presentations.

Dr. Fiona Weldon

One of the questions was about residential treatment for medical card holders. We have had some conversations with the Minister of State, Deputy Shortall, on this issue. We are not aware that there are any specific diversions from strategy around this. There has been no explicit communication with us that funding has been stopped. However, the individual's experience is that when they come to us for assessment, we direct them to the HSE to access funding but they are not returning to us. I am not sure whether that is a difficulty with getting this signed off in terms of funding or it is a reflection of some HSE services developing themselves. Certainly, I am aware there are more individual counselling services available within the HSE. However, those who would be suitable for and would benefit from residential treatment, and there are many, are not getting access to it.

Mr. Tony Geoghegan

There were a number of questions from the Deputies. It will take time to get through them all. I will pass some of them to Denisa Casement.

One of the Deputies brought up the issue of prescription drugs. The widespread prescribing of those drugs is a serious issue. A committee was established in the Department a number of years ago to examine the use of benzodiazepines not just in the drug using community but across the population. The committee made some strong recommendations. Notwithstanding that, very little has happened. One stark finding emerged from the committee. It collated all the prescriptions that had been lodged in pharmacies for dispensing and looked at the spread of prescribing benzodiazepines. When this was overlaid on a map of Ireland showing the district electoral divisions, DEDs, the greatest level of prescribing these drugs was in the most disadvantaged communities across the country.

Unquestionably, drugs are often being prescribed because general practitioners are under huge pressure with people coming through clinics and they feel it is incumbent on them to give some response to it. However, the fallout is that people become dependent on these drugs and, as one of the Deputies mentioned, the drugs then leak onto the black market as well. There are two levels of problems there. For individuals, many older people have become dependent on benzodiazepines, which are intended purely for short-term use. It is recommended that benzodiazepines only be prescribed for four to six weeks in interventions yet many people are on them for years, to such an extent that doctors will come to the conclusion that if a person is elderly, it is easier to leave the person on these drugs than to try to withdraw them from them.

Leakage is a major issue because they are being sold on the street. Mr. James Hurley mentioned that Solpadeine and such drugs are available like smarties, but Zimovane and similar drugs are also available like smarties on the street and sell for approximately 50 cent each. If one wanders around the city centre or down the Liffey Boardwalk, one will see discarded cards on the ground. They are sold like that. One of the difficulties in addressing that is the fact that general practitioners are independent traders. They work for themselves. The Department of Health and the Medical Council issue guidelines in that regard and the benzodiazepine committee issued strong guidelines about not allowing repeat prescriptions and looking at short-term prescribing, but the issue has not seriously been addressed. That is a serious matter for concern.

The Deputy also referred to the impact of the recession. We have seen an impact from the recession. It is not so much that I have seen new presenters arriving in directly through our drug services but where we have probably seen it most is in our homeless services and with people attending our food services. We open early in the morning for breakfast and that is where we have seen the biggest spike. There is a huge enmeshment between drugs and homelessness once people get caught in homelessness. We know many people become homeless because of using drugs but, equally, people who become homeless often commence using drugs by association with people who are there and also as a mechanism for coping with being homeless and having to deal with the issues around that. Both are wrapped up in each other.

In terms of how it impacts on our service provision, I cannot remember the last time the Merchants Quay Project got an increase in any of its budget lines. We receive funding from various State agencies, from the Department of Justice and Equality to FÁS to the Department of Health and the HSE. In the last five years, each budget has been reduced incrementally, by 5% one year, followed by a further 10% the next year etc. Ms Casement is our head of communications and fund-raising, a new venture for us to be involved in. We had to do it to continue to provide the level of services we provide. Without voluntary income we would not be able to provide them. None of our services, from our homeless food service to the detox and residential services, is 100% funded by the State. We are dependent on voluntary income in that regard.

Ms Denisa Casement

We are working very hard to raise funds in the communities where we are treating people. When I first came on board in 2008, the idea was to increase our ability to serve people but now fund-raising is about survival and the maintenance of current services. As we are out there working hard to raise funds and keeping our costs as low as possible, when we raise funds the Government reacts by clawing back more. Rather than getting a pat on the back for putting ourselves in a better position where can continue to serve our clients, our fund-raising is used as an excuse to further cut our budgets. We are finding that across the sector; we are trying to become more independent of Government funding but we are being punished for that. It is a serious issue across the sector. Our independence should not be used as a reason to punish us further and make it harder for us to protect services.

Mr. Tony Geoghegan

Another issue which was mentioned was that of pregnancy. If a woman is pregnant she will be prioritised on waiting lists and will get fast-tracked on to methadone treatment. That fast-track may mean being put on a bus every day from Waterford or Cork to Dublin to get methadone. There is a lot involved in prioritisation. Methadone is a first stage intervention, a platform to engage with people. The real key is about providing pathways from there and that is where there is a deficit. The fact there are 50 detoxification beds for an estimated 20,000 users tells its own story. Pregnant women are prioritised on one level but on the other level they may remain stuck on methadone for a long time.

