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Lyons, Suzi and Long, Jean and Walsh, Simone and Pike, Brigid (2010) Drugnet digest. Drugnet Ireland, Issue 35, Autumn 2010, pp. 7-8.

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Clinical audit of the ICGP Methadone Treatment Protocol
The findings of the general clinical audit of the operation of the ICGP Methadone Treatment Protocol (MTP) between July and December 2009 are summarised in the most recent Methadone Treatment Protocol Newsletter.1 The audit found the most common issues that required a review were: vaccination and virology, record keeping and supervision of dispensing. The newsletter gives examples of discrepancies found between the standard expected and the actual practice among a small proportion of the GPs who participate in the MTP scheme, and suggests ways to improve practice in these areas.
·       On transfer between Level 1 and Level 2 doctors, not all clients had their virology screening or vaccination completed, as required by the protocol. In some cases, screening or vaccination history was not documented.
·       Some cases transfer summaries were difficult to find or were missing, and not every consultation record was complete. 
·       In some cases where at least one supervised dose per week in the pharmacy was the expected standard, no request for such supervision was found in the file. In some cases, ‘supervised dispensing did not appear to be responsive to clinical conditions’, for example in failing to provide for increased supervision if a client appeared to be destabilising.
Irish Prison Service annual report 2009
The Irish Prison Service (IPS) annual report for 20092 states that drug treatment continues to be one of the biggest issues facing the Irish prison health services. Those who present with a history of problem opiate use are offered detoxification if it is clinically indicated, or methadone maintenance treatment. Those who are already on methadone when committed can continue to receive this treatment for the duration of their sentence.
The number of prisoners on methadone treatment increased by 20% between 2008 and 2009. There was a 10% increase in the number of people new to treatment. Over 20% of those on the Central Treatment List (CTL) of methadone clients in 2009 were treated within the IPS, and 31% of all new entrants on the CTL for 2009 were treated within the IPS. Since 2008, pharmacists have provided the methadone treatment in Mountjoy and in the Dóchas Centre. The report states that in 2009 the service continued to face challenges in securing places in methadone clinics in the community for prisoners who were due to be released. 
Detoxification treatment was provided to 1,130 prisoners in 2009, and the addiction counselling services recorded approximately 1,500 prisoner contacts per month. The report notes the benefit of the multidisciplinary approach to the care of drug-using prisoners in Mountjoy prison, which aims for a personalised therapeutic relationship.
The IPS offers a range of care and rehabilitation services to inmates, including those with drug and alcohol problems. These services include education, vocational training, and psychological and spiritual services, which aim to improve re-integration into the community. The IPS works through partnership with voluntary and statutory services to enable prisoners at risk of homelessness to access appropriate accommodation on release.
In a section on prison in-reach services (p. 40), the report states:
A consultant-led Infectious Disease Service has been contracted from St. James Hospital to provide treatment to prisoners who suffer from infectious diseases, including Hep C and HIV. The development of this service has demonstrably decreased the number of prisoners transferred to St. James Hospital Guide Clinics for screening and treatment. It has also been effective in increasing compliance with complicated drug regimes and improving patient outcomes. The IPS in collaboration with St. James’s Hospital are finalising arrangements to introduce a Hepatitis C Virus treatment service to selected Dublin prisons.
According to the report, 760 people were serving sentences for drug offences on 4 December 2009, an increase of 34% on the 2008 figure of 567. The IPS continued to roll-out various security measures introduced in 2008, and has continued to test technology for the inhibition of mobile phone signals within prisons.
Poisons Information Centre of Ireland annual report 2009
The Poisons Information Centre, located in Beaumont Hospital, provides a service to doctors and healthcare professionals throughout Ireland in the diagnosis and management of poisonings.
The Centre’s annual report3 outlines the number and type of enquiries handled in 2009:
·       The Centre received 9,838 calls in the year:  9,647 (98.1%) concerned cases of poisoning in humans, 89 (0.9%) concerned poisoning in animals, and 102 (1%) were non-emergency requests for information.
·       Of the 9,838 enquiries, 5,044 (52.3%) were in relation to children under 10 years of age, the majority relating to the 1–4-year age group.
·       Of the human poisoning incidents, 90.8% occurred in a domestic setting; 59.4% were reported as accidental; 23.2% were suspected to be intentional, or the result of recreational abuse; 11.1% were therapeutic errors; and 6.3% were of unknown intent.
·       As in other years, the largest number of enquiries made to the Centre concerned paracetamol, followed by ibuprofen, codeine and diazepam.
·       The most common household products involved in poisoning were laundry products, and the majority of these cases were in children under 10 years of age.
In 2009 the Centre saw an increase in the incidence of poisoning with alcohol-based hand-gel products. In the past, this type of poisoning was seen mainly in hospitals, but an increasing number of enquiries in 2009 related to children in the home. The report suggests the increase in children’s exposure to hand gels is due to their increased availability in the home and improper storage.
Europe 2020: a strategy for smart, sustainable and inclusive growth
On 17 June 2010 the European Council adopted Europe 2020: A strategy for smart, sustainable and inclusive growth (EUCO 13/10),4 the EU’s strategic framework for sustainable and job-creating growth over the next 10 years. 
By setting targets in relation to employment, research and development, greenhouse gas emissions and education, the strategy aims to promote social inclusion and remove at least 20 million people from the risk of poverty and exclusion by 2020. The European Commission has designed seven ‘flagship initiatives’ to ‘catalyse progress’ towards the five strategic targets, including a ‘European platform against poverty’ which has particular relevance to the social inclusion target. The aim of this initiative is to ensure economic, social and territorial cohesion by raising awareness and recognising the fundamental rights of people experiencing poverty and social exclusion, thereby enabling them to live in dignity and take an active part in society.
At EU level, the Commission will work to:
·       transform the open method of co-ordination on social exclusion and social protection into a platform for co-operation, peer review and exchange of good practice, and into an instrument to foster commitment by public and private players to reduce social exclusion, and take concrete action, including through targeted support from the structural funds, notably the European Social Fund (ESF);
·       design and implement programmes to promote social innovation for the most vulnerable, in particular by providing innovative education, training, and employment opportunities for deprived communities, to fight discrimination, and to develop a new agenda for migrants' integration to enable them to develop their potential;
·       undertake an assessment of the adequacy and sustainability of social protection and pension systems, and identify ways to ensure better access to health care systems.
·       promote shared collective and individual responsibility in combating poverty and social exclusion;
·       define and implement measures addressing the specific circumstances of groups at particular risk (such as one-parent families, elderly women, minorities, Roma, people with a disability and the homeless);
·       fully deploy their social security and pension systems to ensure adequate income support and access to health care.
(Contributors: Suzi Lyons, Jean Long, Simone Walsh and Brigid Pike)
1. Irish College of General Practitioners (2010) General clinical audit findings for Methadone Treatment Protocol.Methadone Treatment Protocol Newsletter, (2): 2. Available at www.icgp.ie/go/courses/substance_misuse
2. Irish Prison Service (2010) Irish Prison Service annual report. Longford. Irish Prison Service. Available at www.drugsandalcohol.ie/13615  
3. Poisons Information Centre of Ireland (2010) Annual report 2009. Dublin: Poisons Information Centre. Available at www.poisons.ie/downloads/Annual_Report_2009.pdf
4. European Council ‘Conclusions on a New Strategy for Jobs and Growth’. 17 June 2010. EUCO 13/10; European Commission ‘Europe 2020: A strategy for smart, sustainable and inclusive growth’. 3 March 2010. COM (2010) 2020.


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