Dr. Bernard Kenny:

From a GP perspective, we mentioned the broader societal issue of stigmatisation and the fear of judgment. In the population in general, there is occasionally the view that it is some sort of moral failing or willpower issue on the part of people who use drugs. We very much recognise the medical model of addiction, however. As part of the ICGP, our role is to promote the education and training of our members in addiction. We offer certificates and additional training in addiction medicine for people who are interested. As part of our GP trainee curriculum we educate people on the medical model of addiction. We emphasise the point that nobody wants to be inflicting harm on themselves through addiction. We emphasise that it is a medical disease, rather than some sort of moral failing. We try to promote this as best we can. There are areas of the country where we have excellent service provision thorough GPs who have additional training. They mainly offer opioid substitution therapy, OST, for opioid use. We would like to see this pushed out and extended into other substances, to reflect the current pattern of use. We know that cocaine is on the rise. As was mentioned, crack cocaine is huge in Limerick. Across the country, we are seeing more and more crack cocaine use and the physical and psychological damage that goes with it. We see a lot of issues with other stimulant use and other psycho-active compounds, such as benzodiazepines, which are bought on the street and not prescribed. This is a huge issue. We support additional resourcing to provide funded treatment for those other substances through GPs as well. This would be similar to the model of the opioid-agonist therapy programmes we currently have in place. We think that would make a huge difference to the provision of care.

As mentioned previously, there are also issues relating to the significant amount of time patients assessed by a GP as requiring residential treatment have to wait. There is also a huge lack of clinical psychology in addiction services throughout the country.

Regarding the dual-diagnosis clinics which are being piloted, we know there is a huge overlap between mental health disorders and substance misuse. A mental health disorder is a huge risk factor for a person developing a substance misuse issue and vice versa. GPs need to have places to refer patients to. It is often very difficult to access psychiatry for those who have a substance misuse disorder, so we certainly endorse the pilot for dual-diagnosis clinics and hope it is extended throughout the country.