, Limerick East): As well as distributing my speech, I have asked my officials to distribute a copy of the press release which contains the Government decisions of 21 February on reducing the demand for drugs and a copy of the Eastern Health Board's plan, which was a response to these decisions.
I am pleased to have the opportunity to address the House on the important issue of drug misuse. I intend to outline the steps being taken by the Department of Health to tackle this serious problem which particularly affects young people and which is the concern of parents and politicians alike in every town and village in Ireland today.
There are no hard data available on the exact number of drug misusers in Ireland. Estimates of the number vary from 3,000 to 7,000. The Health Research Board report of 1994 gave a figure of 2,702 people who were treated in the greater Dublin area. It must be emphasised that this is the number of people receiving treatment and that the number of people misusing drugs is greatly in excess of this figure. Future Health Research Board reports will give statistics on treated drug misuse on a countrywide basis as opposed to the greater Dublin area. The board has already taken steps to access other treatment sources countrywide in order to compile this data.
It is recognised generally that there is a deficiency with regard to gathering of data on drug misusers. The recent Government decisions recognised this deficiency and each health board will now be requested to undertake research on the extent of the problem in its area, the location of the problem areas and the types of drugs being misused. This information will give a more precise indication as to the extent of the problem and will allow health boards to plan their drug strategies accordingly.
In the absence of hard data, other evidence from Garda seizures and health service personnel and anecdotal sources indicate that Ecstasy and cannabis use are widespread. In the greater Dublin area, these problems are compounded by a serious heroin problem.
The Government recognises that the problem of drug misuse is a complex and difficult one to which there are no easy or instant solutions. The strategy to prevent drug misuse, which was published in 1991, employs a multi-disciplinary approach, requiring action in the areas of supply reduction, demand reduction and increased access to treatment and rehabilitation programmes, together with a comprehensive co-ordinated structure geared towards their effective implementation. The Department of Health, in co-operation with other Departments and State agencies, has been implementing this strategy.
Despite this strategy, it was clear to me that more dramatic and forceful action was needed to meet the growing menace of drug abuse and, in particular, the sinister heroin epidemic in the Dublin area. Accordingly, I went to Government with a package of proposals and, on 20 February 1996, the Government approved a series of new demand reduction measures to prevent drug misuse. The objectives of the proposals are based on two key elements: reducing the number of people turning to drug misuse in the first instance through information, education and prevention programmes and providing a range of treatment options for those addicted to drugs, the ultimate objective of which must be a return to a drug free lifestyle, although this may not be a realistic goal in every instance, in the short term at least.
The features of the Government decisions are as follows. No steps should be taken to legalise or decriminalise the use of so-called soft drugs such as cannabis and 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's action plan.
Specific measures include a total of £500,000 will be spent on awareness campaigns, including a major public media campaign which will be launched this year; each health board will launch information and awareness campaigns aimed at young people and their parents, which will focus on the dangers of drug misuse, with particular emphasis on the misuse of Ecstasy; health boards should in future play a more active role in local initiatives on education and prevention; my Department's Health Promotion Unit, in conjunction with the Department of Education and other relevant agencies and groups, will design a specific education and health promotion package for use in the inner city areas of Dublin and which could be adapted for use in other high risk areas.
A task force under the aegis of the interdepartment policy committee on local development will examine the root social factors which give rise to drug misuse in the Dublin inner city area and recommend how best local community groups can be harnessed to prevent misuse and how partnership arrangements with parents on prevention strategies should be structured.
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 be directed to examine best international practice for application in Ireland. Specific measures include a programme manager is to be appointed with specific responsibility for the drugs misuse programme — this post has already been advertised; a system of external evaluation is to be established for the services in the Eastern Health Board area and all services will be funded and co-ordinated by the Eastern Health Board once the new management arrangements are put in place.
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. Specific measures include the ultimate aim of demand reduction measures must be that those misusing drugs and particularly hard drugs will, after appropriate counselling, treatment and rehabilitation, lead a drug free lifestyle. Methadone maintenance programmes are a valid and successful part of an integrated response to the problem of heroin abuse and such programmes should continue to be developed; drug treatment centres are to put in place appropriate measures to ensure that the leakage of methadone on to the illicit market is eliminated; the Eastern Health Board is to engage in widespread consultation with community groups in the establishment of community drug treatment facilities and negotiations with local communities should be handled with the utmost sensitivity; the emergency response service in Dublin is to be extended to a 24 hour service and each health board is to establish a contact service which will provide information, advice and assistance on drugs to the public. While heroin misuse is confined largely to Dublin, all boards are to have in place an emergency response if an addict or addicts should come to stay in the areas or be stranded there.
The Eastern Health Board regional co-ordinating committee is to make proposals on the provision of appropriate services for persons who smoke heroin. 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 a drug free lifestyle. 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 subcommittee of the National Co-ordinating Committee on Drug Abuse should be comprised largely of representatives from these local committees.
Specific measures include each health board is to establish local co-ordination committees to involve all bodies in the fight against drugs; each health board is to formally involve local voluntary and community groups on their co-ordinating committees which gives them a direct input on the decision making process and the national subcommittee on demand reduction is to be composed largely of representatives from the eight regional committees under the chairmanship of an assistant secretary from the Department of Health.
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.
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.
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.
