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Dáil Éireann díospóireacht -
Wednesday, 14 Oct 1998

Vol. 495 No. 2

Adjournment Debate. - Drug Treatment Services.

I wish to share my time with Deputy Gormley.

Is that agreed? Agreed.

My main reason for raising this matter is to seek information on current Government policy on this issue. There is clearly a huge demand for the treatment of drug addicts in the Dublin area. Unfortunately, this demand is not being adequately met. We must develop our treatment and rehabilitation options as well as our after-care programmes. Our treatment must not merely consist of prescribing methadone. We now have a situation in the Eastern Health Board area where there is huge demand for treatment which does not currently seem to be available. There is a new protocol in place which has led to a substantial increase in the demand for methadone at clinics. Addicts who have been attending GPs with large waiting lists are, apparently, now expected to attend local clinics. A number of doctors were seeing huge numbers of addicts in their surgeries and this led to many complaints from local residents. I am glad to see this situation has now been resolved and that we have a new protocol in place. However, we must meet the needs of these patients in the best possible way. I understand that only specially trained GPs can prescribe methadone to a maximum of 35 patients, all of whom will be registered on a central list and identified by photo ID cards.

I raised this item on the Adjournment in order to pose a number of questions. I would like the Minister of State to outline the current situation regarding the use of local health clinics to provide such a service. What arrangements have been made with the clinics in question to prepare for this situation and how many addicts do not have GPs available to them at present? How many specially trained GPs are currently offering methadone to patients, and is there still a shortage of GPs in certain areas? What can we do about this and how can the situation concerning this shortage be dealt with? What special arrangements have been made if local health clinics are to be used, given the range of issues which arises relating to the provision of treatment for drug addicts in such places? Have the health and safety at work regulations of 1989 been adhered to and has a risk assessment been made? Have safety statements been made for the staff involved?

I do not wish to be alarmist, but these clinics are also used for developmental checks on children. Is it feasible to have both groups being dealt with in the same rooms and have adequate arrangements been made? There are risks of infection and it must be made absolutely sure that the necessary safety mechanisms have been put in place. This issue must be tackled positively. Treatment must be provided, but I raise these questions in the interest of ensuring the treatment options are accepted by local communities and those working in local health board clinics.

I thank Deputy Fitzgerald for sharing her time. The four Deputies in Dublin South-East are ad idem on this topic and believe it must be dealt with properly and sensitively. Deputy Fitzgerald raised important questions. It is important Deputies in the area and the community are given full information by the Eastern Health Board. It is only then that proper decisions can be made on these important matters.

No one wants to be alarmist. We acknowledge the need for proper methadone clinics, but when the information given is contradictory, the suspicions of the local community are raised. In Ringsend and Irishtown, the community was told there would be a mobile unit fitted out for high dosage users and this was agreed to. We were then told this was shelved. Subsequently we were told it was back on the agenda but it would be for low dosage users. We were then told it would be accommodated in the clinic. What we do not know in both cases is whether the users will consume the methadone on the premises or whether they will receive scripts. Many people are concerned about the latter because they believe a Trinity Court scenario will ensue with people loitering outside the building. That is something everyone wants to avoid. It would be in the best interests of the community and the Eastern Health Board if this matter were dealt with properly and openly.

The report of the review group on methadone treatment services recommended, inter alia, that strict controls should be introduced on prescribing and dispensing methadone. The Misuse of Drugs (Supervision of Prescription and Supply of Methadone) Regulations, 1998, were introduced by the Minister for Health and Children, Deputy Cowen, to give effect to the recommendations of the review group.

The regulations came into effect in two phases. Under the first phase, which took effect from 16 July 1998, a pharmacist dispensing physeptone/methadone could only do so on foot of a prescription written by a registered medical practitioner on an official prescription form which was introduced on a temporary basis pending the introduction of a new form on 1 October. In addition, from 16 July 1998, pharmacists were required to return a copy of every prescription form for physeptone/methadone to a central point to allow my Department to monitor the prescribing of these controlled drugs.

The first phase of the regulations also provided that, where a general practitioner proposed to prescribe physeptone/methadone to a patient for the first time, that practitioner would also have to notify details of that patient to the Eastern Health Board for inclusion on a central treatment list to be maintained by the board. The purpose of this provision was to ensure that patients were not obtaining physeptone/methadone from more than one source.

Phase two of the regulations came into force on 1 October and, since that date, a general practitioner cannot issue a prescription for methadone to a patient unless a valid treatment card exists in respect of him. Only patients whose details have been entered on the central treatment list are issued with treatment cards. In addition, a pharmacist can only dispense methadone to a patient in respect of whom the pharmacist holds a valid treatment card.

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

The Eastern Health Board, in whose area the vast majority of opiate misusers reside, has appointed liaison general practitioners and pharmacists to recruit general practitioners and pharmacists into the new scheme to ensure an equal spread in each local area where a service is required. That was one of the questions asked by Deputy Fitzgerald. As this recruitment effort proceeds, the board may be required, as an emergency measure, to open facilities in locations where previously no service was provided but where it is clear there are significant numbers of drug users in the immediate locality who are without a service. In many instances, these patients may have been attending general practitioners and pharmacists in locations outside their own areas. The board's overall aim will be to ensure that patients in need of treatment receive it in their own locality.

I am confident the new arrangements will result in a significant improvement in the services provided for drug misusers. They will have the following beneficial effects: the numbers of patients attending individual doctors and pharmacists will now be controlled; only doctors who have received adequate training will be given contracts to prescribe; the possibility of methadone leaking on to the streets will be greatly diminished; and the information available about the prescribing and dispensing of methadone will be greatly improved.

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