Drug Treatment Services

Tuesday, 2 November 2010

Seanad Éireann Debate
Vol. 205 No. 6

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Senator Jerry Buttimer: Information on Jerry Buttimer Zoom on Jerry Buttimer I thank the Minister for being present for this Adjournment debate.

Yesterday I attended the meeting of the joint policing committee in Cork at which I heard there had been a reduction in the number of people arrested for the possession and use of drugs. That is welcome. A couple of weeks ago the Irish Examiner published a chronological chart demonstrating the use of heroin across the country and it is fair to say we have a difficult task ahead in curbing its spread. As the Minister said on previous occasions, the problem is encountered in all four corners of the country and across all sections of society. It is reaching epidemic proportions, which is worrying.

The number of heroin users doubled between 2002 and 2008. It is difficult to comprehend how we took our collective eye off the ball and allowed this to happen. Despite two national drugs strategies and giving more resources to the Garda, there has been a massive jump in the number seeking help for heroin addiction. The Irish Examiner broke down the figures by region. In the mid-west there was a 310% increase; in the east, a 280% increase; in the south east, a 270% increase; in the midlands, a 260% increase, and in the south — my own area — a 240% increase. The number of new treatment cases for opiates has risen from 21 to 71 in the [395]intervening period. The Minister’s adviser, Dr. Des Corrigan, has said the figures highlight the need for investment in treatment services. However, I understand we have a difficulty with the budget. In some regions there is a waiting list for treatment and access to methadone programmes. While I understand we must be prudent financially, I am concerned that cutbacks will lead to a lengthening of the waiting lists and a curtailment of services and the activitiesd of local drugs task forces. People are worried. When the Minister was in Cork last Friday, he saw at first hand the importance of empowering local communities. I know his background is in community work. If we cut front-line services, we will accentuate the problem.

I am glad we have recognised — belatedly perhaps — that this is not just a problem in Dublin city. I was struck by the remarks, quoted in the article in the Irish Examiner, of Mr. Justice Murphy who said we must apply the rigour of the law. He is right. We must do so. However, we must also prevent the scourge of heroin from spreading through the countryside. If it takes root, it will create difficuties for myriad other services and communities and make further demands on them. I am a former schoolteacher and director of adult education services. I am also involved in the GAA. I am worried that more and more young people are dabbling in drugs and poly-drug use. I spoke to a couple of lads in my constituency in the last couple of weeks. They told me readily where they could get drugs of any description, which is a concern.

It is important that the education system is to the forefront in our drugs strategy. I am worried, however, that we have missed an opportunity regarding the addiction services. In that regard, I refer to Arbour House in Cork. Tabor Lodge addiction centre celebrated its anniversary this year, but it needs more support. Fellowship House in Cork city is still awaiting grant approval. I am not being political, but we must support the provision of budgetary funding. We spoke earlier about the Minister’s role in the pre-budget talks on funding for the Irish language. Equally, we must protect and assist services and people under pressure. I commend the work of the local drugs task forces, those involved in the HSE and local gardaí and hope we will not allow funding to be cut completely, as this issue is far too important. We must fight heroin abuse. In that regard, I hope the Minister’s reply will be positive.

Minister for Community, Equality and Gaeltacht Affairs (Deputy Pat Carey): Information on Pat Carey Zoom on Pat Carey I thank the Senator for raising this matter. When I was in Cork last Friday, I availed of the opportunity to talk to the chairman and co-ordinator of the regional drugs task force to be updated on how things were going there.

Heroin use remains a major problem. All the indications are that while the use of heroin is relatively stable in the Dublin region, it has become more widely dispersed around the country, particularly in the major cities and towns across Leinster. Responding to this problem is a priority under the national drugs strategy 2009-16.

It is difficult to establish an accurate baseline for the prevalence of opiate use. A report from the national advisory committee on drugs — Senator Buttimer referred to Dr. Des Corrigan — in December 2009 indicated that there were 11,807 known opiate users in 2006 but that there was considerable doubt about the number of unknown users, those who had not come into contact with the drug treatment services, hospital services or the Garda. Similar issues have arisen in other jurisdictions. A study is being carried out on behalf of the NACD to assess how best to estimate overall opiate user numbers. I fully acknowledge that collecting data is very difficult. A number of localised pilot schemes have been initiated and I hope they will provide the information clinicians and others need and that we can build on their findings in the next few years. Given there has been some geographical spread of heroin use, an increase in the numbers seeking treatment outside Dublin was anticipated when the strategy for the [396]period up until 2016 was being put in place. While there is an increase in demand, in many ways this reflects the efforts made to encourage heroin users into treatment. Their entry into treatment at an early stage increases their prospects for positive outcomes.

