Home > Dáil Éireann debate. Priority question 4 - National Drugs Strategy [37287/06].

[Oireachtas] Dáil Éireann debate. Priority question 4 - National Drugs Strategy [37287/06]. (09 Nov 2006)

External website: https://www.oireachtas.ie/en/debates/debate/dail/2...

4. Mr. English asked the Minister for Community, Rural and Gaeltacht Affairs  the progress made regarding the new rehabilitation tier of the national drugs strategy; and if he will make a statement on the matter. [37287/06]

Minister of State at the Department of Community, Rural and Gaeltacht Affairs (Mr. N. Ahern): The mid-term review of the national drugs strategy recommended the development of a fifth pillar of the strategy focusing on rehabilitation. Arising from this, a working group on drugs rehabilitation was set up in September 2005 under the aegis of my Department to develop proposals to augment existing rehabilitation services. The working group includes representatives from a range of Departments and agencies involved in delivering rehabilitation services, in addition to representatives from the national drugs strategy team, the National Advisory Committee on Drugs and the community and voluntary sectors. The terms of reference of the working group are broad and include examining the existing provision of rehabilitation services, identifying best practice, identifying gaps and recommending actions to develop an integrated rehabilitation service. Some of the group’s key recommendations are likely to focus on ensuring that actions 47, 48 and 50 of the strategy are met.

These actions largely relate to providing a continuum of care for clients through planned progression paths for each problem drug user, while ensuring that quality standards are achieved in the services provided. The group is also likely to deal with wider supports which are needed by recovering problem drug users in areas like involvement in community employment schemes, educational supports and support with progression to employment, housing and child care. It will also recognise the need to involve the families of problem drug users in the process. I expect the working group to complete its report by the end of the year, with a view to beginning the implementation of its recommendations in 2007. I am aware that the HSE has established a working group on residential treatment and rehabilitation for substance users. This group, on which my Department is represented, is examining the residential rehabilitation requirements of people involved in all forms of substance misuse, including the misuse of alcohol. Its report is likely to be available early in the first half of next year.

Mr. English: I am disappointed that just one third of my original question has been answered. I spoke to the Minister about it, but I want to raise it now with the Ceann Comhairle. I am very annoyed. The question I originally tabled was “to ask the Minister for Community, Rural and Gaeltacht Affairs the alternatives to methadone treatment that exist for heroin misusers; the structures in place to allow them to become drug free; the progress made in relation to the new rehabilitation tier of the national drugs strategy; and if he will make a statement on the matter”. I have received an answer to the third part of that question, but the first two parts of the question were the most important and I want answers to them. I will write to the Ceann Comhairle about the matter. As the Minister of State, Deputy Noel Ahern, is in charge of the drugs strategy, he is responsible for answering questions about alternatives to methadone. If I am lucky, I will get an answer to the final two parts of my question from the HSE by Christmas, although it is more likely to be Christmas of next year. I would like a proper discussion about new drugs and other developments in this area, but that is not possible because someone in the Department of Community, Rural and Gaeltacht Affairs decided that it was a matter for someone other than the Minister of State. That is what is wrong with this country’s approach to the drugs problem - nobody wants to take responsibility for tackling it. I told the Minister of State previously that while I accept he has an interest in this area, I do not feel the Government is really committed to solving the problem. If it was committed to dealing with this matter, I would not have received a letter telling me that my question had to be chopped in three and referred to other Departments.

Mr. N. Ahern: What was the bit that was excluded?

Mr. English: Two bits were excluded from the question. I asked about the “alternatives to methadone treatment that exist for heroin misusers” and “the structures in place to allow them to become drug free”. If the Minister of State’s section of the Department is not responsible for such matters, we are wasting our time here. We are supposed to be debating the problem of drugs and the Government’s strategy for dealing with it. They are the two key aspects of the matter. According to the Government’s figures, more than 8,000 people are on methadone and it is costing approximately €30 million. I cannot get further details of the matter or have a discussion on it. How can we talk about the drugs strategy, treatment and rehabilitation when responsibility for providing answers is given to another organisation? I will not get an answer to my question for many months. The Minister of State knows as well as I do what happens in the Health Service Executive when a question is referred to it.

An Leas-Cheann Comhairle: I invite the Deputy to ask a supplementary question.

Mr. English: I will. I am very concerned about this matter and my question needs to be answered.

An Leas-Cheann Comhairle: The Deputy has made his point.

