Mr. Barry McBrien:

I thank the committee for the opportunity to present to it. I am an assistant professor in general nursing in Trinity College Dublin. I also work as an advanced nurse practitioner in a large urban emergency department in a very socially deprived area of Dublin. Prescribing is a core component of my role and many of the patients I manage have an opiate dependency syndrome. These patients require opiate substitution therapy to be prescribed as part of their consultation. Although I can prescribe opiates to this cohort, I do not have the authority to prescribe opiate substitution therapy, which negatively impacts on a patient's clinical outcome.

Nurse prescribing was legalised in many countries around the world, including the United States of America in the late 1960s. In Ireland, nurse prescribing commenced in 2007, based on the recommendations in the review of nurses and midwives. Currently, there are 1,945 registered nurse prescribers in Ireland. This number is set to increase due to policy drivers such as Sláintecare that require additional nursing posts, including clinical nurse specialists and advanced nurse practitioners, where prescribing is essential.

Studies have examined nurse prescribing from a variety of stakeholder perspectives, including patients, prescribers and the wider nurse community in Ireland. These studies reported that patient groups benefit from nurse prescribing. This is achieved through improved symptom management and care that is more efficient. Drennan also reported that prescribing was perceived as a beneficial practice. The benefits included patient satisfaction, comprehensive medication education and reduced waiting times. Because of nurse prescribing, the intent of patients to comply with medication increased and, importantly, the number of healthcare professionals the patients had to interact with during an episode of care was reduced, which in turn reduces the potential for conflicting advice.

In Ireland, nurse prescribing is delivered through open prescribing whereby nurses can prescribe any drug from an agreed protocol, including opiate-based medication. However, in the case of patients with opiate dependency syndrome, nurses cannot prescribe methadone as an opiate substitute. The impact of this is that patients will either leave the hospital setting before their treatment is complete to source methadone, or a doctor will be called away from critical clinical work to prescribe the methadone. Internationally, the safety and efficacy of nurse prescribing of OST and methadone is well established, and its expansion to the Irish context can provide a range of advantages to people who are dependent on opiates and to the healthcare settings they attend. Consequently, there is an urgent need to change legislation in order that nurses have the authority to prescribe OST and methadone.

I thank the committee. I am happy to answer any questions related to nurse prescribing in the context of OST or methadone.