Statement by
Róisín Shortall, T.D.,
Minister of State at the Department of Health
with responsibility for the
National Drugs Strategy
To
The Joint Oireachtas Committee on Health and Children
22nd September 2011 at 11.30 a.m.
I welcome the invitation to address the Joint Oireachtas Committee on Health and Children this morning on the National Drugs Strategy.
I have been concerned about the issue of problem drug use for many years and I have been active in trying to address the consequences that arise from such use in our communities. Therefore, I very much welcome the opportunity of fulfil a ministerial role in this area. I am determined to make significant strides forward in deterring young people from becoming involved with drugs and in improving the treatment and rehabilitation opportunities for people who have drug-related problems.
The overall strategic objective of the National Drugs Strategy 2009-2016 is to tackle the harm caused to individuals and society by the misuse of drugs through a concerted focus on the five pillars of supply reduction, prevention, treatment, rehabilitation, and research. The Government is committed to providing renewed impetus to the fight against drugs and to ensuring the effectiveness of any initiatives taken. The Strategy sets out a series of Actions to be taken to ensure that the overall aims and objectives are met by the various sectors in the period up to 2016. Progress at a national level is reviewed through the Oversight Forum on Drugs, which I chair, and Drugs Task Forces play a key role at regional and local level. I will implement vigorous assessment of progress on the Actions of the Strategy with a view to ensuring that we achieve successful outcomes. I have also emphasised the need for all parties to the Strategy to renew their commitment to the achievement of the key objectives.
Prevalence of Drug Use
A key requirement in the work to tackle the drugs problem is to have accurate information on the extent of drug use. The Drug Prevalence Survey, which is carried out at four yearly intervals in line with stringent international standards, is the best source of accurate information in this regard. The survey is commissioned by the National Advisory Committee on Drugs in Ireland and the Public Health Information & Research Branch of the Department of Health, Social Services and Public Safety in Northern Ireland. The main focus of the survey is to obtain prevalence rates for key illegal drugs, such as cannabis, ecstasy, cocaine, and heroin, on a lifetime (ever used), last year (recent use), and last month (current use) basis.
Fieldwork for the 2010/2011 survey has been completed and I am looking forward to the first results Bulletin becoming available in November. This will give the key findings on drug use and will outline comparisons with the 2006/2007 and the 2002/2003 surveys. This information will subsequently inform policy for the coming period.
Supply Reduction
A Garda Síochána and Revenue’s Custom Service continue their efforts to reduce the supply of drugs into Ireland, and the production of drugs within the country. The agencies co-operate very well together and also with other law enforcement agencies across Europe. They advise that the drugs trade was impacted last year by poor crops in Afghanistan in 2009, some significant seizures, the activity of headshops and recessionary factors. However, heroin is again plentiful on the global market following a successful crop in 2010 and the Gardaí remain very active in the effort to disrupt such trade in Ireland.
Cannabis grow houses have recently become a feature of the drugs trade and, while many have been uncovered, this is a concern, especially as the cannabis now available is of a much stronger nature than that of earlier years. It is thought that the economic conditions, with the availability of unoccupied properties, facilitate this trend in Ireland. Organised crime gangs may have become involved, attracted by the relatively low costs, the ease of transportation, the quality of the product and the relative ease of controlling the overall process. Such grow houses are also a common problem across much of Europe.
A year ago the activities of headshops in Ireland were a matter of great concern to the general public in view of the accessibility of psychoactive substances, the number of people frequenting these shops, the health risks involved and the possibility of use of these products acting as a gateway to the use of illicit drugs.
Regulations under the Misuse of Drugs Acts were introduced in May 2010 making the possession and sale of a wide range of psychoactive substances illegal and subject to criminal sanctions. The Minister for Justice & Law Reform subsequently introduced legislation making it a criminal offence to sell or supply substances that are not prohibited under the Misuse of Drugs Act, but that have psychoactive effects on humans. The number of headshops has dropped from 102 to 12 and An Garda Síochána confirm that no psychoactive substances are being sold in the remaining outlets.
Major efforts will continue to be made on a global level to develop products in an attempt to circumvent legislation and I will continue to ensure that we respond in a timely way to threats as they emerge. With this in mind, and following consultations with relevant authorities to ensure that any legitimate uses of the substances involved are not impinged upon, proposals will shortly be put to Government to commence a notification process at EU level leading to the declaration of a further range of products to be controlled drugs for the purposes of the Misuse of Drugs Acts.
I am sure that the drugs trade will continue to evolve and I will remain vigilant to ensure that we react speedily to the challenges that arise.
I might also stress that I am concerned about the levels of usage of some prescription drugs, whether sourced in Ireland or bought over the internet from abroad. As a first step I have asked the HSE to carry out an examination of the prescribing patterns for benzodiazepines.
Prevention
The further development of prevention measures aimed primarily at those deemed to be most at risk of becoming involved in illegal drug use, and at the younger population generally, is a critical element of the National Drugs Strategy. Along with this, it is necessary to develop awareness among the general population with respect to problem drug use, alcohol use and the misuse of prescription drugs.
As emphasised in the Programme for Government, I see the school setting as being particularly important. The Walk Tall and Social Personal Health Education (SPHE) programmes, at Primary and Second level respectively, are generally agreed to be in line with the best evidence-based practice on prevention. However, the challenge is to ensure that such programmes continue to be up-dated to reflect current realities at any point in time and to deliver the programmes in the most effective way across the whole school environment. In that way all our children will be better equipped to handle the real dangers that they will face. In line with the Programme for Government, the Department of Education & Skills has set up a group to ensure the on-going relevance of the messages being delivered. I also look forward to the contribution that the newly established Department of Children & Youth Affairs can make to the overall effort to limit the use of drugs by our youth.