The areas affected were mentioned. I gave an example of areas around the country most affected. Some that jumped out at me included Louth, where there is a seven month waiting list, the midlands, where it can be a year or more, and even parts of Dublin where there are no clinics, such as Ballyfermot, where there is an eight month waiting list to get on to a methadone treatment programme. It is widespread and if there is no access to treatment the drug using population will continue to grow because the carpet cannot be pulled from underneath it. By providing treatment, demand is decreased. It is a paradox in that unless we provide treatment, in a way we are stimulating demand for the black market.

Ms Amel Yacef

We agree there is a need for a more preventative and holistic way to deal with the issue in schools. It can be seen in the trends that most young people who engage in substance abuse start dabbling at 13 to 14 are starting to become disengaged from school and by 15 or 16, they are completely disengaged. The question, however, is why they disengage from school. One of the main reasons is that the school system at secondary level does not cater for the young people we are talking about. There are issues surrounding these young people, such as family breakdown, substance abuse within the family, issues with the justice system, child abuse and protection issues. We are not talking about young people who can go home to do their homework. The formal education system does not cater for them or for the way these young people would learn. That is why, in terms of informal settings such as training centres or places like The Base, there is an environment that suits young people much better because they do not feel the rigidity, they are not being barked at; there is a flexibility. This is not just about the secondary schools, it is about what can work for these young people.

I was referring to using them as a form of early detection as opposed to dealing with the problem.

Ms Amel Yacef

It depends on the relationships with the schools. We are lucky that we work well with both first and second level schools. When we talk about training and building the challenge is to involve teachers and home school liaison officers as much as possible in our training and getting youth workers into the schools so there is a structure in place that offers early detection. We have been working on positive models in conjunction with the schools. The schools would say, however, that they are limited, particularly with resources being cut. They are now over-reliant on us to pick up the slack. There is a will but not necessarily the resources or structures to facilitate it. It is an area we must examine.

Engaging those young people who are falling through the net is another issue. There will be a youth centre and a school but there are still cohorts of young people who do not engage with either. Can any agency do something about that? One of our case studies included a submission on the DOS model, an appropriate name where the workers are asked if they are dossing. DOS means "detached outreach and street work". The drug services in the area, ourselves and the Cherry Orchard youth service, and the HSE substance abuse and drugs outreach worker work together to pair a youth worker with a drugs worker. There are four routes with four different shifts, where we do mornings, afternoons and late evenings. It was piloted this year and the outcomes were fantastic. When a HSE worker or a drug worker is paired with a youth worker, the expertise is fluid and skills can be exchanged and we have been able to engage to reach young people. There are, however, issues surrounding their own safety. Mr. Hurley was not messing when he said he does not feel safe; there are firearms and knives there, there are gangs and drug dealers. Safety of staff is paramount so even when they know what particular spots are being used, they must look at who is there and see where else they hang out so they can reach them that way.

Where was that pilot project?

Ms Amel Yacef

In Ballyfermot. It is called DOS, an easy to remember name.

The Garda issue can be troublesome. We work well with the gardaí. In terms of steps and effort, we have been working with the community gardaí and the junior liaison officers are completely on board. An example is the Thursday night soccer with the Garda youth services, Youthreach, ourselves and the community gardaí. The Garda noted a 10% decrease in anti-social behaviour on Thursday nights. Initially they were worried that they would not be on the streets because they would be playing football but they are playing football with the lads who would normally be involved in anti-social behaviour. Our workers are working closely with the community gardaí on this initiative.

What I am worried about is when community gardaí or junior liason officers say to children that when they see a particular garda that they are lie low and not to go near him. That is unacceptable. It is not just in Ballyfermot. In my previous job in Coolock and Darndale we had the exact same issues.

The Garda is very aware of the abuse of power. We are part of the policing forum as well but we are highlighting to the Garda that there is a breakdown with the communities not trusting it. They are not talking to the Garda and they will not get anywhere if there is no trust. Mr. James Hurley gets on great with one of the community gardaí who is always in touch with him and with us and is very supportive. I am not throwing a wild-----

To clarify, what the witness is talking about is an issue in regard to individual members of the Garda Síochána rather than the force itself in Ballyfermot. It is important that Ms Yacef clarify for the record because that is not how it came across in her initial presentation. From her initial presentation Ballyfermot appeared like the wild west, in that this was a systemic problem within the Garda there. If it is an isolated issue in regard to particular individuals it is important to correct the record.

Ms Amel Yacef

I would not-----

I was going to make that point at the end. It is important that we clarify, as Deputy Naughten has said, that what we had been presented with earlier is different from what we have been given just now.

Ms Amel Yacef

I would not use the term isolated because it is widespread and it is completely accepted and it is happening every night. Harassment happens every night and it is something that we and our youth workers witnessed. No matter how many times we bring up the issue-----

Where has the issue been raised? Has it been raised at Garda divisional level, has it been brought to the attention of the Garda Commissioner? If there is a serious problem in a particular area, we cannot just brush it under the carpet, it needs to be addressed.