Mr. English: It is not good enough. The Minister of State said last May, in response to a question, that the working group would publish its review by the middle of the year. He answered the same question in October by saying it would be published in a couple of months. He is saying today that it will be published by the end of the year. When will the review be published? Can the Minister of State give us a clue? His reference to actions 47, 48 and 50 of the strategy was the first hint we got of what the working group might be talking about. Will he give us his opinions on the matter? Has he met the members of the working group? He said previously he would not meet them until they had published the full review, but I think he has a duty to meet them before that. As the Minister of State is the expert in this area, he should be involved in the process. The Department of Communications, Marine and Natural Resources, which chose not to answer these questions, should have the expertise in this regard. What does the Minister of State think should be contained in the new structure? What does he think we should concentrate on? He mentioned housing, for which he is responsible, and jobs. People who are trying to come down off drugs can have problems getting housing, such as rented accommodation, and then getting jobs. Getting off drugs is like coming out of prison. We have to find a place in society for such people without any hassle. They should not have to knock on the doors of public representatives to get help. If we get people off drugs, it is in our interest to keep them off drugs. We really have to act on this. If the working group does not report until January and the Minister of State then spends six months reviewing the report, we will still be talking about this matter this time next year.

Mr. N. Ahern: I did not know that part of the Deputy’s question had been excluded. Mr. English: That is my point. Mr. N. Ahern: I do not even see any words that-----

Mr. English: I accept that the Minister of State was not aware, but that is what is wrong.

Mr. N. Ahern: The Leas-Cheann Comhairle might help the Deputy in that regard. Mr. English: No. The Department of Communications, Marine and Natural Resources, not the Ceann Comhairle or the Leas-Cheann Comhairle, cut the question in three.

Mr. N. Ahern: Methadone is the main substitute form of treatment for heroin users. The National Advisory Committee on Drugs produced a major report on a form of medication called Subutex, which is a form of buprenorphine, two years ago. Subutex is used in a number of countries - it is almost as popular as methadone in some countries. The report was referred to the Minister for Health and Children at the time. She has been examining the matter, but the drug has not been made fully available. The Irish Medicines Board is responsible for approving all forms of medication - I do not have that responsibility. Buprenorphine, which is generally made available in tablet form, is deemed to be good for people who are fairly focused and stable. As it takes 15 or 20 minutes to dissolve buprenorphine under one’s tongue, many people in the Health Service Executive feel it offers a fairly large opportunity for diversion. Therefore, it has not become widely used here. It can be prescribed by individual doctors, but it is not in mainstream use. It is legal, but it is not used on a wide scale because of the fears of the authorities in respect of it.

Mr. English: I thank the Minister of State for answering that part of my original question.

Mr. N. Ahern: Approximately 8,000 people are on methadone at present. It is estimated that there are approximately 14,500 heroin misusers in this country. Approximately 4,700 of the 8,000 methadone users are being treated in clinics, approximately 2,800 of them are being treated by their general practitioners and approximately 400 of them are being treated under prison-based methadone programmes. Some 225 general practitioners throughout the country are involved in methadone maintenance, of whom 181 are based in the eastern region and 44 are based outside the eastern region. Delays often arise when people realise there is a demand in a place like Limerick or Waterford, because the doctors and other medical people in such areas may not be trained in the best forms of care. They may be trained to level 1, rather than to level 2. It is not always the case that the service can be opened up because doctors and pharmacies need to be part of it. More than 370 pharmacies are participating in the programme, more than 200 of which are in Dublin. It is significant that approximately 150 participating pharmacies are outside Dublin. I have provided some of the information that Deputy English was looking for. I do not deny that the deliberations of the rehabilitation working group, which is chaired by the Department of Communications, Marine and Natural Resources, have continued for much longer than I thought they would. That the process has lasted so long is good and bad. There is no point in a report being signed by me or by somebody in the Department if people in the HSE, in particular, as well as in the voluntary side, have not signed up to the various services. The working group has encountered many hiccups. It holds frequent meetings. I am sure the officials who are dealing with the group would like it to conclude its deliberations. If the delays result in the production of a good report that everyone can sign up to, they might be worthwhile. A great deal is happening in respect of rehabilitation. Putting 8,000 people on methadone was a short-term measure that was supposed to last a couple of years.

Mr. English: It is now a long-term approach.

Mr. N. Ahern: I accept that. A great deal of good work is being done in the area of rehabilitation, but some unfocused work is also being undertaken. The working group will try to suggest some structures to pull it all together and develop best practice. Some of the rehabilitation work is not great, although most of it is great. It may be the case that more people on community employment schemes, for example, should be involved.

Mr. English: I appreciate the Minister of State’s answer. I am glad that we have been able to discuss the alternative to methadone. That was all I wanted. I understand why we are stuck with methadone, but we should try to move away from it at some stage. The Minister of State said that the working group’s deliberations have taken much longer than was planned. The same thing happened with the regional drug task forces - they took a year or two longer than planned to conclude their reports. Can the Department of Communications, Marine and Natural Resources set deadlines for the production of reviews and reports? Can the Minister of State give me a guarantee we will discuss this report before Christmas?

Mr. N. Ahern: I hope that they will have completed the job before Christmas, but I doubt we will be launching it or discussing it before then. Vol. 627 No. 2 Priority Questions Thursday, 9 November 2006

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