Indeed many of the risk factors around problem drug use are being addressed within the broader Social Policy agenda. The role of the National Drugs Strategy in many cases is to complement the actions developed to respond to broader issues. All relevant agencies must work towards the co-ordination of efforts to boost the life skills, confidence and social competence of individuals in our society.
Treatment and Rehabilitation
I am determined that we will really impact on the treatment and rehabilitation of problem drug users during my time in office and I am already making progress in this regard.
There are approximately 14,500 known opiate users in Ireland, of whom 9,300 are in receipt of methadone maintenance treatment. In total over 12,500 people are in receipt of drug treatment.
Approximately two-thirds of those in receipt of methadone receive their service through HSE clinics, with the remainder under the care of GPs. Since my appointment I have been examining possible reasons for the relatively low number of GPs who are participating in the delivery of opiate substitution treatment. I will progress efforts in the short-term to increase the number of clients being treated by GPs with a view to freeing up clinics to deal with any additional demand arising.
Clients can usually access methadone provision in Dublin within one month of assessment. The major focus recently has been on increasing the availability of services outside Dublin. Over the past 18 months additional services have been put in place in Limerick, Tralee, Cork, Waterford, Kilkenny, Wexford and Dundalk. Further services are planned for Drogheda and the Midlands area. Increased detox facilities have also come on stream recently in Counties Carlow, Kilkenny, Cork and Limerick.
A Review of the Methadone Treatment Protocol, entitled The Introduction of the Opioid Treatment Protocol, was published in December 2010. The Review made a number of recommendations for improving such services including:
· more involvement of GPs, more clients per GP and more emphasis on moving clients towards recovery;
· more opportunities for detoxification with appropriate follow up;
· addressing service provision outside the main urban areas;
· use of drugs other than methadone (e.g. suboxone); and
· opiate substitute prescribing in Garda Stations.
I support these recommendations and I will be following up with the HSE in regard to further progressing their implementation in a speedy way.
Approval has recently been granted for the proposed provision of needle exchange services in approximately 65 community pharmacies at various locations outside Dublin, with part funding being provided by the Elton John Aids Foundation. A National Liaison Pharmacist has been appointed to oversee this programme, the role out of which will begin next month. Needle exchange services in Dublin are provided through HSE clinics, and through voluntary sector providers, so this initiative will facilitate broad national coverage.
The potential of the Drug Treatment Court (which deals with cases involving under 16 year olds) was emphasised in the Programme for Government and I am delight to advise that the Courts Service and the HSE have agreed on the expansion of its catchment area. People from all parts of Dublin north of the Liffey, as well as those receiving treatment in the Castle Street Treatment Centre (covering the Dublin 2, 4, 6 and 8 areas) will be included. The agreement will be implemented on a pilot basis for a six month period before an evaluation is carried out and a decision taken on possible further expansion of the catchment area.
I am particularly focused on ensuring that there is an increased emphasis on moving people on from drug treatment to a drug-free life where that is achievable. It is my belief that there has been insufficient focus on this ambitious goal in the past. In short, we must present drug users with the opportunities to achieve a life without drugs.
The Research Outcome Study in Ireland (ROSIE Study), the first Irish longitudinal drug treatment outcome study (covering those in methadone treatment in particular) demonstrated that drug treatment is broadly successful. A high proportion of clients persevere with their treatment and the outcomes for the majority involved decreased illicit drug use, decreased engagement in crime and improved health and social functioning.
In a recent report prepared for the HSE on Residential Rehabilitation Services it is estimated that, of the clients that were reported to have exited residential services in 2009, approximately 55% had completed treatment, with a further 4% transferring to follow-on treatment in a stable condition. Given the nature of drug misuse, it is to be expected that some who go through a programme of treatment will encounter problems of relapse subsequently. This is something that has to be built into the system more strongly so that people who relapse into drug use can be more readily and more speedily given the option of renewed treatment. More broadly, I will be working to ensure that clients will be strategically case managed towards successful exit from treatment, with step down facilities and appropriate follow-on support being provided.
Meanwhile, the HSE have a National Rehabilitation Co-ordinator in place and the National Drugs Rehabilitation Implementation Committee is working to progress the overall rehab response to empower people to access the social, economic and cultural benefits of life in line with their needs and aspirations. Recently National Protocols for inter-agency working, and Common Assessment Guidelines were agreed for all treatment providers and I hope that this will facilitate more successful outcomes.
I might stress at this point that problem drug use impacts not just on the individual, but also on the family involved. As Minister I hope to further develop the support of families of drug users and also to encourage service providers to better facilitate family participation in the recovery process. Families often have the potential to provide invaluable help to recovering drug users and we will aim to facilitate this.
Research
Meanwhile, the National Advisory Committee on Drugs, representatives of which I understand you are also meeting today, will continue to carry out timely and relevant research in the area of drug use and to advise the Government in this regard. Their most recent publication on the important issue of Parental Substance Misuse: Addressing its impact on Children is being followed up with a conference next month in which both the Minister for Children & Youth Affairs, Ms. Frances Fitzgerald, T.D. and myself will participate.