Ms Amel Yacef

We are trying to do that in a positive structured manner. We are involved with the policing forum in terms of trying to progress the dialogue. We are in consultation with the various service providers in terms of their experience of these issues with the Garda. When those consultations are concluded the findings will be presented but we want to present them in a more structured manner and with more services involved. We are in the process of doing that.

I call Deputy Robert Dowds.

I have a series of questions.

I remind Members to pose questions rather than make statements.

I thank the three delegations for appearing before the committee and making very interesting presentations. Unfortunately, in my constituency, which includes Clondalkin, Lucan and surrounding areas, there is a significant drugs problem. On the issue of the gardaí, the Garda superintendent for Clondalkin also covers Ballyfermot-----

Will the Deputy------

I want to say something positive.

He is most anxious that the gardaí work as effectively as possible so I would encourage as much liaison as possible with him to sort out the problems. I am glad the witnesses have clarified the position because I would be aware of many excellent gardaí, while at the same time accepting that there are some problem areas. The witnesses are right to mention that. It is important to note that the Garda superintendent is anxious that issues would be worked out in a way that is best for the community overall.

I was very interested in the comment from the Rutland Centre representative that an abstinence approach is used to tackle the drugs problem. How successful is that in getting people out of the drugs habit? What is the percentage of success for people who go on programmes to get off drugs? An issue touched on by a few people was alcohol. I am curious to know to what extent alcohol as a legal drug is a gateway to illegal drugs, particularly for those in their early teens? Although drugs are illegal, it is frustrating that they are extremely prevalent. Have the witnesses got any suggestions as to how we could better tackle this issue? Sometimes the effort the gardaí put in to trying to uncover drugs seems almost a waste of time because they get only a small portion of what comes in.

Recently, a colleague of mine, Deputy Michael Conaghan, and I raised the question of the drugs court in the House. We were trying to get its remit extended to include areas of the southside. At present it is in use only in part of the northside of the city. If the witnesses consider it would be good for the drugs court to deal with some of the cases, of which they are aware, I would be grateful if they would write to the Minister for Justice and Equality because it might encourage him to extend the use of the drugs court as an alternative to putting people in prison in certain cases. From what I hear, the cost of dealing with a person through the drugs court is about one-third of what it costs to put them in jail - therefore, it seems beneficial from the point of view of cost and outcomes because it is far better if somebody emerges as a clean individual in terms of drug use.

My last question relates to what Mr. James Hurley said in regard to schooling as opposed to Youthreach. Clearly he had a much more positive view of Youthreach than the school system. If Mr. Hurley, or any other witness, has positive suggestions as to how secondary schools might be organised to help students who get side-tracked into drug use, perhaps they could be forwarded to the Minister for Education and Skills and also to me also because I would then make a point of discussing them with the Minister. That is a very important issue. From my own experience it is all related to the whole issue of self respect by the individual and respect by those in authority for those in their care.

I apologise that I must leave the meeting because the cross-party mental health group is meeting at 1.15 p.m. and I have to attend. Perhaps I can make one brief comment. It is commendable that the witnesses have brought to the committee's attention their observations and experiences of some of the State agencies, I speak specifically of the references to members of the Garda Síochána. People appearing before the committee should not feel that we did not want to hear this. It is important that it has been put on the record. I commend those voices who have brought it to the attention of the committee today.

I call Deputy Ó Snodaigh and ask him to be brief.

I am not singling him out. I am asking everybody to be brief.

I understand the time constraints. The point made by Deputy Ó Caoláin in regard to the Garda Síochána is an issue not just in Ballyfermot. Thankfully, there are some avenues there where it can be addressed. We should not shy away from this. In the past I raised the issue with local Garda structures and some of those who were involved were transferred. However, they seemed to be replaced with another crew who seemed to target young people.

The issue needs to be addressed because if young people do not have faith in the organisation put in place by society to try and help communities, we are only adding to the problem. Thankfully, there is a local drugs task force and the policing forum and the issue has been raised at that level. Some gardaí are very good and in tune with how to deal with the community. The new local community gardaí in Ballyfermot are doing tremendous work. If that work, particularly that of the night soccer leagues, can be replicated around the country, we will have a much better society. I know some young fellows are going to the night leagues just to get the boot into the gardaí, but at least it is done in a structured way and the gardaí seem to enjoy it. We could be here all day discussing the questions on this issue.

I attended a conference - Beyond Methadone - in St. Catherine's Church in 2001 which was also attended by Mr. Geoghegan. It is now ten years later and we still have only the same number of detox beds. Since the State has not moved on that to date, what is the view of the delegation on community based detox facilities? How much would these cost, would they be more cost effective and do they work?

In recent times there seems to have been a move towards centralising some local services. For example, the needle exchange service in Inchicore was moved and the HIV clinic in Cherry Orchard was under threat recently. Is this a concern for groups like those here? Is it a concern that local services we fought for over the years are being centralised? This seems to be a retrograde step.

