Home > Human rights and equality of drug treatment service users.

Dillon, Lucy (2018) Human rights and equality of drug treatment service users. Drugnet Ireland , Issue 66, Summer 2018 , pp. 12-13.

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Our life, our voice, our say is a report published in March 2018 by the Community Action Network (CAN).1 It highlights a range of challenges faced by service users of opioid treatment in Ireland, framing them in the context of users’ human rights and service providers’ obligations under the Irish Human Rights and Equality Commission Act 2014 (IHRECA 2014). Since the introduction of the Act, public bodies have been required to take proactive steps to promote equality, protect human rights, and fight discrimination in relation to their functions and powers.

 

The report is the main output of a project on the topic. It was coordinated by CAN with support from the Irish Human Rights and Equality Commission (IHREC). It contains the findings of the project as well as a set of recommendations from the project’s steering committee.

 

Methods

The report is heavily grounded in the views and experiences of service users. It draws on a number of strands of evidence: a service-user survey; a ‘dialogue’ event; an analysis of relevant legal frameworks; and analysis of relevant health policies and guidelines. The survey of service users had two rounds: the first was carried out in 2012 and the second in 2017.

 

Two dialogue events represented the ‘microcosm of the drug services’ and involved consultation between all stakeholders in opioid service provision. The first event was supported by President Michael D Higgins; the second was attended by Catherine Byrne TD, Minister of State for Health Promotion and the National Drugs Strategy.

 

Key issues

The report is structured around four main sections. Each section explores service users’ experiences, the legal framework, and any relevant guidelines as they relate to the topic under consideration. The four topics are:

  • The practice and frequency of supervised urine sampling
  • The meaningful engagement of service users in drug treatment service delivery
  • Treatment choices and care plans
  • Effective complaints mechanism 

Recommendations

The project steering committee made a set of recommendations based on the findings. It is beyond the scope of this article to list all 28 recommendations but a selection is reported below.

 

Supervised urine sampling

The report is highly critical of the practice of supervised and frequent urine sampling. It is recommended that the Health Service Executive (HSE) provides training and awareness for medical and administrative staff on the following:

  • More evidence-based approaches to providing adequate levels of treatment and care to service users, including the limitations of urine sampling as a condition for service users accessing treatment.
  • The diverse experience of people accessing drug services, including specific issues arising from urine sampling for particular groups. For example, women, transgender people, people with disabilities or people who may have suffered abuse.

Meaningful engagement of service users in drug treatment service delivery

Recommendations under this topic include that:

  • The HSE ensures an end to the culture of blame, stigma and punishment that is reflected in the experiences of the service users documented in the report.
  • The HSE puts a greater emphasis on building a positive relationship and open dialogue between service users and service providers and for a deeper and more meaningful service-user engagement.
  • The HSE designs and promotes dispensing and treatment structures that are person-centred and flexible; recognises the diversity of service users; and aims to facilitate service users to engage in employment, training, education and carrying out family and caring duties.
  • The HSE recognises the value of consultation and that service users are diverse and are not represented by one umbrella organisation.

Treatment choices and care plans

The project steering committee recommends that:

  • The HSE engages with service users to review the provision on treatment choice – including Suboxone®, Subutex®, methadone maintenance, methadone detox, methadone tablets, residential and community detox – and ensures it is accessible and usable for service users in all drug services.
  • The HSE ensures that all drug treatment services provide meaningful holistic care plans that are informed by service users’ personal goals and clearly documented in an accessible manner, and are subject to regular review and update. 

Effective complaints mechanism

Recommendations under this topic include that: 

  • The HSE engages with service users to develop and implement a positive action plan to ensure that information on a complaints system is available in an accessible manner.
  • The HSE ensures that all service users are informed of their right to make a complaint, through an independent system of complaints. 

Concluding comment

This report provides valuable insights into challenges facing service users of opioid treatment services in Ireland and the obligations of providers under various elements of legislation and guidelines. As mentioned in a previous Drugnet article,2 under the IHREC Act ‘in preparing strategic plans, public sector bodies must assess and identify the human rights and equality issues that are relevant to their functions. These issues must relate to all of its functions as policy maker, employer and service provider’ (p. 4).3 Despite this, a human rights and equality assessment was not reported to have been carried out as part of the methodology used to develop the new national drug and alcohol strategy.4 This report highlights the opportunities for services to be more proactive in this area. As recommended by the authors, the report could be a useful document to disseminate to service providers to encourage a more client-centred approach to service delivery.

 

1 Community Action Network (2018) Our life, our voice, our say: applying a public sector equality and human rights duty approach to the human rights and equality issues identified by service users of opioid treatment services. Dublin: Community Action Network. https://www.drugsandalcohol.ie/28876/

2 Dillon L (2017) Human rights and the new drugs strategy, Drugnet Ireland, 63: 12. https://www.drugsandalcohol.ie/28231/

3 Irish Human Rights and Equality Commission (2016) The public sector duty: eliminating discrimination, promoting equality and protecting human rights. Dublin: Irish Human Rights and Equality Commission. http://www.drugsandalcohol.ie/27649/

4 Department of Health (2017) Reducing harm, supporting recovery: a health-led response to drug and alcohol use in Ireland 2017–2025. Dublin: Department of Health. http://www.drugsandalcohol.ie/27603/

Item Type:Article
Issue Title:Issue 66, Summer 2018
Date:September 2018
Page Range:pp. 12-13
Publisher:Health Research Board
Volume:Issue 66, Summer 2018
EndNote:View
Subjects:HJ Treatment method > Substance disorder treatment method
J Health care, prevention and rehabilitation > Treatment and maintenance > Treatment factors
J Health care, prevention and rehabilitation > Treatment and maintenance > Patient attitude toward treatment
J Health care, prevention and rehabilitation > Treatment and maintenance > Provider / worker / staff attitude toward treatment
MM-MO Crime and law > Legal rights > Rights of substance users
T Demographic characteristics > Substance user
VA Geographic area > Europe > Ireland

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