Specific measures include that each health board is to put in place a system of monitoring on an ongoing basis so they will be fully informed of the level of abuse in their areas and of any new trends which may be emerging. This country is to partake with a number of other European countries under the aegis of the Council of Europe as part of a working group to look at approaches to treatment in various member states. Other measures include that all health boards are to be mindful of the security risk to personnel and property in the drugs misuse service. The Eastern Health Board is to discuss with the Garda the discreet local arrangements to be put in place to alleviate the nuisance caused by addicts congregating at treatment centres.
I now turn to the Eastern Health Board development plan for services in the Dublin area. This arises from the Government decision which requested all health boards to produce such plans. However, because of the scourge of heroin in the Eastern Health Board area, it is appropriate that we spend more time on its plan rather than on the others.
An evaluation of existing services in the Eastern Health Board, which was carried out by Dr. Michael Farrell of the National Addiction Centre and Institute of Psychiatry, University of London, and Mr. Ernst Buning of the Bureau of International Affairs in Amsterdam, noted that by international standards, there was a good level of drug treatment service provision in the Eastern Health Board.
Based on the recommendations of this evaluation and on the proposals in the Government's decisions, the board has developed a comprehensive plan for the development of its services during 1996. The plan includes ten specific proposals as follows: (1) increasing access to methadone maintenance treatment, increasing the number of patients on treatment from 1,400 to 2,500 through additional prescribing by GPs, the establishment of additional drug treatment centres and extension of services in existing centres and the introduction of a mobile service providing methadone; (2) the introduction of a seven day dispensing service in community drug treatment centres; (3) providing a rapid response to young problem drug users, including heroin smokers, through early intervention, particularly in the inner city areas; (4) increasing the number of rehabilitation places from 60 to 250 per annum; (5) increasing the number of detoxification beds in Cherry Orchard Hospital from ten to 15; (6) extending outpatient detoxification through both community drug centres and local GPs; (7) establishing a regional education and prevention unit to deliver awareness, education and prevention; (8) providing parenting programmes for drug using parents in the north and south inner city; (9) establishing an information database and (10) establishing a regional telephone helpline.
It is expected that if this plan is implemented in full, significant progress can be made in reaching the vast majority of drug misusers who are at present in need of treatment services. I have asked my officials to circulate the complete plan to Members. The plan is moving in the right direction. We are still discussing some details of it so if Senators wish to make comments on the plan, these can still be taken on board before we finalise it.
In my view the most significant aspect of this plan is the involvement of general practitioners in the provision of methadone to misusers. Up to now, GPs have been slow to get involved in this service and I can understand their fears in this respect. They may be afraid of the effect on their practices of having heroin addicts among their clients; they may even be afraid of violence.
A pilot scheme initiated in March this year aims at implementing all the elements of the Protocol for the prescribing of methadone. These include the provision of a treatment card to all drug misusers and the registering of all patients being treated on a central treatment list. A facilitator will also liaise with GPs, pharmacists and community drug treatment centres. It is hoped that with the success of this scheme, which is being independently evaluated, a number of other GPs will be happy to become involved in the prescribing of methadone. In my address to GPs at the Irish College of General Practitioners' conference last Friday I asked for their assistance in addressing this serious problem and I was encouraged by their response. Indeed, a further meeting held this week between my officials and representatives of the college to pursue this issue further was very constructive and I am confident of a successful outcome.
The expansion of health services alone, however, will not remove the problem of drug misuse from our society. In common with our European counterparts, Ireland's hard drug — heroin — problem can be linked with several socio-economic factors. For example, of those who received treatment in 1994, 84 per cent were unemployed while 60 per cent had left school with the minimum education.
Drug misuse in these circumstances needs a far reaching, multi-agency approach, which tackles not just the results of misuse, crime and ill-health, but also the root causes of the problem, which are linked with a multiplicity of socio-economic factors. In areas such as the north and south inner city, local communities have come together in a positive way to assist statutory and voluntary agencies working in the drug misuse area. With this support, local GPs are becoming involved in treatment, and preventive initiatives are being undertaken among parents who are drug misusers. Rehabilitation programmes such as the Saol and Saoirse programmes provide drug misusers who have become stabilised with the skills necessary to integrate back into society.
In the fight against drugs we should concentrate our efforts on prevention beforehand rather than rehabilitation afterwards. Outside of the Dublin area, where the main drugs of misuse are ecstasy and cannabis, education continues to be the first line of defence. The second level school based programme, which was jointly launched by my Department in conjunction with the Department of Education, is now in place in over 50 per cent of schools, with teachers being provided with training to deliver the programme effectively. A similar programme for primary schools will be introduced next autumn.
My Department's health promotion unit and the Department of Education continue to support the youth health programme being co-ordinated by the National Youth Council of Ireland which is at present drawing up guidelines for youth leaders on how to deal with drug misuse. The HPU also supports parenting programmes and the efforts of a number of voluntary groups involved in education and prevention. It also relaunched "Drugs Questions — Local Answers" last year. This programme can provide local communities with a useful approach to addressing local drug problems. A national media awareness campaign, supported by a wide range of printed materials, will provide adequate information on drugs to parents, youth leaders and young people themselves.
So, as you can see, my Department is actively engaged in a multifaceted approach to tackling the drug problem. We cannot do it on our own, but need the support of community leaders, politicians, educators and parents. The Government decisions have clearly marked the way towards progress. My colleagues in other Departments, particularly the Departments of Justice and Education, have also pivotal roles to play in this process. I am confident, however, that we may see the fruits of our labour soon, with a reduction in the toll and misery caused by drug misuse.