Mr. Barry McBrien:

As I say, the prescribing in Ireland is delivered through open prescription. Effectively, we can prescribe any medication that we want. In a very practical sense, if somebody comes into me and they are opioid dependent and I need to do a procedure, I can prescribe IV morphine to them, which is effectively an opiate. If they then need to wait for admission to hospital, I need to prescribe their methadone. I cannot prescribe their methadone and I cannot complete their episode of care. What effectively happens is the patient will leave the department and try to source methadone. Usually, that is not sourced in a pharmacy; it is sourced from the street and there are huge complications with that because we do not know what is in that methadone.

The patient then comes back with additional problems and additional needs. It has a really negative impact on the patient. From the perspective of nurse practitioners and the perspective of prescribers, they cannot see any difficulty with it at all. They do not understand why we cannot prescribe methadone. In fact, I teach nurse practitioners in Trinity College Dublin and I spoke to one of them about this on Monday. She said if we could prescribe methadone, it would be hugely positive and would improve waiting times and access to methadone clinics, etc. I cannot identify any obstacles and it is really something that is urgently needed.