I fully accept the view that the provision of treatment services is vital to address the needs of problem drug users. This is illustrated by the fact we have 9,400 people in methadone treatment, a very significant proportion of the known users. New opiate substitution services have opened this year in Cork, Tralee and Wexford, and these will be followed shortly by facilities in Kilkenny, Waterford, Limerick, Dundalk and Drogheda. This is being done by the HSE with financial support from my Department. Further opiate substitution services in the midlands are being actively considered. The methadone protocol is under review at present. For the information of the House, I expect to have the experts’ advice shortly on that issue in regard to the recruitment of other doctors, methadone substitutes and so on.

There were 464 people on waiting lists for opiate substitution treatment in October. No people under 18 years of age are awaiting treatment. In Dublin, 112 people are waiting for services, some of whom can access services in Dublin on demand, while the waiting time for others can be up to a month, which is in line with the target set under action 32 of the national drugs strategy. Waiting times in other parts of the country will disappear or reduce significantly when the new services come on stream. I acknowledge there are some areas where waiting times are unsatisfactorily long. My office is working with the HSE to ensure those issues are addressed.

My Department has also provided funding for the provision of a needle exchange and other services in Drogheda. Services commenced there in October and will cover the north east. Progress has also been made towards providing a comprehensive needle exchange programme throughout the country and on the expanded provision of rehabilitation services, including detoxification facilities in counties Carlow, Kilkenny, Cork and Limerick.

The HSE has also allocated additional resources in 2010 to develop front-line addiction services, with a particular focus on those under 18 years of age. This includes additional psychology services, counselling, outreach services and family therapy in each regional drugs task force area. Meanwhile, an independent review of the methadone treatment protocol, which has served us well since it was put in place in 1998, is being carried out. On finalisation of the review, I hope to see further improvements in the provision of the services in the coming years, including a greater focus on facilitating exit from methadone treatment towards rehabilitation, where appropriate, with the consequent freeing up of places for further clients. I have referred to the need for continuing care and inter-agency co-operation. While this is improving, there is a good way to go yet.

I hope that, notwithstanding the current financial constraints facing the public service, the target of having 100% of problem drugs users accessing treatment within one month of assessment by 2012 will be achievable. With respect to rehabilitation, the national drug rehabilitation implementation committee has developed a framework through which to address the needs of individuals in recovery. The overall objective is to seek to enable service providers to offer a range of integrated options tailored to meet the needs of service users through individual rehabilitation care plans. A series of pilot projects is being developed to assess the proposed integrated care pathway model with a view to informing further the protocols and agreements required to implement the model nationally.

The Garda Síochána and Revenue’s Customs and Excise continue to tackle the supply of illegal drugs, including heroin. They are also targeting the gangland activity associated with this [397]supply. I stress my determination to continue to tackle the issue of heroin use in the coming years and I am confident that the actions outlined and the broader implementation of the national drugs strategy will continue to facilitate this.

I thank all the national, local and regional drugs task forces and all the volunteers who work with them and their co-ordinators for the work they are doing. It is a slow and difficult task but I believe they are making progress. I pay tribute to the journalist from the Irish Examiner who has repeatedly highlighted the issues, always in very well researched articles.

Senator Jerry Buttimer: Information on Jerry Buttimer Zoom on Jerry Buttimer I hope there will not be a cut in front-line services dealing with the heroin problem.

Deputy Pat Carey: Information on Pat Carey Zoom on Pat Carey I hope so too.

Senator James Carroll: Information on James Carroll Zoom on James Carroll I wish to focus specifically on the issue of drugs services in the north east, especially in counties Louth, Meath, Cavan and Monaghan, and how these compare nationally. I say this having met various groups in Drogheda and the north east which have raised serious concerns with me about the treatment for drug addicts and the path for addicts into the future. As I have explained to the Minister previously, I will be a trustee in developing a Liberties-style recycling programme in Drogheda which focuses on providing a service for addicts to help them see the light at the end of the tunnel and rehabilitate themselves. There is confusion in providing community employment schemes dealing with addiction services for recovering addicts, which is a key issue I would like the Minister to address. While FÁS is informing the Department that it is adding addiction scheme places, it is not focusing on community employment schemes for addicts and recovering addicts.

We must address the issues. I have met a wide variety of addicts in the course of my work as a Senator in recent months. Some of the people I went to school with spend the time from 9 a.m. until 9 p.m. looking at the four walls. Being a recovering addict can be a very lonely place and this can be a problem in that addicts may slip back into old ways. The investment the State makes in them initially is wasted because we do not have a follow-through path for them.

