Noel Dempsey (Meath West, Fianna Fail)

I am replying to this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. I thank the Deputy for raising this matter and for affording us this opportunity to clarify the position. I will begin by setting out the national context with regard to this issue before dealing with the specific situation in Cork.

At a national level, the HSE provides treatment and rehabilitation services for those misusing opiates and other drugs through a combination of direct provision by the HSE staff, or by voluntary agencies which it funds to provide services on its behalf. There is also a wide range of partnerships with community-based groups and agencies. Individuals presenting for treatment for opiate-related issues are provided with a full and comprehensive assessment of both medical and psychosocial needs. The range of interventions includes assessment, stabilisation, harm reduction measures, care planning, methadone maintenance, counselling and detoxification, either in specialist clinics, in residential settings or in a community setting.

It should be noted that due to the complexity of this client group, people will enter and re-enter services and may need interventions on more than one occasion. The funding committed to addiction services has increased year-on-year over the lifetime of the National Drug Strategy 2001-2008. In 2008, €101.87 million was spent by the HSE on specific addiction services, both those directly provided by the HSE and those which it funded. This represents an increase of over €45.9 million from 2001 levels of funding. In addition, it should be noted that HSE mainstream services such as accident and emergency services, acute hospitals and mental health services address the treatment needs of alcohol and other substance misusers who avail of them. The cost of these services is not included in the figures which I have already quoted.

The numbers of people receiving treatment continue to rise and additional services continue to develop, with an additional 3,686 methadone treatment places from 2001 to 2008. In addition, needle exchange services have been developed in 13 local drug task force areas and five regional drug task force areas covering the areas most affected by opiate misuse.

Training needs have also been addressed. The establishment of the national addiction training programme, in partnership with Waterford Institute of Technology and the community and voluntary sectors, has resulted in the upskilling of 1,645 front line staff. This training has enabled the HSE addiction service to respond to the changing trends in prevalence - for example, polydrug use, cocaine use and the misuse of alcohol as well as maintaining a focus on opiate abuse. The HSE, as the lead agency, has commenced the implementation of the report of the working group on drugs rehabilitation, which was published in May 2007, by establishing the national drug rehabilitation implementation committee and employing a national senior rehabilitation co-ordinator. This committee is developing a rehabilitation framework for all addiction services, as recommended in the report and it is building on co-ordination arrangements already in place in a number of areas.

With regard to the situation in Cork, there are currently 85 clients in methadone substitution treatment in Arbour House clinic in Cork. The medical officers attached to Arbour House clinic commence assessment and treatment planning on the first contact with the client. The assessment process can take up to three weeks. Currently there are 106 opiate users on the waiting list for treatment in Arbour House. However, within this, some people may be prioritised for clinical reasons - for example, pregnant women. Regional drug co-ordinators in HSE south are working with the national GP co-ordinator to increase the number of level one and level two general practitioners in the methadone treatment service. An additional GP has been providing services in Arbour House since January 2009 which has enabled an increased number of sessions to be provided for clients.

To further address the issue of waiting times, the HSE, with the assistance of minor capital grants provided by the Department of Community, Rural and Gaeltacht Affairs, is developing additional methadone clinics in a number of locations - including Cork city. It is expected that this additional clinic in Cork city will be operational in late 2009 or early 2010.

The HSE acknowledges the challenges with respect to waiting times for treatment in certain parts of the country where drug usage has increased significantly in recent years. It points out that while there are approximately 600 clients on waiting lists, more than 10,000 clients received methadone treatment in 2008. Overall, the Minister for Health and Children considers that progress is being made in this area both nationally and in the context of services being provided and developed in the Cork area.

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