Professor Joe Barry:

In Ireland we use a capture-recapture methodology to estimate the numbers of problematic opiate users. It has been done three times in Ireland, in 1996, 2001 and 2007, and is being examined again by the National Advisory Committee on Drugs and Alcohol, NACDA. It is done by counting the persons in receipt of methadone treatment, the people on charges with the Garda and those who have been in an acute hospital and using mathematic modelling. We know how many problematic opiate users there are and, depending on the size of the overlap, we estimate the number of hidden users. It is technical. According to the most recent estimate, there were approximately 14,000 to 15,000 problematic opiate users. Some of them would not take much heroin, for example, those who are participating in methadone programmes but also taking a little heroin as they are still addicted to opiates. Approximately two thirds are reckoned to be in treatment or contact with services. Of the one third outside treatment, I can only speculate. Some do not want to have any contact with the State and the HSE, as people in low threshold programmes tell us. They are taking drugs - people take drugs for many reasons. In Dublin the level of access to treatment is high and outside Dublin it has improved. Most people who are not engaged are not engaged because it is not attractive. Some would engage if they were to receive heroin instead of methadone. On a cost-benefit analysis, it would not be very effective to do this.

Patterns of use have changed. Injecting was the norm in the 1990s, but it is less common now. The culture has changed, as drugs go out of fashion. Opiates have gone out of fashion somewhat, but stimulants are a major problem. Given that there is no opiate response to these non-opiate drugs, we need to provide a psycho-social response to them. There are heroin droughts from time to time and we see many changes. Heroin supply is controlled by the criminal gangs. Some opiates such as morphine are given in medical settings. Morphine is a good drug in treating certain conditions. Although specialists in palliative care use methadone for pain relief, it is not part of the methadone protocol.

We are asking that the time be shortened between a person being on the street and entering recovery. Mr. McAleenan referred to a period of two years and knows much more about it than most people or I do. We are talking about narrowing the gap and then reappraising. Given that every policy change can have unintended consequences, we must examine the upsides and downsides of everything.

Deputy Maureen O'Sullivan mentioned prevention and education, which are important. In the parts of the country where heroin use is most common, particularly Dublin, the vast majority of youngsters do not take opiates. Among those who do, there is a pattern of early school leaving. If I could do one thing to try to reduce the need to take psychoactive substances, it would be to improve the level of school retention. Many children do not make the transition from primary to secondary school. We have forgotten what it is like. While primary school is very sheltered, secondary school is a completely different environment into which young people are thrown and some just fall and cannot sustain it. I would also invest more in preschool services. Other European countries put much more emphasis on it. We need to invest in children if we want to reduce the chances of people taking drugs, but we will never eliminate drug use. There are many issues related to marginal benefits such as giving people self-esteem and teaching them skills. While the schools SPHE programme can and does do it, there is a limit to what it can do if the child's environment is moving in a different direction.