Tuesday, 26 November 2019

Ceisteanna (45)

John Curran


45. Deputy John Curran asked the Minister for Health if the methadone treatment protocols will be reviewed, in particular the length of time persons are on methadone treatment here; and if he will make a statement on the matter. [48841/19]

Amharc ar fhreagra

Freagraí ó Béal (6 píosaí cainte) (Ceist ar Health)

The Minister will be aware that more than 10,000 people are currently on methadone treatment, many of them for extended periods. Will the Minister advise the House when methadone treatment protocols were last reviewed, especially for individuals who have been on methadone treatment for a long time? What are their care and progression plans? How frequently are individuals offered those care and progression plans in light of the fact that many of them have been in receipt of methadone treatment for a good number of years?

I am answering on behalf of my colleague, the Minister of State, Deputy Catherine Byrne. Methadone is one of the medications used in opioid substitution treatment along with suboxone. Methadone prescribing for opioid dependence is a key element of the harm reduction approach to opioid use set out in the national drugs strategy. As of 30 June, 10,396 people were in receipt of methadone maintenance treatment. A review of the methadone treatment protocol was published in December 2010. Arising from the review, the HSE implemented an opioid treatment protocol to provide appropriate and timely substance treatment and rehabilitation services tailored to individual needs. The focus in the strategy is on implementing the HSE national clinical guidelines on opioid substitution treatment published in 2016. These guidelines are the first that specifically relate to opioid substitution treatment in HSE clinics and primary care settings.

Opioid substitution treatment supports patients to recover from drug dependence. HSE addiction services work within the national drugs rehabilitation framework to support progression pathways.

The framework ensures that individuals affected by drug misuse are offered a range of integrated options tailored to meet their needs and to create rehabilitation pathways.

There is international research evidence that increased length of time in opioid substitution treatment is associated with improved treatment outcomes and short-term methadone maintenance treatment is associated with poorer outcomes. I believe that methadone treatment reflects the public health approach to drug and alcohol misuse set out in the national drugs strategy. It is an important tool to reduce harm and to aid people on their journey to recovery from drug use. I am committed to improving the availability of this treatment and to supporting service users to access progression pathways.

The Minister of State indicated there were 10,300 people in receipt of methadone treatment, approximately 6,000 of whom have been on treatment for more than five years, 4,000 for more than ten years and 1,400 for more than 20 years, so some people have been on treatment for an extended period. The pathways to progression are not always very clear. I have met many people who have been on methadone treatment and they indicated it is harder to detox from methadone than from heroin. People are concerned that when they get on methadone treatment, it is not the answer but only part of it. I fully accept and acknowledge the role methadone treatment has in terms of removing somebody from heroin and illicit drugs, removing the criminality element and bringing them into treatment services. However, I have a concern that a significant number of people have been left in treatment for a long time.

The Minister of State made reference to international studies and long-term studies on the positive effects of being on methadone for a prolonged time. Those studies are 20 years old. If we are considering new and alternative treatments, are those studies as valid today as they once were? For individuals who are on methadone treatment, particularly for an extended period, how frequently are their care plans and pathways reviewed with a view to progression?

As I understand it, there are no current plans to carry out a review. A mid-term review of the national drugs strategy is planned for 2020 and I would imagine that would be an appropriate time to consider a review. I accept the Deputy's point that it is a long time since a review was carried out on the length of time, the treatments and the model of care associated with this. Perhaps the review of the national drugs strategy in 2020 is an appropriate time to accede to the Deputy's very reasonable request.

I acknowledge that a review is necessary, particularly in terms of the changing environment. I indicated my concerns for the individuals but I also have a general concern with the amount of methadone. I want to put the following point very clearly on the record because we sometimes do not recognise it. The last full year for which we have figures from the drug-related deaths index is 2016. In that year, there were 72 poisoning deaths in which heroin was implicated but there were 103 poisoning deaths in which methadone was implicated, so the figure is significantly higher for methadone than for heroin. Of those who died, 66 were on methadone treatment. The figures show there is a risk in terms of the population in general because, obviously, some of the methadone that is being dispensed to individuals is not being taken by those individuals and is being used elsewhere. However, even for those who are on methadone programmes, there is a significant risk. In 2016, there were some 9,500 people on methadone treatment and 66 of those died a death where methadone was implicated.

I reiterate my acknowledgment of the Deputy's concerns, which are genuine and valid. I accept there is no plan for a review but I also accept the date and the timeline the Deputy has put forward. Again, I am hopeful that, as part of the overall review of the national drugs strategy, this will be reviewed, starting in 2020.