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.