I am also working with the group of Pastor Amos Ngugi who is providing rehabilitation services for the new Irish, specifically for addicts, and I helped to launch his poster campaign two months ago in the Holy Family centre in Ballsgrove, Drogheda. Pastor Amos is focusing on the cohort of new Irish, many of whom still have not sorted out their citizenship. They have the same problems as many addicts in that it is a long day, a long week, a long month to sit about with nothing to do. Invariably, some fall into the trap of addiction, whether that is through alcohol or drugs, including light drugs, which often lead on to harder substances.

In his previous reply, the Minister referred to the prevalence of heroin. I am very concerned that in certain parts of the north east, as well as in other parts of the country, the problem of heroin is exploding. People would be gobsmacked if they were aware of the problems in various provincial towns.

The Minister should address what we as a Government, country and society are doing to tackle the scourge of alcohol. We all talk the talk and say alcohol is terrible and should not be abused. The reality is different. I am 27 years old and when I left school nine years ago, this was a huge issue. Whether in regard to junior certificate parties or other parties, more young people are getting into serious states of drunkenness, which has many consequential problems. From my work and liaison with the RAPID co-ordinator in Drogheda, I know she sees at first hand the problems where parents have grown up with this as an issue. They might get up at
[398]2 p.m. and come downstairs to take alcohol or even cannabis with their children. What example does this set for our young people?

We need a serious debate. Scandinavia has made it incredibly difficult to access high alcohol content drinks. The two vehicles for reducing consumption of alcohol are increased price and limited access, which are the two paths we must pursue. As a Government, we must focus on this area. People feel it is uncool if a person says he or she does not drink, and if the person says he or she is a Pioneer, people think that person has two heads. We must consider getting people on board who can sell our message, whether this involves sports stars from GAA and rugby or famous actors and actresses, and using them as role models for young people to aspire to. Even sports people might believe they can train hard for a few months and then go on a drinking session for a week. We must tackle this problem because it causes so many problems.

The reality many people have refused to accept is that alcohol is the first step to many harder drugs, whether cannabis, heroin or speed, which raise a gamut of issues. I would like the Minister to address those points.

Deputy Pat Carey: Information on Pat Carey Zoom on Pat Carey I thank the Senator for raising the issues that arise in the north east which are of particular concern to me. I was in Drogheda in July and met the same group as the Senator. I was concerned when I heard about the experiences of some of the addicts. I compliment the Ana Liffey Drug Project in Dublin which has come to the aid of the strategy and is providing services with the help of the HSE and my Department. We will be building on this work shortly.

Solid progress is being made on the implementation of the various actions of the national drugs strategy across its five pillars of supply reduction, prevention, treatment, rehabilitation and research in line with the Government’s commitment to address problem drug use in a comprehensive way. From the establishment of the Department of Community, Rural and Gaeltacht Affairs in 2002 up to 2009, in the region of €197 million was made available for drugs initiatives, in the main through local and regional drugs task forces. I am satisfied that the drugs task forces are continuing to make a positive impact on the drugs problem and a further €36 million has been made available by the Department of Community, Equality and Gaeltacht Affairs this year. In excess of €31 million in current funding has been made available to fund the activities of the task forces, of which €21.045 million has been allocated to the local drugs task forces and €10 million to the regional drugs task forces. This funding will support some 500 initiatives that the task forces have prioritised for investment in their respective areas. In this regard, it should be noted that the steering group for the national drugs strategy recognised the key role that the local and regional drugs task forces have played in addressing the drugs problem in recent years and “believed that the Drugs Task Forces will continue to play a strong role in the coming years”. I am a great believer in the local and regional task forces. I acknowledge that both are stretched, geographically and in terms of resources.

The allocations for the north eastern regional drugs task force, NERDTF, were €590,000 in 2006 and €1.04 million in 2010. The Senator will note the somewhat reduced allocations in 2009 and 2010 which reflect the pressures on the public finances. I advise him, however, of the sustained incremental funding in previous years which facilitated, inter alia, the rolling out of projects and initiatives in the regional drugs task force areas, the introduction of new initiatives and responses to address cocaine usage, measures to support rehabilitation and the ongoing investment in capital projects. These are recognised by the Government as key initiatives to support communities to address the harm caused by problem drug use and deliver meaningful solutions. Our primary concern has been and continues to be the protection of front-line com[399]munity-based services delivering vital programmes and initiatives in the areas worst affected by problem drug use. I am satisfied that the investment being made, including €1.04 million made available to the NERDTF, will continue to address problem drug use in a meaningful and real way and protect front-line services to the greatest extent possible.

