Chairman: I welcome our visitors to the meeting. This one of our meetings where we are dealing with the problem of illegal drug use. From the Rutland Centre, we have Dr. John O’Connor and Dr. Fiona Weldon; from Merchant’s Quay, we have Mr. Tony Geoghegan and Ms Denise Casement; and from The Base, we have Ms Sharan Kelly, Ms Amel Yacef and Mr. James Hurley. Also in the gallery, we have Maris Clifford, Chris O’Rourke, Elaine Gray, Nicola O’Leary, Phillip Cullen, Jason Power and Daryl Moss. I welcome all our visitors, in particular, the young people who are here. It is good to have a group of young people speaking to the committee on such an important issue.

Before we commence, I remind visitors that they are protected by absolute privilege in respect of the evidence they are to give to the joint committee. However, if they are directed by the committee to cease giving evidence in relation to a particular matter and they continue to do so, they are entitled thereafter only to qualified privilege in respect of that evidence. Visitors are reminded that only evidence connected with the subject matter of these proceedings is to be given and are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against any person or persons or entity by name or in such a way as to make him, her or it identifiable. Members are reminded of the long-standing parliamentary practice that they should not comment on, criticise or make charges against a person or persons outside the House or an official either by name or in such as a way as to make him or her identifiable.

I thank the visitors for coming in and I invite Dr. O’Connor to make his opening statement.

Dr. John O’Connor:  I am a consultant psychiatrist and medical director of the Rutland Centre. We are pleased to have the opportunity to address the committee on how we can assist its important work in reviewing drug misuse, emerging trends and related matters. I am joined by the clinical director of the Rutland Centre, Dr. Fiona Weldon, who has extensive expertise in this area, and my fellow board member, Ms Maura Russell.

To help focus discussion and in the interest of assisting the work of the committee, this statement comprises the following three elements: an overview of the Rutland Centre and its work; our views on emerging drug trends; and comments on related public policy issues. Dr. Weldon will make the presentation on our behalf. While the presentation will be brief in nature, members can rest assured that we are happy to expand on any points of interest or matters which may assist them in their deliberations.

Dr. Fiona Weldon:  The Rutland Centre is a 25-bed residential treatment centre for addictions to alcohol, drugs, compulsive gambling, sex addiction and eating disorders. It is situated in Knocklyon, Dublin 16, and is a registered charity with a board of directors. The Rutland Centre is widely regarded as a leader in the field of addiction treatment. We offer a full range of services, including assessment service; pre-treatment; a five-week residential programme incorporating group and individual therapy; family support and intervention groups; a relapse prevention programme; continuing care programmes of at least one year; a ten-week general outpatient programme; and a 12-week dual diagnosis outpatient programme.

Our programme is unique in that it is abstinence based, focusing on client-centred treatment without the use of mood altering substances throughout residential care. Our services are delivered by a multidisciplinary team of skilled professionals including addiction counsellors, psychotherapists, nurses, a GP, a consultant psychiatrist and clinical psychologists. We work through group and individual therapy and a significant part of the recovery process involves the completion of a specific recovery and relapse prevention plan tailored to individuals’ needs. Independent research found that 79% of those addicted to alcohol and drugs were abstinent one year after completion of our residential and aftercare programme. Higher levels of quality of life were found in all participants who were abstinent for at least one year following completion of the programme. Since its establishment over 6,000 individuals have completed a Rutland Centre programme and many thousands of families have also benefited from our services. Approximately 200 individuals pass through our doors per year.

In regard to emerging trends, we draw the attention of the committee to issues arising on three fronts, namely, misuse of prescription drugs, polydrug use and cannabis addiction. The centre has seen a significant rise in addiction to prescription medications. When polysubstance addiction is taken into account this figure rises significantly. Approximately one third of those addicted to alcohol are also abusing prescriptive medications. It is cause for concern that many individuals are taking these medications for the treatment of anxiety or sleep problems without ever having had access to psychological therapy for treating these conditions through primary care. We are also seeing an increase in individuals with chronic pain conditions who have become psychologically and physically dependent on their opiate pain medications. These trends indicate a need to integrate pharmacological intervention with psychological treatments in order to minimise reliance on medication as a single primary intervention for psychologically treatable conditions.

We have also seen an increase in those presenting with complex needs as a result of polydrug use, including alcohol. Cognitive impairment as a result of chronic drug or alcohol use requires assessment and treatment needs to be informed by this process. Underlying depression or anxiety conditions may be present before addiction or may be as a result of addiction.

In terms of illicit drug use, the continued presentation of young males addicted to cannabis and in particular the stronger form of this, skunk, is a serious concerns. Skunk has a concentration of THC that is two to three times higher than cannabis. In many cases these young males have experienced psychotic episodes, including the development of paranoia, related to their cannabis use. The detoxification time for weed is also significantly longer. We are concerned about the rise in young males addicted to ketamine, a tranquiliser used in veterinary practice which has become widely available on the streets. Increased addictions to opiates have also been noted among females with undiagnosed eating disorders. In many cases, females are using the opiates to control their appetite and anorexia is undiagnosed.

In regard to public policy, it is important to acknowledge the scale of moneys spent by the State in tackling the drugs problem. Well over €250 million - €265 million - is being spent this year, including €30 million for drugs task forces. Our interest is to ensure this investment is spent to best effect and with the best outcomes for those in addiction, their families and the wider community. Certain issues arise within this framework which we wish to briefly address.

Continuum of care versus opiate substitution is a matter of fundamental importance. The Rutland Centre has deep concern about the value and effectiveness of methadone treatment for large numbers in addiction, as opposed to a more thorough integrated programme of care that addresses underlying psychological and other issues. Treating addiction to one substance and targeting services accordingly is not likely to be effective and outcomes will be deceptive and skewed. For example, methadone treatment is often accompanied by abuse of alcohol and other illicit or prescription drugs. It is reported anecdotally that the quality of engagement and support for many on methadone is less that satisfactory, despite significant costs to the State, which spent €14 million in 2007 not including inpatient costs.

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