Deirdre Clune (Cork South Central, Fine Gael)
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I thank the Chair for the opportunity to raise the concerns of the community in Cork about the escalating use of heroin. There has been some very high profile media coverage of the problem in recent days. However, it is an issue of which those of us who read the local press, discuss the matter with the Garda and speak to local health professionals have been aware for quite some time. The list of those seeking methadone treatment is growing.

Heroin use is growing in the Cork area and there is a fear that it will attract the violence associated with that drug. There has been a recorded increase in drug related burglaries in the Cork area. The Garda set up a dedicated heroin unit in Cork in 2006 in response to the growing problem. The number of heroin detections in 2004 was four but last year that number rose to 159, a fortyfold increase. There were six heroin related deaths in 2007, eight in 2008 and, alarmingly and tragically for the families of those involved, there have been four such deaths in the past five weeks.

There has been a very large increase in the number of addicts seeking treatment, with more than 100 people treated in 2008. It is estimated there are 150 people on the waiting list for methadone treatment in Arbour House, which I visited recently along with the Minister of State at the Department of Community, Rural and Gaeltacht Affairs, Deputy John Curran, when he opened the refurbished facility. The Minister of State will be well aware of the excellent service provided by health professionals in the treatment centre. Certain people must wait for more than one year for methadone treatment and during that year those addicts will undoubtedly continue to use the drug, to put their health at risk and continue to place stress on their families as they struggle to find the estimated €100 to €300 per day necessary to feed the habit.

A consultant in emergency medicine in Cork University Hospital has warned of an increasing number of heroin and methadone cases. He also warned the problem will escalate and that by this time next year Cork will have a serious heroin problem. All the signs, evidence and figures are available. We do not wish to see such a drug problem develop with all the negative social consequences it would entail.

All of this takes place against a background of a cut in the budget of the local drugs task force of 20%. Is there a central solution to such a problem? Having to wait for treatment for more than one year is unacceptable, and it is also unacceptable that there is only one doctor available for those in need of methadone treatment. The Garda and the local drugs task force must be involved along with health professionals.

I am conscious that this is taking place in the context of the very gloomy economic background against which we live at present. However, the long-term social consequences, havoc and devastation that this drug can wreak on communities will undoubtedly result in a much higher financial cost and social cost and this must be factored into today's thinking. All the warnings are available. I have outlined them and they have been heard loud and clear by communities in Cork. I call on the Minister to do what he can to support the health professionals, the Garda and those working on the ground to ensure the drug use does not escalate to epidemic proportions as predicted.

Noel Dempsey (Meath West, Fianna Fail)
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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.