Peer education in schools is another issue. How can we encourage the Department of Education and Skills to play a full role and provide training for teachers to spot problems at an early stage and how can we ensure the teachers are aware of the services they need to access? Mr. Hurley had his experience but his experience is not the normal experience of most people in St. John's college. It happens in every college that some individuals do not fit in with the ethos of the college. They may want a different type of secondary education or may need extra supports so that they fit in. Youthreach provided a different type of education and was more akin to what Mr. Hurley needed.

While we are discussing drugs, teachers need to be able to spot other issues. If, for example, somebody is not in tune with the rest of the class, are schools involved enough with local services to be able to contact a service such as a local drugs service and let it know it has concerns about the issue? I realise this happens in some areas, but it does not happen throughout the country. Some areas have the advantage of dealing with this issue over 20 years, but other areas have no experience and teachers do not seem to understand the issue.

The Base takes an innovative approach, but sometimes there is a stigma attached to facilities such as The Base. How did the centre overcome the tag that is sometimes applied that it is a centre for problematic kids? This attitude is not that of the adults, but from some kids. The Base has overcome that problem, but it is a problem facing services that reach out and provide extra services for problematic kids.

My final question relates to mental health and suicide. In recent years we seem to have heard more of suicide and attempted suicides by young people. What additional supports and services do we need in our youth services to ensure there are services for young people suffering from a mental illness or because of drugs or substances they take that put them in situations where they contemplate taking their own lives?

We have taken three lots of questions together. I now invite Dr. Weldon, Mr. Geoghegan and Ms Kelly to respond.

Dr. Fiona Weldon

With regard to Deputy Dowds' question about abstinence, our research shows that approximately 75% to 80% of people on our programme are abstinent at a one-year follow-up check. We view abstinence as a starting point, a difficult starting point to achieve. Western culture is very focused on looking for a pill for fixing ourselves, but abstinence is an important and fundamental way for us to work with individuals and families. We see addiction as a process. We focus on abstinence. The end goal from our perspective is not just about not using a particular substance, because we are very aware that is not what defines addiction.

Addiction is about dependency, which is not just a physiological thing but also a psychological variable. It is probably predominantly psychological. The physiological dependence is easier to treat. While some detox processes are lengthier than others, at the end of the process the person is essentially free of the substance. However, unfortunately, within 24 hours and certainly within a week, people relapse. Therefore we ask why that happens. It happens because of the psychological dependency or the underlying reasons and context within which people use substances. Whether illegal substances or prescribed medication, the face of addiction changes depending on the reasons and whether the underlying predisposing factors are treated or not. It is for that reason that abstinence is our longer term goal.

We recognise the benefits of pharmacological treatment for psychological and addiction problems, particularly in terms of stabilisation, etc. It is important to note that mental health and substance use are very interrelated. However, if we do not focus on treating individuals and families and healing relationships and on treating the underlying reasons somebody uses a substance, we will get nowhere. That is the reason for our approach. It is a successful approach because we use evidence-based interventions on our programmes, such as cognitive behavioural therapy, dialectical behavioural therapy, psychodynamic group therapy and individual therapy. We also tailor our intervention, which is important.

Along with many others we must define whether trauma is present. Much of the time sexual abuse is highly prevalent and there is a high incidence of suicide and suicide attempts. There is also significant organic damage in these groups. Where people use substances, whether alcohol, prescribed meds or other illicit drugs, there is often cognitive impairment and problems with memory and impulsivity, which also has implications in terms of relapse.

The Deputy asked whether alcohol was a gateway to illegal drugs. We all know that alcohol disinhibits people. Therefore, people under the influence of alcohol will likely be more impulsive and engage in behaviour in which they would not normally engage. Where alcohol is involved, it makes it more likely they will experiment with other substances and become addicted to something else.

Thank you.

Mr. Tony Geoghegan

A number of issues were raised in the questions. I concur with Dr. Weldon that alcohol is a significant gateway and that most of those people who use drugs had already commenced with alcohol. It is important to link with The Base and support its services. A number of years ago at Merchants Quay, we did a review of our needle exchange services. We have nearly 6,000 people on our needle exchange database who use the exchange. The biggest single common denominator was early school leaving. If people get into second level education and get through it, they generally have resources behind them and will probably do okay. People who fall out of school between first and second level are at serious risk. More needs to be done in that area.

Merchants Quay does not engage too much in prevention programmes because when we talk about risk, the fact is that everybody can be at risk. However, my own view is that poverty is the biggest gateway into drug use. Parents who themselves have not got the resources to cope with their own life difficulties are rearing children who are getting into other life difficulties that they further cannot cope with. Initiatives like Youthreach and services like the Base which engage people are the way forward and I support them fully.

I outlined the treatment and outcomes statistics for Deputy Dowds in our submission. The Irish study, known as the Research Outcome Study in Ireland, or ROSIE, has done a one year and three year follow up across all modalities of treatment, and is now engaged in a five year follow up. There have been significant successes in all areas. I concur with Dr. Weldon that people have a one dimensional view that if somebody becomes alcohol free or drug free, then all problems are solved. There are many people out there causing mayhem who are not using drugs or drinking alcohol.