In terms of a national comparison between the north-east region and the national position, from a funding perspective, total funding has more than doubled since 2006 across the regional drugs task force areas, notwithstanding the reductions in 2009 and 2010. I understand from the task force that, given the reduced budget for 2010, following similar reductions in 2009, the NERDTF had a renewed focus on ensuring projects delivered consistent and effective services across the four counties of Cavan, Louth, Meath and Monaghan. In some areas, this led to restructuring of services in order that there would be a clear focus on ensuring there were small multidisciplinary teams in place in each HSE local health office area which would be able to respond to the needs of their community and work co-operatively with other key service providers. This transformation could not have been achieved without the support of the voluntary sector addiction service providers which proved their willingness to adapt to the new requirements. I am additionally informed by the NERDTF that it now has in place key front-line services which are able to ensure people who are experiencing difficulties due to their addictions and who are willing to address them can quickly access a range of addiction services in a localised community drug and alcohol team setting. These core front-line services consist of the Meath Community Drug and Alcohol Response Project, the Cavan/Monaghan Drug Awareness Project and the Louth community drug and alcohol team.

In addition to the work of the NERDTF which is funded by my Department, HSE addiction services in the north eastern counties are provided through a range of services. These include an addiction service for counties Louth and Meath managed by the Louth local health office under the direction of the drug service facilitator; an addiction resource centre in counties Cavan and Monaghan, managed and delivered through the mental health services; and a methadone programme in the north east providing services for counties Louth, Meath and Cavan and Monaghan, managed through the Louth local health office. I understand HSE expenditure on the addiction services for counties Louth and Meath was just under €800,000 in 2009 and €500,000 on the addiction resource centre for counties Cavan and Monaghan and that 1,111 clients from the north-east region received treatment for drug and alcohol use.

My Department has also provided funding for the provision of needle exchange and other services in Drogheda. The service commenced there in October and will cover the north east. I look forward to continuing co-operation with all drugs task forces, including that in the north east, and greatly appreciate the work being done.

Let me address the four issues raised by the Senator. The Liberties-style initiative and the community employment scheme issue are linked. The initiative in the Liberties is long established and based on rehabilitation, well thought through strategies and the use of community employment schemes. There are 1,000 ring-fenced community employment schemes nationally for drug misusers. I am working with representatives of FÁS on the oversight group on drugs which I chair. We are working on how we can ring-fence community employment scheme places nationally to assist the rehabilitation of drug misusers. I will be happy to discuss how we might go about doing this with the Senator.

On the issue of the new Irish, the oversight group has recently produced a report on what we call communities of interest, including the new Irish. Issues have arisen as part of the study that need to be addressed. They will have to be incorporated into the strategy, both at regional and local level.

[400]The Senator referred to alcohol abuse. When I was in charge of the national strategy some years ago, I started the process of trying to align the national drugs strategy with an alcohol strategy. That process is well advanced. A group co-chaired by the Department of Health and Children and my Department is working to prepare a draft strategy and a number of significant recommendations have been made. The draft report is all but ready. However, some of the recommendations will be challenging. There are already fears among some groups, including sports organisations, that some of the traditional funding streams for sponsorship, etc., might be interfered with. More important, we will be addressing the issue of the accessibility of alcohol and the fact that it is increasingly the gateway drug used by most people. When I visited a treatment centre in Clare recently, I met a woman who told me she had taken her first drink of alcohol at 11 years of age. It was given to her by her mother. As the Senator rightly stated, the mother was smoking cannabis.

I am under no illusions about what lies ahead, but I am anxious to have an aligned alcohol and drug misuse strategy in place in the new year. There are a number of locations at which groups have come forward offering to pilot the strategy. If the Senator or anyone else has an area in mind in which a pilot project could be rolled out, I will be more than happy to work with him or her and try to provide resources. In County Donegal there is very good group, the North West Alcohol Forum, which does extremely good work. It is very important that we work with local groups to determine whether we can design local solutions.

Senator James Carroll: Information on James Carroll Zoom on James Carroll I thank the Ana Liffey Drug Project for filling a gap in the Drogheda drugs service. When one looks at the figures, one thinks they are very good, but one should realise much of the funding goes on wages, for example, not on front-line services. Some believe the community employment scheme to rehabilitate drug users is bad, but it is my experience that it often provides the peer support and network required which make a big difference. I look forward to working with the Minister.

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