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Long, Jean (2009) Comptroller & Auditor General report on drug treatment. Drugnet Ireland , Issue 31, Autumn 2009 , pp. 13-14.

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 The Comptroller and Auditor General published a report entitled Drug treatment and rehabilitation on 6 June 2009.1 The drug treatment services examined in this report were those caring for people with addiction to illegal drugs (mainly cannabis, cocaine, ecstasy and heroin). The report reviewed:

  • the extent to which the demand for drug treatment and rehabilitation services is being met;
  • the timeliness of access to drug treatment;
  • the extent to which the effectiveness of drug treatment and rehabilitation services are evaluated; and
  • the effectiveness of the arrangements for co-ordination of drug treatment and rehabilitation at an individual case level, and nationally. 
This article presents the findings with respect to drug treatment.
 
Treatment for problem opiate use
It has been estimated that there were between 12,884 and 15,883 problem opiate (mainly heroin) users in Ireland in 2001. Up to 2000, opiate use was concentrated in the greater Dublin area, but at the time of this report there was evidence that it had spread throughout the country. Methadone substitution treatment is the main form of treatment for opiate addiction in Ireland. At the end of 2007, just over 8,000 people were receiving methadone treatment. Around one-third of those receiving methadone treatment are cared for by private general practitioners. Needle-exchange services are provided in some areas, with the aim of reducing the risks associated with the sharing of injecting equipment. According to this report, there was some increase in the provision of needle-exchange services between 2001 and 2009, but gaps in service provision remain. The author report that in the period under review the numbers of opiate users who received detoxification treatment and the numbers who attended follow-on rehabilitation treatment were very low when compared with the numbers who received methadone treatment. They estimate that the extent of detoxification treatment provision was in the region of 100 courses of treatment per year. While the authors acknowledge that long-term methadone maintenance is likely to be the best outcome that can be achieved for a significant proportion of opiate users, they suggest that the HSE set targets for rates of progression through the various forms of treatment.
 
Treatment for problem drug use (excluding opiates)
The prevalence of cannabis and cocaine use among the general population increased between 2002/3 and 2006/7. The authors assume that the habitual use of a number of other drugs was also on the increase between the two survey time periods. The authors report that, despite this, there did not appear to have been a commensurate increase in the number of cases treated for problem use of cannabis over the life of the National Drugs Strategy. The findings of the review indicate that changes in the pattern of drug misuse (e.g. heroin addiction outside of Dublin and cocaine addiction in Dublin) created a challenge that service providers and planners found difficult to address. The review notes that many clients report multiple addictions. The current pattern of drug use suggests that there are, in effect, two separate client groups for whom drug treatment needs to be provided:
  • those with a largely opiate-based addiction problem, with more than three in five reporting multiple drug use, concentrated in certain marginalised and poor sectors of society;
  • those with problem use of drugs such as cannabis, cocaine and ecstasy, spread more widely across social groups and geographic areas. 
Although the prevalence of illegal drugs such as cannabis and cocaine was higher in Dublin than in the rest of the country, the rate at which users of these drugs entered treatment appeared to be significantly lower in Dublin than elsewhere. The authors note that there is a risk that the uptake of addiction treatment reflects the available services in a geographical area rather than the needs of the people living in the area.
 
Demand for treatment
Accurate information about the level of demand for treatment for problem drug use is very important for service planning purposes. A database on treated drug and alcohol use in Ireland is compiled and managed by the Health Research Board (HRB). This database, the National Drug Treatment Reporting System (NDTRS), relies on treatment service providers to collect details on each individual who presents for treatment. The information is transmitted to the HRB, without personal identification details (e.g. name or address) of the individuals receiving treatment. The result is that while the number of courses of treatment delivered can be identified, it is not possible to track the progression of an individual from one service provider to another. The review notes that ‘the NDTRS has the potential to generate better estimates of demand for treatment, but greater compliance by service providers with the NDTRS data input rules would be required if this is to be achieved.’ The review recommends that ways of recording treatments sought and provided on an individual basis and in a manner that ensures security of the information. The authors go on to recommend that this should be tackled by the HRB in liaison with service providers and with the Data Protection Commissioner.
 
Access to treatment
This review reported that the NDTRS data may underestimate the extent of waiting for assessment. The practice in some areas is that recording of information for NDTRS purposes starts only at the time of assessment, rather than at the time of initial presentation or referral. Some service providers also operate ‘informal’ waiting lists, and call those on the informal list only when an assessment appointment becomes available. In addition, where drug users are aware of long waiting times for access to local services, they may be deterred from presenting for assessment. The HRB provides a protocol defining the terms referral, assessment and treatment, but needs to put more emphasis on ensuring that all service providers record information completely and accurately so that the true extent of waiting for treatment may be gauged. Subject to these limitations, analysis of NDTRS data indicates that an estimated 82% of those beginning methadone treatment in 2007 commenced treatment within the one-month target following assessment. In almost all cases treated for cannabis, cocaine or other stimulants, treatment was provided within the one- month target.
 
While a high proportion of individuals commenced treatment within the one-month target, approximately 460 people were recorded as waiting for methadone treatment in April 2008. The average waiting time for those on the lists in some areas was over a year.
 
A target of carrying out an assessment within three days of presentation (or referral) for treatment has been set. Of the opiate cases recorded by the NDTRS for 2007, an estimated 61% were reported to have been assessed within three days of initial presentation. Almost one in eight of those assessed were reported to have waited more than a month for their assessment. For persons presenting for assessment for problem cocaine use in 2007, 56% were recorded as having been assessed within the three-day target. Of those presenting for assessment for cannabis or stimulant use problems, less than 40% were assessed within the target time.
 
Effectiveness of treatment
Evaluation of treatment effectiveness is complex. Nonetheless, some sound and informative work has been done in relation to treatment of opiate addiction in Ireland. The ROSIE study2 found that there had been reductions among those interviewed in the reported rates of illicit use of drugs and of involvement in crime after one year in treatment, and increased rates of employment and independent living after three years in treatment. No significant improvement in health status was noted.
 
The effectiveness of treatment for problem use of drugs other than opiates needs to be evaluated.
 
1. Comptroller and Auditor General (2009) Drug addiction treatment and rehabilitation. Special report, Value for   Money 64. Accessed June 2009 at http://audgen.gov.ie/viewdoc.asp?DocID=1142
2. The Research Outcome Study in Ireland (ROSIE) is a large-scale longitudinal study of outcomes achieved for a sample of over 400 people receiving treatment for opiate addiction or availing of needle exchange in 2003/2004.
Item Type:Article
Issue Title:Issue 31, Autumn 2009
Date:October 2009
Page Range:pp. 13-14
Publisher:Health Research Board
Volume:Issue 31, Autumn 2009
EndNote:View
Accession Number:HRB (Available)
Subjects:HJ Treatment method > Treatment outcome
VA Geographic area > Europe > Ireland
J Health care, prevention and rehabilitation > Health care economics
HJ Treatment method > Substance disorder treatment method
MP-MR Policy, planning, economics, work and social services > Economic aspects of substance use (cost / pricing)

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