We cannot be only focused on whether people are drug or alcohol free. There have to be measurable outcomes, such as improvements in their well being, decreases in criminal activity and anti-social behaviour, family achievements and so on. These are the outcomes that we are looking for. We need to shift that mind-set from thinking whether they are "cured" or "better". Unfortunately, life is not like that. It is like the old joke that it is easy to give up cigarettes when one has done it hundreds of times. That is the case. Addiction is a relapsing condition. What is really important is that people learn along the way and learn from their mistakes.

Deputy Ó Snodaigh spoke about the rationalisation of services and unfortunately, that is a concern. While there is a vast array of services on paper, when people actually go to access them, they find that they have been pulled back into the centre. There is serious concern among the service providers in that regard. I understand the HIV respite ward is under threat and may be gone already. It was the only respite care facility available for drug misusers and people affected by HIV. There are other programmes that have been cut in the Deputy's constituency and there are concerns about that kind of rationalisation.

Ms Sharan Kelly

To reiterate what Mr. Geoghegan and Dr. Weldon have said, our experience of alcohol is much the same. It is very much a cultural thing and we use our various programmes and services to respond to that issue. It is not a quick fix. It is very complex and we wanted to get that message across today. It is about having all the services on board in that regard, whether it is a family support service, a service like our own, or whether it is the school itself and a drug related service. They all need to be working together.

One of the experiences we have is the values and attitudes by which we work and our own behaviour which comes from that. When we talk about structural change, we mean it in terms of the Department of Education and Skills beginning to view young people in a different way, that they have strengths in different areas, and that the traditional way of teaching may need to be modified. We have had great experiences with Youthreach. We have seen models in the US that we would love to bring to our own organisation and use them with young people and their individual learning. These models have been very successful abroad.

Deputy Ó Snodaigh asked a question about stigma. We view young people equally and we value them equally. When a young person comes into us, his or her background or issues do not matter. I hope that is how it will continue. We have a mix of different programmes under the one roof, so that brings that value to us as well, because we have young people coming in who may be mainstream but still at risk to some degree, while we have others who engage in preventative and early intervention programmes. That mix makes a difference. The bottom line is about who we are, what we are about and what we believe in. Where we get people with like minded views and values in education or in health services, we can do wonderful work. For us, it is about trying to have that permeate through people's practices on a regular basis.

Questions were asked about the impact of the recession on our organisation. We started off in minuses when getting ourselves up and running. I had a huge battle in the early days with my board to get funding to start off. We opened our doors in September 2008 with less than we needed, but we had a highly committed group of people on the team, and we have managed to do amazing work, still delivering late nights and so on. The fact that the cuts have impacted on us is a great credit to the team I have working with me, because we still manage to deliver services across the board in all areas.

Our difficulty with the recession is that we have had cuts that are 50-60% on overtime, and we are hanging on by a thread. We will keep doing the valuable work that we do as much as much as we possibly can, but we just cannot open as often as we need. We cannot provide more of the services that are being demanded because there are only so many people to do so much work.

I call on Deputy Doherty.

I thank the witnesses for their attendance. While it might be a little daunting for the professional people, I am sure it was very daunting for Mr. Hurley. I am very glad he attended this meeting. They say a picture paints a thousand words, and Mr. Hurley has painted a very positive picture of the services and the outcome of those services he engaged with, so I thank him very much for his attendance here.

I have many questions, but I do not want to hold up the committee and I would be grateful to engage with the witnesses through e-mail. However, I want to ask one question. From what I am hearing today and from the submissions made, I gather that the witnesses are not happy with the national drugs strategy. Given that it is not necessarily this Government's drugs strategy, what one thing would they like to see changed in the strategy? What difference would it make to what they are trying to achieve?

Like the previous speaker, I will be very brief. Would the witnesses agree that Irish society is in denial on the whole question of drugs? The pillars of society bear the principle blame for that, be they politicians, the church, the police, the medical profession and so on. The drug of choice by far in this society is alcohol. I represent a working class area and I live in a working class area. I have never met any teenager who left home and went straight onto cocaine, heroine or hash. I am not saying that would not have happened. Part of the whole hypocrisy of all this is that because alcohol has such a privileged position in this society, just it does in the UK. The drinks industry is one of the most powerful lobbies here. When do we hear somebody involved in Irish politics or medicine stand up and say that alcohol is the national drug? When do we hear such people use the phrase "alcohol and other drugs"? I used that in a speech on one occasion at a well attended awards service two years ago.

I use this terminology because I do not distinguish between alcohol and cocaine. The media is to blame in many respects. They refer to a teenager, because he or she happens to be using cocaine, as a junkie. "Junkie" is one of the most insulting terms to use about a human being. However, if someone is using beer or spirits, he is just a bit of a lad. This is the contradiction that is inherent in how the media deal with the issue. Go to an accident and emergency department and ask a nurse or doctor what their biggest fear is, and they will tell one their biggest fear is not a cannabis user or a cocaine user. Members know the answer themselves: their biggest fear is those who are using alcohol. I am not a member of the Free Presbyterian church or a prohibitionist - in fact, I would be against prohibition. The witnesses are at the coalface, dealing with the situation by treating people, but many people who have other responsibilities in this society will not stand up and say "Hold on a second - we should not have 12 and 13 year olds walking into supermarkets and buying a drug in a can". It is wrong. We will be back here discussing this in 12 months' time and in 12 years' time unless this society owns up to the fact that its drug of choice is alcohol, followed by others.

