Vol. 466 No. 5
3 Ms O'Donnell asked the Minister for Health the specific strategies, if any, planned within his Department to improve urgently health services for drug addicts in the State; the current number of addicts seeking treatment; the range of existing services; the extent of the waiting lists; the resources currently allocated in respect of drug treatment and rehabilitation; and if he will make a statement on the matter. [11877/96]
(Limerick East): Drug misuse is a country-wide problem while heroin addiction is confined largely to the Dublin area. Treatment services for heroin addicts are currently provided by the Eastern Health Board at its centres at Baggot Street, Ballyfermot and Amiens Street. Such services include methadone maintenance, counselling, HIV testing and free condoms. A similar range of services is provided by the drug treatment centre in Trinity Court, Pearse Street. Approximately 700 patients are on methadone maintenance programmes at these four centres and a further 700 patients are on methadone maintenance with general practitioners in the Dublin area. Approximately 720 patients are on the waiting lists at the Eastern Health Board centres and Trinity Court.
To address the problem posed by drug misuse the Government decided, on 20 February last, on the implementation of a range of measures aimed at reducing the demand for drugs. These measures included the following: (a) that no steps should be taken to legalise or decriminalise the use of so-called "soft drugs" such as cannabis; (b) there should be further development of education and prevention programmes in conjunction with the Department of Education and other relevant agencies; this will include the development of a multi-media awareness and prevention campaign, a programme aimed specifically at deprived areas and the other educational programmes outlined in the Department of Education Action Plan; (c) a task force under the aegis of the Interdepartmental Policy Committee on Local Development will examine the root social factors which give rise to drug misuse in the Dublin inner city area, recommend how best local community groups can be harnessed to prevent misuse and how partnership arrangements with parents on prevention strategies should be structured; (d) new management and evaluation procedures should be put in place for the services of the Eastern Health Board area, these procedures should be ongoing and directed to examine best international practice for application in Ireland; (e) treatment programmes should continue to be developed and have as their objective in the short-term control of the drug misuser's addiction within the context of the long-term aim of a return of the drug misuser to a drug-free lifestyle. Methadone maintenance programmes should continue as a valid and successful element in treatment services and the role of general practitioners in providing this service is to be strengthened; (f) the Eastern Health Board Regional Co-ordinating Committee is to make proposals on the provision of appropriate services for persons who smoke heroin; (g) adequate detoxification programmes are to be developed and health boards are to be responsible for the development of appropriate counselling, treatment and rehabilitation programmes, including those provided by voluntary bodies and therapeutic communities, to lead to a drug-free lifestyle; (h) local co-ordination committees representing all local interests should be established at health board level to develop and monitor education and prevention measures and service provision and the demand reduction sub-committee of the National Co-ordinating Committee on Drug Abuse should largely comprise representatives from these local committees; (i) a new unit is to be established to ensure that all businesses involved with controlled drugs comply fully with the terms of the Misuse of Drugs Acts, 1977 and 1984, and the UN Convention on Narcotic Drugs and Psychotropic Substances; (j) liaison arrangements between the health services and the prison services should be put in place to ensure that co-ordinated treatment regimes for prisoners are in place. It is further agreed that the National Co-ordinating Committee be given specific responsibility to achieve maximum co-ordination; and (k) there should be a greater emphasis on providing basic information on the extent and type of drug misuse and more research should be undertaken as to best approaches to demand reduction services. An extra £3.5 million is being made available this year towards implementation of these measures.
Arising from the decisions each health board was requested to prepare a plan in respect of its area which would provide an effective response to the problem. These plans are being finalised at present and the Eastern Health Board has produced proposals which will involve a major development of its existing services in Dublin. The proposals which are being implemented at present will result in the provision of an additional 1,100 places for methadone treatment for drug misusers by the end of 1996.
The board will also improve the range of other services available by increasing the number of in-patient detoxification beds available, allowing for more outpatient detoxification, extending the number of rehabilitation places, providing early intervention programmes for young heroin smokers, establishing a telephone helpline and organising parenting programmes for drug using parents in the north and south inner city. I am confident that with the implementation of these proposals significant progress can be made in reaching the vast majority of drug misusers currently in need of services.
It is difficult to be precise about the amount of funding allocated to drug treatment but it is estimated that a sum in excess of £13 million was expended in 1995. This included services for HIV-AIDS because our HIV-AIDS and drug treatment strategies are closely interlinked. This would not include out-patient and in-patient treatment provided at general and psychiatric hospitals or services provided by general practitioners as part of overall patient care.
It was announced yesterday that the methadone maintenance treatment programme was to be extended to treat up to a total of 2,500 addicts to the end of this year. I welcome the Minister's acknowledgment that there are other aspects to the Government's proposals in this respect, but does he agree that methadone maintenance represents a substantial plank of the Government's response to the growing drugs crisis? While such programmes are accepted as being a beneficial aspect of treatment of destabilised, chaotic drug abusers, does he agree there is need to question whether there should not be a parallel allocation of resources and support for a drug-free therapeutic recovery programme such as that run by the Coolmine and Rutland Centres?
(Limerick East): Heroin addiction is very difficult to overcome. The ideal solution is a series of strategies which would restore heroin addicts to a drug-free lifestyle. That option is now available, with 25 detoxification beds available in Dublin between Beaumont and Cherry Orchard Hospitals. That is a significantly greater number of beds, for example, than would be provided in, say, Manchester, which has a larger population and a greater heroin problem, and where we understand they are coping well with the problem. I am concerned about the repeated use of detoxification beds by the same addicts, but it is a very difficult problem. While methadone maintenance is not an ideal solution, a person on methadone rather than on heroin remains alive, tends to be a better family person, whose wife and children very quickly reap the benefits of his stabilisation. People can move from methadone treatment to detoxification and quit taking drugs. A methadone maintenance programme along the lines of that now available will have major social effects. If we are to believe the claims that a great deal of crime in Dublin is driven by addicts endeavouring to buy heroin, and addicts are provided with methadone free of charge, it is quite clear there will be a major reduction in crime. We have not yet solved the overall problem and there are some 1,400 people on methadone treatment programmes. Our best estimate is that just over 700 more people would use the facility and we are in the course of providing more than 1,000 places.
