Mark Ward (Dublin Mid West, Sinn Fein)
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Go raibh maith agat, a Chathaoirligh Gníomhach. I thank the witnesses for coming in and giving their opening statements. I read them with great interest before coming in. I have worked in front-line addiction services across Dublin and outside of Dublin for many years. I have worked in HSE facilities and in community-based services. I have worked in HSE and statutory methadone clinics and in community-based methadone clinics. The difference between them is vast.

My first questions will be for the HSE. My experience of working in a statutory methadone clinic, as we call it colloquially on the ground, though Ms Queally referred to "opioid substitution-agonist treatment", is that the patients gets in, gets the methadone and gets out, without any wraparound services. The community, despite limited resources, tries to take a holistic approach to helping people on a methadone substitution programme.

Over the years, methadone has turned into a maintenance programme just to keep people where they are. From a harm reduction perspective, it has its place but it has turned into a be-all and end-all. It is difficult for a person to take ownership of their life when they run into a bureaucratic system that is there to maintain them on methadone. They have to be on a certain amount of methadone to go on detox, they cannot have certain drugs in their system to go on detox and so on. If you are trying to start in the community, where the problem probably begins, it makes it even more difficult. People I know well describe it as having liquid handcuffs on. They have to be at a certain place at a certain time and if they step out of line or have a bad day at a clinic, which I have seen happen, they are punished. They may be sent into town - Trinity Court or one of those places - rather than treated in their community. This is regular and it is hard to engage with people on a human level when they face that daily. That is their lived experience.

Of the 11,385 people currently on an opioid substitution programme, how many are on a detox programme or want to be on a detox programme? Has that research been done? In the context of the citizens' assembly recommendations, will the HSE consider a move from a primary maintenance programme of methadone to a recovery-based programme?