I had better prove the Deputy wrong. As a doctor, I will stand up and say the major drug problem in this country is alcohol. We do acknowledge it, and it is something we need to fix.

The Senator is the first to do so.

I ask the Senator to be brief.

I do not intend to give a big speech about alcohol, but I am interested in alcohol policy as part of a fundamental reform in our drug policy. I will put the thought into people's heads that we should commit ourselves to having a blanket broadcasting ban on all alcohol advertising as a quick first step.

That is something that should be done and there are exactly zero reasons it cannot be done early on.

I have a quick and focused question for all our welcome visitors. We cannot fix everything at once, but I have had a bee in my bonnet, as a doctor, over the years about the problem of narcotic opioid use. This is slightly different from some of the other problems. Clearly, as we have heard from Dr. Weldon, the psychological underpinning of much dependency is not fixed by either the application or deprivation of chemicals. When people become addicted to opioids, they have an illness which is very much physical. For them, the illness is treated by taking an opioid, and if they do not get it they will be sick. It is that simple. Society acknowledges that by providing methadone for people.

I have been doing a private set of consultations over the last few months, since I became involved in the Seanad, and I am experiencing some frustration in trying to get to the bottom of some of the questions I have. Perhaps the witnesses could help me with one of these. Why is it that so many people who have a physical dependence on opioids find methadone so unsatisfying? Another question I have - I am not saying I think we should do this, but I am trying to formulate an opinion about it - is whether there would be a certain amount of sense in medicalising injectable heroin and morphine for patients who are addicts rather than putting them on methadone, which clearly in many cases does not satisfy the physical craving, causing people to indulge in the behaviours they need to indulge in to get access to opioids. Even if they have a personal will to cure themselves with help, they are forced to interact with some of the most undesirable sectors of society, that is, people who are in the business of selling illegal drugs.

As part of a national debate, should we consider allowing people who have a complete physical and chemical dependence on heroin or morphine to get their heroin or morphine in well-supervised, clean, incorruptible circumstances? Care would be taken to ensure the stuff could not be taken and sold on the black market and that needles, syringes and medical attention were available. This could be built into a comprehensive programme which is aimed at reforming people but with an understanding that for some people, abstention will not work. It would at least minimise the harm that occurs to them, their families and society at large from drug-seeking behaviour. I am not saying this as a statement or a speech; I am asking it as a question.

Good point.

The two questions I was going to ask have been asked and answered already. I had intended to ask the representatives of the Rutland Centre about the medical card issue, and the other question was the one raised by Deputy Boyle about the national drugs strategy. Before people go, I would like to make two comments. The Merchant's Quay Project is in my own constituency, as is the Base. When I entered politics in 1999, Merchant's Quay was constantly on the agenda at the city council with complaints about people hanging around and anti-social behaviour. This is the first time I have seen Mr. Geoghegan in a jacket. Normally, when one sees him his sleeves are rolled up and he is in the midst of it all. I compliment him in particular on recognising, many years ago and before many communities did, that there was a need to provide a full service, rather than an intermittent service, to people in need. The Merchant's Quay Project has outdone itself on many occasions. I visited it a number of times, including with the Taoiseach long before he became Taoiseach, and I am always impressed with the services that are provided and the way people are dealt with. Many of the people, unfortunately, are people that other organisations cannot manage. I compliment the Merchant's Quay project on its work.

I know a little about the Rutland Centre, of which Mary Banotti, a good friend and colleague of ours, was a founding member. Anything Ms Banotti would stand over has long life insurance. I first heard about the Base when it was on a piece of paper at City Hall as a planning application. I am talking about the building it is located in. As someone from a background of community youth work, particularly voluntary youth work, I was impressed with the Base because it is, for me, what a youth centre should be about. It should not be about the table tennis and everything else; it should be about dealing with individuals on a one-to-one basis. I have experienced this on many occasions when visiting the Base with the man who is now Taoiseach. Maybe we will go back there now that he is Taoiseach.

I compliment Mr. Hurley on his presentation. Education is not a one-size-fits-all experience. When I left school at 14, I was told by the nuns I would be a good housewife and a good mother. People should not always believe what is said into their ears. One must work for what one wants. I had help from a lot of people I met growing up and I must say I had an exceptional father, mother and family. I was the wild one at home - always out and involved in different things, mostly sport. We cannot always blame schools for how things are. Sometimes people just do not fit in that space. I know the feeling, as I was not an academic person - I was more of a sports person and was involved heavily in the community. Education was not high on my agenda. It was when I went out into the community that I found who I was and what I wanted to do in life. One should not ask me why I went into politics, but I am here.