What we have done already in Kilbarrack is proving successful. Deputies will be aware of the difficulties of having methadone clinics accepted by local communities but, in Kilbarrack, health board property is being used and local general practitioners are being invited to dispense the drug. The clinic in Ballymun has been established and has been dispensing for the past three or four weeks. In a number of locations around Dublin methadone programmes are having an impact. When addicts are stabilised at clinics they should move on to general practitioners, a significant number of whom are now taking on a small number of addicts. I hope we can make significant progress with this development.
A Government decision on a methadone maintenance programme was taken in February last. We are now in the final stages of a recruitment selection competition for a programme manager for the Eastern Health Board whose job it will be to drive these decisions within the Eastern Health Board area. It will be a full-time job to drive and implement this programme. I must stress that I am dealing with the demand side; the supply side is another day's work.
The Minister accepts that the overall objective is to attain the recovery of the addict in addition to protecting the community to whom addicts might be a danger. Has there been an analysis of the success rate of methadone maintenance programmes in terms of addict recovery compared with that of the Coolmine drug-free recovery treatment with a 40 per cent success rate? Has any cost analysis been undertaken of the relative cost of providing an open-ended methadone maintenance service for a huge number of people compared with providing a drug-free, therapeutic residential care option? Only 70 places are available in Coolmine with another 50 in the Rutland Centre. Has any analysis been undertaken of the cost and success rate of both therapies?
(Limerick East): I have no information to date on the relative cost but we have established a co-ordinating committee which will continuously examine issues such as those raised by the Deputy.
Take an example of an addiction such as alcoholism. Many Members would be more aware of alcoholics than of drug addicts and of how difficult it is for an alcoholic to stop drinking, even when he participates in a residential course. Various institutions claim very high success rates, but it depends on how one defines such success rates. I will not criticise the work being undertaken by any individual or institution. The heroin problem is an extremely difficult one to tackle and the Coolmine people do a very good job. What they do is not capable of being applied on a widespread basis but I hope they will continue their work.
The methadone treatment was successful in other European cities when they were at about the same point as we are now with the heroin problem. It certainly stabilises people and allows the possibility of initiatives leading to a drug-free lifestyle. That is the way I foresee the resolution of the problem developing.
I will be grateful for any advice because this is a very serious problem. When I came to terms with the level of the problem in Dublin, it became quite clear to me that nothing had been done in Dublin for years to combat this problem in terms of the demand side. Effectively this means we are kick-starting programmes in Dublin, for which nobody had taken political responsibility, for quite a while. I am not talking about the supply side, the Garda or the Revenue Commissioners, but about a Minister for Health taking responsibility for reducing demand. It is a major problem but we are making some progress in its resolution.
I am sorry the Minister does not have figures for or an evaluation of the success rate of methadone maintenance programmes either here or abroad. That would be very useful, if they are to be a main plank of the Government's response to this problem, particularly since we have clear figures for the success rate of our drug-free therapeutic programmes. Will the Minister agree to have some research undertaken in his Department on the success of methadone maintenance programmes? Furthermore, does he accept that, in the main, methadone maintenance, represents an official recognition and acceptance of managed drug dependence? Does he accept that, in the long-term, it might be appropriate for us to consider the drug-free therapeutic response, particularly in the case of young addicts? It is not socially acceptable merely to write off large numbers of young people to managed drug dependence, and the therapeutic response must be considered in parallel.
(Limerick East): While those are comments with which most of us could agree, they are appropriate to an ideal world and inner city Dublin does not represent an ideal world. Indeed it is not so long ago that the parents, brothers and sisters of persons who had died from heroin overdose marched on this House seeking action and someone to take responsibility and provide methadone treatment for their children. We are now doing that. All this is a reflection of what is ideal is peace time talk, but we are now at war with drugs and people should put themselves on a war footing. While comparative statistics between one strategy being implemented in, say, Amsterdam, against another in Glasgow would be very interesting, our present priority is to start moving a “can do” agenda forward. Whereas to date the contention has been that we had been doing nothing over the past six months——
That is not true; that is not fair.
(Limerick East):——it appears now we are doing the wrong thing. This criticism is being levelled by those who did absolutely nothing when charged with that responsibility.
I have welcomed the strategies adopted by the Government and yesterday's initiative to extend the methadone service, but it is timely and legitimate for Members to raise questions as to the appropriateness or otherwise of an open-ended methadone maintenance programme when all parents, irrespective of whether their children are aged 15 or 26——
The time available for dealing with Priority Questions is quite exhausted.
——and others interested in drug addiction want a therapeutic response to the problem with a view to recovery rather than the maintenance of it in the long-term and a writing off of people to endless drug addiction.
(Limerick East): I agree with what the Deputy said and I thank her for her support. I view the methadone maintenance programme as a major initiative designed to quickly take many people off heroin. It is a means towards an end, the end being a drug free lifestyle for drug misusers. I realise that only a minority will arrive at that destination and many will stay on methadone for quite a long time. I agree with the Deputy as to where the destination should be, but we must prescribe methadone treatment to stabilise people in the first instance to get them to that destination.
Priority Questions Nos. 4 and 5 will be dealt with in ordinary time.
