Written Answers. - Heroin Use.
Brendan Howlin
Ceist:
35
Mr. Howlin
asked the
Minister for Health and Children
the progress that has been made by the medical authorities to establish the cause of a number of deaths apparently related to contaminated heroin; the number of deaths generally attributed to heroin abuse since the beginning of 2000; the number of deaths that are believed to be due to contaminated heroin; if he has satisfied himself with the adequacy of record keeping in regard to drug deaths; and if he will make a statement on the matter.
[18539/00]
Brian O'Shea
Ceist:
61
Mr. O'Shea
asked the
Minister for Health and Children
if any new plans are being considered to combat the heroin menace in the Dublin area, having regard to the reported deaths from heroin of seven people in a matter of weeks; and if he will make a statement on the matter.
[15911/00]
I propose to take Questions Nos. 35 and 61 together.
In mid-May a European wide alert was issued in relation to admission to hospitals in Glasgow of 20 injecting drug users, nine of whom had died.
On investigation in the ERHA area it was found that from the beginning of April there has been 19 cases, with eight deaths with a case definition of injecting drug user with evidence of a severe inflammatory process. The illnesses that were caused appeared to be related to injecting heroin into tissues which caused severe damage, with a rapid deterioration in health over a number of days which developed into a septic shock syndrome.
I am also informed that between April and the end of May 2000 the ERHA received notifications of 19 heroin related deaths from the City and County Coroner's Office, eight of these deaths are those related to the case definition as I already mentioned. This information was received in the context of the ERHA's investigation into deaths of heroin misusers with evidence of severe inflammatory process and cannot be validated at this stage.
The ERHA is working closely with the authorities in Glasgow, the National Disease Surveillance Centre, the UK health authorities, cases have now been identified in Northern England, and the Centre for Disease Control in Atlanta to isolate and identify the exact cause of the illness. An expert from Atlanta, Dr. Kristy Murray, has come to Dublin to assist the ERHA's department of public health. The ERHA has sent tissue and blood specimens to the Centre for Disease Control in Atlanta to help with identification. A sample of the heroin thought to be responsible for these illnesses has also been sent to the CDC by the Garda Síochána.
All avenues in relation to the illnesses are being investigated including the possibility of infection by the bacterium, clostridium novyi type A, which the Greater Glasgow Health Board stated had been isolated in three of the nine cases in Glasgow.
In response to the heroin deaths the three area health boards in the ERHA implemented a range of measures to discourage people from injecting and to encourage anyone who noticed unusual abscesses or symptoms to seek immediate medical attention.
A 24-hour freephone telephone helpline was established offering advice and information and referral to treatment centres. In addition, notices issued to all drug treatment clinics, health centres and GPs and in newspapers advising clients and their parents and families of the need for extreme care and vigilance as there may be contaminated heroin in circulation.
In addition to the 52 treatment locations where assessment and appropriate treatment may be accessed by heroin misusers the following measures were instigated. Additional outreach workers were assigned to Dublin 8 and 12 to make contact with drug users on the street and give advice about the dangers of injecting and refer appropriate clients to treatment centres for emergency assessment. Needle exchange facilities advised active contacts about the danger of continuing to inject. Patients on low dose methadone were given the opportunity for increased enrichment of the dose to discourage the practice of topping up with heroin. All addiction centres had facilities for emergency assessment on demand. Arrangements were made to increase treatment capacity in a number of specific areas including: James's Street, Crumlin, Cabra, Finglas.
The mobile methadone bus continued to provide emergency services at Dr. Steeven's, Ballymun, Blanchardstown and Empress Place.
Since the emergency response services were set up approximately 250 people have presented for emergency assessment at local area health board clinics.
Information on drug related deaths is collected by the Central Statistics Office for the general mortality register in accordance with guidelines developed by the World Health Organisation using International classification of diseases code 9 which includes deaths due to drug dependance and poisoning by opiates and other narcotics. In the past few years there has been ongoing discussion between the drugs misuse research division of the Health Research Board, the Central Statistics Office and other relevant actors and efforts have been made to improve the reliability of reports of drug related deaths. These reports are based on death certificates which often give the main cause of death as a medical condition other than drug use, although drug use may have been implicated in the death. The drugs misuse research division is also working with the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) to apply a new drug related deaths standard definition which would include deaths from causes such as road traffic accidents where drug misuse was involved. The intention would be that this standard definition would be applied across EU member states and thus allow for the comparison of data.
The number of drug related deaths reported by the CSO in 1999, applying the ICD 9 definition, which includes drug related deaths, is 80. This figure should be regarded as provisional at this stage, as further validation may still need to be carried out.
