Dr. Eamon Keenan:

Yes, Ireland has high levels of drug-related deaths but other countries also have high drug-related death rates if they use similar methods of recording them. If we are to compare European countries, we need to have a systematic approach to recording deaths across all European countries and that would give a better picture of where Ireland sits. Obviously, Ireland's death rate is high and that is why we are looking at issues such as the supervised injection facilities, the roll-out of naloxone and increasing access to treatment. That is a real priority for the HSE. I absolutely acknowledge that but in a European context if we want to compare countries we have to use the same methodology.

The Deputy asked a specific question around nurse prescribing of OAT. I am not so sure that necessarily will be a big answer to the problems. We do not have huge waiting lists for OAT at the minute. The nurses play an extremely important role throughout addiction services in this country and when talking to anybody who has accessed treatment they will always identify the support the nurse has given them. The HSE is working, through the director of nursing and addiction services and with the chief nursing officer at the Department of Health, to enhance the role of nurses within our service. That is a stepwise progression so it is looking at having a career pathway for nurses within the service to become clinical nurse specialists, nurse managers and up to advanced nurse practitioners who would be the people who could prescribe drugs. It is also to look at other drugs nurses can prescribe within the service such as benzodiazepines and alcohol detoxifications before we need to get legislation around opioid substitution treatments. That might be down the line but-----