The one thing that shook me more than anything else was Mr. Hurley's words about the Garda Síochána. I have a deep involvement, as does Deputy Ó Snodaigh, with the local community policing forum, the joint policing committee and the district policing body. I will acknowledge there have been difficulties with certain members of past forces around the country who just do not know how to deal with people. Some people are not suited to be in the Garda. Others are not suited to be priests or nuns, but we will not go into that. If there is a problem in the community with particular sections of the Garda, I would have great difficulty with that. As one of the sitting Deputies in Dublin South Central, I have height of regard for many of the gardaí I deal with on a daily basis, including community gardaí. I would like to put myself forward to the Base and offer to sit down with its members, the superintendent and the inspector to try to work out some of the difficulties they are experiencing, particularly young people. We need a police force and people need someone to look up to in life. It is a bad reflection on us all if certain sections of any group are not doing what they should be doing. I wish to put myself forward perhaps along with some of the other Deputies in the area and we could try to organise something in The Base and meet the local superintendent and inspector whom we know well. Perhaps we will somehow get to grips with what is taking place on the ground.

I have two questions. During the police forum in Cork County Hall last Monday a former UK police officer, Mr. Tom Lloyd, raised the issue of the war on drugs. I am paraphrasing but he suggested we are wasting our resources and our time given the current format. There was an article on the issue in the Cork Evening Echo last Tuesday. Are we doing things wrong as a society or as statutory agencies in terms of the war on drugs? I am keen to hear from Dr. Weldon regarding medical cards and why there are no patients or people coming into her with medical cards at the moment. We did not get an explanation for that. Is it because the organisation is not covered by the HSE? Is there a reason this is the case? I will leave it at that. There were a series of questions so I call on Mr. Geoghegan, Dr. Weldon and Ms Kelly to reply.

Mr. Tony Geoghegan

Thank you, Chairman. There are several questions to address so I will try to be brief. I am involved in the national drugs strategy. I am on the steering committee which is drawing up the national drugs strategy and I am also involved in the steering group to examine integrating the new alcohol strategy into the drugs strategy.

I acknowledge the comments that several Deputies and Senator Crown have made. Certainly there are difficulties, not least that the alcohol industry is a powerful lobby group in itself. The thrust of the alcohol industry is to make profits. They are private commercial companies and that is their aim whereas the aim of the national alcohol strategy is to try to reduce the overall consumption of alcohol. We are aware there is a direct correlation between the consumption of alcohol and the amount of harm in society. There is an inherent conflict here.

What would I do to try to improve the national drugs strategy? There is a concern with the incorporation of alcohol. Will the necessary resources be transferred from alcohol into the strategy to address the needs that arise? This is a significant concern. As Deputy Ó Snodaigh remarked, the other major concern has been a rationalisation or pulling back of services. This has also taken place in the national drugs strategy. The core of the national drugs strategy was the bringing together of the statutory, voluntary and community sectors directly to solve problems in a collaborative way. The decision-making has now been pulled back from that forum into the Department. Certainly that is how it appears as a member of the voluntary sector and I am aware that the community sector holds the same belief. The greatest step I would take to try to address and make a success of the strategy would be to ensure that decision making is collaborative and that the community and voluntary sectors are directly involved. It is all the more necessary in a time of reducing resources to involve the community and voluntary sectors in such decisions rather than imposing decisions from a central source.

Senator Crown raised the question of the provision of methadone and it echoes Deputy Catherine Byrne's comments about one size fits all in education. That is the approach in drug treatment. Pharmacological drug treatment is one size fits all as evidenced by the fact that there are 10,000 people on methadone. I agree fully with the committee and I advocate that we should consider other treatment and substitution options. The difficulty seems to be more moral than anything else in the sense that as a society our opening stance is that if someone is taking drugs, they are morally deficient. This was the old view of alcohol use: if someone developed problems with alcohol they had some sort of moral deficit and they could not manage their alcohol use the way ordinary people did. We must challenge that view. I am unsure why we are so invested in methadone treatment rather than considering individual needs.

It has been proven in other countries and internationally that if one provides injectable heroin, as has been suggested, people do not necessarily chose to stay on it for long because it is provided in clinical situations. The research raised the idea that often it takes the fun out of drug use if one must go into a clinical setting every day to receive injectable heroin, etc. The research also found a considerable transfer from that into other substitution treatments and towards total abstinence. I believe there should be a more rational approach to drug treatment in this regard but I appreciate that it is probably a big step for us to take.

In the course of my involvement in alcohol policy, it has struck me that alcohol is cheaper than water now. I bought a small bottle of water on the way in here today and it cost me €1. One can go into any supermarket and buy cans of beer for 50 cent each. There are price wars and so on. There is considerable resistance from the alcohol industry to addressing marketing, below cost selling and such issues. These are the fundamental issues that we must address if we wish to reduce alcohol consumption on a total population basis rather than simply focusing in on a narrow group. Naturally the alcohol industry is keen for us to focus on alcoholics or addicts because then it is simply those people and not everyone who is involved.

