Social Inclusion Commentary

Opioid substitute Treatment (month in arrears)

• 9,743 patients received treatment (excluding prisons) as of the end of November which includes 4,183 patients being treated by 354 GPs in the community.
• 685 pharmacies dispensed treatment catering for 6,809 patients.
• 81 HSE clinics were providing treatment and an additional 10 prison clinics were provided in the prison service.
• 65 new patients commenced treatment during August (9 in General Practice, 46 in HSE clinics and 10 in the prison clinics).

The majority of Opioid Substitution Treatment (OST) KPIs are on target with the exception of transfers. Reasons behind the below target transfer of stabilised clients to the lowest level of complexity (Level 1) from clinics and Level 2 GPs continue to be discussed at CHO Performance Meetings. The following constellation of issues are impacting clients in achieving the level of stabilisation required to move to the community for their treatment:

o Poly-drug use

o Significant benzo misuse

o Homelessness

o Mental health issues

o Behavioural issues

Client progression will also be reviewed through the National Addiction Advisory Governance Group.

No of people trained in SAOR (Screening and Brief Intervention for problem alcohol and substance use)

National target of 300 people to be trained in SAOR in 2016 which was exceeded in the first quarter. 7 CHOs over performed and 1 underperformed. The 3 highest over performers were: CHO 2 (+1013%), CHO 5 (+446%), CHO 8 (+646%), CHO 3 underperforming at -45%.

Pharmacy needle exchange (PNex) (quarter in arrears)

• Currently operating at 109 pharmacies which is 10 less than yearly target. Pharmacies have been recruited to date from Cork, Limerick and Kerry. Recruitment will continue in Waterford and South Tipperary and other areas were a specific need is identified. Some pharmacies have left and local recruitment has been done where appropriate and possible.
• The number of unique individuals attending pharmacy needle exchange has increased to 1,624 in July, 1753 in August and 1,793 in September. This is a demand led service and feedback from pharmacies indicates a widespread knowledge of the service among those who misuse drugs.
• The number of needle exchange packs provided was above 4,200 for Jul-Sept, which is 23% above target. Ratio of balance of 10 packs to 3 packs is approximately 1:1.5. The increase in 10 packs given out may result in an increase in the number of clean needles per person.
• Nationally the average no. of needle/syringe packs per person is 18 clean needles each month. Pharmacists are trained to encourage clients to ensure they have sufficient needles. This statistic may be influenced by a number of factors including the frequency of injecting and type of drug injected (e.g. clients in treatment may need less needles or clients may not be regular injectors/users; clients may also be getting packs from different pharmacies).
• The percentage rate of needles returned remains below target at 25%. However, a greater number of packs were given out and returned in 2016. The total number of packs returned up until September far exceeded the total number of packs returned for 2015 (2,923 versus 1,060). This may have been influenced by various strategies put in place during the year including pharmacy training and support and the work of multi-disciplinary Drug Related Litter (DRL) groups. DRL reports have decreased particularly in areas where DRL multi-disciplinary focus groups are in place e.g. Limerick, Cork, Midlands and Waterford. 

Tobacco

Smokers receiving intensive cessation support

• 764 received support. 1,237 in November, 1,183 in October. (Expected Activity 585)
• 14,475 YTD, 25.9% ahead of the YTD target. (Expected Activity YTD 11,500). CHO 3 is below target at -57.0%. The National Quitline is performing above target at 78.5%. 

Frontline staff trained in brief intervention smoking cessation

• 39 received training. 145 in November, 60 in October. (Expected Activity 80)
• 1,306 YTD, -3.3% below EA (Expected Activity YTD, 1,350). CHOs performing below target include CHOs 1, 5, 6, 7 and 8 at 0% variance. CHO5 reported the lowest performance at -57.6% below target.