Ms Martina Queally:

I thank the Leas-Chathaoirleach and members for the invitation to meet the committee to discuss drugs policy, the national drugs strategy and a whole-of-government approach. I am joined, as introduced earlier, by my colleagues Dr. Eamon Keenan, national clinical lead, HSE addiction services, and Mr. Joe Doyle, national lead for social inclusion services. I am also supported by Ms Sara Maxwell from the office of the CEO of the HSE.

My opening statement will provide information on the HSE addiction services and the work to progress actions identified in our national drug and alcohol strategy, Reducing Harm, Supporting Recovery, particularly as the actions relate to the recommendations that emerged from the report of the Citizens' Assembly on Drugs Use. The HSE welcomes the publication of that report and its recommendations. Many of its actions are aligned with the ongoing work of the HSE as an organisation.

The HSE addiction and social inclusion services are responsible for the delivery of a wide range of treatment interventions nationally for problematic drug use. The services are rolled out across community health organisations, all of which will be incorporated into the six new health regions. They work in partnership with the community and voluntary sector.

HSE addiction services operate across various care groups and divisions within the HSE. The services operate in accordance with the HSE corporate plan and annual service plan, with priorities informed by and aligned with the aforementioned national strategy document.

To provide a brief overview of the work of HSE addiction services, it may be useful to highlight some of the key areas that align with the recommendations of the Citizens' Assembly on Drugs Use. Opioid substitution-agonist treatment remains a core component of the HSE harm reduction response to opioid dependence. At the end of April 2024, there were 11,385 people on opioid agonist treatment, OAT, 853 of whom were receiving buprenorphine-based products, including the newly approved injectable buprenorphine. There are 85 HSE opioid substitution clinics, 266 level 1 GP services, 89 level 2 GP services and 759 community pharmacies involved in the scheme. Professor Keenan can give more detail on these services, if required.

Addiction treatment is a key focus for the services. Including those individuals on OAT, it is estimated that circa 23,000 people annually receive treatment for drug-related issues. The HSE has significantly increased availability and training with regard to naloxone, a critical harm reduction measure. In 2023, legislation was amended to allow the HSE to become a recognised trainer, with training modules now incorporated into HSeLanD, which is the HSE’s online learning platform for staff. Since January this year, 977 people have completed module 1 training and 179 have completed module 2. In 2023, naloxone was administered on 461 occasions. That equates, according to international research, to approximately 18 lives saved. The HSE continues to work with An Garda Síochána, including on a pilot programme on naloxone which it is hoped will commence later this year.

Cocaine and crack services are now available in each CHO area as a result of funding initiatives in the national service plan 2022 and 2023. These are undergoing evaluation to identify areas of best practice so they can be sustained and scaled. The HSE recognises the importance of medically supervised injecting facilities as a major harm reduction measure. One such facility is expected to open in quarter 4 of this year at Merchants Quay as a pilot programme. Once operational, the service will be overseen by a monitoring committee and be subject to evaluations at six months and 18 months to determine effectiveness. Stakeholder engagement in this initiative is ongoing and critical to success, as is the participation of UISCE, the national advocacy service for people who use drugs in Ireland.

The recently launched safer nightlife programme 2024 will have a presence at four festivals this year, including back-of-house drug checking and volunteer engagement with attendees. This intervention proved very successful and was a fundamental component of the HSE’s response to synthetic opioid overdoses in late 2023. We can provide more details on that, if required. The HSE diversion programme is progressing with involvement from the Department of Health and Department of Justice. The HSE is recruiting nine practitioners nationally to facilitate brief interventions and onward referrals utilising the SAOR model.

Residential services are critical to addiction treatment and four such services are provided through statutory and community or voluntary services. The HSE received additional funding of €1.125 million through the national service plan in 2021 and €900,000 in 2023, and it is currently purchasing more than 1,000 treatment episodes.

The HSE remains committed to the development of a health-led approach to drug use in Ireland. It recognises that many of the recommendations in the report will support this objective and complement treatment and harm reduction initiatives already in place. However, in recent years the European drug market has become increasingly complex, as referenced in earlier presentations. A concrete example of this has been the emergence of synthetic opioids. HSE addiction services face significant challenges in responding effectively and will require ongoing and sustained investment in treatment services. The HSE will continue to engage with all relevant stakeholders, in particular people with lived experience, to ensure a comprehensive health-led approach is adopted across government and society. At the same time, we are conscious that treatment alone will not address all aspects of the problem.