Anyone can develop a problem with alcohol if circumstances unfold a certain way, if one's partner dies or if one is suddenly at home and one falls into a pattern of behaving in a certain way. Anyone can develop a problem with drugs in the same manner. We should take a total population approach rather than focusing on these people. If we do not, it allows the industry to sell as much as they like to everyone else because there is a view that they are okay. We need to address these issues but it involves a quantum jump for us.

Ms Amel Yacef

We have recommendations in regard to the national drugs strategy. One thing we are keen to see changed is for young people to be featured at all levels and in all the pillars, not only in education prevention. It is important for them to be included in a youth-centred, youth-friendly way and to take into account their brain development as well. The treatment for a 25 year old does not involve the same methods or interventions as for a 14 year old. Young people are a good deal more resilient and interventions can be remarkably quick and fast. One can reach abstinence quickly with a young person of 15, 16 or 17 years of age compared to someone who has more problematic use. We should challenge the vision of it being simply a case of young people and education prevention. Treatment and intervention is needed. There are major polydrug use issues and mental health issues. Psychosis usually declares itself at 17 years of age for males and when substances are involved, this speeds up the whole process and the problem is accentuated.

Our wish in terms of the national drugs strategy is to be back at the table as Mr. Geoghegan suggested. The community and voluntary sectors must be at the table again and people's voices must be heard.

Dr. Fiona Weldon

The question of what one change would we like to see or what one thing would we like to see focused on was raised. To incorporate many of the points discussed today, the word for me is "balance". I am keen to see a re-balancing of treatment options available in terms of our drugs strategy to the point where it might acknowledge that clients can identify what they might need and have a choice in terms of access to treatment and what kind of treatment they might need. Mental health and substance abuse are interrelated. Increasing the focus on dual diagnosis services would be a major point in terms of integration. The integration of our services and a rebalancing of treatment options is important.

On Deputy Maloney's comments in regard to denial around alcohol use, about 58% of our young adults binge drink compared to about 28% in Europe. There is a huge difference in how our young population treats alcohol compared to Europe. There is still a myth that binge drinking is not as harmful physically or psychologically as chronic alcohol use. We need to do a huge amount of work in this country on our relationship with alcohol. Our young people are learning coping mechanisms from their parents about how alcohol is used. Alcohol is used as a destresser to unwind at the end of the day and is still being overused in that way. Young people are turning to it in a similar way. It is an important point to emphasise.

A question was asked about medical cards. To clarify, alcohol problems are not covered by medical cards and we would like to re-examine that rule. I am not aware there has been any change in policy in regard to those with drug difficulties who are medical card holders, other than the experience of clients which is that they are not getting funding. There is a difficulty in terms of funding being signed off, how that process is happening and steps the clients are being expected to take before funding is provided.

How are patients referred to the centre?

Dr. Fiona Weldon

Our service operates by self referral. Anybody can ring the centre and refer himself or herself. One of the difficulties we face with people who are medical card holders is whether we assess them. It is difficult to decide to put such people through what can very often be a very emotionally traumatic assessment as we are looking at all of the person's clinical history which could involve trauma or other issues.

Having been put through such a process, we may tell people they need to see a rehabilitation officer in their area and go through a similar assessment with him or her. I am aware of six people in the past year who have been waiting. They are quite motivated and telephone us on a monthly basis to ask if funding has come through but nothing has happened. We cannot provide them with the service. It is very difficult.

What happens to such people during the interim period?

Dr. Fiona Weldon

That is one of our questions. I understand they work with local HSE services. They may be receiving individual counselling or working on a detox programme. I do not know what happens. It is quite difficult to get a sense of what happens.

We have had a very in-depth discussion today. I thank the delegates for coming before the committee and for the quality of their presentations. I thank members for their contributions. We have an issue with alcohol not just as a gateway drug, but as a drug of choice. As a society we need to seriously examine the issue and this committee will do that.

Today we received three very interesting and different presentations on drugs, drug use, alcohol and the relationships between them. The views will be forwarded to the Minister of State, Deputy Shortall, who will be here next week as part of a series of meetings on this issue. It is important we reflect the views expressed by the delegates. They have challenged us, which is good. In particular, we need to examine the vehicle that is the national drugs strategy as the means by which we help to reduce and eliminate drug use.

Mr. Geoghegan's point on the community and voluntary sector should be made again next week to the Minister of State. The remarks on the Garda provoked a lot of reflection and commentary. Fortunately there is a proactive community presence in Cork which works in collaboration with young people and communities. It is important that we all play our part in society.

I am not singling out Mr. Hurley but it is important that he came before the committee today and is a model for how we can change attitudes and behaviours. There is a myth that an 18 or 19 year old young man cannot speak before the Oireachtas which he has dispelled today. He has taken a major step forward for which I commend him. I hope he grows and progresses in life.

We are discussing people, which should be on our minds. I hope the delegates have benefited from the meeting. I ask them to express our apologies to Dr. O'Connor who had to leave before we could hear his presentation.

The joint committee went into private session at 2.26 p.m. and adjourned at 2.45 p.m. until 11.30 a.m. on Thursday, 22 September 2011.
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