In 2002, the Department of Health and Children requested the Methadone Prescribing Implementation Committee to review the Methadone Protocol that was introduced in October 1998. The published review was released in June 2005.1 

According to the review, there were 6,883 people receiving methadone treatment in Ireland at the end of December 2003.

As part of the review, submissions were invited from interested parties and 46 submissions were received in September 2002. The submissions were analysed to identify themes and recommendations were made to address the themes identified.

The themes identified through the submissions were:

• Breadth of representation on the Methadone Prescribing Implementation Committee
  A number of submissions identified the need to invite representatives from the community, service users, the voluntary sector, the Drug Treatment Centre Board, the former Area Health Boards and the Irish Psychiatric Association on to the committee. The committee will invite representatives of the Drug Treatment Centre Board, the former Area Health Boards and the Irish Psychiatric Association to be represented on the committee. 

• Revising aspects of the regulations
  Several submissions requested revisions to the prescribing of methadone. None of these suggestions were taken on board as it would mean re-writing the regulations. 

• Clients’ experiences of methadone treatment services
  Clients attending methadone treatment programmes requested that all clients should participate in their treatment plan, stable clients should not need to attend weekly, individual appointment times should be given to clients, clients continuing to use drugs chaotically should be treated separately from more stable clients, and the issue of privacy with respect to urinalysis should be addressed. The committee recommended that it would be more appropriate to address these issues through the service users’ charter in each HSE area. 

• Issues pertaining to general practitioners
  A number of submissions stated that there is a need to take a co-ordinated approach to methadone treatment outside the HSE Eastern Region and to increase the recruitment of level 1 and level 2 general practitioners throughout the country. The committee will review the role of the National General Practitioner Co-ordinator to ensure greater support to the areas outside the Eastern Region. A small number of general practitioners requested an increase in the number of clients that a practitioner is permitted to treat. The committee will deal with such requests on an individual basis. It was suggested that training on treating opiate misuse be included in undergraduate and postgraduate medical training. In addition, it was suggested that specialist methadone training should continue and that completion of such training should be one of the criteria for GMS posts in deprived areas. These ideas were welcomed by the committee and will be recommended to the relevant authorities. It was also suggested that general practitioners be given the resources to comply with the requirements of the National Drug Treatment Reporting System. Such compliance is a condition of the general practitioners contract negotiated in 2003. 

• Issues pertaining to pharmacists
  Pharmacists requested joint training with other health professionals, which the committee considered a useful suggestion. The need to increase the recruitment of pharmacists was raised. The committee recommended the employment of a liaison pharmacist for the HSE areas outside the Eastern Region. Some pharmacists requested routine hepatitis B vaccination; this is available free from the HSE to all participating pharmacists and their staff. Pharmacists and clients raised the issue of security and privacy in pharmacies. The committee reported that these issues were outside their remit as they had resource implications, and noted that grants were available through the HSE for upgrading premises. Some pharmacists reported that a regular client might present to a pharmacy without a prescription and the pharmacists experienced a dilemma: to follow the regulations, or to fulfil their duty of care to the client. The committee took a pragmatic view, stating that the pharmacist should provide the previously prescribed treatment, document the experience and ensure the client sought an up-dated prescription as soon as possible. Actions should be taken to prevent its occurrence if this practice is repeated on a regular basis. 

• Co-ordination between services and continuity of care for clients
  According to the text of the submissions, the lack both of co-ordination between psychiatric services and drug treatment services and of continuity of care between prison services and drug treatment services needed to be addressed. The committee agreed with these statements and welcomed the establishment of a national committee to develop protocols for transfer of clients between the prison services and the HSE. The committee stated that structures should be developed to ensure that clients on methadone treatment who require psychiatric treatment are not at a disadvantage. 

• Guidelines for the management of young drug users
  Guidelines for the management of opiate users aged under 18 years were requested; these will be provided by the Department of Health and Children’s working group in the near future. 

There were 19 recommendations in the Methadone Protocol, of which 12 were completely implemented by the end of 2004, four were almost completely implemented and the remaining three required some further work. The three requiring further work related to service provision, including the range of services, the link between treatment services and general practitioners, and pharmacists’ contracts. 

1. Department of Health and Children (2005) Review of the Methadone Treatment Protocol. Dublin: Department of Health and Children.